Sahbhagi Shiksha Kendra (SSK)’s report on occupational health issues faced by migrant workers in Ghaziabad systematically catalogues the daily health risks faced by five major occupational groups of migrants in the informal sector. Reviewing the awareness of migrant workers about their rights and entitlements, and highlighting key health concerns, the report presents policy recommendations and stresses the pressing need for affordable and accessible healthcare.
Ghaziabad is a major industrial hub in North India. SSK has extensive experience with migrant workers in Ghaziabad, and their previous study on expenditure patterns in Ghaziabad, explored the major labour chowks of Ghaziabad where migrant workers congregate to seek employment and analysed the constructive usage of remittances and wages earned by these workers.
This study focuses on similar occupation groups (pillow-makers, domestic workers, rickshaw pullers, ragpickers and construction workers), but looks more closely at the less visible implications of their work on their physical well-being. The survey is extensive; and encompasses 250 migrant workers belonging to five occupational groups.
Studies on labour migration often bifurcate the social and the economic, and see the work process as linked to the economic and financial, and the social as linked to family life, households, and social relations. However migrant work in the informal sector is often highly strenuous physical labour; and the work process itself takes a severe toll on workers’ well-being. It is thus important to examine the work processes not simply as ones that result in financial gains, but also as having long-term implications for the health and well-being of those involved in them.
Key health risks
Pankaj is a 23 year old young construction worker, who has been in the construction sector for the past eight years. During construction work, he often worked in close contact with cement, which over a period of time has caused a skin condition known as ‘cement burns’.
Health implications range from the occupation-specific (such as concrete burns), to those common across the occupation groups caused by severe physical exertion (fevers, weakness, back and joint pain), and range from chronic illnesses (such as the prevalence of breathing problems and TB) to minor recurrent ones. As with most kinds of repetitive strenuous manual labour, health implications build up over the years, and are worsened by repeated and continued work in the same postures and affecting the same parts of the body.
Pillow-makers often inhale the synthetic adhesive used in pillow-making which is of poor quality, and this coupled with the cotton dust from the raw materials used to stuff pillows, causes severe breathing problems. Construction work too involves a dusty environment, and continuous work with certain building materials such as cement, lime and paint may result in skin
Pankaj’s hands carry blisters skin discoloration and dead skin, from working in close contact with cement. He is left with no other alternative, as he has developed skills only in the constructions sector, and can be found searching for work daily at the labour chowks in Ghaziabad.
conditions such as roughness, itching, eczema etc. Prolonged contact with wet Portland cement results in a skin condition known as ‘cement burns. Domestic workers too work long hours, and are prone to joint pain and back pain, along with lowered immunity and higher susceptibility to multiple illnesses.
Ragpickers are especially susceptible to diseases, due to their exposure to toxins and waste matter. They are prone to skin diseases and infections, breathing problems, and injuries such as cuts and bruises from sharp objects encountered while working.
These workers often do not have a balanced diet or a calorie intake adequate for their level of physical work, and are thus even more vulnerable to health problems.
A vicious cycle
Kalpana works as domestic worker in Ghaziabad. Originally hailing from Damoh (M.P.), she migrated with her husband who works as a construction worker. At present she works in two households in a well-to-do locality which takes nearly one hour on foot to reach. A while ago, she fell from the stairs while sweeping the floor and injured her ribs. However she must continue with her work in order to support her family. She also has to do her own household chores and is the mother of two small children.
Migrants workers in the informal sector are usually daily wage labourers, whose day-to-day survival depends on their ability to work on that day. Because they are exposed to potentially hazardous working conditions, and their health suffers due to overwork and exhaustion; they are often forced to take leave; and on days that they take leave, they earn nothing. These workers are thus trapped in a vicious cycle; and are faced with the dilemma of working and risking worsening their health, and not working and losing out on money they need for food and shelter on a daily basis. Over 60% of workers in most groups said that they take more than 5 days of leave in a month. Added to this is the issue of non-payment of overtime wages in sectors like construction work. Nearly 50% of construction workers surveyed, who worked overtime, were not paid overtime wages.
A majority of migrant workers worked eight hours and above daily, and for many professions such as pillow-making and ragpicking, the amount of time invested is directly proportionate to earnings. Thus these workers, whose income is often barely enough for their daily survival, feel pressured to work for prolonged periods of time, thus negatively impacting their health.
The need for affordable and accessible healthcare
A strong majority of the sample interviewed (231 of 250) claimed that they did not visit government hospitals, but unauthorised medical practitioners. A major reason cited was the fact that doctors at government hospitals prescribe medicines to be bought externally, in the market, and the price of these is beyond the means of these migrant workers. This reason seemed to be the most significant for most occupational groups. These workers also complained that doctors and staff at government hospitals do not treat them well. Staff behavior and perceived negligence of doctors was cited as a reason by 36% of pillow makers, 44% of rickshaw pullers, 27% of domestic workers and 21% of ragpickers. The distance of the hospital from their homes was also another major factor.
The reasons for avoiding government hospitals mentioned above reflect serious flaws in the public healthcare system. Government hospitals are responsible for providing accessible quality healthcare, yet the hostility experienced by these migrants in these spaces, reflects a failure on the part of the state and public healthcare system in their responsibility towards marginalised groups.
“Out of 250 respondents from all five occupations, 205 said that they visit unlicensed medical practitioners because it is affordable, for the rest of the respondents, even these unlicensed medical practitioners were too costly. In such a scenario where quality medical treatment is getting more costly day by day, it is incumbent upon the government to provide affordable medical facilities to these marginalised populations.” (SSK 2015)
Schemes and entitlements: Lack of awareness
The Rashtriya Swasthya Bima Yojana is a scheme that can be especially beneficial for migrant workers, as it has a split-card facility and can thus be used at both the source and destination end. However, there was a near-complete lack of awareness about this scheme evident from the survey undertaken by SSK. 86% of pillow makers, 74% of ragpickers, 78% of construction workers 74% of rickshaw pullers and 86% of domestic workers said they have not heard of any such scheme. Only one pillow-maker out of all of the 250 migrants surveyed, possessed an RSBY card.
The RSBY card is only available to those categorised as Below the Poverty Line (BPL). However, many migrant workers who fall just above the poverty line, or are not registered under the BPL scheme, cannot avail of the scheme, and are greatly in need of state support in terms of healthcare. Healthcare expenses and expenditure on major illnesses, take a large chunk out of household incomes. It has been hypothesised that in many countries, there are vast numbers of people only ‘one illness away’ from poverty—implying that affordable and accessible healthcare must be a crucial factor in poverty prevention policy.
“Ideally speaking, migration as a strategy is an important route out of poverty. But the condition of the unskilled/semi-skilled migrant labourer belies this hypothesis at the ground level…. there are several welfare schemes aimed at labourers which could actually benefit the migrant population as well, but in the absence of special provisions for the migrant population many such schemes are not availed of by migrant labourers. ” (SSK 2015)
SSK’s Recommendations: connecting workers to entitlements
SSK identifies a primary and pressing need for better awareness amongst migrant workers about government schemes, and their entitlements under these. They also highlight the need for sensitisation amongst migrant worker about health issues. Awareness drives about common health concerns and engaging with them to help develop safer working practices that would benefit their health in the long run, could go a long way.
Sanitation was also a concern noted by the surveyors while interviewing respondents at their homes. Apart from the unsanitary working conditions for groups like ragpickers, and the unsafe environments of construction work and pillow-making, surveyors found that a lack of access to proper housing and extremely poor living conditions, also affected migrants’ health. The slums that migrants live in have poor infrastructural facilities, and lack of potable water and overcrowded living conditions makes contracting diseases more likely.
SSK emphasises that even though the issue of urban development is gaining traction in policy discourse, health issues must be highlighted in policy conversations about urbanisation. Added to this is the need for policy and planning to provide support not only for migrants registered under the BPL scheme. Policy-makers must also account for migration and occupations –specific concerns, and take cognizance of the nuances of how policies can be made accessible for mobile labour populations.
Read the full report: ‘Suffering Continues: A study on occupational health issues faced by migrant labourers in Ghaziabad’
SSK is a support organisation and centre for participatory learning, which works for the empowerment of socially and economically backward communities by promoting their participation for good governance through capacity building of CSOs, CBOs and institutions of self-governance.
Radhika M. Chakraborty
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