Experiencia de inclusión y cambio individual.

The Middle East and Malaysia are amongst the major migrant receiving countries in the world. There is a growing number of illegal migrants globally, including those in the Middle East and Malaysia (Castles & Miller, 2009). Illegal migrants move from their country of origin to destination countries not following the regulatory norms of countries of origin, transit and destination. In other words, migrants enter host countries illegally (without any documentation or meeting immigration regulations) in order to stay and/or work in these countries (IOM, 2011). It is not considered practical to approach and collect information about illegal migrants as it perceived difficult to gain appropriately disclosed information about their status. Hence, a decision has been made to approach only legally employed workers for this Ph.D. study, although it is recognized that occasionally official data or studies on migrant workers may inadvertently include (some of the) illegal migrant workers.

An estimated 26.6 million migrants (of whom 38% are female) were in the Middle East in 2010, an increase of 4.5 million migrants compared to 2005 (UNDESA, 2009). In the period from 2005 to 2010 the net migration rate still increased in the Middle East from 9.2 to 9.8 migrants per thousand of the population (ibid). Some Middle Eastern countries have a high share of foreign workers making up their total labour forces. For example, Qatar has one of the highest (94%) proportion of migrant workers as part of its total labour force followed by United Arab Emirates (UAE) (83%) and Kuwait (83%) (ILO, 2013b).

Similar to Middle Eastern countries, Malaysia is another popular destination (in South East Asian countries) for migrant workers. An estimated 1.6 million (7.0 % of total population) migrants were in Malaysia in 2000; most of them in low- skilled jobs (e.g., construction, manufacturing and agriculture). This figure increased to 2.0 million in 2005 and 2.4 million in 2010 (UNDESA, 2009). Most of the migrant workers in Malaysia are from Asian countries (ILO, 2007). In recent years, Malaysia has been one of the more popular destination for millions of migrant workers from Indonesia, Nepal (about half a million Nepalese

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migrants work in Malaysia), Bangladesh, India and Philippines (The Kathmandu

Post, 2013). These migration data justify the need for the research to focus on

migrant workers in the Middle East and Malaysia. Health risks facing migrants in these areas, the Middle East and Malaysia, are now discussed in the following section.

2.3.1 Health issues of migrant workers in the Middle East and Malaysia

Similar to other countries receiving large numbers of immigrants, migrants in the Middle-East and Malaysia also face difficulties in adjusting to their new society including adopting safe and healthy life-styles. One study of Middle Eastern immigrants from Asia has found that migrants from poorer groups are at a higher risk of mental illness due to their living and working conditions (Arnold & Shah, 1984). A review of occupational injuries in Bahrain has revealed that immigrants are at higher risks of having accidents than national workers and that this risk is still higher for immigrant construction workers (Al-Arrayed & Hamza, 1995). Research carried out among Filipino home-care workers in Israel has concluded that they are at a high risk of workplace injuries, verbal abuse and hunger (Ayalon, 2008). Similarly, the prevalence of pulmonary tuberculosis among migrant workers in Kuwait is higher than the general population (Akhtar & Mohammad, 2008). A review study in the UAE has suggested that migrant construction and domestic labourers are victims of debt bondage and face wage exploitation. Moreover, domestic workers in the UAE have experienced high rates of physical, sexual and psychological abuse (Sönmez et al., 2011). A second study in the UAE has found that migrant workers are at risk of mental illness including depression and suicidal thoughts (Al-Maskari et al., 2011).

Work-related accidents, deaths and suicides are common in Gulf countries and Malaysia (The Himalayan Times, 2011). It is estimated that two Asians die per day on Dubai construction sites and a case of suicide occurs every four days (Keane & McGeehan 2008). In addition to this, the suicide rate appears highest among Indian workers in UAE (in 2008); the main reasons behind these deaths appear to be financial or psychological (Kannan, 2012). Likewise, independent

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research from the trade construction publication, Construction Week, has reported that 880 migrant construction workers (460 Indian, 375 Pakistani and about 45 Bangladeshi) died in the UAE in 2004, yet the Dubai Municipality only recorded 34 deaths in the same period (Human Rights Watch, 2006).

Prevalence of tuberculosis among Asian migrants (mainly from India, Pakistan and Nepal) working in Qatar’s garment industry is high (Al-Khal et al., 2005). Similarly, lower urinary tract symptoms are common in young male immigrants (mostly of Indian origin) in Qatar (Prasad et al., 2006). In addition, a study of immigrants in food handling occupations has revealed that those immigrants from the Indian sub-continent and the Philippines are more likely to carry hookworms (Abu-Madi et al., 2008). Research carried out among Nepalese migrants in Gulf countries and Malaysia has found that migrants are at a high risk of stomach pain, malaria, blood pressure, kidney failure and mental problems (NIDS, 2006). A recent study of Nepalese migrants in the Gulf countries has shown that migrants working in construction industries are at a higher risk of accident and injury (Joshi, 2009). Likewise, another observational study among Nepalese workers has found that the Nepalese are importers of Hepatitis E in Qatar (Ibrahim et al., 2009). A review paper on immigrants also suggests that immigrant workers in Malaysia (Abas et al., 2011), Singapore (Bong et al., 1976), Australia (Corvalan et al., 1994) and UK (Lee & Wrench, 1980) have worse working conditions than native workers (Salminen, 2011). In Malaysia, Indian workers are three times more likely to experience occupational injuries than native workers (ibid). Similarly, a study about Asian migrant workers (mainly from Indonesia, Pakistan and Myanmar) working in Malaysia has found that migrant workers are at a higher risk of accidents, multiple injuries and cranio-cerebral injuries than the general population (Murty et al., 2006). This review has highlighted that migrants working in the Middle East and Malaysia experience a range of health issues. Therefore, this combination of empirical evidence from two generally risky occupations (e.g. manufacturing and constructon industries) and two geographical areas justifies the research focus of this thesis on the Middle East and Malaysia. Having examined the health issues experienced by migrant workers in general, it is considered that further in-sight

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on their experience is necessary. The next section outlines general information on those migrating from Nepal to other countries.