Lost in translation: Migrant workers’ healthcare rights still a chimera

migrant workers healthcare crisis
Government schemes offer healthcare portability for migrant workers, but implementation gaps leave them in the lurch.

India currently has approximately 140 million migrant workers, according to 2011 census data. This figure reflects the movement of workers, relocating human resources to sectors and regions where they are more effectively utilised. Key sectors absorbing this workforce are construction, textiles, chemical industries, brick kilns, transportation, mining, quarries, and agriculture. Workers in these sectors often face extreme environmental conditions such as high or low temperatures, and hazardous working conditions, which expose them to harmful chemicals and materials.

According to the government of India’s 2017 Working Group on Migration report and other significant studies, migrant workers are prone to various health issues such as work-related illnesses, infectious diseases such as sexually transmitted infections, and psychological disorders. For women migrant workers, critical health issues include pregnancy and maternal health concerns, the prevalence of anaemia, risk of STIs, spousal abuse, and workplace harassment. Further complicating these challenges are issues such as powerlessness, discrimination, lack of identity, and limited access to health, education, livelihood, food security, government programmes, and services.

The psychological impact of migration on workers is profound and often overlooked in discussions of migrant welfare. Migrant workers frequently experience isolation, anxiety, and depression due to separation from their families and familiar social environments. The transient nature of their work can lead to a sense of impermanence that undermines their mental health. Addressing these psychological challenges is crucial, as they affect not only the well-being of the workers but also their productivity and the overall social fabric of the host communities. Mental health services and support systems tailored to the unique needs of the migrant population are essential components of comprehensive health care provision for this group.

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Laws covering migrant workers

The Inter-State Migrant Workmen (Regulation of Employment and Conditions of Service) Act, ISMWA 1979 and Central Rules 1980 establish clear guidelines for employing inter-state migrant workers and defending their interests. The Act ensures healthy working conditions in a new socio-environmental setting, provision of adequate residential accommodation during employment, free medical facilities, protective clothing, and mandates the reporting of any fatal accidents or serious injuries to specified authorities and the workers’ next of kin.

The central rules require contractors to provide adequate medical facilities for outpatient treatment, free treatment of ailments for migrant workers and their family members during employment, and preventive measures against epidemics or viruses. These rules also ensure the availability of clean drinking water, latrines, urinals, and washing facilities to maintain safe and sanitary conditions at work.

The Occupational Safety, Health, and Working Conditions Code 2020, the Code on Wages, the Industrial Relations Code, and the Social Security Code have been ratified by Parliament, but their implementation is still pending. Subsuming the Inter-State Migrant Workmen Act of 1979, the OSH Code expands eligibility for inter-state migrant workers to include those who register via self-declaration and Aadhaar. The code maintains the provisions of its predecessor and introduces new measures such as grievance redressal mechanisms, a toll-free helpline, collection of statistics, and a portal for Inter-state migrant workers.

The practice of the ISMW Act 1979 involves layers of specified implementation authorities, which, combined with local power accumulation by contractors and employers and inadequate penalties, lead to significant contraventions. The provisions of the ISMW Act are seldom invoked, with perpetrators typically prosecuted under the Penal Code, indicating both a lack of awareness and apathy among enforcement officials regarding these laws. As a result, sanitary compliances are often neglected, injuries and accidents go unreported, medical and sanitation facilities are inadequately provided, and accommodations are substandard. The new labour codes, which await uniform implementation, represent a future opportunity to address the health rights of migrant workers more effectively.

Suggestions and way ahead

Navas M. Khadar, a researcher at Mahatma Gandhi University who has spent the last eight years studying interstate migrants in Kerala, recommends interstate collaboration as the primary means to secure the rights and well-being of migrant workers. Despite some initiatives being implemented by the Kerala government, practical benefits for migrants remain elusive, leaving them without adequate social welfare protections. Khadar has cited instances of mass mob violence against interstate migrant workers, exacerbated by the lack of specific laws to protect migrants. Moreover, the government has been slow to identify and address criminal elements responsible for such violence.

The disruption and loss of lives during the 2020 COVID-19 reverse migration highlighted the policy gaps reflected by the outdated comprehensive data on migration. The Union government’s initiatives such as the National Database of Unorganised Workers (NDUW) and the eShram portal are steps in the right direction, potentially aiding in the portability of social services like the Public Distribution Systems (One Nation, One Ration Card) and healthcare systems.

Technology has the potential to significantly enhance the welfare of migrant workers by improving access to information and services. Mobile technology, in particular, can be leveraged to disseminate critical information about rights, entitlements, and services available to migrant workers. Apps and portals can facilitate real-time communication and feedback, enable better tracking of work conditions, and provide a platform for grievance redressal.

Moreover, technology can help streamline the documentation process, reducing the bureaucratic hurdles that often prevent migrant workers from accessing government schemes and benefits. The integration of technology in managing migrant worker affairs could thus play a transformative role in ensuring their welfare and integration into the broader societal and economic systems.

Dr Bijulal MV of Mahatma Gandhi University noted that fewer than 1,000 interstate migrant workers in Kerala registered for the One Nation One Ration Card scheme, and most did not receive their rations, indicating that the implemented portability method is not effective. A detailed assessment of access to health services is necessary to ensure that the burdens are not disproportionately borne by overworked and exploited migrant workers, in terms of high out-of-pocket payments.

The lack of awareness among migrant workers about their rights, entitlements, and the general application of laws makes it difficult for them to voice their concerns, health-related or otherwise. A corrective step would involve the Union and state governments coordinating and collaborating with the participation of Civil Society stakeholders to effectively communicate and disseminate information to these vulnerable populations. Similarly, enhancing the capacity of enforcement officers to foster a rights-based approach in ensuring compliance and addressing violations of labour codes is essential.

Stringent punitive measures should be introduced to improve compliance. Judicial decisions and guidelines must be strictly and consistently followed. Different healthcare policies and insurance schemes should be universally available in all states, covering all types of workers, especially unorganised workers including migrant workers. There is also a growing need for explicit inclusion of migrant workers in all aspects of the existing healthcare system to improve its delivery, administration, and management.

(Manahil Kidwai is a research intern at the Centre for Migration and Policy Inclusive Governance, School of International Relations and Politics, Mahatma Gandhi University, Kottayam.)