Under the Kafala System, migrant workers face challenges accessing healthcare

The kafala system is a legal framework outlining relationships between migrant workers and their employers. In Lebanon, migrant workers are sponsored by an employer, who directs the terms and conditions under which they work.   

According to the charity providing humanitarian medical care, Médecins Sans Frontières (MSF), this step leaves migrant workers "vulnerable to exploitation and abuse and restricts their access to healthcare."  

Based on the charity and the latest data, Lebanon hosts around 135,000 migrant workers.  

Most are from Ethiopia, Bangladesh, Sierra Leone, Sri Lanka, and the Philippines, and most are women working in private homes as domestic workers.  

"Many patients, mostly women, have highlighted the poor and unhealthy conditions in which they live and work, leading to negative impacts on their wellbeing," expressed Hanadi Syam, MSF medical referent for the migrant workers' project.  

Syam added that there is an urgent need to reform the Kafala system.  

With the rising inflation, many people, including migrant workers, now find healthcare access challenging.  

"Most of our patients who do not live in their employers' houses stay in unsanitary or overcrowded homes, and many turn to destructive behaviors as a coping mechanism," said Nour Khoury, MSF psychologist.  

"They tell us about the difficulties of coping with the socioeconomic crisis and with their daily lives, but also about experiencing violence, forced labor, and sometimes even torture," Khoury added.  

Under the Kafala system, employers are legally bound to provide health insurance for domestic workers, but this only includes hospitalization in work-related accidents. Based on MSF, this makes health services limited for many migrant workers in Lebanon.  

Further, employers often can not afford to pay their salaries, while other migrant workers are obligated to flee because they face exploitation or violence.  

Meanwhile, many migrant workers who want to be repatriated cannot leave the country without the proper documents.