In December 2022, Kuwait’s Ministry of Health began charging non-citizen residents a medication dispensation fee at public hospitals and clinics. Non-citizens are now required to pay a flat fee of KD 5 (US$16) when collecting prescribed medication from primary health clinics and hospital emergency rooms and KD 10 (US$32) at outpatient clinics. The new charges have been imposed in addition to existing consultation fees (KD 2 at polyclinics and KD 10 at outpatient clinics) as well as laboratory, in-patient care, and radiology fees that migrant patients must pay when availing public health services. To renew their public health insurance, workers in the private sector also pay an annual KD 50 (US$ 163), a sum which, on paper, is meant to be covered by the employer though this is not always the case in practice. Ostensibly aimed at “stopping the squandering of medical supplies, and elevating healthcare services,” the new measure represents yet another discriminatory obstacle to accessing healthcare for the vast majority of Kuwait’s population, specifically low-wage earning migrant and domestic workers.

Local news outlets have already reported a sharp decline in the number of daily visits to public clinics in neighbourhoods where a majority of residents are non-citizens. While the fees may seem modest, they are anything but trivial in a country where the official minimum wage is KD 75 (US$248), for both migrant domestic workers and workers in the private and oil sectors. Countries of origin can and do set their own minimum wage thresholds for their citizens in Kuwait. While these are higher than those set by Kuwaiti authorities, they are also generally quite low. For Indian nationals, for example, the minimum monthly wage stipulated by the Indian Embassy in August 2022 for various categories of labourers is a mere KD 100 (US$320).

Reflecting on this reality, a migrant community organizer wondered how workers can be expected to afford the new fees. “Imagine you’re earning KD150 a month and you fall sick. And what if it's the middle of the month, and you haven't been paid yet? And you have rent and other expenses? How do you pay? How?” The situation is even worse for those with chronic conditions who require daily medication. Forced to choose between sending money to their families back home and paying for their own food and shelter, many de-prioritise their health.

Speaking to Migrant-Rights.org on condition of anonymity, a doctor at the public hospital in Jahra expressed concern that the new fees would discourage low-wage earning workers from accessing basic health services. “Many of these workers, especially those from South Asia suffer from hypertension and diabetes,” the doctor said. “What they do is when they visit their homes every three years they will go to a doctor there and buy medication in bulk because it is cheaper. Once they are back here, they will try to stretch whatever they have rather than going to the hospital here.” Visits to the hospital are reserved for when pain becomes truly debilitating or even when one is at death’s door. Telling, perhaps, of the extent of official awareness about migrant workers’ access to its services, the MOH issued a rare English language press statement in January 2023. It clarifies that non-citizens with certain acute emergency cases would be exempt from hospital fees at the ER.

Numerous charities and hospital-run patient funds offer to cover the cost of treatment for those with no or limited ability to pay. Yet, these resources can be hard to access unless one speaks Arabic and has the time to complete lengthy and bureaucratic application processes, a luxury for workers who can barely afford to take a sick day. Some civil society groups have also raised concerns about the new fees’ negative impact on workers’ health. Yet, on the other hand, recent news reports indicate that the MOH is also clamping down on individual healthcare professionals who try to support financially insecure patients through not-by-the-books circumvention of laboratory and X-ray fees.

For domestic workers, Kuwaiti law requires employers to directly cover any medical care they need in the country. However, another community organizer who works closely with Ethiopian domestic workers says that, in practice, many employers often refuse to take their staff to the hospital in the first place. And when they do, a worker’s lack of awareness of her rights means that she ends up paying out of her own meagre wages. If her employer isn't with her, and she doesn't have a bank card, she may not even be able to pay the fees without asking a stranger for help. Public clinics and hospitals in the country no longer accept cash payments. “Many of them [employers] will not pay unless we [community organizers] go to the police or open a file at the Domestic Workers Department,” the organizer said. So while on paper the new fees at public pharmacies come out of employers’ pockets, the unequal power dynamics between domestic staff and their employers means that the most vulnerable are at risk of bearing the brunt of these costs themselves.

Moreover, domestic workers are often told to “just take Panadol” and keep working. Panadol has long become the go-to medication of choice for most migrant workers, regardless of symptoms or diagnosis. Medical research over the last few years has shown that long-term use of paracetamol may pose increased cardiovascular and renal health risks. But rather than incur a chain of fees for every consultation, referral, test — and now, medication —  at hospitals, many workers prefer to self-medicate or simply walk down to their local pharmacist and purchase whatever the store chemist recommends. Some workers are also sceptical of the quality of care they should expect at public facilities, “Why pay KD 10 when they prescribe only Panadol?” one said.

The Kuwait MOH is expected to raise KD 29 million yearly from the fees now collected at its pharmacies, in addition to the approximately KD 100 million it already earns on average annually in health insurance fees from non-citizens. Yet, this additional revenue is a drop in the bucket compared to the ministry’s overall budget— just about one percent of its KD 2.69 billion budgeted expenditure for the 2022-23 fiscal year.

In all, the new fees are one more item in the long list of discriminatory and extractive healthcare policies emerging in Kuwait. From the prioritisation of citizens for Covid vaccines, to the restriction of certain medications to nationals only, the cost of good health for Kuwait's migrant workers is only increasing.