On the need for political interventions
AJOY MEHTA: What kinds of policy interventions do we envision when we look at the health of migrants? First and foremost, let’s not see it as an enforcement measure
demographic problem or danger. It is a human problem that must be treated with compassion. Mumbai provides free health care at its corporate hospitals, which are well supplied in terms of human resources and equipment, but how many migrants know that medical care here is free? Even if they knew, how many migrants would walk into a municipal hospital and demand the service?
On gender specific issues
DR VANDANA PRASAD: Migration of single people is predominantly male, but we have women who come as construction workers, teachers and nurses for the rest of their families. Economic distress therefore has a strong feminization. It has also resulted in health problems as we know that malnutrition and anemia among women is very high in India. So when the migrants returned home, in many places they were welcomed and the panchayats made efforts to take them back. In many places it was the opposite. It is therefore important to provide community facilities for quarantine, isolation, especially with regard to returning migrants.
On the alienation of migrants
DR PAVITRA MOHAN: What we were seeing (last March) was not affected that much by the Covid, but was linked to the shutdown of all health services, the lack of transport, an acute food shortage, which resulted in a increase in diseases such as tuberculosis. Government departments have either focused on Covid or nothing, and because of this, deliveries have dramatically increased at home, leading to an increased risk of maternal deaths, etc.
In some regions, we have seen what is called a syndemic, where the Covid was there, but it was also associated with a sharp increase in tuberculosis. In areas of high migration, the malaria epidemic has also started to increase with very limited access
take care of.
In the villages, we have seen a 1.5 times increase in the levels of malnutrition among children.
In the following months, when Covid, even in cities, declined before wave two, one of the vestiges of wave one was how migrants were treated upon their return. In general, they do not feel assimilated in the cities. But during this time, they felt even more alienated. It had a huge impact before the second wave, when vaccination was promoted. This alienation from the system has led to a lot of mistrust and a refusal to accept vaccines. Restoring confidence among the migrant population is extremely important.
On community participation
Uma Mahadevan: We talked about community health services. My team created a platform for a pandemic response, linking requests for assistance to support offices, mapping all government facilities, service delivery units, nearest anganwadi, closest primary health center nearby, post office, bank branch, police station, Indra canteens. It is possible to connect with nearby civil society groups who may be able to help. It should be doable and in (different) languages. We can have call centers and resource centers for migrants and can give welcome kits to all migrants with details of the nearest services.
On universal health coverage
K Srinath Reddy: It doesn’t really help us to say that we should only look at what happened to them (the migrants) during the Covid period. It was an acute exacerbation of long-standing neglect. There are a number of sections of our population that are in fact deprived of essential health services, in terms of accessibility, appropriate care and affordability. This is why we call for universal health coverage, not only to protect human productivity, which seems to be the concern of those who view migrants as a human resource, but also as an essential human right.
On the need for better living conditions
Dr Pavitra Mohan: Living conditions are one of the central determinants of the health of migrants. We cannot talk about health if 50 people live in a room without water, without toilets, without ventilation. In times of Covid, we understood the interest of ventilation. But before that, many of them suffered from tuberculosis.
Perhaps, next, we can think of political means to promote safe, secure and healthy housing. Most developed countries have invested in safe housing for migrants and for the urban population and this has been central to the development of public health. The second concerns working conditions. We see so many cases of silicosis in southern Rajasthan where people are dying in their 30s and 40s because they have been involved in stone cutting or mining.
The third is access to healthcare. It is not just portability because, as a citizen of the country, health is a fundamental right. Ideally, you shouldn’t need to carry anything. The policy should aim to universalize access to health care for migrants, whether the documents are there or not.