Health status and health risks of male Nepalese migrants in the Middle East and Malaysia

This thesis investigates the health status of and health risks to male Nepalese migrant construction and factory workers in the Middle East (West Asia) and Malaysia. After the more seasonal migration to India, the Middle East and Malaysia are the second most popular destinations for Nepalese workers. Differences in the health status and health risks for Nepalese workers associated with the type of work-place, demographic, socio-economic and health characteristics have been investigated in this Ph.D. This study adopted self-reported tools to measure general physical and mental health. These health risks have been measured in terms of perceived health risks and experience of work-related accidents at work. This study uses a mixed-methods approach including questionnaires and in-depth interviews with male Nepalese migrant workers, upon their return to, or prior to their departure from Nepal. Questionnaire data (n=403) estimated the health status of migrant workers and the level of risk to which they are exposed. The interviews (n=20) with a sub-sample of the survey population has offered detailed. Ethical approval granted by the Nepal Health Research Council. Nearly half of the respondents (46%) were aged 20 to 29, most were married (91%), without formal education or only had completed primary education (71%). Most (87%) rated their health as “very good/good or fair”. More than three quarters (79%) perceived their work environment as “very good/good or fair”. Two-thirds (65%) were satisfied with their accommodation abroad. The majority had semi-skilled jobs (69%) and 71% had registered with a doctor; 62% had national insurance; 17% had experienced a work accident. Overall, age was associated with self-reported poor health status as health appeared to worsen with increasing age. Perceived diet, health risks and the work environment were strongly associated with self-reported poor health status. Age, satisfaction with accommodation, work environment and country of work were strongly associated with accidents at work. Country of work and health insurance were significantly associated with not visiting a doctor abroad. The qualitative findings focus on six main themes: (a) push factors of migration; (b) pull factors; (c) living abroad; (d) working abroad; (e) health and health services; and (f) suggestions to improve health and well-being. The in-depth interviews confirmed that Nepalese migrant workers experienced accidents at work, skin problems, heart attacks, mental health issues and even death. In general, employers were perceived not to value the health of migrant workers enough and due to the pressures of work many workers took risks. A significant minority of Nepalese migrant workers working in the Middle East and Malaysia have experienced work-related risks, unsafe and stressful working and living environments and delayed medical treatment. Health and safety at work should focus on encouraging employers to provide safe work environments by giving health and safety training to ensure potential harm reduction. However, the main evidence from this study is that the majority of Nepalese male migrant workers do report a fairly positive experience e.g. with their health, health insurance and access to health services, of living and working abroad. This phenomenon coupled with the poor living and working conditions in Nepal helps explain why workers are willing to work in high risk jobs and in relatively poor working conditions abroad.