Consolidated Reply: Philippines – Lack of data on mental health and stress-related issues among women migrant workers
2 August 2010
Prepared by Bethany Donithorn and Bertine Bos, M4D-Net Facilitation Team
Summary of responses
Responses in full
Original Query: Malu Marin, Action for Health Initiatives (ACHIEVE), Inc. – Philippines
Women migrant domestic workers experience various forms of discrimination due to their gender, race and class. Many are isolated and subjected to exploitation, physical abuse, sexual violence, maltreatment and labour rights violations, such as contract substitution and non-payment of wages. Because domestic work is not recognized as work in many countries of destination, women working in this sector do not have access to social and legal protection. They also have limited access to health services and information, including mental health services.
Mental health encompasses a person’s emotional stability to handle pressure and other stressors. In the case of women migrant domestic workers, they are clearly placed in situations where there are additional stressors brought about by their working and living conditions and also by the distance and separation from their families and social networks. Returning migrant workers, especially those who underwent distress and abuse, are often brought back to their families and communities without adequate and sustained psycho-social support. There are very few services addressing health, specifically mental health concerns of women migrant workers. Government agencies and CSO service providers also speak of their inadequate capacity to address mental health issues. Such absence or treatment gap is likely to be related to the absence of collated, updated and relevant data.
Action for Health Initiatives (ACHIEVE), Inc., an NGO in the Philippines and Vrije Universiteit – Metamedica/Health Care and Culture (VU-MHCC) in Amsterdam are undertaking an action research [with funding from the JMDI] to investigate the mental health status and concerns of women migrant workers from the Philippines, specifically those working in the domestic or household sector. The research will provide evidence in the formulation of rights-based and gender-responsive policies and programs addressing mental health issues of women migrants. In addition, the project will also develop a package of interventions and conduct a pilot training course on crisis intervention and counselling, specifically targeting frontline personnel from service provider institutions from both government and CSOs. This project is pioneering and strategic, providing the opportunity to use innovative approaches.
Currently, a literature review is being conducted in order to identify existing data on mental health-related problems among women migrant domestic workers and data on existing services and programs addressing these problems. The findings from the literature review confirm a lack of such data. This raises the question, whether such information is lacking at all or has not been documented. Therefore, we’d like your input on the following questions:
* To what extent do baseline data on mental health and stress-related issues among female migrant workers exist in other countries?
* Do services and programs that address mental health and stress related issues among female migrant workers exist in other countries?
* How do people in other countries deal with the lack of data and treatment gap?
1. Ding Bagasao, ERCOF Economic Resource Center for Overseas Filipinos, Philippines
2. Charito Basa, The Filipino Women’s Council, Italy
3. Serafim Florea, Moldovan Diaspora Federation (ACUM), UK
4. Andrew Samuel, Community Development Services (CDS), Sri Lanka
5. Titilola Banjoko, Africarecruit/Findajobinafrica.com, UK
6. Mariya Samuilova, Migration Health-International Organization for Migration (IOM), Belgium
7. Rebecca Bardach JDC’s Center for International Migration and Integration, Israel
8. Audrey Le Guével, International Labour Organization (ILO), Belgium
9. Ilse Derluyn, University of Gent, Belgium
10. Romina Iebra, UN-INSTRAW, Dominican Republic
11. Bernard Headley, University of the West Indies, Jamaica
Summary of responses:
Women migrant workers represent a population which is highly vulnerable to discrimination, abuse, and exploitation, especially where they work in under-regulated sectors such as domestic work. They are also likely to suffer from stress caused by the dual burden of domestic and family duties combined with external paid work; and/or conflicts and tensions with family members – particularly children – who remain in their country of origin. However, there is a lack of baseline data on mental health and stress-related issues among this group of migrants and there are often no specific or focused programmes beyond limited government healthcare services designed to address their mental health issues.
Romina Iebra, UN-INSTRAW, illustrates women migrant workers’ vulnerability to mental health issues by sharing a study of Korean migrants in Toronto, Canada (Noh et al. (1992)), which aimed to identify the factors which contribute the most to gender differences in reported depression. The results indicated that migrant women presented a higher incidence of depression than migrant men. The employment factor (being employed) appeared as a particular strong risk factor for women. Among the participants observed, employed migrant women were almost eight times as likely to experience depression as their male counterparts, indicating that they may experience a “role-overload” due to also having to fulfil traditional family responsibilities.
Other contributors address mental health and stress-related problems among women migrant workers in more detail. One contributor describes the situation, from 1997-2004 in Switzerland, where an estimated 6,000 undocumented Filipino workers were largely hesitant to seek medical care in view of their status. They did not want to risk the investment made to be able to migrate to Switzerland, nor the potential income they could earn as domestic workers, and by holding multiple part-time jobs. Since the early 2000s migrants in Switzerland are able to purchase health insurance, and services in general are available to all, regardless of immigration status (no specification was given as to whether mental health care is covered, though). Despite efforts by the Philippine Embassy in Switzerland to organize a group insurance scheme for Philippine migrant workers, only 5 responded to the offer and they eventually failed to continue their health insurance payments. They said ‘they would just be more cautious and keep healthy through vitamins, and just leave everything to God.’
Another example shared is that of Moldovan migrants in Italy who suffer the so-called ‘Italian syndrome’, which is described as being ‘caught in between the homeland and an incomplete sense of participation in the new society’. The problem is a growing one as the number of Moldovan migrants to Italy is increasing. Moldovans face great difficulties in renewing their visas, as well as the constant stress and fear of being arrested, if they overstay. A proliferation of laws and differences in their interpretation from one region and municipality to another creates a climate of insecurity. In addition to these factors, families suffer due to a sense of alienation between children who have grown up in Italy and have adopted an Italian lifestyle, and parents who seek to preserve more religious and traditional ties to the homeland and their past. It is also difficult for Moldovan migrants in Italy to find a job suited to their level of education. All these factors contribute to mental health and stress-related issues such as depression.
Contributors emphasize that the political climate in some countries causes migrants to avoid government agencies and all related services. Many responders also highlighted that reporting abuse or healthcare issues may involve risks as migrants often do not have legal protection. Access to (legal) information is therefore pivotal, particularly for migrants without a visa. Initiatives have been set up to address this, such as the EU-funded initiative Enhancing Vulnerable Asylum Seekers Protection (EVASP), implemented in four European countries (Italy, the UK, the Netherlands and Greece), which facilitated the exchange of information on mental health and migration with the aim of ensuring that vulnerable asylum seekers are identified and receive an adequate response to their psychosocial and mental health needs during the asylum-seeking process. EVASP aimed to set up a transnational network of experts better able to assess and address asylum seekers’ mental and psychosocial needs. Similarly, the EU’s MigHealthNet, the information network on good practice in healthcare for migrants and minorities in Europe, aims to stimulate the exchange of knowledge on health services for migrants and minorities, and to give migrant and minority groups easy access to a dynamically evolving body of knowledge and a virtual network of expertise. 19 EU member states are participating and have created ‘Wikis’ which contain information about individuals, organisations and resources dealing with migrant and minority health.
Rebecca Bardach, from JDC’s Center for International Migration and Integration in Israel also stressed the key role of NGOs and semi-governmental organisations in developing responses to migrants’ mental health needs in Israel, where the notion of mental health and migration is still in its infant stage. There are currently no established programmes designated by the Israeli government specifically for the treatment of migrants’ mental health problems.
Another example shared by Andrew Samuel of Community Development Services in Sri Lanka, which involves returning migrants, demonstrates that reintegration should also include mental health care support. Research shows that returning migrants often complain of constant headaches, body and joint aches, high instances of diabetes and respiratory illness and reproductive health issues. Other issues include the inability to reintegrate rapidly enough into the local culture and society, forgetfulness, feelings of disconnectedness, and a longer time needed to emotionally connect and bond with younger children in the family. To address these issues, Andrew proposes a government sponsored, voluntary reintegration medical check-up for returning migrants to Sri Lanka, including a focus on their mental health.
Women migrant workers returning to Jamaica experience similar reintegration issues. Prof. Bernard Headley of the University of the West Indies writes that since 2007 Jamaica’s Ministry of Labour has facilitated temporary or guest worker programmes specifically for women to work as temporary hotel workers in cities, mainly in the southern United States. The women leave their families in Jamaica and often find themselves in unfamiliar and sometimes unfriendly situations in cities that lack the Jamaican overseas support systems of more traditional centres of immigration such as New York, London and Miami. A recent study found that, after returning to Jamaica, many participants in the programmes believe the experience was worthwhile in terms of improving their family’s economic situation. However, they also expressed high levels of worry and anxiety about the care and the raising of their children during their sometimes long period of absence from home. The limited government healthcare system in Jamaica does not have specific or focused programmes to address mental health and stress-related issues among female migrant workers. These women therefore fall back on friends and family and other informal systems such as the church for support. Prof. Headley mentions that teachers, school principals and social workers also provide limited assistance, for example by supporting the troubled children of women migrant workers.
In conclusion, the responses contributed indicate that there is a general lack of studies and data on the mental health effects of migration on women migrants. However contributors shared some studies that have looked into the issue of the mental health of women migrants and describe their experiences. Government sponsored programmes to assess and/or treat mental health and stress-related issues among women (returning) migrant workers are rare. It appears that mental health is generally clustered together with other more general health services (available to migrants but not specifically geared towards their particular living situations). Even where some form of migrant mental health care is offered, the political climate in some countries nevertheless prevents migrants from approaching government services. Access to information therefore plays a key role, as migrants need to be supported to learn about the available services and how to access them. However, in the absence of dedicated, accessible healthcare services for women migrants’ mental health needs, NGOs, family and friends, the church and sometimes teachers and social workers are in many cases filling the gap.
Switzerland – From 1997-2004, of approximately 8,000 Filipino workers in Geneva and Canton Vaud, 25% were employed and generally covered under an employer’s insurance plan. Medical services are generally free and open to all, regardless of immigration status, and since 2000 even undocumented workers are able to obtain medical insurance. Of the remaining population of Filipino migrants in Switzerland at that time, almost all were employed throughout the domestic sector, which is approx. 90% women, most of whom are undocumented. Residency status represents a stressor, which in many cases has shown to be a barrier to migrants seeking support. Migrants are often reluctant to seek treatment until it is absolutely necessary, for example for fear that medical professionals would transmit their coordinates to government officials. Contact: Ding Bagasao, ERCOF Economic Resource Center for Overseas Filipinos.
Italy – In 1999 the Russian default brought waves of migrants from Moldova to Italy, with roughly 90,000 Moldovans now living in Italy. The numbers have been growing rapidly; an article describes the depression suffered by many Moldovan migrants in Italy as ‘’the Italian syndrome.” The Moldovan community is the tenth largest in Italy, and Rome is the European city with the second largest population of Moldovans (12,800). The number of Moldovans living in Italy multiplied almost tenfold between 2001 and 2004, from 4,000 to 38,000, and by 2008 it had increased significantly once again. Women migrant workers make up 67% of the Moldovan population in Italy and neighbouring areas, as men tend to migrate elsewhere (Russia, Romania, Israel, etc). Moldovans face great difficulties in renewing their visas, and there is a constant stress and fear of being arrested among those who overstay. In addition, families suffer enormously due to the generation gap between children raised in Italy and their parents who seek more religious and traditional ties to their past and the homeland. Approx. 70% of Moldovans in Italy are said to hold a degree (of which 5% a PhD), and 30% hold a secondary or professional studies diploma. However, only one-third manage to achieve a position suited to their level of education. These factors have a potential impact on the mental health of Moldovan migrants. Another contributor states that the healthcare situation in Italy is not bad, and state services do exist, providing legal, health and labour assistance to all persons. However, many undocumented workers are hesitant to attempt to learn more about their rights and the existence of services they could benefit from. Language is also a large part of the problem. Contact: Charito Basa, Filipino Women’s Council, Italy and Serafim Florea, Moldovan Diaspora Federation (ACUM), UK.
Israel – Beginning in 1989 Jews from the former Soviet republics began to migrate in huge numbers to Israel in search of refuge and a new start. While they have built a large community in Israel, issues remain which limit their integration into Israeli culture and lifestyle. In addition, non-Jewish women migrant workers, including from Latin America, have little chance of attaining a position for which they are qualified, and are usually forced into occupational downward mobility, working in multiple jobs. These factors become stressors and endanger the mental health of women migrant workers, as they are one of the most vulnerable groups due to their status and working conditions. Many of those with children are forced to become full-time ‘overseas mothers’ due to necessity, working longer hours than male migrants and giving up their role as the main caregiver for their children to provide for them financially. Mental health is not prioritized among the psycho-social support services currently available in Israel, although this is changing. Source: Raijman, Schammah-Gesser & Kemp “International Migration, Domestic Work, and Care Work: Undocumented Latina Migrants in Israel” (2003)
Sri Lanka – Sri Lanka has limited services to address general mental health issues that are not specific to migrant workers, an issue which is being studied by a World Health Organization (WHO) project, beginning in 2006. In close cooperation with the Ministry of Healthcare and Nutrition, the project aims to create an assistance programme devoted to mental health. In addition to those suffering mental health problems following the Indian Ocean tsunami, returning women migrant workers have also demonstrated a need for the inclusion of a mental health assessment during medical check-ups. These women are experiencing a variety of symptoms that may be linked to mental health, such as high incident of diabetes and respiratory issues, body aches, reproductive health issues, inability to reintegrate into society, forgetfulness, a feeling of being lost or detached and a delayed bonding with younger children in the family. Government policy on reintegration in Sri Lanka does not currently include support for mental healthcare programmes. Source: World Health Organization (WHO), Sri Lanka & Andrew Samuel, CDS, Sri Lanka
* Access to Healthcare for Undocumented Women in Europe, ILO 2008 – document on the realities of access to healthcare for undocumented women in Europe. The International Labour Organization (ILO) outlines points where vulnerable groups can be placed at risk and excluded- making it dangerous for public health in general.
* International Migration, Health and Human Rights, WHO 2003 – publication providing an overview of some of the key challenges for policy-makers in addressing the linkages between migration, health and human rights. It recognizes that there is limited data available and thus does not provide a full picture but attempts to provide a useful platform to stimulate action towards addressing migration and health in a comprehensive and human rights-sensitive way.
* Mental Health Update, WHO Sri Lanka 2008 – looks at the situation of general mental health and care in Sri Lanka and highlights ongoing projects.
* The Italian Syndrome, Osservatorio Balcani e Caucaso 2010 – Laura Delsère discusses the notion of the “Italian Syndrome” with data on the Moldovan population in Italy.
* International Migration, Domestic Work, and Care Work: Undocumented Latina Migrants in Israel, Raijman, Schammah-Gesser & Kemp 2003 – article exploring the situation of undocumented Latina migrants in Israel.
* For references by Romina Iebra, UN-INSTRAW, Dominican Republic please see here.
Articles related to vulnerabilities of women migrant workers:
* Gender and Labour Migration in Asia, IOM 2009 – describes the “gendered migration process” which has developed especially since the 1990s and the increased visibility of women as labour migrants in the region, which has brought a number of economic and social issues to the forefront. Also described is the vulnerability of male migrants in terms of rights, access to services and the change in gender roles.
* Working to prevent and address violence against women migrant workers, IOM 2009 – Describes IOM’s work to protect women migrant workers from violence.
* Violence against women migrant workers, United Nations 2003 – report of the United Nations Secretary-General providing information on measures taken by Member States and activities undertaken by UN organizations and other intergovernmental bodies in the area of violence against women migrant workers. The report concludes with a series of recommendations for future action.
Articles shared in Italian:
* The Psycho-Social Health of Foreign Workers, La salute psicosociale dei lavoratori stranieri. Aspetti e prospettive dall’evidenza empirica, by Paolo Borghi and Francesco Grandi – Italian article looking at employment and the possible triggers/consequences it can have both socially and physically on migrant workers. The authors point out that being able to get a job and being able to stay in the country can be key stress factors and that access to social and medical care are not guaranteed.
* Migrant Mothers- Care Migration from Romania & Ukraine, MADRI MIGRANTI Le migrazioni di cura dalla Romania e dall’Ucraina in Italia: percorsi e impatto sui paesi di origine, CeSPI – Castagnano et al. discuss the “care migration” phenomena or the “care drain” among women migrant workers in Italy and analyses psycho-social effects on women migrants.
* A Complex Phenomenon: Immigrant Women’s Work, Un fenomeno complesso: il lavoro femminile immigrato Lavoro domestico, politiche migratorie e immigrazione filippina. Un confronto tra Canada e Italia by Ludovica Banfi, Istituto Nazionale Previdenza Sociale – Italian article providing a general chronological history of the role of women migrant workers, focussing on Philippine women migrants.
* Enhancing Vulnerable Asylum Seekers Protection (EVASP) – the website provides information on mental health and migration in four EU countries (the UK, the Netherlands and Greece).
* MigHealthNet – aims to stimulate the exchange of knowledge on healthcare services for migrants and minorities. 19 EU member states are participating and have created ‘Wikis’ which contain information about individuals, organisations and resources dealing with migrant and minority health.
Responses in full:
1. Ding Bagasao, ERCOF Economic Resource Center for Overseas Filipinos, Philippines
I could not respond directly to the questions as I am not familiar with the information the questions require. What I would like to share comes from discussions we had (as Ercof), in Geneva, many years ago with a representative of Medecins San Frontieres (MSF) Switzerland, who wanted some inputs on how to reach out to Filipina migrant workers who, compared to their counterparts from Latin America or other countries, seemed to be invisible or are not patronising health services in Switzerland, which are generally free and open to all, regardless of migrant status. The following thoughts and possibilities might be worth considering in your research, from our discussions with MSF:
1. When I was in Geneva from 1997 to 2004, there were an estimated 8,000 Filipino workers or residents in Geneva and Canton Vaud. The Philippine mission listed about 2,000 working in international organisations or multinational headquarters, or married to locals. They are generally covered by health insurance by their employers and are sufficiently if not generously protected on health concerns. The remaining 6,000 Filipinos are mostly working in the domestic sector, around 90% are women, a large majority of whom are undocumented. Being undocumented, they are hesitant to come forward, even during emergencies, for fear of exposing their status. It is believed that many do self-medication, (as we also do here in the Philippines), it is only when they are brought to the hospital with life threatening illness or accidents, that they receive treatment, albeit involuntarily. There are instances when medical treatment had come too late due to hesitancy on obtaining treatment.
2. Given the high cost of migrating to Switzerland (or other EU countries for that matter, it is now about 700,000 pesos with no assurance of placement), and risking all this and the actual or potential high income they can earn even as domestics, and with multiple part-time jobs), the reluctance to come out in the open might be unwise, yet understandable. The migration costs might even have come from proceeds of pre-departure loans with oppressive interest rates, some being paid for the first year or two.
3. As far as I know, domestic workers, even undocumented workers, can obtain medical insurance in Geneva, in a law passed sometime in the early 2000. However, before that, undocumented workers were not allowed to get insurance in Switzerland. During that time, given the unprotected status of undocumented workers, the Philippine mission with the help of NGOs, and sympathetic and enterprising Swiss insurance people, were able to arrange a group insurance through a French insurer. For a reasonable amount of about SF150 per month, a migrant worker would be covered with health, accident and life insurance, including repatriation of remains, in the event of death, an expense which cost at least SF10,000. Only 5 responded to this offer, and even these 5 eventually failed to continue premium payments after a few months. They said ” Sayang yung SF150 a month, or SF1, 1800 a year (SF1=Php38 at that time), puede nang magparal ng 2 tao sa PIlipinas. “They will just be more cautious and keep healthy through vitamins, and just leave everything to God”.
I would suggest you contact the Philippine mission, should you wish to know more information about status of Filipinos in Switzerland. The situation might also be different in other countries like Italy, France where there are also a lot of undocumented Filipinos. I believe that many EU countries, particularly major destination countries, have regulations and health protection for migrant workers but this can be also affected by the type of government present. For instance, in Italy, the right wing government of Berlusconi had required doctors who had treated undocumented migrant workers, to report information on the worker, to the police.
- Ding Bagasao, Economic Resource Center for Overseas Filipinos (ERCOF), Philippines
2. Charito Basa, The Filipino Women’s Council, Italy
In the last years, social researches are increasingly focusing on life conditions of domestic workers, even if these researches mostly highlight work conditions and migration strategies of women; mental health and psychological diseases are not well documented yet.
Among the last specific researches on this topic, it can be mentioned: ‘La salute psicosociale dei lavoratori stranieri. Aspetti e prospettive dall’evidenza empirica’ by Paolo Borghi and Francesco Grandi.
The psycho-social effects on migrant women are also well analyzed in this paper: Cespi, 2007, ‘MADRI MIGRANTI Le migrazioni di cura dalla Romania e dall’Ucraina in Italia: percorsi e impatto sui paesi di origine’ by Eleonora Castagnone, Michael Eve, Enza Roberta Petrillo, Flavia Piperno, and with cooperation of Jonathan Chaloff. You will also find some few observations on this respect in: INPS 2007 ‘Un fenomeno complesso: il lavoro femminile immigrato’.
As regard specific research on Philippine women, there are many which could be mentioned, I would suggest: Ludovica Banfi, ‘Lavoro domestico, politiche migratorie e immigrazione filippina. Un confronto tra Canada e Italia’ and L. Banfi (2008) Genere e legami familiari transnazionali, in Badanti&Co, il Lavoro domestico straniero in Italia, a cura di Catanzaro e Colombo, il Mulino.
Recently published there is also IOM’s study Gender and Labour Migration in Asia. By presenting the case of domestic workers from the Philippines in Italy, it portrays some of the challenges facing transnational families and the potentially negative consequences of separation on children’s well-being but also how remittances increases educational opportunities for children.
The IOM is currently implementing a pilot project aimed at supporting Ukrainian women working in domestic services in dealing with some difficult psycho-social consequences of their living abroad, such as stress generated by conflicts and tensions with family members, especially children and teenagers left behind. The project is also aimed at reducing social disintegration in local communities in Ukraine caused by emigration by improving social cohesion of local communities, with a specific focus on children left behind, their mothers and their families and by strengthening local institutions and public services.
The project is also expected to modify some of the most common stereotypes within migrants’ community of origin, often describing migrant women as individuals with low morality. This initiative also raise awareness on the rights of children left behind in Ukraine and it would promote some positive aspects of migration like promoting local development through remittances or increasing communication between mothers and their children. The projects is currently undertaking a social research focusing on the psycho social conditions of Ukrainian women in Italy and the potential of female migration to support development of their local communities of origin through decentralized cooperation initiatives between the two countries.
3. Serafim Florea, Moldovan Diaspora Federation (ACUM), UK
In line with our discussion on women migrant workers’ mental health, from Rome, we received the following article by Laura Delsere shadowing the life of Moldavian women migrant workers/ health and stress related issues. The phenomenon is called – the Italian Syndrome.
The Italian Syndrome
There are roughly 90,000 Moldovans living in Italy – with numbers growing fast, as shown by a recent report by Caritas-Migrantes. Among the many difficulties of living abroad, one problem is spreading very quickly: the Italian syndrome, a depressive form that affects illegal immigrants and their children.
Italy represents a European junction for the Moldovan diaspora. Moreover, the number of immigrants from the banks of the rivers Dnester and Prut is growing at double the speed of that of immigrants from other countries, thus making the Moldovan community the tenth in the country, after the Romanian and Ukrainian communities. Rome has become the second European city for number of Moldovan citizens, after Moscow: the latter has 145,000, while Rome has 12,800, followed by St Petersburg (more than 9,000), Istanbul (8,000), Odessa (7,650) and Milan (5,800). The most up-to-date profile of this community is offered by the report ‘Moldovan citizens in Italy’, carried out by Caritas and Fondazione Migrantes, in collaboration with the Moldovan Embassy in Rome.
Nowadays there are almost 90,000 Moldovan citizens in our country. Yet, the most impressive thing are the growing numbers in the last ten years: from roughly 4,000 in 2001 they reached 38,000 in 2004, and by 2008 the number of Moldovan immigrants living in Italy has grown by a third (+30,4%), compared to an average growth of +13,4% in the general foreign population in Italy. Women are the pioneer immigrants. They mainly move towards the Mediterranean area (Italy, Spain) to work as carers, so much so that they currently make up 67% of the whole community. Moldovan men, on the other hand, mainly move to Russia, Romania, Ukraine, or Israel.
The second generation grows
Moldovan migrants are increasingly oriented towards moving to Italy permanently. According to the figures offered by the report, nowadays 5% of the community was born in Italy, roughly 2000 newborns in 2008. And roughly 15% of the children are enrolled in Italian schools. “Schools and universities are strategic places for the integration of the younger generation”, as explained by some girls under 30 part of the association “Dacia”, dealing with the Moldovan diaspora in Italy. And they surprisingly mention above all the religious universities, like the one called Angelicum, where Karol Wojtyla studied when he was 20. “The world ‘clandestine’ shouldn’t have been born in this country, cradle of the humanistic culture” state some Moldovan university students.
Churches represent an important reference point for adults. “This is where we can preserve our history, values, language, but also our faith in human rights” as explained by some activists of the non-profit organisation ‘San Mina’, which defends the civil rights of Moldovan citizens in Italy. Cultural development is a very important achievement, but it “inevitably creates a gap between parents and their kids, who feel part of the Italian culture in every respect”, according to the report by Caritas and Migrantes. “The result is that often the second generation doesn’t want to move back to their homeland”. And they end up in a sort of no-man’s-land: for them, “caught in between their homeland and an incomplete sense of participation in the new society – according to the report, obtaining Italian citizenship and nationality will be decisive”.
The new Moldovans from Lazio and Veneto
There are two “Moldovan capitals” in Italy: Rome (and the Lazio region) and Padua (in Veneto). They represent the areas with the highest concentration of Moldovan migrants, with almost 8,000 residents in total. They are employed mainly in the sector of home caring (32%), building (12%), and services (11%). According to the map offered but Caritas-Migrantes, the highest concentration is in the North West (35.2%), followed by the North East (27%) and the Centre (25.1%). The concentration is lower in the South (9.1%) and on the isles (3.7%). But their path is constantly uphill, according to the voices of the diaspora. “The renewal of the residence permit is the main problem, and it is becoming more and more difficult to obtain” explains Natalia Moraru, president of the association ‘Dòina’.
The situation is substantially better for regular immigrants, even though they often occupy positions below their level of education: in Rome, for example, 70% of Moldovan immigrants have a degree (of which 5% has two degrees or a Ph.D.), 30% has a secondary school diploma or a professional qualification. But only 30-35% manages to achieve a position suited to their level of education, and the most common jobs are the manual ones in the services sector, or in families and hotels. Despite the many associations constituted so far, the main space of socialisation for Moldovan immigrants remains the street: the squares in front of the churches they attend, often the ‘work markets’, and the bus stations (in Rome, at Tor di Valle), since the bus has become the symbol of commuting between Italy and Chisinau. According to many, in the stations the trips are controlled by the racket of drivers and transport companies, who have complete control over the tariff and the goods sent, which often include parcels full of cash. Sometimes they get ‘stolen’ and in order to get them back a ransom has to be paid – as happened to a lady whose 8,000 Euro savings disappeared.
The Moldovan diaspora: One citizen in four lives abroad
The big wave of migration from Moldavia started in 1999, the year after the Russian default during which the level of poverty reached its peak in the country: 80.9% in the small villages, 76.2% in the rural areas, 50.4% in the big cities. During those 12 months 100,000 people left. In 1992 a further push had come from the conflict with Russia in Transnistria, an area with a high concentration of factories, which increased the occupational catastrophe even further.
Today, one out of four of the 4.2 million Moldovan citizens lives abroad. The republic has also entered the worldwide top list of countries with the highest level of remittances in proportion to the population: almost a third if their national GDP (36%, equal to 1.4 billion dollars in 2008). The money is often sent via informal channels, very seldom using banks. The total amount of remittances sent from Italy during the same year was of 54.5 million Euro. According to the report, “if the whole family is in Italy Moldovan immigrants send an average of 400-600 Euro back to their home country, while if husband and children are still in Moldavia the amount can reach 10,000 Euro per year”. The average figure is of 7-8,000 Euro per year, “used mainly to provide for the family, pay for their children’s education, buy a house”.
Among the most disadvantaged when it comes to getting a EU visa
Apart from poverty, unemployment, and low wages, nowadays some of the main causes of emigration are “the political instability, corruption and the denial of human rights – as explained by the analysts that carried out the 2009 report – At the moment Moldovans are among the most disadvantaged groups as far as getting a EU visa is concerned”. Just think that from 2007 (when Romania entered the EU) until 28th January 2009 (when the Italian diplomatic head office in Chisinau started issuing visas), Moldovan emigrants used to go to the Italian embassy in Bucharest in order to apply for visas to travel to Rome, as they did for Spain or Slovenia. In order to obtain a visa for Greece or Cyprus they used to travel to Ukraine instead. “A gold mine for criminal organisations, to say the least”.
It is sufficient to ask migrants themselves to obtain up-to-date tariffs: today a visa for Italy costs 4,500 Euro, and it is issued by the not-so-transparent Moldovan job agencies, which also prepare the candidates for the interview at the embassy (“be natural”, “don’t blush”, “repeat exactly what we tell you”), while in 2004 the middlemen could only ask for 2,500 Euro.
The majority of Moldovan immigrants arrive in Italy with a tourist visa, but the percentage of victims of human trafficking is still among the highest in Eastern Europe. 919 were assisted in Italy over the last few years, according to the Report, which makes this community the most vulnerable after the Nigerian and Romanian ones.
Bureaucracy, the main obstacle to building a life in Italy
“Once here our emigrants need most of all information and not to be left alone” explains Tatiana Nogailic, president of Assomoldave. “Access to information is vital for an immigrant. So much so, that whenever a new law is approved we rely not only on our blog to spread the news, but also on text messages. We send up to a thousand of them”.
Which are the main difficulties for Moldovan immigrants? “It depends on whether they hold a visa or not. Those who do include the Romanian ones, while the ones that don’t are considered outlaws under the new “security measures”. Personally, I lived in fear while I was waiting for my visa to be first issued and then renewed. The first time for one and a half years, the second for two. While we are illegal we are forbidden from going back home, and this makes us non-existent”. As Ms Nogailic adds “in general the insecurity never ends due to the countless laws and the many different interpretations they’re subject to. Just think about the certificate of permanent address required to obtain a residence permit: instead of a single regional law, each municipality in Rome has different procedures, from 2 to 12 certificates”.
More and more hidden: how the latest mass regularisation failed
What changed after the late mass regularisation? “It was only a partial success, we received only half of the applications we expected – says Ms Nogailic – One of the reasons behind the failure is the fact that employers started to lay employees off shortly before the act of indemnity. For three reasons: the excessive costs for the employer, fears related to bureaucracy involved in the application procedure, and lastly the availability on the market of low cost commuters. But the main fault of the law was regularising those who had only one employer, thus leaving out for example all the domestic helpers who worked for more than one family. We all know that these women are still working, even if with more disadvantages. But even if they worked more than 12 hours per day and were willing to cover all the costs, they weren’t given the possibility to become regular. We reported with no success what was happening to the Provincial Governor Mario Morcone, head of the Department for Civil Liberties and Immigration of the Ministry of the Interior”. But recently the governor himself, while presenting the results of the mass regularisation, admitted that “there are still many illegal immigrants and the regularisation should be extended”.
4. Andrew Samuel, Community Development Services (CDS), Sri Lanka
This pioneering work is very timely and appropriate as we believe most sending countries will have little data to support the mental health of migrant returnees. The provisional recorded figures for Sri Lanka show that there were 7,724 female and 1,940 male complaints received in 2008. Of these figures 1,155 were physical and sexual harassments.
Unfortunately the data does not capture the mental health condition of returnees or repatriates. There is also little or no data to monitor any post arrival mental health conditions of the migrant worker. It is much later that when various symptoms occur that the health status could be linked to migration.
Government policy on reintegration does not include support for mental health care programs. Our qualitative research on the field with returnee migrants have brought to light complaints about constant headaches, body and joint aches among female migrant returnees, high incidents of diabetes, high incidents of respiratory illnesses and other reproductive health issues such as delays in the menstrual cycle and excessive bleeding during the menstrual period. Some other factors that came out were the inability to reintegrate quickly enough to the local culture and society, forgetfulness, spaced out feelings, longer time period taken to emotionally connect and bond with younger children in family etc.
It is perhaps pertinent to suggest that a government sponsored reintegration voluntary medical check-up be carried out with emotional counselling facilities to returnee migrants on a range of health subjects that focuses on mental health.
- Andrew Samuel, Community Development Services (CDS), Sri Lanka
5. Titilola Banjoko, Africarecruit/FindajobinAfrica.com, UK
The main challenge will be that countries that are most likely to have very high numbers of abuse are where abuse will be under/not reported and when reported not documented or acted on. The implications of reporting may even be dangerous with no protection for the migrant.
Human Rights, Multilateral or UN organisations can act as information sources, e.g. some below found via Google:
Dr Titilola A Banjoko, Africarecruit/Findajobinafrica.com
6. Mariya Samuilova, Migration Health-International Organization for Migration (IOM), Belgium
We are not directly involved in projects working with women migrant workers, but more from the perspective of providing training to health and other staff in reception/detention facilities on mental health-related matters, such as sensitization to mental health issues/practical skills in recognizing mental health implications for staff and migrants in reception facilities, etc.
Thus I would suggest that you check the webpage of EVASP [Enhancing Vulnerable Asylum Seekers Protection] project’s database, led by the Psychosocial Unit of IOM in Rome, where you can search for relevant materials on the topic of mental health and migration: EVASP.
And going back to the initial request, I agree with Malu Marin’s findings from the literature review that there is a serious gap in the available data on the topic of migrant health, not to mention even mental health. I would suggest checking also the MIGHEALTHNET project’s website, where you can find more information on the current research networks active in Europe and dealing with the problem of migration and health, and perhaps direct the questions to some of the project coordinators: MigHealth
Migration Health – International Organization for Migration (IOM)
40 rue Montoyer
1000 Brussels, Belgium
7. Rebecca Bardach, JDC’s Center for International Migration and Integration, Israel
Given the relative newness of international migration flows to Israel, the state has not developed uniform or comprehensive responses, policies or procedures to address the range of needs around labor migration and labor migrants. No comprehensive baseline data on mental health issues or stress related needs of migrant workers, or female migrant workers specifically, is collected. While there are no comprehensive state-sponsored mental health or stress-related services for female migrant workers, some non-governmental or semi-governmental organizations strive to meet such needs. For example, “Mesila,” established by the Tel Aviv municipality, provides social services, including mediation, therapy, and referrals to address migrant workers’ health and psycho-social issues. Likewise, a shelter established by the government for victims of trafficking provides similar supportive services. Individual organizations or government agencies may try to meet needs as they arise, and civil society plays a key role in developing responses. I believe that regular migrant workers are entitled to national health insurance and would therefore be entitled to the same services as citizens including in this field but this needs to be verified vis-à-vis the National Health Insurance agency.
Many thanks & I hope this is of some assistance.
JDC’s Center for International Migration and Integration
8. Audrey Le Guével – International Labour Organization (ILO), Belgium
I am sending you here, some information I received from Geneva but the IOM and WHO might be more able to answer some of the requests.
Access to Healthcare for Undocumented Women in Europe
9. Ilse Derluyn – PhD, University of Ghent, Belgium
These are quite extensive questions that are not that easy to answer.
1. There is quite a large amount of literature documenting mental health (especially depression) and stress-related issues (especially post-traumatic stress disorder) among migrants in general, and most of these data can be split up according to several demographic characteristics, such as age, gender, refugee status… Most of this literature is based on studies done in western countries; there are not that many studies in ‘developing’ countries.’
2. There are a bunch of programmes addressing these issues for female migrant workers, although most of these programmes intend a “holistic” approach, which means that they try to tackle a number of issues (housing, documents, schooling, children, psychical etc.), leading to neglect – sometimes – of mental health issues. The trans-cultural psychosocial organisation HealthNet TPO in the Netherlands could be interesting to have a further look at.
3. Research on mental health in refugees & migrants is growing; the treatment gap on the other hand is difficult to bridge, and mainly addressed through the development of specific programmes (or part of programmes) for the target groups.
I hope this helps you further!
All the best,
10. Romina Iebra, UN-INSTRAW, Dominican Republic
Gender values and its impact on immigrant women’s psychological wellbeing
The relationship between socially induced stressors and their consequences for the mental health of immigrants has been observed by several authors (Lin & Ensel, 1989; Lin et al., 1999; Miranda & Umhoefer, 1998; Noh et al., 1992; Thoits, 1982). Some evidence drawn from these studies reinforces the idea that the immigration process has different effects on men and women, that traditional gender values still play an important role in everyday life of these individuals and that the overload of responsibilities has a direct impact on women’s health and acculturation process, especially if they do not have strong social support in the new society.
Noh and his colleagues (1992) studied a large sample of Korean immigrants in Toronto with the purpose of identifying what factors contributed the most to gender differences in reported depression. The authors looked at two alternatives, the “double burden hypothesis” and the “power hypothesis”. The “double burden hypothesis” emphasizes that negative psychological outcomes like stress and depression are mainly due to role overload (domestic and family duties combined with external paid work). On the other side, the “power hypothesis” proposes that psychological stress partially results from the ways power is allocated within the family. Within this perspective, factors such as external paid work are considered potential enhancers of women’s power capacity within the family and the community in general, promoting lower levels of psychological stress.
The results reached by Noh et al. (1992) indicated that immigrant women presented a higher incidence of depression than immigrant men. The employment factor (being employed) appeared as a particular strong risk factor for women. Among the observed participants, employed immigrant women were almost eight times as likely to experience depression. Gender differences in depression were more evident in the most “advantaged” immigrant group (greater income, higher educational level) where men presented a much lower tendency for depression than their partners.
It seems likely that the approval of more traditional gender values within the family is one of the causes for different gender levels of depression and stress. Within this context, employment is observed as a stressful factor if combined with the fulfilment of domestic and family roles, as the double burden or role overload hypothesis propose. As Dion and Dion (2001) referred, “it is also possible that the greater reported depression among employed women might be partly attributable to the process of renegotiating family, specifically, spousal roles, as a result of changed circumstances associated with immigration” (2001, p. 514)
Other factors have been considered in order to understand the relationship among the stressors, mediators and coping resources and the distress/health outcome in immigrants. In a more recent study with a large group of Koreans in Toronto (who had immigrated at the age of 18 or older), Noh and Avison (1996) analysed how coping resources function to mediate or buffer the potentially harmful impact of social stressors resulted from the acculturation process. A basic assumption of this research is that it is not just the exposure to life stressors that determine immigrant’s mental health, but also the pre-existing resources that individual possess in order to deal with these conflicts (such as personality, coping skills, and sources of effective social support).
Dion, K. K., & Dion, K. L. (2001). Gender and cultural adaptation in immigrant families. Journal of Social Issues, 57, 511-521.
Lin, N., & Ensel, W. M. (1989). Life stress and health: Stressors and resources. American Sociological Review, 54, 382-399.
Lin, N., Ye, X., & Ensel, W. M. (1999). Social support and depressed mood: A structural analysis. Journal of Health and Social Behavior, 40, 344-359.
Miranda, A. O., & Matheny, K. B. (2000). Socio-psychological predictors of acculturative stress among Latino adults. Journal of Mental Health Counseling, 22, 306-317.
Miranda, A. O., & Umhoefer, D. L. (1998). Depression and social interest differences between Latinos in dissimilar acculturation strategies. Journal of Mental Health Counseling, 20, 159-172.
Noh, S., & Avison, W. (1996). Asian immigrants and the stress process: A study of Koreans in Canada. Journal of Health and Social Behavior, 37, 192-206.
Noh, S., Beiser, M., Kaspar, V., Hou, F., & Rummens, J. (1999). Perceived racial discrimination, depression, and coping: A study of Southeast Asian refugees in Canada. Journal of Health and Social Behavior, 40, 193-207.
Noh, S., Wu, Z., Speechley, M., & Kaspar, V. (1992). Depression in Korean immigrants in Canada. Correlates of gender, work and marriage. Journal of Nervous and Mental Disease, 180, 578-582.
Thoits, P. A. (1982). Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. Journal of Health and Social Behavior, 23, 145-159.
Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology, 54, 416-423.
11. Bernard Headley, University of the West Indies, Jamaica
1) Jamaica’s Ministry of Labour has for generations facilitated temporary or guest worker programmes of mostly men going up to the United States and Canada as farm workers. The present Jamaica Labour Party Government has, since its election to power in 2007, energetically initiated similar programmes tailored for women. Mostly these are programmes that see Jamaican women, many of them trained in Jamaica’s well established tourist and hospitality industry, going up to work in off-the-beaten-path U.S. localities as temporary hotel workers–in cities often in the Deep American South. The women usually leave behind in Jamaica families of usually dependents elders and small, dependent children; and they often find themselves in unfamiliar and sometimes unfriendly locales: they are not in cities like New York or Miami with existing hosts of overseas support system. A recent study one of my sociology graduate students did (for her Master’s thesis) on a sample of these women, while they were back home in Jamaica, revealed that although the women felt worthwhile for being able to improve theirs and their family’s situation economically, they also expressed high levels of worry and anxiety about the care and the raising of their left-behind children during their sometimes long period of absence from home. We should indeed be recording and collecting baseline data on the effect of this kind of migration on women’s’ health and well being.
2) “Do services and programs that address mental health and stress… exist” in Jamaica? As far as I’m readily able to tell (from admittedly little research), there are no specific or focused programmes outside the already limited Government health care system designed to address the mental health and stress-related issues among the female migrant workers,certainly not (as far as my graduate student was able to say) for the population mentioned above.
3) “How do people in other countries deal with the treatment gap?” The primary source that anxiety-driven migrant women seem to fall back on are (as with nearly all other threatening circumstances) friends and family, and other informal systems like the church. Also of limited, secondary assistance are the teachers, school principals and social workers who sometimes have to intervene with the troubled children of these women migrant workers.
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