MHADRI Member: Hassan Imam, Bangladesh

Hassan Imam

Managing Director of DEVCOM & independent migration and health consultant, Dhaka, Bangladesh

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Hassan at a seminar on migration and reintegration in Dhaka, Bangladesh

MHADRI member Hassan Imam is Managing Director of the Centre for Development Communications DEVCOM, a consultancy firm based in Dhaka, Bangladesh which provides technical support to national and international development agencies and NGOs. Hassan has been working with migration and health issues for more than 20 years, with a focus on migrant workers and health as a human rights issue for those affected by migration. He has been involved in research, capacity-building and communications across the migration and health field and in recent years has collaborated with the International Organisation for Migration (IOM), the International Labour Organisation (ILO), the United Nations Development Program (UNDP), UN Women and other international agencies in addition to his ongoing partnerships with local organisations and ministries. Hassan also works as an independent consultant and migration and health researcher.

Hassan’s migration and health research interest began in the mid-90s, with a focus on the sexual and reproductive health of migrant workers. From this period until the mid-2000s a significant amount of funding was available for migrant-health-related research and initiatives in Bangladesh, particularly those relating to HIV/AIDS. However, in recent years a significant decrease in funding opportunities for this area of research has resulted in less opportunities for investigating and improving the health of those affected by migration. The gaps in migration and health research, Hassan explains, are a symptom of a lack of interest and, subsequently, funding.

“The problem is that my work is related with existing opportunities. The organisations are mainly focusing on migration, human rights, recruitment … but few organisations are focusing on the health issues of migrant workers.”

Hassan’s work focuses primarily on labour migration from Bangladesh. While, in the past, the national migration and health focus has been on migrant sexual and reproductive health, more recently studies have been looking at the ‘re-integration’ of migrant workers and the psychosocial effects of migration on those returning to Bangladesh. For Hassan, the lack of occupational health and safety for migrant workers is a major concern as, when people migrate from their home country, they’re often unaware and unprepared for the reality and risks at the destination. Hassan is worried about the glaring absence of much-needed research on the occupational health and safety risks for migrants travelling to other countries for work, and feels that a major issue in need of addressing is the lack of training and orientation supplied before people migrate. Hassan also raises the mental health of migrant workers returning to their country of origin as an issue in need of urgent attention. Despite high rates of suicide linked to issues migrant workers experience in ‘re-integrating’ these issues are yet to be addressed by any service providers or government initiatives.

However, Hassan is optimistic about the future of migration and health governance in Bangladesh. Laws, policies and departments focused on migration have been developed in recent years, but despite satisfactory progress in many areas, the prioritisation of migration and health issues is still absent. As one of the highest migrant-worker-sending countries, it is essential that the government and the private sector collaborate to meet the needs of migrant workers. Hassan runs training programmes and participates in migration-related and health-related workshops run by various supranational agencies and NGOs, using these platforms to raise awareness about migrant health issues.

“For the last 20 years I have been working with migration, and definitely I have a responsibility as a student of public health, so I think that these are the areas I should always raise whenever I have the opportunity.”

Hassan finds migration and health data and resources “sporadically” as there is no centralised system presently available for sharing information and ideas. In order to improve access to data and resources, and information sharing about ongoing and published research, Hassan recommends establishing a central depository under the mandate of the UN or the IOM. He suspects that coordination between different organisations, government departments and agencies will be challenging, but believes that establishing these linkages is essential to improving migration and health research and governance.

Hassan reviewed the draft report on the Global Compacts – on Refugees and on Safe, Orderly and Regular Migration – in January, and harbours doubts about the effectiveness of these Compacts.

Although [the Global Compact on Safe, Orderly & Regular Migration] focuses on the rights of migrant workers … it has limitations on the rights issues as they are not addressed adequately in the document. It is not clearly articulated [in the Compacts] what would be the role of destination countries. For example, Bangladesh is a low-HIV-prevalence country, but if you look at the data more than 70% of people living with HIV are either migrants or a member of their family is a migrant. How did this happen? Healthy migrant workers who migrate from Bangladesh are getting HIV in the destination country, but when they return home Bangladesh is taking responsibility for the health care of the migrant workers, but there is no responsibility of the country of destination. I expected that the responsibility of the countries of destination should be clearly reflected in the document, but I found that was missing.”

Hassan believes that despite these limitations, the Compacts are important for a country like Bangladesh which cannot depend solely on bilateral agreements.

For example, we have Memorandums of Understanding (MOUs) with [influential] countries like Saudi Arabia who [are often able to push their agenda further than smaller] countries like Bangladesh can. When the GCM is there, Bangladesh is getting the opportunity to raise these points at the multilateral forum. That’s why the GCM is definitely very important for Bangladesh… but it has to be legally binding for all countries somehow. Otherwise it will not be effective”

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Hassan with his DEVCOM team members and young researchers

Hassan’s professional network has been significantly shaped by his involvement with organisations such as CARAM Asia (Coordination of Action Research on AIDS and Mobility), MFA (Migrant Forum in Asia), BCSM (Bangladesh Civil Society on Migration) – a network of civil society organisations (CSOs) working on migration issues in Bangladesh. Through events and conferences hosted by these organisations Hassan has been able to build a network of migration and health colleagues across South Asia with whom he can consult and collaborate. Hassan is also connected to a network of journalists and reporters concerned with migration issues in Bangladesh. While he is not a member himself, Hassan has regular communication with this network, sharing his research and making use of communication channels to disseminate information and improve public awareness about migration and health issues.

Hassan is confident that if migrant health issues were to become a major public health concern for the government of Bangladesh then funding would soon become available for research. At present, the IOM is working with Rohingya refugees, and Hassan is hopeful that as part of their Knowledge, Attitudes and Practice (KAP) study migrant health will emerge as a key area for concern, encouraging action from the government. While Bangladesh has made significant progress in improving various health outcomes across the general population, the many actors – national and international -working on health issues in Bangladesh are not focusing on the relationship between migration and health. This is also reflected in an IOM study Hassan has recently collaborated on concerning labour migrants preparing to depart from Bangladesh. While Hassan hopes this study will measure the extent to which the health of participants is affected by their migration to the destination country and then back to the country of origin, the health of labour migrants is not the focus of the study, it is only one aspect. Hassan calls for studies focused purely on the nexus between migration and health, particularly as cross-border labour migration continues to increase.  The lack of opportunity to focus on migration and health issues exclusively has been a key motivation for Hassan to join the MHADRI network.

Hassan joined MHADRI after the network was suggested to him by a friend working with the IOM. Upon learning that MHADRI was specifically focused on migration and health issues, Hassan eagerly applied. Hassan has high hopes for the future of the MHADRI network, particularly relating to the potential for the network to connect researchers across regions and equalise the findings of early-career and global south researchers with those generated by established and global north researchers. The most important function of a network like MHADRI, according to Hassan, is to ensure that the benefit goes to those affected by migration.

“It is important that what we learn from the researchers and from the data base and other information sources can be brought to the migrants at the grass roots level.”

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Hassan as an ILO facilitator at the BAIRA (Bangladesh Association of International Recruiting Agencies) members Capacity Building Workshop

Hassan was interviewed in October 2018 by MHADRI Research Assistant and intern Holly McCarthy as part of a scoping exercise with leading migration and health researchers based in the global south.

This scoping exercise aims to

  • map what is accessible and available in terms of migration and health data and research
  • identify gaps in migration and health research across different regions
  • collate the views of leading researchers on the most pressing issues in migration and health governance in their region

We envisage publishing a summary of this initial scoping in some form, and will be posting more profiles like this on the work and reflections of leading migration and health researchers.

If you are interested in taking part in this exercise please contact us.

MHADRI Member: Dr Renuka Jayatissa, Sri Lanka

Dr Renuka Jayatissa

Head of the Department of Nutrition, Medical Research Institute of Sri Lanka
Colombo, Sri Lanka

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Dr Renuka Jayatissa is Head of the Department of Nutrition at the Medical Research Institute of Sri Lanka. While Renuka has always conducted nutrition and public health-related research, her interest in migrant health stems from her involvement in studies of internally displaced populations in the wake of the 2004 tsunami disaster. While Renuka’s work is primarily focused on the health of internal migrants – including those forced to move to due to the civil conflict in Sri Lanka- in recent years she has increasingly engaged with the area of cross-border migration. Renuka collaborates with various agencies and organisations working on migration and health issues in Sri Lanka and South Asia more broadly, particularly with MHADRI Secretariat Dr Kolitha Wrickramage at the International Organisation for Migration (IOM) who, last year, recruited her to join the MHADRI network.

During her time working for UNICEF, Renuka developed a broader understanding of the migration and health challenges experienced in different global south regions – particularly South Asia and parts of East and Southern Africa. Whenever she conducts national studies, Renuka includes migration as a variable in order to collect and compare data on the health outcomes of migrant populations. Renuka looks at nutrition status across different population groups but is concerned about the lack of studies of the overall health of people affected by migration in Sri Lanka. She stresses the importance of not only considering the health and wellbeing of those who migrate, but monitoring the health of the children left behind and the relatives who care for them. So far, Renuka’s studies of the nutrition status of migrants have revealed that nutrition levels are not too dissimilar to that of native populations, however, without targeted research that considers all aspects of health it is difficult to further understandings of health behaviours, challenges and risks for migrant populations in Sri Lanka.

While the government appears, on the surface, to be proactive about migration and health issues – as evidenced by numerous regulations and policies – Renuka questions to what extent these regulations and policies are actually implemented. Concerned about the effectiveness of these efforts, Renuka posits that monitoring and evaluation of existing programmes should be carried out in order to measure how these policies and initiatives are performing. A monitoring and evaluation framework could be the missing piece in the puzzle of migration and health governance in Sri Lanka.

Renuka observes that Sri Lankan government ministries often follow the lead of international agencies such as World Health Organisation (WHO), meaning that documents such as the Global Compacts – on Refugees, and on Safe, Orderly & Regular Migration – have potential to refresh the government’s  focus on migration issues and can, hopefully, improve migration governance.

“Sometimes in government we are very monotonous and go in the uniform direction, so it is good when [external actors] bring new ideas to reimagine and restructure our programmes.”

However, Renuka remains apprehensive about the relevance of the Compacts across different contexts. For her, the Compacts illustrate an intention to influence countries when it isn’t always necessary given that migration challenges vary considerably from region to region.

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Regional Nutrition conference in Korea with Nutrition teams

 

Renuka and her colleagues are pushing for a greater focus on migration in health policy and research and the consideration of health and wellbeing in migration management. In order to achieve this, Renuka takes part in various forums relating to internal migration issues, and shares research and ideas relating to public health and the health of those affected by migration.

“Because I am working for the Ministry of Health, I have access to all the committees … so I can always raise my voice, even up to the President level.  We write to newspapers, run workshops, start awareness programmes and appear on television in order to leverage policy makers and raise awareness with the general public.”

At present, migrants are largely ignored in research and policy, but Renuka is optimistic about the potential for “strong evidence”, gathered from scientific research, to affect positive change. In the 20 years Renuka has been working as a researcher, she has found that people do not argue with evidence and if migration and health challenges are to be taken seriously and acted upon, then compelling data needs be collected and shared. She believes that improving access to data and research is essential to shaping domestic and international policy.

“It’s much easier to inform policy action and convince people when you have strong evidence, otherwise it can be dismissed as a ‘perceived’ issue.”

Though demographic and health (DHS) surveys in Sri Lanka collect useful data, for those studying migration and health this resource is relatively limited as the DHS doesn’t factor in migration or mobility. Renuka feels that if the DHS surveys were to consider migration then it could be a valuable resource for scholars in this field. However, when it comes to improving access to peer-reviewed literature and published research Renuka is confident that a central database could address some of these barriers.

“Sometimes when you are searching it is very hard to find [what you’re looking for]. I know I have half a paper sitting on my computer which I have not been able to complete … but it is very difficult to find the literature. Sometimes you do the work but you get stuck with the discussion because you can’t really find much literature for that. So, it’s a very good idea to have a kind of central database, at least some abstracts or something, so it is easier for people doing migration-related research so they have more access, that would be a great idea actually.”

In terms of staying up-to-date with migration and health research in Sri Lanka, Renuka explains that people in the field tend to know each other and try to meet at least once a year to exchange ideas and research. For Renuka, networks are a key tool for accessing and disseminating research and data.  She is a member of formal networks in the health field, such as the Sri Lanka Medical Nutrition Association, though networks relating to migration and health specifically are less formal.

“We have a network within Sri Lanka. The National Science Foundation tried to do the official kind of network, but in addition to that people have unofficial networks because we meet each other in our professional forums. Even within the Ministry of Health we have a very good networks, and if anyone is doing research within the Ministry we will know.”

Through Renuka’s connection to the IOM she has been able to connect with others working on migration and health issues, something she believes gives her the necessary exposure to different methods and knowledges.

“It is good to see the research others are doing and see how you can do the same kind of research in your country. It’s very useful to learn from each other, then we can compare and improve together.”

Renuka identifies networks as one of the most helpful tools for early-career researchers, and believes that getting involved by coordinating events to link new and established researchers together is an important role early-career researchers can fulfil. Given that established researchers are often very busy and don’t have time to organise such events, Renuka is optimistic that early-career researchers can benefit in the long-term from investing their time in strengthening existing networks.

A network like MHADRI is full of experts and Renuka believes that there is potential not only for established researchers to share their experiences and ideas with one another, but for early-career researchers to receive much-needed mentoring. Renuka hopes that the MHADRI network can be catalyst for joint research ventures which measure and compare migration and health issues in different regions, enabling countries to learn from each other, shaping migration and health governance to ultimately improve health for all.

Dr Renuka Jayatissa can be contacted here .

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Dr  Jayatissa and Dr Kraus Karmer at the 2017 Scaling Up Nutrition Movement Global Gathering, Ivory Coast

 

 

Renuka was interviewed in October 2018 by MHADRI Research Assistant and intern Holly McCarthy as part of a scoping exercise with leading migration and health researchers based in the global south.

This scoping exercise aims to

  • map what is accessible and available in terms of migration and health data and research
  • identify gaps in migration and health research across different regions
  • collate the views of leading researchers on the most pressing issues in migration and health governance in their region

 We envisage publishing a summary of this initial scoping in some form, and will be posting more profiles like this on the work and reflections of leading migration and health researchers.

If you are interested in taking part in this exercise please contact us.