INNOVETH: Innovative Health Intervention for Ethiopian Migrant Domestic Workers in the Middle East

1. BACKGROUND 1.1 Migration and Health Migration is a dynamic and complex global phenomenon that shapes the political, economic, demographic, and socio-cultural situations of nations, communities, and individuals [1]. According to the latest available evidence, there were 281 million international migrants worldwide in 2020 [2], accounting for 3.6% of the global population. Migration is triggered by several factors such as political instability, economic difficulties, and environmental disasters [3]. Modernisation, globalisation, stronger social networks, and the desire for a better life are also key facilitators of migration [4]. The effects of migration are multifaceted and can have significant consequences for both the sending and receiving countries [5]. One of the sectors shaped by migration is domestic work [6]. Reports showed that there are 11.5 million migrant domestic workers (MDWs) worldwide [7], representing 7.7% of the global estimate of 150.3 million migrant workers. The Arab States are among the major global destinations for MDWs, accounting for 27.4% of the 11.5 million MDWs worldwide [7]. Nearly three-quarters of the MDWs in the Arab States are women. Most of them are from Asian and African countries such as Sri Lanka, the Philippines, Bangladesh, Nepal, Indonesia, Ethiopia, and Kenya [8]. MDWs provide indispensable services in the destination countries [9]; nonetheless, they are confronted with vulnerabilities, leading to violations of their human and labor rights [10]. Evidence also shows that domestic workers often lack access to timely and appropriate health services.

Ethiopia is one of the major source countries for MDWs to the Middle East. Due to the economic crisis, high unemployment rate, internal conflict, and war, many are still forced to leave Ethiopia to seek employment abroad [11]. In the stakeholder engagement and involvement activity for Phase I grant of this project, the Ministry of Labour and Skills (MoLS) of Ethiopia reported that between July 2023 and May 2024, over 314,000 people, most of them were women, migrated to the Middle East using the legal channel and a lot more using illegal routes. MoLS also has a plan to send more than 700,000 domestic workers to different Middle East countries per year.

A recent phenomenon shaping the migration dynamics in Ethiopia is return migration [12]. According to official reports from the Ethiopian Ministry of Women and Social Affairs, over 70,000 MDWs are being deported from the different Gulf States every year. A significant number of other MDWs are also voluntarily returning. Several factors contributed to return migration [13], including adverse social and cultural environments, emotional maladjustment, serious health problems, and lack of skills to fulfil employers' needs. Most Ethiopian MDWs return before or without achieving their migration objectives.

Several studies documented the adverse experiences of Ethiopian MDWs in the Middle East. These include human rights violations [14], sexual abuse [15], denial of salary, lack of access to healthcare, overwork, and sleep deprivation [16], deportation [17], detention and confinement [18], physical and mental health problems, and stigma and discrimination [19,20]. Migration has also led to social, psychological, and economic crises, affecting not only the migrants themselves but also their families and communities [21]. A preliminary analysis of the scoping review was conducted in Phase I of this project and showed a higher prevalence of both mental (24%-51%) and physical (20%-40%) health issues. Higher prevalence of anxiety, depression, stress-related disorders and physical ailments were reported. During our stakeholder meeting, participants with lived experience of MDW shared their experience, stating, "The emotional, mental and physical challenges we experience, including depression, sleep deprivation, overwork, and inadequate meals, are overwhelming." Most of the studies conducted in MDWs are either qualitative or cross-sectional surveys, mainly among migrant returnees. To the best of our knowledge, there are no studies on Ethiopian MDWs in destination countries nor on interventions that mitigate the negative experiences of MDWs.

In the last few years, a new bilateral agreement was signed between the government of Ethiopia (GoE) and some of the Gulf States on recruiting MDWs. The agreement requires the GoE to offer qualified MDWs who meet certain specific criteria, including medical and physical fitness, to carry out specific tasks. Host countries then imposed comprehensive pre-migration medical screening, covering a wide range of conditions such as tuberculosis (TB), HIV, mental, sexual and reproductive health (MSRH). Twelve private health facilities in Addis Ababa were certified by the Gulf Medical Council to do the screening. Only those deemed medically fit are allowed to travel. Our preliminary analysis of the pre-screening electronic medical data in Phase I showed substantial variability of MDWs in their socio-demographic characteristics such as age, marital status, geographical origin, education, previous migration and domestic work experience, suggesting variable risk profile among MDWs. Regardless, limited awareness of their legal and medical entitlements, coupled with their socioeconomic standing and nature of their work renders MDWs a vulnerable, hard-to-reach population [22].