Re: Tuberculosis and Migration in the Gulf States
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Treatment Action Group is an independent AIDS research and policy think tank fighti ng for better treatment, a vaccine, and a c ure for AIDS. TAG works to ensure that all people with HIV receive life saving treatm July 13, 2015 ent, care, and information.
To: XXXX From: Treatment Action Group Re: Tuberculosis and Migration in the Gulf States
Overview The United Arab Emirates and Qatar rely heavily on an immigrant work force to feed their growing economies. Both countries have policies in place to perform health screenings on individuals who secure work in the countries to ensure that these relocating workers do not pose a public health risk to the populations with which they interact. However, in contrast with global public health guidance and policies, these countries’ current policies appear to allow for termination of employment, detention, and deportation of migrant workers who have X-rays that present with lung scars that
261 Fifth Ave., Suite 2110, New York, N.Y. 10016 Tel 1.212.253.7922 Fax 1.212.253.7923 www.treatmentactiongroup.org reflect TB lung scars.12 As such, many people are being forced to leave their work and homes due to unfair policies not based in good science or public health.
About Tuberculosis Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs (pulmonary) but can affect other parts of the body as well (extra-pulmonary). TB is spread via airborne transmission when someone sick with pulmonary disease expels bacteria, typically by coughing. The World Health Organization estimates in its 2014 Global Tuberculosis Report that there were 9 million new TB cases in 2013 in addition to 1.5 million TB deaths.3 The WHO also estimates that roughly one-third of the world’s population has latent TB.4 A person with latent TB usually has a skin test or blood test that indicates infection, but has a normal chest X-ray and negative sputum test, does not feel sick, and cannot spread TB to others. In contrast, a person with active TB disease usually has a skin test or blood test that indicates infection, and also may have an abnormal chest X-ray or positive sputum test. The individual usually feels sick and experiences symptoms including coughing, fever, and weight loss, and has the potential to spread TB disease to others.5
However, TB is both preventable and curable. Someone with a past history of TB may have scars appear on their X-rays from previous damage done to the lungs, even though they have been cured and actually do not even carry TB infection, and are not sick or infectious. As such, relying on an X-ray to diagnose TB disease is not the standard of care. Instead, patients suspected of having pulmonary TB should have sputum specimens submitted for smear microscopy or a single sputum specimen for Xpert MTB/RIF testing in a lab.6
A Cry for Help Many affected migrant workers have commented on an article on this issue that was run in 2014 on TBOnline.info, a website that Treatment Action Group (TAG) helps administer (see Appendix 1, or the original posts via footnote).7 There have been more comments on this article than on any other published on the website, indicating the importance and urgency of the issue. Readers continue to comment, and their urgency and readiness for mobilization, as well as lack of avenues for influencing policy, are apparent.
Progress So Far One vocal affected person, Mr. Charanjeet Singh, who was deported from Dubai in the United Arab Emirates in February 2013, has been campaigning for these termination and deportation policies to end.8 His campaign has attracted some media coverage, but it does not appear policymakers have reacted.
While working on TB-related issues of migration and employment is outside of TAG’s mandate, TAG has taken some steps to explore channels for potentially influencing these unjust, discriminatory, and scientifically unfounded policies. TAG has contacted a number of parties – Human Rights Watch, Harvard Medical School, Lawyers Collective, Canadian HIV/AIDS Legal Network, and the University of Chicago – however those that have responded appear unable to assist Mr. Singh personally and their efforts to tackle the issue as a whole have not gained ground (see Appendix 2 for an archive of these communications).
Many others have taken to the Internet to share their experiences in the United Arab Emirates. One Pakistani woman created a petition calling for a change to the U.A.E.’s policies.9 A number of individuals have written similarly and expressed sympathy on a website called Expat Blog, a website dedicated to living abroad.10
1 http://www.hrw.org/middle-eastn-africa/qatar 2 https://www.hrw.org/middle-east/n-africa/united-arab-emirates 3 http://www.who.int/tb/publications/global_report/en/ 4 http://www.who.int/mediacentre/factsheets/fs104/en/ 5 http://www.cdc.gov/tb/publications/factsheets/testing/diagnosis.htm 6 https://www.thoracic.org/members/assemblies/assemblies/mtpi/resources/istc-report.pdf 7 http://www.tbonline.info/posts/2014/5/12/dubai-deporting-foreign-workers-based-flawed-tb-sc/
8 https://www.change.org/p/heights-of-discrimination-against-indians-in-dubai-united-arab-emirates 9 https://www.change.org/p/dubai-health-authority-stop-deporting-latent-tuberculosis-patients 10 http://www.expat-blog.com/forum/viewtopic.php?id=122523&p=3 Regardless of how they communicate, it is clear that many others echo Mr. Singh’s story of hoping to make a life in the U.A.E. Another thing is also clear. Their voices are either not heard or they are ignored by decision- makers who hold the power to impact change.
A Call for Action It is our hope that another group with the appropriate network, experience and resources will take over this very important human rights issue to advocate for better policies to be put in place. Specifically, policies should be revised to ensure that 1) TB screening consists of appropriate testing, and that 2) if evidence of active TB disease or TB infection is found, an individual receive treatment rather than deportation for this illness, and be able to continue working once confirmed to be non-infectious.
TAG will be happy to serve as a resource on the health and technical factors as work progresses. Should this work involve interviews or other contact with affected persons, TAG is also able to provide contact information for those who have commented via TBOnline (upon receiving their consent to share such information). Appendix 1: People affected by regressive TB and migration policies commenting on TB Online
Country Date Contacted Comment (Claims TB Online Email Address Permission Made By User) Username to Contact
1 U.A.E. 5/22/2014 Unable to stay in A. I. Shaikh [email protected] Dubai after test, cured of TB. 2 U.A.E. 11/5/2014 Deported in 2008 Joe for pneumonia scar. 3 12/26/2014 Deported in 2014 Marvin [email protected] without TB history. 4 2/2/2015 Waiting for result. Kumar Ravish [email protected] 5 U.A.E. 2/6/2015 Waiting for result. Prakash [email protected] 6 U.A.E. 2/9/2015 Brother has scar but Princy Chacko [email protected] no TB history. Asks if he can work. 7 2/13/2015 Deported for old TB Nilofer [email protected] scar, is healthy. 8 2/20/2015 Deported for scar, varat [email protected] warns others they will be deported. 9 2/24/2015 Banned for Brian [email protected] pneumonia scar. 10 3/6/2015 Deported for old TB nadia [email protected] scar, does not have active disease. 11 U.A.E. 3/14/2015 Deported for lung diana [email protected] scar, no detail given on its cause. 12 U.A.E. 3/17/2015 Deported in 2014 pratip [email protected] for scar. 13 U.A.E. 3/19/2015 Told he has active Jim [email protected] TB and needs to be cured in isolation. 14 Qatar 3/21/2015 Banned for lung scar abdul [email protected] but no TB history. 15 3/28/2015 Question not R j [email protected] comprehensible. 16 U.A.E. 4/4/2015 Plans to go to U.A.E. kyrie [email protected] but has lung scar. 17 Qatar 4/6/2015 Had TB, was rajeev parmar [email protected] deemed medically unfit but not sure this was due to TB scar. 18 U.A.E. 4/9/2015 Banned for lung scar belinda [email protected] but no TB history. 19 4/13/2015 Banned for lung Mohammad mohammadamarhussain@yaho scar. Not sure if Amar hussain o.com previous TB. 20 Oman 4/21/2015 Banned for lung vasu [email protected] scar. 21 5/5/2015 Banned for lung Shahid [email protected] scar. Nadeem m 22 U.A.E. 5/5/2015 Banned for life, even Janne [email protected] from tourism. 23 5/12/2015 No information in irshad [email protected] post. Assume lung scar. 24 U.A.E. 5/16/2015 Had TB, family Kurdaps [email protected] encouraging her to go for work. 25 U.A.E. 5/20/2015 Had scar but was Naeem [email protected] tested for TB. Test was negative and he was cleared to work. Says to speak up to the doctors. 26 5/21/2015 Lost two chances to Mohammed [email protected] work. No other Mustafa information. 27 U.A.E. 5/22/2015 Deported in 2015 wasif nazir [email protected] for old TB scar. 28 5/28/2015 Sister had sputum mona [email protected] test, waiting for results. 29 5/31/2015 Got approval even AK47 [email protected] with TB scar. 30 U.A.E. 6/2/2015 Banned for lung scar jovari [email protected] but no TB history. 31 6/3/2015 Advocates for work Bong [email protected] in Singapore. 32 U.A.E. 6/5/2015 Banned for old TB Donnie [email protected] but claims no history. 33 6/12/2015 Offers support. bittu 34 U.A.E. 6/13/2015 Comment not Syed zaheer [email protected] comprehensible. hussain shah 35 U.A.E 6/16/2015 Has TB scars, has Anita Singh [email protected] not had medical checkup yet. 36 U.A.E. 6/21/2015 Husband has lung Shalini [email protected] scar but not TB history. Not yet banned. 37 U.A.E. 6/25/2015 Has old TB scar nad AKK [email protected] has checkup every 3 months, allowed to work. 38 U.A.E. 7/3/2015 Has lung scars, Bella [email protected] awaiting decision. 39 U.A.E. 7/4/2015 Looking for x-ray Batman [email protected] facility to go to. 40 U.A.E. 7/9/2015 Has lung scar, says Lakshmi [email protected] that people are reviewed case-by- case now. 41 7/10/2015 Posts link to share Scars Ban [email protected] information 42 U.A.E. 7/10/2015 Given 9 month ban. Sandhya [email protected] 43 U.A.E. 7/12/2014 Posts petition. Charanjeet [email protected] Singh Appendix 2: TAG’s correspondences with other parties concerning Charanjeet’s story
2.A Correspondence with Charanjeet Singh
From: Charanjeet Singh
Dear Erica,
My name is Charanjeet Singh, i received your reference from Alberto and i thought to speak to you regading my issues .As already mentioned in my trail , luckily my issue is been published by gulf news yesterday and a couple of other news papers.But no hope yet from anywhere.Also had an interview with P7 news personally at my home to tell them about the discrimination happened with you.And it came in news channel also.
I did launched a petition to encircle the brutalization of gulf countries especially Dubai.
Kindly support .
Gratitude Charanjeet Singh
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From: Erica Lessem
Dear Charanjeet,
I am so sorry to hear of your unfair and frustrating experiences. I am going through the links you sent and will try to think of some next steps to address this. Tell me, is your goal to get permission back into UAE? Or are you happy to stay in India, but want these discriminatory and nonsensical policies to change for the benefit of others?
Best, Erica
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From: Charanjeet Singh
My first goal is to back to UAE and work .
I do like to change it for others so that they may not suffer like me. Only the wearer knows where the show pinches.I felt pain and i knew it better who else will ?
2.B Correspondence with Anand Grover (Lawyers Collective)
From: Erica Lessem
Dear Anand,
Greetings from TAG! I hope you are well. I am writing as an urgent case of a discriminatory policy has recently come to TAG's attention, and I was hoping you may be able to help. Mr. Charanjeet Singh was deported from the UAE back to India for having what was deemed "TB scars." He has been confirmed to be tuberculosis-free by doctors in India. Moreover, he never even received paperwork from the UAE to validate what they claim to have found in him. He has had articles written about him (e.g. http://gulfnews.com/news/gulf/uae/general/man-deported-for-old-tb-scar-cries-foul-1.1222836).
But he has not yet been successful in gaining permission to return to the UAE to work, or in changing this discriminatory policy to prevent the same thing from happening to countless others like him.
Would you be able to help this case? If not, would you have other recommendations of where he should seek assistance?
Mr. Singh is copied on this email and his number is +91 9560728263, so please feel free to be in touch directly.
Many thanks in advance, and best regards, Erica
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From: Anand Grover
I can certainly make an urgent appeal. Please send a complaint to me and copy my assistants, who are copied on this email.
2.C Correspondence with Salmaan Keshavjee, Ankur Asthana, and Suchitra Kulkarni (Harvard University)
From: Erica Lessem
Hi Salmaan + Ankur + Sue,
Hope you are well.
I'm reaching out with a TB issue that's come to our attention that I think you all might be better equipped to deal with (or know someone who is) than us.
As you know, many South Asians migrate to Gulf States to work. Apparently, many of these places have discriminatory policies in place where they terminate employment of, detain and even deport migrant workers who have x-rays that reflect TB scars, even in the absence of active TB or positive TST. It is a huge issue, and one that's attracted more comments (and some very upsetting ones) than any other post on the news site TBOnline.info--see comments here: http://www.tbonline.info/posts/2014/5/12/dubai-deporting-foreign- workers-based-flawed-tb-sc/ One man, Charanjeet, has been campaigning for these policies to end, and some media coverage has been attracted, but no change in sight (http://www.gopetition.com/petitions/a-true-story-of-a-victim-of-dubai- united-arab-emirates.html) This population is so dis-empowered to advocate for their rights to stay and work in these countries, and I think they really need someone to go higher up on their behalf.
This is unfortunately outside of TAG's purview, as we don't have a network or other connections in the Gulf States. Also, working on TB-related issues of migration and employment, while important, are just outside of our mandate. We've contacted Brian Citro, Lawyers Collective and a few others about this issue but they didn't have capacity to work on it or really connect us to other groups who might.
Given all the work you've been doing in Dubai, and the interest in expanding their involvement with the Cities project, I'm wondering if there's a gentle way you guys could do some advocacy to encourage them to lead on TB not only in funding other cities, but in changing a policy there and getting other Gulf States to follow suit?
Let me know what you guys think, we're happy to send more background info or a briefing doc if it would help kick things off.
All the best, Erica
2.D Correspondence with Richard Elliott (Canadian HIV/AIDS Legal Network)
From: Erica Lessem
Dear Mr. Elliott,
Greetings from Treatment Action Group. I am writing as an urgent case of a discriminatory policy has recently come to TAG's attention, and I was hoping the Canadian HIV/AIDS Legal Network may be able to help.
Mr. Charanjeet Singh was deported from the UAE back to India for having what was deemed "TB scars." He has been confirmed to be tuberculosis-free by doctors in India. Moreover, he never even received paperwork from the UAE to validate what they claim to have found in him. He has had articles written about him (http://gulfnews.com/news/gulf/uae/general/man-deported-for-old-tb-scar-cries-foul-1.1222836) and started a petition (http://www.change.org/en-IN/petitions/heights-of-discrimination-in-dubai-d-h-a). But he has not yet been successful in gaining permission to return to the UAE to work, or in changing this discriminatory policy to prevent the same thing from happening to countless others like him.
Would you be able to help this case? If not, would you have other recommendations of where he should seek assistance?
Many thanks in advance, and best regards, Erica
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From: Richard Elliott
Hi Erica, Charanjeet and others: I don't think we're in a position to be of much assistance, I'm afraid. We're in neither of the jurisdictions in question, aren't in a position to provide legal advice on an individual case about UAE law, and don't really have any particular connections or traction with UAE officials.
If the goal is to get back to UAE and work, then I think you need to get connected to a lawyer there who can assist with the necessary paperwork and procedures (including a possible appeal, since it sounds like that is probably necessary). If, either just to assist with this particular case or to effect broader change), you want to get some sort of international support around this particular instance, I'd suggest contacting UNAIDS, the Office of the UN High Commissioner for Human Rights, and perhaps the International Union on TB and Lung Disease for some support and perhaps expression of concern to the UAE authorities. You might also consider an appeal to the UN Special Rapporteur on the right to health, whose contact info is available on the website of the OHCHR.
I hope this is useful.
Richard
2.E Correspondence with Brian Citro (The University of Chicago)
From: Lindsay McKenna
Hi Brian,
Hope this finds you well! I am reaching out in hopes that you or someone you know can help organize around a discriminatory policy that has recently come to TAG's attention.
We posted an article to TB Online about Charanjeet Singh, who was deported from Dubai as a result of an immigration policy, UAE Federal Law No 28/2010, which states that "new visas with old pulmonary tuberculosis or active pulmonary tuberculosis are to be considered unfit by law" and have since received a ton of comments from others who have experienced the same.
Here is a link to the post on TB Online, where you can see all of the comments coming in: http://www.tbonline.info/posts/2014/5/12/dubai-deporting-foreign-workers-based-flawed-tb-sc/
If this is an issue you or your colleagues would be interested in taking on, I can put you in touch via e-mail with Charanjeet and the individuals who have reached out to us through TB Online.
Looking forward to hearing from you.
Best, Lindsay
2.F Correspondence with Iain Levine (Human Rights Watch)
From: Iain Levine
Thanks
Iain
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From: Erica Lessem
Tamar, thank you for putting us in touch!
Dear Iain, thank you so much for the fast response and your offer to connect me to your colleagues. I'm director of the TB/HIV project here at Treatment Action Group, and we've been hearing from a lot of migrant workers affected by discriminatory policies in UAE and Qatar regarding past history of tuberculosis (TB).
These policies appear to allow for the termination of employment, detention and deportation of migrant workers who have X-rays that reflect TB scars, even in the absence of active TB disease or evidence of TB infection.
As you may know, TB is an infectious disease that primarily affects the lungs. However, it is both preventable and curable. Someone with a past history of TB may have scars appear on their X-rays from previous damage done to the lungs, even though they have been cured and actually do not even carry TB infection, and are not sick or infectious. As such, relying on an X-ray to diagnose TB disease is not the standard of care. Nevertheless, it appears many workers are losing their employment and status as a result of TB scars appearing on their X- rays.
We've received a lot of comments (and some very upsetting ones) on the website we support, TBOnline.info that featured an article on this issue (in fact, we've gotten more comments on this than any other article featured on the site). One affected man, Charanjeet, has been campaigning for these policies to change, and some media coverage has been attracted. We tried to support with a few appeals via the UN Special Rapporteur and the WHO EMRO office, but it does not appear things are moving, and this is unfortunately outside of TAG's mandate, so we cannot pursue.
Given the overlap of health, migration, and human rights, and your excellent work on similar issues in these countries, we're hoping that HRW may be interested and able to explore these issues and advocate for more sound, just policies.
We'd be happy to send more background info or a briefing document in the next week or two if it would help. If this is an area HRW would be able to pursue, we can also provide contacts for affected persons who can speak first-hand to these issues, and we'd also be happy to act as a resource for any of the TB-specific questions as needed.
Thanks again, and best regards, Erica