Post-War reconstruction and redevelopment :

Immigrant workers and spectrum of diseases

Dr. Chinthaka BATAWALA

Disease surveillance is the corner stone of response to emerging disease threats.

Population movements that either place people at risk for diseases or cause them to pose a risk to others cannot be stopped. However, prevention measures can address the causes of these movements which, in developing countries, are often prompted by need rather than choice; if living conditions and opportunities improved in their place of residence, people would not be forced to move. In cases where movements are unavoidable, people should be made aware of the risks and have adequate access to treatment. Epidemics are more likely to take place in areas where healthcare, education and knowledge may be poor or lacking.

Influx of infected

Areas at risk for epidemics through the influx of infected people should be identified to avoid or control epidemics. Particular attention should be paid to areas where post-war reconstruction and redevelopment of Sri Lanka takes place, given the increasing number of cases of transmittable diseases like HIV and Tuberculosis can occur.

Some experts say globalization brings the suffering of the world’s poor directly to the attention of those fortunate to have been born non-poor in high-income countries. And still there is plenty of suffering. An estimated 969 million people - more than 18 per cent of the world’s population - lived on less than roughly one dollar a day per person and were thus classified as “extremely poor” by global standards.

Foreign aid - the transfer of government resources to poorer or developing countries - has long been deemed an essential part of any strategy to reduce poverty and hunger. It encompasses both short-term relief of suffering resulting from natural disasters and war, as well as longer-term development to end chronic deprivation.

According to a press release, it was noted that India has made an initial allocation of a credit line of US$ 100 million for the integrated development of the Colombo - Matara rail network. It was agreed at the request of the Sri Lanka side, that India would take this process forward by the extension of concessionary terms to be mutually agreed upon, for the allocated credit of US$ 100 million, and for any additional credit to be made available for the said project. A multi-disciplinary delegation from India has already visited Sri Lanka.

Also the Indian side in recognition of the high priority to reconstruction and development in the North and East, offered to support these efforts through technical and financial assistance.

Arrival of foreign workers

In addition bilateral understandings being reached on identifying joint ventures for the development of the port city of Trincomalee, and its surrounding regions. It was noted the need to prepare a master plan for realizing, including through the building up of the necessary infrastructural support, the full economic potential held out by Trincomalee and its environs. It was agreed in this context that a coal based power project of capacity 2x250 MW will be set up in the Trincomalee region of Sri Lanka, as a joint venture between the National Thermal Power Company Ltd, a Government of India enterprise and the Ceylon Electricity Board, a Government of Sri Lanka entity.

In coming years, the imminent arrival of thousands of foreign construction workers (from India) for post-war reconstruction and redevelopment in various parts in Sri Lanka could cause a surge in spread of diseases.

Once considered almost exclusively a source of immigrants to more prosperous regions outside Asia, many Asian countries have become net recipients of people seeking improved job prospects or a better place to make a life.

The international dimensions of emerging infectious diseases are readily understood. Diseases do not respect political borders, and geographical boundaries. Oceans and mountains can be easily crossed in times of high-speed aircraft travel. The threat of emerging infections can no longer be seen as of one country or a region.

Disease surveillance is the corner stone of response to emerging disease threats. Surveillance indicates where a disease has appeared and gives vital clues about how the emergent infectious agent may spread in nature. After surveillance has brought attention to the problem, however, actual prevention and control measures ultimately require additional information.

Regional cooperation

There are greater benefits to be obtained through regional cooperation than would be possible through the independent actions of each country. Communicable diseases are transmitted by people, pests, parasites, livestock, food, and other common vectors and environments throughout a particular geographic region, regardless of national borders.

Regional cooperation will enable participating countries to exchange best practices on health policies, system design, specific disease interventions, and other key lessons. This will facilitate greater frequency, consistency, and clarity in information exchange. It will also engender trust and transparency in surveillance, response, and reporting, an essential component of communicable disease control among countries.

Spread of epidemics

Migration for better opportunities is an important process of change for populations in developing countries. Migration is a primary cause of behaviour change - by their very act of migrating, migrants are different from those who do not migrate.

Migration is one of key social factors that have contributed to the HIV epidemic. However, many countries do not have a surveillance system that captures the extent to which migration contributes to the HIV transmission, and monitors the effectiveness of HIV prevention programs among migrants.

With an estimated 2.5 million people living with HIV, India accounts for around 13 per cent of global HIV infections. Six of the India’s States and Union territories contain two-thirds of reported infections (Andhra Pradesh, Tamil Nadu, Maharashtra, Manipur, Nagaland and Karnataka). In these six, prevalence is four to five times higher than in other States.

Lack of knowledge and education is impeding prevention and treatment efforts and perpetuating risky sexual behaviour. According to experts only an estimated 10 per cent to 20 per cent of people living with HIV in India know that they have the virus. Many do not know where to get an HIV test. Despite rising infection rates in the general population, the perception remains that HIV is largely restricted to sex workers, truck drivers and injecting drug users. Also India accounts for one-fifth of the global tuberculosis incident cases. Each year over 1.9 million people in India develop tuberculosis, of which around 0.87 million are infectious cases. It is estimated that annually around 325,000 Indians die due to tuberculosis.

Once called “consumption” or the “white plague,” tuberculosis killed hundreds of thousands of people earlier in this century. By the mid-20th Century, powerful drugs were developed to treat it, and the incidence of tuberculosis declined. In recent years, however, tuberculosis has made an unwelcome comeback. Not only is the disease making a comeback among certain high-risk populations, it is also developing multidrug-resistant strains that are extremely difficult to cure.

Awareness

Previous studies with migrant workers, their families and communities have shown that it is not sufficient to stay active merely on the migrant community level - there is a need to bring the information gathered in a very organized way and cohesive way to the attention of governments.

It is well-known that in many instances the national instruments designed to provide protection from foreign migrant workers to the receiving community, are not sufficient as they are easily amended without the knowledge of such a community to get protection from diseases carried by the foreign migrant workers. At another level agreements made between sending and receiving countries are kept away from the receiving community and those advocating on their behalf for the protection and promotion of their rights.

Blind eye

Sending countries within the region have not merely become dependent on the remittances but also political, economic and social agendas and in the process policy makers have turned a blind eye to the issue of protection of rights of receiving community. The laws are written in such a way that do not provide a strong legal framework to punish those who abuse the system. Bilateral agreements that effectively protect the rights of receiving community are difficult to obtain because of the unequal power relation between the sending and receiving countries.

Facilitation of collective bargaining processes between sending and receiving countries could contribute to the development of a model bilateral agreement that would be readily adopted by responsible sending and receiving countries. It is a well-known fact that receiving communities are struggling to adapt to ‘unprecedented’ levels of migration.

Collective capacities

It is proposed that what a receiving community’s citizens think, the way they perceive their social conditions, their social segmentation, their willingness to underwrite with their own resources, local social services, and their individual collective capacities for entrepreneurship and cooperative (though not necessarily consensual) effort are as important as the community’s economic and physical infrastructures.

The economic benefits derived from influx of foreign workers has resulted in social costs and social problems including rising crimes, fraud, social deviance, healthcare costs and the transmission of communicable diseases including HIV/AIDS and tuberculosis. In that context policies to control the impact of foreign workers in spreading diseases, creating high risk environments and risk behaviours associated with dilemma for the spread of diseases such as HIV/AIDS and tuberculosis have to be implemented.