End GAMCA Discrimination

Migrant-Rights.org receives the highest proportion of policy complaints on issues related to GCC Approved Medical Centers Association (GAMCA) practices. In particular, the discriminatory ban and deportation of individuals with TB severely distress current and prospective migrant workers. Xenophobic GAMCA policies are more than a medical issue – they are a human rights issue.

End GAMCA Discrimination

Migrant-Rights.org receives the highest proportion of policy complaints on issues related to GCC Approved Medical Centers Association (GAMCA) practices. In particular, the discriminatory ban and deportation of individuals with TB severely distress current and prospective migrant workers. Xenophobic GAMCA policies are more than a medical issue – they are a human rights issue.

  • Rs 450 Million in fines were levied against Pakistan's GAMC facilities for exploitative behavior
  • 142+ Filipinos with infectious diseases were deported from GCC countries within the last year
  • x 2 Cases of TB in Dubai & Abu Dhabi more than doubled in one year after introducing zero-tolerance deportation policies
  • 341+ Migrants with TB were deported from Dubai in 2009

Next: Background

A Migrant Rights Campaign

Background

GAMCA clinics operate by standardized guidelines set by the Gulf countries, and are the only medical facilities authorized to test and clear migrants for employment in the Gulf. Though sponsors and employers are  required to pay for virtually costs relating to recruitment, migrants are often burdened with these pricey pre-departure tests themselves.

Many migrants report they receive no explanation of the tests performed on them, or even of their results. Migrants struggle to discover the veritable medical reason behind their denied entry. Extraneous screening disqualifications include non-infectious and non-medical issues; physical disabilities that pose zero threat to Gulf societies, including, diabetes, color-blindness, and deafness, render migrants ‘unfit’ by GAMCA standards. Pregnancy, HIV/AIDS, as well as active and inactive TB also disqualify migrants from medical clearance.

 In particular, the GCC’s discriminatory TB policies are deficient from both a public healthy policy and rights perspective.  Migrants with healed TB scars pose virtually no medical threat to public health yet  are deported and prospective migrants are banned from entering Gulf states.  Medical professionals and migration experts certify that GAMCA policies contradict GCC government concerns for public health. Under the repatriation policy, migrant workers are disincentivized from reporting and receiving treatment for TB.  Read more about the medical inexpediency of GAMCA’s TB policies here.

According to the UN,  disease-related restrictions on travel are discriminatory unless the disease in question is yellow fever (requiring a travel certificate), or in the case of an outbreak of a contagious disease such as cholera. Restrictions on travel and the liberty of movement due to healed TB cannot be justified by ambiguous “public health” concerns.

GCC medical practices also legitimize discrimination and stigma within origin-country communities. The GCC could contribute to global efforts to combat TB discrimination  – which studies have proven inhibit effective treatment- rather than to perpetuate it.

Migrants with healed TB scars pose virtually no medical threat to public health yet are deported and prospective migrants are banned from entering Gulf states.

Next: Case studies

And in-depth policy analysis

Case studies

1.Discriminatory TB polices are medically unsound and constitute human rights violation

Large-scale international efforts to combat AIDS discrimination with regards to work and travel should be extended to counteract TB discrimination as well. No public health rationale exists for restricting the liberty of movement in the case of either TB scars or HIV; according to the UN,  disease-related restrictions on travel are discriminatory unless the disease in question is yellow fever. Consequently, restrictions on work/travel due to the presence of TB scars violate the principle of non-discrimination and contravene international norms.

UN efforts to differentiate between HIV transmittance and airborne diseases are relevant to combating misconceptions of TB; Individuals who have successfully completed TB treatment are extremely unlikely to pose any threat to public health. TB stops being infectious, at most, two weeks after commencement of treatment. Even in the case of infectious TB , close contact with someone with infectious TB in the lungs or throat is required.

In one case highlighted on Migrant-Rights.org last year, UAE officials justified the deportation of a migrant by claiming that old scars can be easily reactivated. However, relapse occurs in only 5 percent of cases – not nearly significant enough to invite severe restrictions on the movements of migrants with healed TB. GAMCA’s overly restrictive TB policies are consequently incommensurate with the minimal risk factor, rendering them inefficient/overreaching  as ‘preventative measures.’

Even in the case of active TB, close contact with someone suffering from infectious TB in the lungs or throat is required.

TheTruthAboutTB.org counteracts distortions about infectious TB:

“60% of healthy adults have an effective enough immune system to completely kill off the bacteria, if they breathe it in, presenting no further harm. About 30% of people’s immune systems do not kill off the bacteria completely but control the infection enough for it to remain dormant or latent. Only 10% of these latent cases later develop into active illness, meaning 90% do not.”

TB stops being infectious at most two weeks after commencement of treatment.

The detrimental public health ramifications of restrictive AIDs policies are comparable to those  encountered by TB policies. Counterpoints to the “public health” rationale of discriminatory travel restrictions include:

  • A false sense of security is created within the population, which comes to think that AIDS is a “foreign” problem that can be solved by border controls.

  • It is impossible to close frontiers effectively and permanently.

  • Restrictions may lead people to enter a country clandestinely and, because of their clandestine status, not use preventative measures.

  • According to a study performed in the US, the practice of deportation may actually increase the spread of TB; the legal stigmatism discourages residents and illegals from reporting symptoms immediately, many citing fear of deportation as their rationale. This delay in treatment increase the opportunity for infection to spread. Since the Gulf bans individuals with TB for life, the fear of deportation is even more potent.

  • A study specific to Oman also found the “treat and deport” policies counteractive to combating TB

2.Good Practices

The United States provides an example of a more rights-conscious and medically effective approach to migrants with healed or active TB; the government provides population with more reliable health protections without imposing unnecessary stress on migrants. For example, foreigners with TB may apply for a waiver to enter the country legally, and can also re-apply for a visa once cured. TB control programs specifically list  

“…safeguard[ing] the confidentiality and civil liberties of persons who have TB, and…protect[ing] them from unlawful discrimination because of their disease,” among their primary objectives. The UK’s TB policy is similarly tolerant, and neither countries have faced TB outbreaks or other significant public health consequences.”

In a policy proposal, the World Economic Forum recommended that medical providers and employers link HIV/AIDS anti-discrimination efforts with TB initiatives. In particular, the WEC emphasizes the necessity in providing TB services without risk of employment so that individuals are not deterred from receiving proper care.

Another policy study funded by the Canadian government proposed a set of procedures to assess the human rights impact of public health policies with a specific reference to TB and HIV. The study concluded that “because exclusion of those who test positive would be mandatory, decisions would not be made on an individualized, case-by-case basis,” as is conducted under GAMCA practices.

Medical and ethnographic researchers investigating have also documented the similarities between HIV/AIDS and TB with regards to stigma and discrimination.  GAMCA medical practices legitimize this discrimination. Rather than perpetuating TB discrimination, the GCC should contribute to global efforts to combat TB discrimination and as a consequence, to combat the disease itself.

 Unfortunately, origin governments express little concern for any of GAMCA’s policies. Guidelines and good practices should be developed by health authorities and advocates in order to encourage both sending and receiving states to reform discriminatory TB practices.

Next: Suggested Action

Suggested Action

    GCC states can soundly protect public health without transgressing on basic rights of mobility and employment. States should take immediate steps to:

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    • Ensure GAMCA policies do not contravene the principal of non-discrimination, including the disqualification of individuals with treatable diseases or non-medical issues
    • Educate GAMCA employees regarding patient care and require facilities to provide support services to migrant workers
    • Regulate and standardize GAMCA costs
    • End deportations of migrant workers with active or healed TB. Instead, adopt “short-term interventions” to facilitate early detection and permit affected individuals to continue working after treatment.
    • Increase efforts towards global control of TB through technical and financial support for TB control programs, as well as funding for further research, which could result in more cost-effective and sustainable outcomes
    • Improve low-income migrant workers’ access to affordable and appropriate health care services, rather than one-time disease-control services. This includes improving housing plus overall living circumstances, and to institute a health insurance system for expatriate

    Origin countries should engage in multilateral negotiations with GCC states to reform GAMCA practices, and should also implement internal mechanisms to support prospective and deported migrant workers.

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    • Monitor GAMCA facilities to ensure migrants are not financially exploited
    • Provide additional support mechanisms for GAMCA patients, including community-educational initiatives to combat discrimination against TB

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