An alarming number of returnee migrants and their relatives are being diagnosed with fatal diseases like HIV during voluntary testing, but there are no mandatory rules for them to undergo any screening on arrival, raising serious concerns about the country's health surveillance and medical record-keeping systems.
Around 17 million Bangladeshis migrated for overseas jobs from 1976 to 2024, an annual average of around 340,000.
As many as 15 per cent of 1,438 newly diagnosed HIV-positive individuals were returnee migrants in 2024, according to the AIDS Control Programme of the Directorate General of Health Services (DGHS).
HIV testing is a voluntary process, meaning only those who recently returned and voluntarily opted for testing were included in the list of the government survey, officials told the FE.
Moreover, spouses and relatives of migrants account for a significant portion of the 24 per cent of newly diagnosed individuals from the general population. In 2023, 17.7 per cent of newly diagnosed HIV cases were from returnee migrants and 27.7 per cent were from general population.
The real situation could be far worse, as many returnees do not go through any medical examinations after their return due to higher expenses, according to experts. As many as 57 per cent of surveyed Bangladeshi returnee migrants who were denied medical care in their destination countries borrowed Tk 90,000 on average for medical purposes, according to a recent study of Ovibashi Karmi Unnayan Program (OKUP).
The countries who hire workers from Bangladesh adhere to strict rules to make sure that no unfit individuals obtain visas. In contrast, Bangladesh doesn't follow any health surveillance mechanism when they visit home or are deported.
Senior public health expert Dr. Abu Jamil Faisal expressed serious concern over the negligence of the government health agencies concerned.
"We know some migrants, particularly women believed to be infected with HIV, return home on medical grounds. However, they do not undergo any medical examination upon their arrival, raising fears of potential transmission of deadly diseases," Dr. Faisal said.
"Medical examinations should be mandatory when migrant workers return home periodically or permanently on medical grounds. We are already late in formulating policy in this regard. If we ignore it, we would face a serious situation in the future," he said.
DGHS AIDS Control Programme also suggested establishing testing facilities in all public and private hospitals with a regular reporting mechanism.
"This situation exists not only because of ignorance but also because of a lack of understanding among officials about managing migrant issues. We have medical technical capacity but what we lack is policy support," Dr. Faisal observed.
Migrant workers are recruited as 100 per cent fit for work through 'Mandatory Health Tests', but their health is simply overlooked, their access to healthcare is often denied and they are often thrown back home (sent, deported) if they become ill, according to OKUP study.
"This is a big concern for Bangladesh," Shakirul Islam, chairperson of OKUP told the FE, suggesting a mandatory medical examination policy for the returnee migrants in coordination with destination countries.
The countries, especially in the gulf region, conduct medical examinations of the migrant workers when they reach the destinations, and before their every renewal of work permit. If destination countries in the Middle East find any major disease like HIV, they deport migrant workers within 24 to 72 hours.
"Those destination countries don't share any details of the information (disease diagnosed) with the government. As a result, they don't know the cause of return or if they are carrying any infection," Shakirul explained.
"Deported returnee workers often get married and live normally at their village homes. This makes both migrants and their families vulnerable. Furthermore, it causes a huge financial burden when they learn they require medical treatment."
The Bangladesh government must gear up its negotiation capacity with the destination countries to ensure support and health insurance for migrants. Furthermore, forced return because of disease like HIV is a violation of international law, according to the OKUP chairman.
The ministries concerned, however, are pushing the responsibility to one another over screening at the arrival of migrants.
Mohammad Shaheen, joint secretary at the expatriates' welfare ministry, told the FE that this is not a matter to be dealt with by a single ministry, adding that his ministry is not dealing with it.
"We can assure that we will extend all necessary support to establish health surveillance system for the returnee migrants," he said.
Requesting anonymity, an AIDS Control Programme of DGHS official told the FE that currently there is no screening or HIV health surveillance system for migrant workers when they visit home or are deported on medical grounds.
"The destination countries do not share any information about the cause of deportation. So, we have to remain in the dark about the health status of migrant workers. It's a massive task to run a health surveillance system for so many migrants who visit or are deported regularly," he added.
The official pointed out that while health screenings were conducted at airports during the Covid-19 pandemic, no such surveillance is currently active.
"But we are working on how to deal with the issue as it has become a serious concern," the DGHS official said, adding that a meeting is being scheduled with the ministries concerned to find a way out.
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