1
Faculty of Graduate Studies
Department of Political Science
Fall 2015
POLS 6245 Global Politics of Health
Uneven Access ...
2
Introduction
The increasing migration and movements of people, flows of money and proliferation of
technological advance...
3
Dubai and Abu Dhabi has precipitated immense government spending in many important infrastructural
projects; most notabl...
4
health insurance for Emiratis and plans of different packages for expatriates even covering the lower
strata of the work...
5
has facilitated the division in healthcare outcomes. The UAE is a loose federation of seven city states that
are dominat...
6
preforming advanced procedures such as organ transplants and complex heart surgery.
Although facilities are concentrated...
7
The imagined community as alluded to by Anderson vis-à-vis Morone constructs members who
share the same history, fates a...
8
complement each other and increase its efficacy23
. A great deal of focus has been developing the private
sector which i...
9
The UAE has increased its presence internationally primarily because of what Neha Vora
explains as “exceptional space(s)...
10
On some occasions, the UAE‟s rulers have paid the debts of Emirati nationals ahead of
major holidays36
.
The large gove...
11
the quality of healthcare satisfactory and locally available41
. Similarly, given the labour shortages in
talented home...
12
The lack of transparency has made the burden of information overwhelmingly on investigative journalism
and reports publ...
13
is a signatory, considers this a violation of the Convention on the Abolition for Forced Labour48
. With
international ...
14
condemned have resulted in a number of adverse health outcomes. Suicidal ideation and depression were
linked to poor wo...
15
overcapacity59
. Several scholars and NGOs, most notably Kristiansen has noted that the next steps in
caring for migran...
16
by either the 1980 UAE Labour Law or the 2007 Draft Labour Law and so are not entitled to labour
protection”63
. Becaus...
17
Practices to Protect Women Migrant Workers67
” outlined Jordan‟s deep participation in the report and
even named the co...
18
enforcement mechanism on complaints against recruitment agencies72
. The treatment and legislation put
forward to prote...
19
recruitment system has resulted in systematic human rights abuses for these workers, most of whom,
women are placed in ...
20
Works Cited
"A Lifetime of Perks in UAE Help Cushion Wealth Gap." Daily Mail United Kingdom [Umm Al-
Quwain] 4 Nov. 201...
21
Hvidt, Martin. "The Dubai Model: An Outline of Key Development-Process Elements in
Dubai."International Journal of Midd...
22
Vora, Neha. "Unofficial Citizens: Indian Entrepreneurs and the State-Effect in Dubai, United Arab
Emirates." Internatio...
of 22

POLS 6245 Final Paper Usman Javed

Published on: Mar 4, 2016
Source: www.slideshare.net


Transcripts - POLS 6245 Final Paper Usman Javed

  • 1. 1 Faculty of Graduate Studies Department of Political Science Fall 2015 POLS 6245 Global Politics of Health Uneven Access to Health, Unfair Labour Practices & Health Disparities for Migrant Workers in the United Arab Emirates A Study of Low-Waged Migrant Workers in a Neo-Patrimonial & Neoliberalized Political Economic Order Usman Javed 210223402 Professor Rodney Loeppky POLS 6245 December 2, 2015
  • 2. 2 Introduction The increasing migration and movements of people, flows of money and proliferation of technological advancement have been central characteristics and defining features of globalization. Much scholarly literature has defined globalization as according to George Ritzer among many others as the “trans-planetary process or set of processes involving the increasingly liquidity and the growing multidirectional flows of people, objects, places and information as well as the structures they encounter and create that are barriers to, or expedite, those flows1 . Michael Freeden defines globalization as occurring within a neoliberal framework and defines it as “not an ideology, but a political and economic process that can denote the breakdown of political borders and of the realm of states; or a demand that claims for justice be treated irrespective of their geographical origin2 . Jonathan Tritter defines globalization as playing a role in promoting and transmitting policy ideas and solutions, while the ultimate political mechanism that can induce policy changes towards institutions like healthcare is the nation state3 . While definitions are endless, the most important aspects are changes in the distribution of income and poverty; the globalization of production; the liberalization of trade; and the reshaping or hollowing out of nation-states4 . No such change has occurred so rapidly than states in the Gulf Cooperation Council (GCC) with the United Arab Emirates (UAE) and its city-states – Dubai and Abu Dhabi headlining this change. Since the UAE‟s independence in 1971 from the Great Britain, the UAE has transformed from undeveloped fishing and pearl ports to one of the “world‟s wealthiest oil producers, with socio-economic conditions comparable with – and in some cases superior to – those of many Western states”5 . The massive profits derived from the oil industry, coupled with increasing diversification of the economies of 1 Ritzer, George. "Liquids, Flows and Structures." Globalization: A Basic Text. Malden, MA: Wiley-Blackwell, 2010. 2 2 Freeden, Michael. Ideology: A Very Short Introduction. Oxford: Oxford UP, 2003. 90 3 Tritter, Jonathan Q., Meri Koivusalo, and Eeva Ollila. Globalisation, Markets and Healthcare Policy: Redrawing the Patient as Consumer. London: Routledge, 2010. 4 Doyal, Lesley. "Putting Gender into Health and Globalization Debates: New Perspectives and Old Challenges." Third World Quarterly 23.2 (2002): 235 5 Davidson, Christopher M. The United Arab Emirates: A Study in Survival. Boulder, CO: Lynne Rienner, 2005.
  • 3. 3 Dubai and Abu Dhabi has precipitated immense government spending in many important infrastructural projects; most notably, healthcare and transportation. Healthcare in the UAE is now considered highly developed up to European standards and meets typical Western healthcare indicators such as low infant mortality rate and a high life expectancy of 78.36 . Dubai and Abu Dhabi are widely considered important cities for medical care attracting international patients from the region and abroad. To build and power these achievements, the UAE has had to rely on the large influx of foreign labour that has essentially become the economic backbone of the country. The emergence of the UAE is in large part due to the estimated 7.3 million migrant workers who primarily come from the Philippines, India, Pakistan, Bangladesh to name a few7 . With minimal socioeconomic rights from a classist and racist government structure that places superiority of the Emirati at the individual level8 , there have been numerous reports about the unfair treatment and exploitation in the employer dominated Kafala sponsorship system. Furthermore, while strides have been made to protect workers, there are continuing health disparities implicated by human rights abuses. The objectives of this paper are to uncover uneven and unequal access to healthcare services in the UAE with a focus on low-waged migrant workers. The current healthcare system is typical to other developed countries with a strong public sector and a rapidly growing private sector. The Ministry of Health controls 36.4% of all hospitals in the UAE while separate ruling governments administer other hospitals and since 2006; the private sector has an increased share in patient encounters9 . Furthermore, since 2006, Emirates in the federation have followed Abu Dhabi‟s lead in introducing mandatory health insurance for all residents in the UAE. Healthcare plans are diverse, with different prices being available to different classes. For example, the Thiqa plan provides free, universal 6 "Expat Guide to the UAE: Health Care." The Telegraph. Telegraph Media Group, 23 Sept. 2010. Web. 26 Nov. 2015. 7 Rothna, Begun. I Already Bought You: Abuse and Exploitation of Female Migrant Domestic Workers in the United Arab Emirates. Rep. N.p.: Human Rights Watch, 2014. Print. Middle East and North Africa Human Rights Watch. 8 Hamza, Sara. "Migrant Labor in the Arabian Gulf: A Case Study of Dubai, UAE." Pursuit: Journal of Undergraduate Research at the University of Tennessee (n.d.): 97 9 Albert, Ian, and Mansoor Ahmed. United Arab Emirates Healthcare Overview. Rep. Vol. Q4 2013. Abu Dhabi: Colliers International, 2013. 6
  • 4. 4 health insurance for Emiratis and plans of different packages for expatriates even covering the lower strata of the workforce10 . This paper argues that migrant workers face serious health problems and disparities due to a wide confluence of factors: neoliberal globalization has reduced their legal and socioeconomic status, while the state‟s muscular reassertion of sovereignty with strict citizenship and national identity being part and parcel to marginalizing migrant workers as „others‟ and aliens. The structure for this paper goes as follows: a conceptualization of globalization and an overview of the development of its two tiered healthcare system; a discussion of the political framework of the UAE where less than 15% of the population are citizens and rests on a neo-patrimonial framework which privileges Emirati citizens while limiting citizenship and benefits only that ethnic group. Within this section, there will be an analysis and discussion of the role the state plays in accommodating affluent Western expatriates vis-à-vis an opening of the national identity while excluding lower waged migrant workers predominantly hailing from Asia; The final section will deal extensively with the health problems and disparities experienced by migrant workers in the UAE focusing on core groups of: construction workers and domestic servants. Additionally, the inhumane labour practices practiced under the Kafala sponsorship system severely under powers migrant workers and interlinks human rights abuses to health disparities11 . To conclude this section, a comparison between the UAE‟s treatment of migrant workers in relation to healthcare is made to Jordan‟s rather comprehensive and progressive healthcare system which enables equitable access to healthcare for domestic workers in particular. Jordan is an important contrasting point because it is widely seen in the region as being the healthcare leader and a symbol of progress. Globalization and UAE‟s Healthcare System This section will argue that the process of globalization – increasing interconnectedness vis-à-vis economic integration while protecting sociocultural values and upward mobility of its Emirati citizenry 10 ibid 11 Sonmez, Sevil, Yorghos Apostopoulos, Diane Tran, and Shantyana Rentrope. Human Rights and Health Disparities for Migrant Workers in the UAE 13.2 (2011): 20
  • 5. 5 has facilitated the division in healthcare outcomes. The UAE is a loose federation of seven city states that are dominated by its two largest cities – Dubai and Abu Dubai serves as the commercial center of the Middle East and Abu Dhabi serves as the political capital of the country responsible for matters of national defense and diplomacy. The ambitious goals set by the country‟s late leader, Sheikh Zayed bin Sultan Al Nahyan have transformed the country from an undeveloped backwater in the Persian Gulf into one of the most prosperous nations in the world containing within it glamorous mosques, luxury shopping malls, tax free salaries and the tallest buildings in the world12 . With the massive profits derived from the oil sector and an “opening up” of international capital, the government has made profound investments in the last few decades in infrastructural development centered on health, transportation and education13 . During the time of independence, healthcare in the United Arab Emirates was considered very poor. Tahira Yaqoob‟s newspaper article on the role American missionaries played in transforming Abu Dhabi‟s healthcare situates healthcare during the 1950 to 1970s in the Emirate as comparable to Afghanistan today with “the population in decline because of disease and death”14 . Receiving technical help from the United States, United Kingdom, Oman, Iran, Egypt, the UAE began to develop a self- sufficient healthcare system which became stable, but uncoordinated by the early 1980s15 . Interestingly, healthcare was afforded to all residents regardless of citizenship or nationality because of the low number of foreigners. Eric Hooglund and Anthony Toth provide a historical backdrop to the social developments in the healthcare system: All residents received free medical care until 1982. In that year, escalating costs, shrinking oil revenues, and a change in attitude towards foreign residents cause the UAE to begin charging noncitizens for all services except emergency and child and maternity care. . …In the early 1990s, the UAE had a modern health system with facilities and professionals (predominantly foreigners) capable of providing excellent care 12 Hvidt, Martin. "The Dubai Model: An Outline of Key Development-Process Elements in Dubai."International Journal of Middle East Studies 41 (2009): 398 13 Al-Khouri, Ali M. The Challenge of Identity in a Changing World: The Case of GCC Countries. Proc. of The 21st Century Gulf: The Challenge of Identity, University of Exeter, United Kingdom. N.p.: U of Exeter, 2010. 2 14 Yaqoob, Tahira. "How Missionaries Transformed Abu Dhabi Healthcare." The National [Abu Dhabi] 5 Nov. 2010, UAE sec.: n. pag 15 Hooglund, Eric, and Anthony Toth. "Chapter 5: United Arab Emirates." Persian Gulf States: Country Studies. Ed. Helen Chaplin Metz. Buffalo: Library or Congress: Federal Research Division, 1993. 212-4
  • 6. 6 preforming advanced procedures such as organ transplants and complex heart surgery. Although facilities are concentrated in the cities of Abu Dhabi and Dubayy, most of the population had access to at least basic facilities16 . Hooglund and Toth‟s contributions are important for understanding the changing dynamic of national identity which is interlinked and induced by globalization. Since oil exports began in the 1950s onwards, the UAE has had to rely on increasing influx of foreign labour to sustain this economic growth because of its labour shortages. The United Nations Population Division Report of 2015 reported that population of the UAE at independence in 1971 was roughly 275,000. In 1982, when the changing national identity influenced the monarchy to narrow access to the healthcare program entitling only the Emiratis with free universal healthcare, the population had risen to 1,158 million. The trajectory in population growth continues to rise to this day with the population dramatically increasing to 9,157 million with fewer than 20% being Emiratis17 . The rapid population growth brought on by increasing human movement liquidity18 has precipitated a change in how the government and Emiratis perceive foreigners, bringing exclusions of foreigners to welfare programs and government services. Using the contributions of James Morone in his Enemies of the People: The Moral Dimension to Public Health, the use of an imaginary community of “them vs. us” conceived by Benedict Anderson becomes applicable in the case of the UAE: Social welfare programs are embedded in a cultural construction of “us” – what [Benedict] Anderson calls an “imaginary community.” Somehow, millions of strangers believe that they are connected to one another. They share history, values, and fates. This vision of shared community fosters support for programs such as Medicare and Social Security. It articulates the universe for universal programs. The imaginary community comes more sharply into focus when it confronts outsiders. The 1996 welfare revisions illustrate the shifting communal boundaries by ruling that most immigrants are ineligible for most federal welfare benefits. But the divisions between us and them run much deeper than the simple question of citizenship19 . 16 Hooglund 1993: 213 17 United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision. DVD Edition. 18 Ritzer, 2010: 2 19 Morone, James A. "Enemies of the People: The Moral Dimension to Public Health." Journal of Health Politics, Policy and Law 22.4 (1997): 993-4
  • 7. 7 The imagined community as alluded to by Anderson vis-à-vis Morone constructs members who share the same history, fates and values and turn them into commonality. In the face of a perceived threat, such as migrants, this imaginary community informs the national identity of who belongs and who is excluded. Its nation-ness is not given, but according to Morone and by extension, Anderson, is socially constructed – a cultural phenomenon. The UAE, with over 200 nationalities is undergoing a crisis of national identity which has led to “legislative structures to preserve the Emirati identity through various reforms in health, labour and immigration policies because of a fear of foreigners. Ali Al-Khouri presents an illustrating portrait of the changing dynamics of GCC governments to limit this identity threat. He states that the colossal influx of workers and their families has led to a “co-existing of different identities in region bringing with them different cultural backgrounds, particular values and norms” – or in other words, differing national identities20 . He states that that that groups like the Emiratis, Qataris, Kuwaitis, etc… “find it difficult to accept that they are now minorities” given that their traditional values and customs are under greater threat. This has pushed ruling monarchies and governments which gains its legitimacy and loyalty of these specific ethnic groups to “construct new forms of legislative structures to preserve identity in the forms of a more rigid, exclusive healthcare, labour and immigration programmes”21 . The healthcare system in the UAE is a reflection of the strict ethnic citizenship reserved for Emiratis and national identity based on Emirati culture. Currently, the healthcare system is divided between public and private healthcare providers22 . First, the Ministry of Health, Dubai health Authority, The Health Authority Abu Dhabi, and the Abu Dhabi health Services Company oversee government run healthcare in the country with great focus on Dubai and Abu Dhabi as centers for healthcare administration. Second, the private hospitals often times alleviates the pressures from the sheer number of privately insured patients using government run hospitals and at often times, the coordination of both 20 Al-Khouri 2010: 6-7 21 Al-Khouri 2010: 7-8 22 The U.A.E. Healthcare Sector. Rep. Washington D.C.: U.S.-U.A.E Business Council, 2014: 3
  • 8. 8 complement each other and increase its efficacy23 . A great deal of focus has been developing the private sector which is very important to „UAE vision 2021‟ and the development of the country‟s healthcare infrastructure over the long term24 . Starting in Abu Dhabi then onto Dubai in 2006, health insurance became mandatory for all residences. While this does not affect the other Emirates, they are quickly following suit. In Abu Dhabi in particular, residences can qualify for several plans except the Thiqa plan. The Thiqa plan covered by Daman National Insurance Company and is universal, free and allows for medical coverage overseas but only reserved for Emirati citizens25 . Companies like Daman also cover populations of different income levels with a “basic” package for lower waged migrant workers26 . Some estimates put it at roughly DHS 500–700 which amounts roughly USD $135-$190 which must be covered by employers and not passed down to employees27 . Laws such as Abu Dhabi‟s “Implementing Regulations of Law no. 23 of 2005” and Dubai‟s “Dubai Health Insurance Law no. 11 of 2013” enforces and requires employers and sponsors to guarantee the availability of minimum levels of healthcare services for those under their sponsorship28 . While minimum levels of healthcare are guaranteed by private insurers vis-à-vis enforced legal legislation, “both governments of Abu Dhabi and Dubai are funding the healthcare expenses for nationals who are registered”29 . While on paper migrants are afforded healthcare by their employers, the situation may differ practically, with practices by employers under the Kafala sponsorship system30 showing that government regulation and enforcement are not always abided by because of the lack of regulators within government ministries. Neo-Patrimonialism in the UAE 23 U.S.-U.A.E Business Council 2014: 3 24 Ibid. 25 Albert 2013: 9 26 Ibid 27 Bicknell, Thomas. "Compulsory Health Insurance Touches Down in Dubai." Al Tamimi & Co. [Dubai] Feb. 2014, Law Update ed.: n. pag. Print. 28 Karbal & Co. Health Insurance Law & Abu Dhabi: Employer Responsibilities and Duties. Rep. Abu Dhabi: n.p., 2015. Print. And Bicknell, 2014 29 Karbal & co 2015 30 The Kafala Sponsorship system is a system used to monitor migrant workers and will be discussed at length in the last section.
  • 9. 9 The UAE has increased its presence internationally primarily because of what Neha Vora explains as “exceptional space(s) because of the seemingly unlikely coexistence of a neoliberal, rapidly growing economy and a nonliberal, authoritarian, monarchical state”31 . It is unique because the state has opened up to globalization while disregarding or blocking the political transformations that accompany globalization. Gilbert Achcar‟s convincing point that the region is dominated by neo-patrimonial states whose legitimacy rests on securing loyalty from its citizens is also applicable in the case of the UAE. He defines neo-patrimonialism as: “an absolute, heredity type of autocratic power”32 . For the UAE, the ruling groups dominated by the Al-Nahyan family of Abu Dhabi and Al Maktoum family of Dubai “appropriate the state for itself, the economic means at its disposal, the state administration and secure loyalty of its citizens using resources of the state”33 . Similarly, the framework of the UAE prevents a liberal political development of the state as it undermines the possibility of liberal democratic developments and effective rule of law through the denial of citizenship and deportation34 . The state gains loyalty through lavish perks and robust social welfare programs which the Emiratis benefit from, such as free healthcare, cushy pension funds, and the work nationalization program called Emiratisation which encourages employers from private as well as government ministries to hire Emiratis35 . The Daily Mail published an article which focused on what neo-patrimonialism ensues through the lavish treatment of Emiratis by their government: The government benefits that Emiratis have long enjoyed would be unthinkable in most of the world: tax-free income, free high-quality healthcare, subsidized fuel, generous government-funded retirement plans, access to land to build homes with interest-free loans, free higher education even when pursued abroad. …To ease marriage costs, the government gives Emirati men 70,000 Dirhams ($19,000) when they marry an Emirati woman. A debt settlement fund provides a one-time bailout to entrepreneurs who need it. 31 Vora, Neha. "Unofficial Citizens: Indian Entrepreneurs and the State-Effect in Dubai, United Arab Emirates." International Labor and Working-Class History Inter. Labor Working-Class Hist.79.01 (2011): 123 32 Achcar, Gilbert. The People Want: A Radical Exploration of the Arab Uprising. Berkeley: University of California, 2013. 58 33 Achcar 2013: 72-3 34 Hertog, Stephen. "The United Arab Emirates: A Study of Survival by Christopher M. Davidson." Review. British Journal of Middle Eastern Studies 34.1 (2007): 99 35 "A Lifetime of Perks in UAE Help Cushion Wealth Gap." Daily Mail United Kingdom [Umm Al-Quwain] 4 Nov. 2014, Associated Press ed
  • 10. 10 On some occasions, the UAE‟s rulers have paid the debts of Emirati nationals ahead of major holidays36 . The large government run social welfare program designed for Emiratis creates a social and wealth gap which effectively separates itself as the dominant group from the expatriates. The creation of an imagined community stated earlier is ever important for this clientalist, patrimonial political system. Davidson notes that the ruling families and governments revived and even reinvented cultural, religious, and ideological resources incorporating most segments of the Emirati population through commonalities like shared memories, common causes, and a greater sense of Emirati identity37 . The reinvention of the National Day celebrations every year in early December serves this purpose of reinforcing the imagined community. With globalization along neoliberal lines, expatriates are clearly becoming defined by their social class, country of origin and economic status38 . The westernization of Emirati culture, a phenomenon both feared and accepted also helps with the gradual inclusion of western expats into the national identity of the state39 . With the UAE‟s unprecedented growth, liberalization into a consumerist and material society, affluent westerners and high income expatriates are seem as residents and within the national identity, but denied full citizenship. On the other hand, there are the lower waged expatriates – who are increasingly seen as migrants, immigrants, and guests. Also important is the material resources available to the UAE which has enabled the government to strengthen its legitimacy formula. The substantial oil wealth has allowed the government to provide the bulk of the population with a series of distributions of wealth and comprehensive welfare package which the rulers have been able to “purchase political acquiescence and considerable popular support from the locals40 . The focus of healthcare being high quality for Emiratis has been the focus on the ruling government since its independence in 1971. Now, most Emiratis are satisfied with their healthcare according to one major newspaper in the UAE. Through the highly efficient Thiqa insurance plan available to Emiratis, many of those interviewed found 36 Associated Press 2014 37 Davidson 2005: 104 38 Koutonin, Mawuna Remarque. "Why Are White People Expats When the Rest of Us Are Immigrants?" The Guardian 13 Mar. 2015: n. pag 39 Winslow, Wendy Wilkins, and Gladys Honein. "Bridges and Barriers to Health: Her Story - Emirati Women's Health Needs." Healthcare for Women International 28.3 (2007): 286 40 Davidson 2005: 104-5
  • 11. 11 the quality of healthcare satisfactory and locally available41 . Similarly, given the labour shortages in talented home-grown medical professionals, the UAE has begun to focus heavily on training Emirati healthcare professionals which will, in turn, “improve medical outcomes, quality of care and in return, restore trust in the system”42 . Uneven and Unequal Healthcare and Migrant Workers in the UAE This section, undoubtedly the most important in this paper focuses on the uneven and unequal socioeconomic status which is then reflected into disparities in health for low-waged migrant workers. The UAE, since the proliferation of the oil industry in the early 1980s and then the subsequent diversification of the economy has had to rely enormously on the influx of large numbers of low-waged migrant workers to fill these shortages in labour. These workers, predominantly from countries like Iran, Pakistan, India, Nepal, Sri Lanka, Indonesia and Philippines outnumber the Emirati citizens by a large margin. Human rights abuses suffered by low-waged migrant workers in the UAE and throughout the GCC region is interlinked to health disparities and ailments such as higher rates of suicide, mental illness caused by long working hours, physically and mentally hazardous working conditions, high rates of work related accidents, and squalid living conditions, all occurring often with little health care access or consultation. This section will be carpmentalized through discussions of migrants in the construction and domestic service industries through the Kafala system43 . Secondly, in comparison to Jordan‟s progressive adherence to migrant rights and healthcare access for this vulnerable group, the UAE and its infamous Kafala employment program has much to learn if the government wants to avoid damaging allegations of further human rights abuses from NGOs and the world community. While strides have been taken by the government to respect human rights when it comes to labour issues, enforcement has been sporadic with the Ministry of Labour employing only 140 inspectors to oversee 240,000 businesses and companies44 . 41 Ismail, Manal. "UAE Healthcare Gets Higher Approval Rating than US from Emiratis." The National UAE [Abu Dhabi] 2 Sept. 2012, Arts and Life ed.: n. pag. Print. 42 Ibid. 43 Sonmez 2011: 24 44 Hamza 2015: 92
  • 12. 12 The lack of transparency has made the burden of information overwhelmingly on investigative journalism and reports published by NGOs and civil society located abroad. a. Kafala Sponsorship System With 1,300 construction projects totaling over $418 billion in development45 focused on developing real-estate and industry, the UAE has had to rely on short term migrant labour through a large Kafala sponsorship system. The Kafala sponsorship program in the UAE is meant to bring in temporary labour that could be brought into the country through recruitment agencies and sponsored by the individual or employer. Migrant workers are legally bound to the employer representing an uneven delegation of power from the sponsor over the migrant. In essence, the migrant worker cannot transfer employment, enter or leave the country without expressed written consent from the employer46 . Much criticism from organizations like the Human Rights Watch (HRW), International Labour Organization (ILO) and Amnesty International has stemmed from human rights abuses caused by the Kafala system. Ramon Bultron from the Asia-Pacific Mission for Migrants appropriately summarizes the Kafala system in his research on the impact of the sponsorship system: The Kafala system creates a severe power imbalance between employees and employers. Scholars, human rights activists and international non-profit organizations describe the system as part of modern day slavery and a form of structural violence against migrant workers. The Kafala system causes, facilitates and perpetuates human rights abuses against migrant workers47 . Sonmez adds on that the Kafala system as articulated by Bultron allows the employer to conduct a wide array of practices that are deemed illegal by the International Labour Organization (ILO). For example, the widely practiced activity by employers to retain the passports of migrant workers who sign a contract in their home country and land in the UAE forces migrant workers in a predicament where they are forced to work under abhorrent conditions and cannot freely leave. The ILO, through which the UAE 45 Sonmez 2011: 20 46 Policy Brief No. 2: Reform of the Kafala (Sponsorship) System. Rep. Quezon City: International Labour Organization, n.d. Print. Migrant Forum in Asia. 47 Bultron, Ramon. The Kafala: Research on the Impact and Relation of the Sponsorship System to Migrant Labor Bondage in GCC Countries. Rep. Hong Kong: Asia Pacific Mission for Migrants, 2014: 28
  • 13. 13 is a signatory, considers this a violation of the Convention on the Abolition for Forced Labour48 . With international pressure mounting from NGOs like the HRW to pressure governments to reform labour laws as well as have better inspections and enforcement mechanisms, the government has been reactive in an effort to preserve its public image. Article 1 of Ministerial Decree 764 of 2015 created in response to these issues sets a standard where the employer and worker enter in an agreement under explicit guarantees of “information on pay, date and duration of contract, and the nature of the work to be performed”49 . Maria Kristiansen notes with optimism that recent changes at the policy level outline an increasing commitment to human rights have been made by the government. The UAE “has begun revising laws to better safeguard the rights of migrant workers” with revisions including “outlawing confiscation of worker passports; allowing transfer of sponsorships within the Kafala system, banning recruitment fees, withholding wages”50 . She notes however the weakness and infrequent enforcement system in place which is problematic for these new reforms. b. Abuses within the Kafala Sponsorship System In addition to the widespread, unwritten policy of having migrant workers give up their passports, migrant workers also undergo grueling work conditions in an arid, desert climate. Workers are reported to stay in the heat for up to 14 hours per day despite UAE law mandating that workers take breaks during the hottest hours51 . Heat exhaustion, heat stroke and dehydration were the most common health risks encountered by migrant workers in the construction industry “often leading to hospitalization”52 . Working conditions are also characterized as low payment, long working hours, and at times, physically and mentally hazardous working conditions with limited access to quality healthcare53 . These factors, widely 48 Sonmez 2011: 19 49 Stork, Joe. UAE: A Move to Protect Migrant Workers: Contract Fraud Measure Can Deter Forced Labor. Rep. Human Rights Watch, 1 Nov. 2015. Web. <https://www.hrw.org/news/2015/11/01/uae-move-protect-migrant- workers>. 50 Kristiansen, Maria, and Aziz Sheikh. "The Health of Low-Income Migrant Workers in Gulf Cooperation Council Countries." Health and Human Rights Journal (2014) 51 Sonmez 2011: 21 52 Ibid 53 Kristiansen 2014
  • 14. 14 condemned have resulted in a number of adverse health outcomes. Suicidal ideation and depression were linked to poor work practices and solitary labour camps in the UAE. One study, published by Al-Maskari found that there mental illness of various kinds were extremely high compared to the general UAE population with suicidal ideation being particularly high for Pakistani immigrants at 12%54 . Many of the sources of mental illness and depression can be attributable to “incomes less than one thousand UAE Dirham (USD $275), high cost of living, not being able to remit enough to support relatives and poor working conditions55 . High rates of work-related accidents and mental health problems coupled with gross human rights violations in the workplace compounds these health risks. Adequate healthcare services and quality care have been hindered by the employer in the Kafala system as well. While mandated by UAE that employers must purchase private health insurance for migrant workers56 , “only the most serious injuries receive medical care”57 . This is in part due to the unwelcomed, extra-medical costs as explained below: The employer pays for transportation to the hospital and for medical expenses, which laborers must repay upon recovery – thereby increasing their debt. In 2004, five workers died and 12 were injured when a reinforcement case support a wall collapsed. In the same year, 5,000 construction workers in Dubai were admitted to Rashid Hospital‟s emergency room between July and August alone; in 2007, seven workers died and 15 were injured when a bridge collapsed at the Dubai Marina58 . The problems encountered by migrant workers are not only limited to the work environment, but their living arrangements which spread infectious diseases, contains weak plumbing and substandard drinking water. HRW reported that living conditions in labour camps were below government standards and violated hygiene and safety rules. In addition, the report included that construction workers in labour camps lived in conditions where raw sewage was exposed, ventilation was not refreshed, and rooms were 54 Al-Maskari, F., S. M. Shah, R. Al-Sharhan, E. Al-Haj, K. Al-Kaabi, D. Khonji, J. D. Schneider, N. J. Nagelkerke, and R. M. Bernsen. "Prevalence of Depression and Suicidal Behaviors Among Male Migrant Workers in the United Arab Emirates." Journal of Immigrant and Minority Health 13.6 (2011): 1030-1 55 Al-Maskari 2011: 1031 56 The U.A.E. Healthcare Sector 2014 57 Sonmez 2011: 21 58 Ibid
  • 15. 15 overcapacity59 . Several scholars and NGOs, most notably Kristiansen has noted that the next steps in caring for migrant workers should focus on an emphasis of health activism. She states that while enforcing labour rights is ever important, pressing for timely, effective and equal healthcare outcomes is interwoven with human rights promotion to target health inequalities and improvement of life. These include a need for government-run demographic statistical information gathering including migrant workers and providing a detailed outlook on “adequate stratification of data on the burden of disease, living circumstances, and access to healthcare services according to ethnicity, sex and occupation”; health promotion programs run by the government authorities to tackle mental health problems which often lead to an increased suicide rate, and interventions to address common communicable and non-communicable diseases among migrants; and finally, accessible, acceptable and timely healthcare based on satisfactory access to doctors and health practitioners of the same culture as migrants60 . c. Domestic Workers Women as migrant labourers are particularly vulnerable in the UAE. Exploitation of domestic workers where women comprise of 50% to 75%61 the domestic service industry has been promulgated by various international outlets from the United Nations to NGOs. There have been reports that some encounter sporadic human rights abuses, isolation and mental distress. Emiratis and affluent Western expatriates use domestic servants as status symbols and a show of luxury. The domestic service industry is also very prevalent and a dominant feature for life among Emiratis and affluent Westerners. For example, Sonmez reports that 150,000 Emirati families employ about 300,000 domestic servants, while 150,000 expatriate families employ about 150,00062 . With the interlinking of labour policy and practices affecting and implicating health, domestic workers do not receive the same protections as othersmigrant workers in sectors like construction and the service industry receive. “Domestic servants are not covered 59 Available at http:// www.migrant-rights.org/2009/03/03/overcrowding-in-dubai-labour-camps/. 60 Kristiansen 2014 61 Sonmez 2011: 25 62 Sonmez 2011: 22-3
  • 16. 16 by either the 1980 UAE Labour Law or the 2007 Draft Labour Law and so are not entitled to labour protection”63 . Because many of the locations of work are in private households, the government cannot actively enter and inspect the treatment of domestic servants. This makes them relatively invisible and puts them at a higher risk than any other expatriate demographic group. The story of Sadiyah, a Filipino domestic worker recounted to the HRW her story: “Madam kept shouting – always like that. She would say I “don‟t have a brain,” “don‟t have common sense,” “donkey” in Arabic. In Abu Dhabi mall, I was crying in the restaurant because she shouted at me saying “You have no brain,” in front of other people”64 . These psychological, physical and sexual abuses go unpunished because of the lack of oversight and regulation by the state, fear of the worker in making a claim and the exploitative nature of the Kafala system which gives almost unhindered power to the individual in their private home. There were also reports of untreated illnesses, widespread sexual abuse, weak state enforcement and lack of clarity in work contracts between a family and domestic servant and arbitrary deductions of money for food and healthcare insurance65 . Because domestic servants are not considered employees due to UAE Labour Law, healthcare is not mandatory for domestic servants66 resulting in undeclared illnesses, infrequent medical care. Healthcare insurance is an undesirable expense for many affluent families despite possessing enormous capital and riches. d. The Jordanian Example Jordan can be in many respects an example of good faith for the UAE to follow. Furthermore, with the international community as a catalyst, the UAE can begin working with international organizations and NGOs and distance itself from the many public relations issues and scrutiny over its treatment of migrant workers by signing and ratifying international organizations and conventions that respect human rights in good faith. The United Nations Development Fund‟s report entitled “Good 63 ibid 64 Rothna, Begun. I Already Bought You: Abuse and Exploitation of Female Migrant Domestic Workers in the United Arab Emirates. Rep. N.p.: Human Rights Watch, 2014. Print. Middle East and North Africa Human Rights Watch 65 Sonmez 2011: 24 66 ibid
  • 17. 17 Practices to Protect Women Migrant Workers67 ” outlined Jordan‟s deep participation in the report and even named the country a model to follow for its neighbours wrought with human rights abuses and health disparities. Jordan considers itself a part of the international community that upholds the rights of individuals regardless of nationality, sex or race68 . This involvement in the international community includes the signing and ratifying of many conventions that look closely upon the human and labour rights of migrant workers. Jordan has ratified the UN Declaration of Human Rights, International Covenant on Social, Cultural and Political Rights, The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and has even ratified a “large number of ILO conventions and 7 of the 8 core standards on Fundamental Principles and Rights at Work”69 . These include a myriad of rights, but most important and with great contrast to the UAE, the right to organize, freedom from forced labour, and protection from discrimination in employment70 . The Ministry of Labour in Jordan embarked on building upon already existing laws that emulated conventions signed by the state, however, it was one project specifically that the report lauded Jordan for – The Special Working Contract. Considered the first of its kind in the region, it regulates “the coordination between sending countries and Jordan, and guarantees migrant women‟s rights to medical care, life insurance and rests days”71 . This contract, dealing specifically with vulnerable groups like domestic workers was created because the neglect and lack of oversight for domestic workers within Jordan‟s national labour laws. Furthermore, another initiative taken by the government was introducing an effort to regulate the work of recruitment agencies, both domestic and from abroad – a focus of criticism within the UAE‟s Kafala system. In Jordan, the Ministry monitors the work of recruitment agencies, hands down severe punishments for violators of the regulations and has improved the 67 D'Cunha, Jean, and Fareeha Ibrahim. Good Practices to Protect Women Migrant Workers: High Level Government Meeting of Countries of Employment. Rep. Bangkok: United Nations Development Fund for Women, 2005. 68 D‟Cunha 2005: 42 69 ibid 70 ibid 71 D‟Cunha 2005: 44-5
  • 18. 18 enforcement mechanism on complaints against recruitment agencies72 . The treatment and legislation put forward to protect the rights of domestic workers, if not all workers in Jordan improves the health outcomes, guarantees their access to health and improves their well-being. This is a crucially important distinction between the UAE and Jordan for many reasons. Recruitment agencies exploiting and working within the Kafala sponsorship system under a weak regulatory and legal framework have been infamously known for misleading, and manipulating potential migrants with the promise of high wages, decent healthcare, ability to remit money back home and escape from poverty. Domestic workers are of particular concern in the UAE with the Human Rights Watch blaming the Kafala sponsorship system and the “lack of labour law protections which has led to some migrant domestic workers “beaten, exploited, and trapped in forced labour situations73 . Jordan has done some “Pioneering work in the Arab region in protecting migrant women domestic workers, and the situation today is visibly better”74 . Despite its successes, it still lacks in developing comprehensive welfare and support services for mental health to migrant women. This becomes further problematic because even in embassies that represent expatriate workers there is little support and services offered. Nevertheless, the UAE with its profound rise and international recognition can learn from its regional neighbor whom it shares roughly the same neo-patrimonial framework, need for migrant labour and cultural values. Concluding Remarks This paper has argued that neoliberal globalization‟s impact in the UAE has resulted in a number of outcomes: the reinforcement of strict citizenship and national identity as part and parcel to a muscular reassertion of sovereignty, the development of healthcare as reflective of that and its implications for migrant workers who are seen as „others‟. The lack of labour laws, coupled with an exploitative 72 D‟Cunha 2005: 43 73 "UAE Slams Human Rights Watch Report on Domestic Worker Abuse." Gulf Business [Abu Dhabi] 26 Oct. 2014, Industry sec.: n. pag 74 D‟Cunha 2005: 51
  • 19. 19 recruitment system has resulted in systematic human rights abuses for these workers, most of whom, women are placed in the most precarious of positions. These human rights abuses and unfair labour practices has resulted in health disparities to which international organizations and NGOs have lambasted the government for doing too little to address these growing concerns. This paper has also made the connection that unfair labour practices; human rights and health access are interlinked. The struggles of the migrant labourer in the 21st century, given the economic context of neoliberal globalization, coupled with the weakening of state as an enforcement module has made them of subjects of human rights abuse not properly examined by the world community. The development of the UAE has come at great expense – the revocation or lack thereof, their rights and liberties, whose lived experiences are often omitted by the successes of their labour. In conclusion, in order to avert these growing crises in human rights and health, the archetypal international institution and state must recognize health for all and not focus on a citizen-centric analysis of health access, but access for inhabitants.
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