Reaping What Was Sown

By Dr Milton Lum | 20 January 2021

Attributing the increase in the numbers of cases to the public’s compliance with standard operating procedures is pathetic especially when the public have no means to control the spread among migrant workers.

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The economic effects of the Covid-19 pandemic have led to the loss of jobs and reduction in wages. This has affected low-wage and low-skilled migrant workers disproportionately around the world. Their predicament has been exacerbated by a lack of assistance from host countries as governments prioritise assistance for citizens.

Migrant workers are an integral part of the Malaysian economy. They have contributed to the growth of the nation and they comprise about 15% of the workforce doing jobs Malaysians shun in many economic sectors.

Migrant Worker Numbers

The data on the number of foreign workers in Malaysia, particularly the undocumented ones, is varied.

It is estimated that there are about 2 million documented migrant workers comprising about 15 per cent of the total workforce. In addition, the Institute of Migration, an inter-governmental organisation estimates there are an additional 2 to 4 million undocumented workers.

The World Bank, in its 28 March 2019 report, Malaysia: Estimating the number of foreign workers, stated “the Ministry of Home Affairs reported that four out of ten foreign workers are irregular, based on its enforcement and amnesty program operations, suggesting the number of irregular foreign workers be about 1.2 million in 2017 and the total foreign worker population of about 3 million. Unofficial data suggests as many as 4 million irregular foreign workers.

None of these figures are backed up by rigorous analytical methods, except the estimate by the Institute of Labour Market Information and Analysis, which estimates the total foreign worker population to be 3.5 million using foreign-worker-related insurance subscription data.”

The report estimated that “the total number of foreign workers in Malaysia ranged from 2.96 million to 3.26 million in 2017. Among these, the number of irregular foreign workers is estimated to be 1.23 million -1.46 million.”

According to the Malaysian Employers Federation, there are about 700,000 and 309,000 documented migrant workers in the manufacturing sector and services sector respectively; about 130,000 domestic helpers and the rest in the construction, agriculture and plantation sectors.

Health Care Of Migrant Workers

Migrant workers often have limited or no access to health care, particularly the undocumented workers.

A multinational team from Malaysia, China, United Kingdom and United States reported, in 2019, on migrant workers’ access to health care in Malaysia. They found that “health care services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector.

“Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers.

“Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities.

“Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent.”

The Khazanah Research Institute in their report, on the State of Households 2020 Part III, stated “Certain segments of the working population are more vulnerable than others. Those in informal employment and foreign workers are more vulnerable to ill health due to the nature of their work. While work can expose individuals to work-related hazards, lack of work, i.e. unemployment, is a predictor of poor health.”

Covid-19 And Migrant Workers

Since the early days of the Covid-19 pandemic in Malaysia, medical professionals have expressed their concerns publicly and privately about the migrant workers being the Achilles heel in its control.

The Health Ministry’s analysis of positive cases from 1 February to 30 May 2020, found that foreigners comprised just under a quarter i.e. 1,396 (23.8 per cent) of the total of 5,889 cases.

The number of migrant workers tested monthly for Covid-19 varied from 5,059 to 8,644 between 29 June and 29 September 2020, with the positivity rate increasing 2.57 times from 29 October to 29 November 2020 (Table I).

The numbers tested weekly varied from 6,745 to 16,553 between 29 October 2020 and 27 December 2020. Since 3 January 2021, the numbers tested weekly varied from 10,328 to 78,964 which was reflective of the government’s requirement for mandatory testing of all migrant workers in the Klang Valley from 1 January, 2021. The positivity rate had increased progressively, in seven weeks, from 14.04 per cent on 29 November 2020 to 20.47 per cent on 17 January 2021 (Table II) which is 3.74 times that of 29 October 2020.

Commissions And Omissions

Although migrant workers comprised just less than a quarter of positive cases at the end of May 2020, there was no increase in the testing rates until after the end of September 2020. There was only significant increase in testing after mandatory testing in the Klang Valley was implemented on 1 January 2021.

The positivity rates, which were about 5 per cent or less until 29 October 2020, increased by 3.74 times over the 16 weeks since then to more than 20% from 20 December 2020. It is very probable that this increase reflected the increase in spread amongst the migrant workers.

Why was there no targeted testing of migrant workers from June to September 2020 when they already comprised a disproportionate number of positive cases at the end of May 2020? What were the reasons for the squandered opportunity to reduce the viral pool in the migrant workers population during these four months?

The Workers Minimum Standards of Housing and Amenities Act was passed by Parliament in July 2019 and gazetted in September 2019. The Employees’ Minimum Standards of Housing, Accommodations and Amenities (Accommodation and Centralized Accommodation) Regulations 2020 were gazetted on 28 August 2020 and came into effect on 1 September 2020.

The Human Resource Minister stated, on 3 December 2020, that 1.4 million (91.1%) of the migrant workers were provided with accommodation that was not in compliance with the legal requirements.

All this while the Health Ministry’s public message has been to physically distance; use masks; avoid crowded places, confined spaces and closed contacts; and wash hands frequently. How is this possible when the migrant workers’ accommodations are below the minimum legal requirements? Was it not known to anyone that overcrowded accommodation contributes significantly to the spread of the virus?

There have been few reports of actions taken to enforce the law on workers’ accommodation, and no reports of the impact on limiting the spread of Covid-19.

The undocumented migrant workers are another significant issue in the control of Covid-19. In the initial phase of the pandemic, they were encouraged to come forward for testing. But since May 2020, there have been arrests followed by deportation. This has led to these workers going below the radar screen. Will the SARS-CoV-2 virus disappear then?
Explanations from the authorities about the above commissions and omissions are necessary.

Do the authorities have a duty to protect public health?

Going Forward

The country is reaping what was sown.

The SAR-CoV-2 virus, which causes Covid-19, do not make any distinction between Malaysians and the migrant workers with whom Malaysians interact, in some way, in daily life, with or without the Movement Control Order.

Among the fundamental flaws in the control of Covid-19 in Malaysia are inadequate measures to control its spread among the migrant workers.
Table III provides the estimated numbers of positive cases among migrant workers according to their estimated numbers and positive rates of 14 to 26 per cent. The numbers are mind-boggling, to say the least.

The economic case for humane treatment of migrant workers in reducing the spread and impact of Covid-19 has been made out well by the Khazanah Research Institute in June 2020.

There is also a compelling health case for an urgent comprehensive plan to manage the migrant workers, whether documented or undocumented, if the country is to come to grips with the Covid-19 situation. Testing and even vaccination are only part of the solutions; improving their living conditions is even more critical. Half measures are not much better than no measures as it only scratches the surface. The root cause has to be addressed.

There is limited time to come out with solutions that can rein in the current rampaging Covid-19 situation.

Attributing the increase in the numbers of cases to the public’s compliance with standard operating procedures is pathetic especially when the public have no means to control the spread among migrant workers.

Quo vadis, control of Covid-19 in Malaysia.

Dr Milton Lum is a past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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