‘Behind Closed Doors’ Global Seminar on the Human Rights of Migrant Domestic Workers in an Irregular Situation A call to action: ensuring equitable access to a continuum of health care and services for migrant domestic workers Dr. Maria Nenette Motus International Organization for Migration (IOM) Regional Office for Asia and Pacific, Bangkok 1

Migration Mega-trend: 1 in 7 on the move 7 billion Population 1 billion Migrants 247 million International >740 million Internal Urbanization: 50% + Feminization: ca. 50% Irregular : 15-20% 17 – 25 million women in domestic services (83%) Six Drivers of Migration 1. DEMOGRAPHY 2. DEMAND 3. DISTANCE 4. DIGITAL REVOLUTION 5. DISPARITY 6. DISASTERS 2

Why focus on health of migrant domestic workers? They are human beings, and have a right to health Migrant-inclusive health systems improves global health outcomes and health security (origin/transit/ destination) Healthy migrants contribute to positive sustainable development outcomes. The right to health is a human right, i.e. a birthright of every human being. Especially groups of vulnerable migrants (women, children, undocumented and low skilled migrant workers, etc.) are at higher risk of not having those rights realized. From a public health perspective, realizing migrants’ right to health makes practical sense – it is cost-effective and improves public health outcomes. Promoting the usage of primary health care and early treatment, as opposed to leaving migrants’ health to be managed by costly emergency care, avoids high costs for the health system and reduces the risk of transmission of communicable diseases. From a global economic, social and human development perspective, migrants’ health is a prerequisite for migrants to be able to contribute to development and enhance their personal well-being, as well as that of their families, and countries of origin and destination. Indicators that monitor the equitable access of migrants to healthcare, and that inform evidence-based, relevant policy coherence across sectors, should be included within the post-2015 development framework. A shared responsibility!

‘Healthy Migrant Effect’ & Spaces of Vulnerability Destination Pre-departure Return Travel Cross-cutting factors When migrating , people bridge disparate health environments. people bring their epidemiological profiles ,culture, values, health beliefs and vulnerabilities. Health of migrants can be better as compared to the host community for some conditions, or worse. Migrants may introduce conditions and acquire conditions while migrating or residing in host communities and introduce acquired conditions when returning home. This is not only of relevance in the context of infectious problems , but as evidence proves, also NC conditions. A WHO 2008 WHO Secretariat report on the health of migrants clarified that most migrants are healthy , young people - the ‘Healthy Migrant Effect’ - but conditions surrounding the migration process can increase vulnerability to ill health. This is most obvious for those who migrate involuntarily, fleeing natural or man-made disasters and human rights violations, or those who migrate clandestinely or fall in the hands of traffickers

Domestic Service - a space of vulnerability

Trafficked Migrant Domestic Workers (IOM Indonesia Recovery Center 2005-2006) Number of positive Chlamydia test results based on type of exploitation. Percentage of positive STI results among VOTs assisted in year 2006

Trafficked Migrant Domestic Workers (IOM Indonesia Recovery Center 2005-2006)

Stranded Domestic Workers in Conflict Situations Libya Crisis

Stranded Domestic Workers in Irregular Situation in Conflict Situations Syria Crisis Yemen Crisis

IOM Migration Crisis Operational Framework 15 Sectors of Assistance Emergency Evacuations Health Care Assistance Travel Health Assistance Psychosocial Support Return and Reintegration

Challenges in promoting health & well being of migrant domestic workers National level: health of migrants not often safeguarded: Migrants still seen as burden on health system and carriers of disease ‘Generous’ social rights seen as a potential pull factor Migrants too often remain invisible, marginalized and excluded (empowerment?) Lack of policy coherence, and multi-sectoral collaboration International level: health of migrants absent in global debates: Often absent in global health debates (SDH, NCD, Disease Control programmes, etc.) Often absent in debates on migration & development (HLD M&D, GFMD, GMG, Post-2015, etc.)

Operational Framework on Migrants’ Health: WHO & IOM Global Consultation on WHA 61.17 Resolution on Health of Migrants (2010) Operational Framework on Migrants’ Health: Monitoring Migrant Health Partnerships, Networks and Multi country Frameworks Policy and Legal Frameworks Migrant-Sensitive Health Systems

Opportunities for Advocacy Efforts Global Forum on Migration and Development (GFMD) Colombo Process

A shared responsibility : to promote equitable access to continuity of health care services Conceptual framework STAKEHOLDERS Action Pillars Critical Domains Gov’ts (origin/transit & destination) _____ Regional Government Structures Migrant Workers & Families Labor Migration & Development Health Services Capacity Buiding Migration Health Research & Data Sharing Social Welfare Advocacy for Policy Changes Research Donor Community Multi-Sector Partnerships Civil Society Primary Heath Care & Referral Sustainable Development Goals Rights & Protection Social Determinants of Health Media & Public Info 14