15 October 2020, NIICE Commentary 6299
Bulbul Prakash
Health concerns do not stop at national borders. In the recent years, health has evolved as a strategic foreign policy and diplomatic concern for many countries and regions of the world. A policy shift from ‘power and prestige’ to ‘peace and prosperity’ has taken place. The issues of “hard power” have given way to a number of international agreements on “soft issues”, such as the environment and health. The migration of refugees and migrants from a public health point of view is a complex phenomenon affecting people with various health profiles and backgrounds who are moving across countries and often in precarious and vulnerable environments. The refugee and migrant health have in fact become a specific and politicised sphere of health diplomacy, which, on the one hand, shows political forces representing the benefits of globalisation, the human movement, and, on the other hand, shows the sovereignty of the nation states and challenges to refugees and migration.
South Asian countries are very far from achieving adequate protection for migrants across borders. Most of the migrants to Urban India rely on unqualified medical practitioners and spend huge proportion of their earnings in seeking health care services. Under nutrition and inadequate immunization coverage are responsible for the high frequency of mortality rates among the migrant children. Regional fora in Asia have been crucial for vital approaches to problems, including the creation of ties between mobile communities, trafficking and HIV. The health sector alone cannot ensure high-quality care for refugees and migrants, which requires addressing cross-cutting social determinants of health governed by other sectors, such as education, employment, social security and housing. Governments have a better understanding of the role of multiple determinants of health and the need for a multi-sectoral involvement to achieve better health and well-being for all, leaving no one behind. Looking at migration through the health lens means that the existing political and technical consensus on good practice can be used and it highlights the deep and fundamental human dimensions of migration, which are easily obscured when policies are discussed without reference to their impact on human health and well-being.
The relation between migration and health diplomacy in South Asia has not been explored so far. The WHO European Region had been particularly active in its commitment to coordinate and develop foreign policy solutions at the local, country, regional and global levels. Migrants face social inequalities and go through several experiences during migration that puts their physical, mental and social well-being exposed. The health of migrants as a human rights and social equity problem suggests the need for multi-disciplinary and multi-sector stakeholders to work in partnership for improving migrant health and preventing their social exclusion. Equity in access to health services has been defined as the success of European governments, yet changing health needs and specific vulnerabilities of the target population are not addressed.
With the pandemic hitting the health sector badly and exposing the shortcomings of South Asia’s public health care capacities, the role of Universal health coverage in health care should be urgently explored in India. India has the capacity to effectively perform the role of ‘Pharmacy of the World,’ subject to availability of essential drugs in India at a reasonable price. Migrant health issues are getting considered national priority in Bangladesh. Thousands of Bangladeshi patients come to India in search for better facilities for treatment with no strict border checks or documents. The number of students studying medical sciences in India from Bangladesh is higher. The pre-departure health screening system to be implemented by the Maldives government, calamities and forced migration related to migrant health raising issues and adoption of National Health Sector Strategy (NHSS) 2015–2020 in Nepal, Colombo Declaration where Sri Lanka mainstreamed migration health agenda and pushes for grassroots involvement in health diplomacy, Bhutan drafting a comprehensive health legislation, are all pointing at the intersection of diplomacy and health.
Being healthy and staying healthy is an imperative for migrants to be productive and contributes to labour. ILO 2018 estimates 15 percent of the migrant workers in the world come from South and South East Asia. EMPHASIS Project 2014 proposed that providing cross-border migrants with information in their home countries and their destinations could contribute to better mobility and improved health outcomes. Health planning across boundaries and migration corridors needed a comprehensive and flexible monitoring network that was tightly orchestrated by all stakeholders and collaborators. The need for grassroots feedback prior to the introduction of cross-border migrant services has been recognized in order to adapt to growing conditions and needs.
The challenge to reduce poverty and improve economy should start with addressing the challenges of migration in South Asia. In the field of health care, most of the existing migrant health care in South Asia comes from non – governmental sector. Almost none of the government agencies have databases pertaining to migrants updated over time. The data available remains confined to the labour sector. There is an importance of bringing immediate attention to cross border mobility, esp. from Bangladesh and Nepal to India. The porous borders and history of migration which is often not perceived as “foreign employment” poses the major risk. The fear for disclosure of their illegal status makes them approach private health services, though expensive. Carrying out information sessions with health staff at destination and source, increasing health workers’ awareness of the rights of migrants and patients to receive non-discriminatory health services shall be done. There shall also be appointment of health attachés in Embassies as a critical link between the health agencies and the foreign policy apparatus of both the sending and receiving country and as an important step to enhance cause of death reporting accuracy in South Asian countries.
However, many South Asian countries lack a comprehensive health strategy or national health policy for migrants. Though migration policies do exist in countries such as India, health is not mainstreamed into it. Lack of separate data relating to the major health issues or challenges in the Region poses another risk. There is very little information on both the health status and health policies of labour migrants. Often, the information available does not differentiate between documented and undocumented labour migrants.
A political mapping of various stakeholders involved and integrating them into a single regional framework for the protection of migrant and refugee health crisis is the need of the hour. There is also a necessity to identify whether states are equipped to address cross-border health threats in the 21st century when globalisation has opened up multiple channels of migration. The role of international organisations such as WHO to address the challenges of Health Diplomacy in South Asia would also be explored regarding the same. Health care initiatives for migrants in South Asia must also be closely matched with their interests, not just to meet existing circumstances, but also to be open and available to them at a period that does not undermine their everyday attempts to earn a living.
