La importancia de la mujer en el proceso comunal y la participación como un hecho cotidiano.

2.4.1 International migration trends and patterns in Nepal

Although Nepal a landlocked country situated between the populous lands of China to the north and India to the south remained closed to the outside world for many years, Nepalese people started to emigrate from the beginning of the 19th century. The main reasons for migration were: recruitment to the British Army in former British India (Bhattrai 2007; Subedi, 1991), forced labour within the country, and poverty in general (Kansakar, 2003). However, until 1950, emigration to countries other than neighbouring South Asian countries was limited. The collection of data about migration within Nepal started with the 1920 census; however, its scope was quite limited until the first scientific census of 1952/54. According to the 1952/54 census, 198,130 people (2.3% of population) were living abroad for more than six months. Of those, 97.3% originated from the mountain and hill districts of Nepal. The number of Nepalese living abroad for more than six months has increased rapidly in each subsequent census reaching 402,977 (2.7%) in 1981, 656,290 (3.7%) in 1991, 762,181 (3.4%) in 2001 and 1,921,494 (7.25%) in 2011 (CBS, 2002; CBS, 2012).

It is the case that until 2001, most Nepalese migrants went to India; 79.4 % of migrants in 1952; 93.1% in 1981, and 89.2% in 1991. Although the absolute number of Nepalese migrants moving to India continues to increase, in 2001 the proportion of Nepalese emigrants to India actually decreased to 77.3%. The main reason for the decrease in the proportion of migrants to India in 2001 was the flow of Nepalese to other countries such as Saudi Arabia (8.9%), Qatar (3.2%), UAE (1.7%) and Hong Kong (1.6%) (CBS, 2002). As most Nepalese migrating to India and the Middle East were there in search of temporary jobs, the majority were males. The 2001 census in Nepal reported that the proportion of males and females among Nepalese migrants was 89.1% and 10.9% respectively.

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International labour migration from Nepal to the Middle East and Malaysia is a new phenomenon and started three decades ago (Bhattarai, 2005). In the beginning, relatively high volumes of Nepalese migrants were concentrated in Middle Eastern countries (i.e. Gulf States) but the direction slightly changed later with people migrating to Malaysia in the last decade (ibid). The selection of destination countries is based on income and education (the socio-economic status) of Nepalese migrants as well as the types of work available in the receiving countries (Adhikary et al., 2008; Adhikary et al., 2011; Bhandari, 2012; Dhungel, 1999; Gurung & Adhikari, 2004; Joshi et al., 2011b; Sapkota et

al., 2014). For example, people with poorer status migrated to India, the Middle

East and Malaysia (Adhikary et al., 2011; Joshi et al., 2011b) whereas people with better socio-economic status moved towards Europe, America, Australia, Canada, Japan and South Korea (Adhikary et al., 2008; Bhandari, 2012; Sapkota

et al., 2014).

The number of Nepalese migrant workers going to Malaysia and the Middle East has increased in recent years. To date, most migrant workers in Malaysia are from Indonesia followed by those from Nepal, which is the second largest labour supplying to Malaysia (The Kathmandu Post, 2010). It is estimated that there are about 519,000 Nepalese migrant workers in Malaysia, 465,000 in Qatar and 321,000 in Saudi Arabia working in semi-skilled or manual roles; most are males and a substantial proportion are employed in the construction and manufacturing sectors (Baruah & Tuladhar, 2012; Mohamed et al., 2012; Nepal news, 2010; Sani, 2010; The Kathmandu Post, 2013). This general migration pattern gives credence to the focus of this research in the Middle East and Malaysia in the construction and manufacturing sectors. Along with the increased flow of migrant workers, there has also been a concurrent increase in the remittance that Nepal has received from migrant workers, the equivalent of $2.93bn US dollars (NRs. 209 billion) in 2008 (Rauniyar, 2009b). The next section focuses on health issues associated with Nepalese migrants abroad.

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2.4.2 Health issues of Nepalese migrant workers abroad

There is a growing literature on international migration looking at the health and well-being of migrant workers, but very little investigating the health and well being of migrant workers from Nepal. This chapter reviews the general issues around migration from Nepal and health issues among Nepalese migrant workers.

Similar to migrant workers from all around the world, Nepalese migrant workers also experience serious health and safety problems in host countries including death on some occasions. There have been several serious incidences involving Nepalese migrants working abroad; for example, the massacre of twelve Nepalese workers by an Iraqi extremist group in 2004 (Stillman, 2011). Although deaths are not common, occupational deaths among Nepalese migrant workers in the Middle East are commonly reported; more than five hundred workplace- related deaths were reported in the Gulf region among Nepalese workers in 2008 (Infoshop news, 2008). Poor labour conditions may have contributed to these deaths. Other reports highlight the death of 24 Nepalese workers in one month in Qatar alone due to cardiac arrests, respiratory diseases, kidney failure, heart attack, road accidents or suicide (Nepal News, 2009a), and the death of 12 Nepalese and 11 Indian cleaners on a capsized ship in July 2009 (Nepal News, 2009b). Workplace related accidents, including deaths, however, seem to be officially underreported. For example, 30 Nepalese workers died in the UAE in 2005, yet the employer only recorded one death in the same period (Hadid, 2005). The causes of these deaths according to the Embassy of Nepal in the UAE included cardiac arrest (n=13), suicide (n=7), road accidents (n=7) and unknown (n=2) (ibid). In addition, anecdotal evidence shows that high mortality rates might be associated with large intakes of home-made alcohol and risky jobs (Joshi, 2009).

A recent study with Nepalese migrant workers returning to Nepal established that they often work in risky occupations (such as construction) and frequently face accidents and injuries (Joshi et al., 2011b). However, one limitation of this study is that it was unable to collect in-depth qualitative information from the Nepalese

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migrant worker as the study only figured out the size of problems in the country of migration. Similarly, cases of industrial accidents are high in Malaysia. Research on migrants in Malaysia found that workers experience work-related accidents including cuts, bruises and sprains (Ratnasingam et al., 2011). The Nepalese Embassy in Malaysia has reported that 192 Nepalese lost their lives due to industrial accidents in five years the proceeding (Rauniyar, 2009a). Recent news highlighted that in 2011 over 800 Nepalese workers died abroad in addition to 160 cases of suicide (The Himalayan Times, 2011).

In addition to occupational injuries and deaths, migrant workers are also at risk of suffering from other infectious or mental illnesses. Studies of Nepalese migrant workers in India (including returnee migrants) identified that Nepalese migrant workers are not only vulnerable to HIV/STIs but also created high-risk situations by spreading HIV/STIs in the far western part of Nepal (Poudel, 2003; Poudel et al., 2004; Vaidya & Wu, 2011). There are also reports of poor working conditions for Nepalese migrant workers such as noise, pollution, heat at work, and lack of sanitary and bathroom facilities (Frost, 2004). A recent study of Nepalese migrants in the UK found that migrants with low levels of education and an insecure immigration status (e.g. refugee/asylum seeker) are far more likely to have poor dental hygiene and lack of regular exercise than those with higher levels of education and secure immigration status (Adhikary et al., 2008). This UK-based study is small-scale and lacks depth as it is used a purely questionnaire-based, quantitative, approach.

General issues identified by Gurung and Adhikary (2004) include key problems such as low salaries, sexual exploitation of women, inadequate protection and insurance against death and accidents abroad (excluding India). Some studies have suggested that Nepalese migrant workers working in new environments with long working hours and poor living and working conditions are more likely to suffer from accidents and other health problems (Adhikary et al., 2011; Joshi

et al., 2011b; NIDS, 2006). Hence, the available literature suggests that there is a

gap in our knowledge, i.e. although patterns of work-related migration and some of the key problems workers face are reasonably well documented, there is a lack

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of in-depth insight. This suggests that the need for further focused qualitative and mixed-methods research on the health and well-being of Nepalese migrant workers is highly appropriate.

In order to understand the health of Nepalese workers abroad, it is necessary to understand some of the key issues related to their health, especially work and health in Nepal. The following few sections summarise work, working and living conditions and health and health care systems in Nepal.