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Lucy McCray from The Freedom Story, Migration and Health in South-East Asia

South-East Asia is home to 11.6 million migrant workers, at least 2.3 million of whom live in Thailand (ILO, 2019, Thai Ministry of Labour, 2020). Despite contributing significantly to aging economies and working low-skill, often low-wage jobs that are not preferable to national works, migrants still face significant discrimination in destination countries. This is true globally, and research in the Asia Pacific region has shown that attitudes towards migrant workers are worsening (ILO, 2019). This is true for Thailand, the country in South-East Asia with the highest number of international migrants, and therefore the focus of this commentary (UN, 2020).

Despite significant efforts by governments in South-East Asia to establish legal, formal mechanisms for international migration in the region, also known as the ‘MOU’ system, ‘regular’ migration via these legal channels is often too expensive and too complex for many migrants. This ‘irregular’ migration can put them at greater risk of experiencing both negative health and work outcomes, including exploitation and trafficking. These experiences are exacerbated by marginalization and discrimination, all of which result in worse health outcomes. There are significant barriers to accessing the healthcare system for many migrants, including facing discrimination. All of these challenges have been compounded throughout the COVID-19 pandemic, resulting in even poorer health and work outcomes for migrants.

Migrants to Thailand experience a range of health and work outcomes, which exist and occur on a spectrum, from decent work, good health, and well-being on one side to labour exploitation and poor health on the other (McAlpine, 2021, Skrivankova, 2010). Both sides of this spectrum compound each other, with decent work resulting in better health outcomes, and those who experience exploitation experiencing worse health outcomes.

Many migrants to Thailand are low-skilled and therefore work in low-wage, ‘3-D’ jobs, often described as dirty, dangerous and difficult, or demeaning. Many of these jobs in sectors such as agriculture, manufacturing, and seafood processing pose significant health risks and exposure to occupational hazards such as ‘lifting heavy objects’ and ‘use of sharp instruments’, exposure to chemicals, excessively long working hours, and a lack of protective equipment or training (Zimmerman, et al 2014). These health risks are exacerbated by poor living conditions including overcrowded living spaces and shared bathing facilities.

The sectors that migrants in Thailand tend to work in have higher instances of exploitation and trafficking in general. Migrants report instances of exploitation such as wage theft, restricted freedom of movement, excessively long working hours, and lack of access to their own documentation (Zimmerman, et al 2014, Harkins et al 2017). For those who experience the worst forms of exploitation and trafficking, the health implications are great. In a survey of those accessing post-trafficking resources in the Mekong region, 49% of men and 60% of women with lived experience of trafficking and exploitation reported experiencing violence at their destination location (Zimmerman, et al 2014). These risks are often increased by a lack of knowledge of labour or human rights and a lack of knowledge and access to protection mechanisms in destination countries. Risks of these negative outcomes are even greater for irregular migrants, who are both at greater risk of these outcomes and who also exist outside formal protection mechanisms due to their migration status. Discrimination against irregular migrants in destination countries is also higher.

These outcomes can and are compounded by experiences of discrimination in destination countries. Despite a significant need for migrant workers due to an aging population, over 50% of Thais say the country does not need low-skilled migrant workers (ILO 2019). Beyond mere need, many Thais believe migrants themselves are at fault should they be exploited, that migrants should not receive the same salary as national workers, and that irregular migrants should not have any rights (ILO 2019). These findings are reflective of wider attitudes and beliefs towards migrants in the ASEAN region and beyond, with impacts filtering into the day-to-day lives of migrant workers, for example in accessing healthcare services.

Globally, migrants face barriers to accessing healthcare services in their destination countries. For example, lack of language skills, fear of deportation, lack of access to financing or insurance schemes, and discrimination can all keep migrants from accessing local healthcare systems (Legido-Quigley, 2019). In Thailand, regular migrants with work permits have access to the Thai social security scheme, including health benefits (Tangcharoensathien, 2017). While this is a promising start to expanding access to healthcare, irregular migrants are not eligible under this scheme, and many who are lack knowledge of how to access their rights (ILO 2021). While other voluntary health insurance schemes have been offered to regular and irregular migrants and have made progress in expanding access to healthcare, for most migrants practical barriers such as cost, language, and cultural differences mean they lack access to healthcare (Tangcharoensathien, 2017).

In Thailand, these barriers increased throughout the COVID-19 pandemic, as all population groups became more hesitant to access healthcare services or service availability decreased due to pressure on the system due to the pandemic. Indeed, within Thailand, migrants have been disproportionately more likely to contract and spread the virus due to close living and working conditions, an inability to work from home, and other factors (IOM 2021). Because of this, migrants have also been unfairly blamed for being vectors of the disease, facing more discrimination than previously. This hesitancy is occurring during rising levels of socio-economic vulnerability to exploitation due to the pandemic. COVID’s impact on the risk of exploitation has just begun and is likely to continue for many years.

Health is a universal right, and migrants should have equal access to healthcare services, especially those experiencing or at risk of exploitation and trafficking. Migration to Thailand remains high, despite the pressures of the COVID-19 pandemic. While Thailand has made strides to expand access to healthcare, practical barriers remain for migrants. More research needs to be done on how to increase access to healthcare for irregular migrants, how to address discrimination in healthcare services and how to address practical barriers to healthcare access for migrants. References: Kiss, L., Pocock, N. S., Naisanguansri, V., Suos, S., Dickson, B., Thuy, D., Koehler, J., Sirisup, K., Pongrungsee, N., Nguyen, V. A., Borland, R., Dhavan, P., & Zimmerman, C. (2015). Health of men, wome Zimmerman, C., Kiss, L., Pocock, N., & Naisanguansri, V. (2014). Health and human trafficking in the Greater Mekong Subregion: Findings from a survey of men, women and children in Thailand, Cambodia and Orrenius, P. M., & Zavodny, M. (2009). S DO IMMIGRANTS WORK IN RISKIER JOBS?*. In Demography (Vol. 46). http://read.dukeupress.edu/demography/article-pdf/46/3/535/880252/535orrenius.pdf Skrivankova, K. (2010). Between decent work and forced labour: examining the continuum of exploitation. www.jrf.org.uk International Organization for Migration. (2021). SOCIOECONOMIC IMPACT OF COVID-19 ON MIGRANT WORKERS IN CAMBODIA, LAO PEOPLE’S DEMOCRATIC REPUBLIC, MYANMAR AND THAILAND. www.thailand.iom.int Chantavanich, S., Vungsiriphisal, P., Lim, H., Yamada, Y., & P. V. (n.d.). Myanmar Migrants to Thailand: Economic Analysis and Im ILO. (2021). Public attitudes towards migrant workers in Thailand. https://www.ilo.org/asia/publications/ Tangcharoensathien, V., Thwin, A. A., & Patcharanarumol, W. (2017). Lessons from the field Implementing health insurance for migrants, Thailand. Bull World Health Organ, 95, 146–151. https: Engblom, A., Lephilibert, N., & Baruah, N. (2020). COVID-19: Impact on migrant workers and country response in Thailand. In International Labour Organization. Franchino-Olsen, H. (2021). Frameworks and Theories Relevant for Organizing Commercial Sexual Exploitation of Children/Domestic Minor Sex Trafficking Risk Factors: A Systematic Review of Proposed Frameworks Olsen, W. (2014). Comment: the usefulness of qca under realist assumptions. Sociological Methodology, 44(1), 101–107. https://doi.org/10.1177/0081175014542080 Harkins, B., Lindgren, D., & Suravoranon, T. (2017). Risks and rewards: Outcomes of labour migration in South-East Asia. www.ilo.org/publns. HealtH. (n.d.). Migration and. https://doi.org/10.1136/bmj.l4160 International Labour Organization. (2019). Public attitudes towards migrant workers in Japan, Malaysia, Singapore, and Thailand. United Nation. (2020). International Migrant Stock | Population Division. International Migrant Stock. https://www.un.org/development/desa/pd/content/international-migrant-stock International Labour Organization. (2019). Public attitudes towards migrant workers in Japan, Malaysia, Singapore, and Thailand. Mcalpine, A. M. (2021). analysis and agent-based model. For more information about The Freedom Story's work, follow them on Twitter and Instagram, or visit their website at https://thefreedomstory.org/.

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