ABSTRACT
Some research indicates that migrants generally, and Central Asian migrants to Russia in particular, exhibit a ‘healthy migrant effect’ – that most are in good health when they arrive, but there is no effective system of medical monitoring to provide evidence of Tajiks’ pre-departure health. Once in migration, they confront several risk factors. First, accident rates are high in construction, the most common area of male Tajiks’ employment in Russia. Russia’s Federal Labour Inspectorate reports that the majority of workplace accidents, and nearly 40 per cent of deaths, occur in construction, where few even skilled workers were found to be familiar with safety regulations. Injuries among migrant workers are reportedly common, some return home as invalids, and hundreds reportedly die each year in building and road construction accidents (Olimova 2003). Work in trade, which is relatively common for women, produces injuries related to lifting and loading as well as exposure to cold in outside markets. As long as workers are informal, employers effectively bear no responsibility for health and safety conditions. Housing conditions also present risks, particularly poor, crowded, unsani-
tary living quarters. Many Tajik migrant workers – reportedly 70 per cent – live on construction sites, or in non-residential buildings and barracks or other marginal housing provided by employers. Others rent rooms or apartments, often in buildings far from the centre, sometimes with several people sharing a room and sleeping in shifts. According to both survey evidence and interview informants, it is common for migrants to live in cellars and unheated dwellings, and for as many as 20 to share an apartment. Isolation from their families potentially contributes to risky sexual behaviour. Several studies have shown low levels of information about transmission, prevention, diagnosis and treatment of common infectious illnesses (i.e. TB HIV/AIDS) (Gilpin 2012; Weine 2008). In addition, unregistered migrants are often subject to arrest and sometimes deportation; in either case they may be held in Russian prison facilities where levels of TB, including multi-drug-resistant TB, are high; xenophobic violence is also a risk. Despite these risks, there is no definite evidence that Tajik labour migrants
suffer more health problems than their non-migrating counterparts. Of surveyed migrants who have returned to Tajikistan, 11 per cent consistently reported ‘worsening of health’ as their reason for returning; and that medical care in Moscow, while preferable to that in Tajikistan because it is higher in quality, was too expensive and difficult to get without legal residence or citizenship (Hemmings 2010: 17; International Labour Organization 2010: 18). Dushanbe doctors report illnesses related to hypothermia and a rise in TB and HIV/AIDS among returnees (FIDH 2011: 16). Most of the international health workers I interviewed believed that migration produced negative health effects. However, the Tajik government’s health data does not include a separate category for migrants; studies by international organisations based on limited sampling have produced inconsistent results. My study is not premised
on a claim that migration worsens health. Rather, it has aimed to understand how health and other social service needs experienced in migration are addressed in Russia. As for social policy, my research reveals that the Russian welfare state has
become fragmented, with different populations, defined by ethnicity and political/citizenship status, having access to dramatically different levels of services and healthcare. Russian citizens and legal residents have employerpaid medical insurance and can access the public sector, though even for citizens a significant level of informality in the public system creates obstacles to access (Cook 2014). Many migrants working legally in Russia have had their rights (and rights of accompanying family members) to medical insurance curtailed since 2011, and related changes in policy and practice have restricted access for migrant women and children. Unregistered migrants have virtually no rights to the public health system beyond emergency care. Nor are NGOs able to compensate much in filling ‘gaps’ left by the state. As the chapter shows, Moscow-based NGOs’ efforts to provide health services or related advocacy for migrants appear to be few andweak. International organisations that administer global public health regimes have little leverage to affect migrants’ rights. Other migrants in the diaspora may help, but Tajiks in Moscow constitute a dispersed community; the resources it can provide appear to be ad hoc and short term, often amounting to collection of funds to send an injured or ill migrant home. When migrants do receive more and better care, focus group participants indicate that it comes either through personal connections, or the ethics of individual employers and medical professionals. There are two sets of implications for the welfare state. The first is strongly
negative. Migration has grown large, socially excluded populations in Moscow and
other major Russian cities. These marginalised populations live precariously, eroding levels of human security. Most by necessity work in informal labour markets and rely on informal social service markets, contributing to expansion of a shadow economy that the state cannot regulate, tax or to a large extent see; much of migrants’ lives are legally invisible and exempt from the state’s surveillance. The shadow economy erodes the tax base that finances the public sector. Private employers and government officials develop vested interests in persistence of informal and corrupt networks and practices. The state’s capacities to govern and allocate resources are undermined. On the other hand, the marginal status of migrants creates beneficiaries,
and arguably facilitates the labour market adjustment and welfare retrenchment that are inevitable in the current economic downturn. Migrant labour, characterized by lack of rights, minimum wage or social taxes, is cheap, benefiting employers and upper-income Russians who hire domestic and service workers. The profit migrant labour creates contributes to the social benefits of workers in the formal sector, and to some extent all with social rights. Migrants constitute a disposable labour force that has no claims on the employment system. They are highly vulnerable to economic and political
