One of the main concerns regarding migration in the study countries relates to the neglect of human rights of migrants. Among these basic rights, access to health services is significant. The costs of modern health systems in the subregion are also a significant barrier to accessing them for the general population. For migrants, the barriers to accessing health services can be both institutional and financial. Exclusion from the formal health care system can place migrants at greater risk of illness and injury as well as exclude them from the formal medical system. The marginality of migrants means that they are often faced with the double jeopardy situation of being more likely than non-migrants to need health services, but less able to access them.
An area of particular concern with respect to denial of rights and lack of access to health services relates to temporary international labour migrants whose irregular status in the destination society can both expose them to higher risk of illness than residents and deny them access to the health services to deal with them. It has already been demonstrated that spending on health services is lower per capita in this area than any sub-region in the world. Consequently, access to health services is limited for migrant and non-migrants alike but the situation is often exacerbated for the latter.
For temporary labour migration, best practice models have helped to ensure that migrant workers have access to health services before, during, and after the migration process (Hugo 2008). In Sri Lanka, for example, migrant workers leaving under official auspices are required to contribute to a health scheme with employers. In addition, there are special programmes for departing migrants. However, for many migrants who move outside the official system, the cost of obtaining services in the destination location can be prohibitive. Cultural and linguistic barriers can also play an important role and the development of migrant-sensitive health systems is a major priority of a recently implemented World Health Organization (WHO) initiative on migrant health (Fortier 2010).
As previously mentioned, there is increasing concern about migrant women having less access to reproductive health information and services than non-migrants (Gardner and Blackburn 1996, Huntington and Guest 2002). The barriers experienced by migrants and especially refugees and IDPs in accessing these services relate to a lack of knowledge and information about how the services are organized and are able to be accessed as well as to cultural, language and financial issues. Moreover, in some cases, there may be institutional barriers to accessing services. In addition to institutional barriers, low usage of health services by migrants can be attributed to financial constraints, language barriers and not having legal status in the host location as wells as cultural factors, such as traditional health beliefs.
A common theme in the studies of health of international labour migrants is the role of high costs and illegal status as barriers to accessing health services. Gaur and Saxena (2004) in a study of Indian workers in Lebanon described their plight as follows:
Refugees and IDPs is one group that may have difficulty accessing health services. This is especially true when they are in flight, but may also be the case when they are in camps, which are often overcrowded and under resourced and may not provide adequate health services.