Catriona Fraser-

Migrant workers from South and Southeast Asia are facing egregious human rights violations by health and social care companies headquartered in the Global North.

At the Business & Human Rights Resource Centre, we have been tracking cases of abuse in the care sector, and found that 80 percent of cases over the past two years impacted workers from Asia, predominantly women from the Philippines and India. Our data echoes warnings by NGOs, unions, journalists, government advisors, and academics of increasingly frequent care worker abuse. When analyzed further, we found most violations took place in the United Kingdom (65 percent) and the United States (20 percent). While blame tends to focus on state policy failures, companies must also urgently take responsibility to identify, prevent, mitigate, and account for rights violations in their operations in line with international standards.

This is more important now than ever before. Demographic changes are augmenting demand for care in the Global North, yet acute labor shortages have increased reliance on recruitment from the Global South. This reliance is partly dependent on migrants forced to accept worse conditions for lower pay amid acute and rising inequality between the Global North and South. Failure to address rights risks will lead to more and more cases of abuse, further exacerbating racial and gender inequalities.

Abuses Experienced by Asian Migrant Care Workers

Since January 2022, our research has found that the most common abuses reported by migrant care workers were the charging of recruitment fees (54 percent of cases) and restrictions on workers’ freedom of movement (46 percent of cases).

Migrant workers from the Philippines and India reported paying colossal fees, up to 25,000 pounds ($31,466) for employment, including for the related costs of visas, flights, and training, which is in breach of international fair recruitment principles. Often, these fees were charged by agencies in origin countries, where fee charging is legal and rampant. However, this practice is not legal in the U.K. or U.S. Care companies at the top of supply chains in both nations are evading responsibility for the charging of recruitment fees by shifting blame to recruitment agents and sub-agents in origin countries.

Recruitment fees are also paid to companies headquartered in the Global North, including reports of cases in which illegal fees have been split with U.K. care operators. Shockingly, some U.K. care companies have baked profit from recruitment fees into their business models, with workers alleging “they just want to make money selling visas.” While such practices are illegal, enforcement is an issue, with the risk of labor inspection so rare that often businesses embed the costs of breaching laws into their business plans.

To address the governance gap created by differing laws in origin and sending countries, as well as inadequate law enforcement, a first step for companies dependent on migrant labor is to undertake effective human rights due diligence that considers recruitment risks specific to the workers’ country of origin, including the risk of unscrupulous agents offering employment under false pretenses, a widely documented practice. Companies must also prevent and remedy fee charging by implementing the Employer Pays Principle.

Once in the destination country, workers commonly report restricted freedom of movement due to the misuse of repayment clauses – a feature of the industry in both the U.S. and U.K. Workers were charged inflated costs (up to $25,000) by U.S. and U.K. companies if they chose to leave employment  – including illegal charges, such as the predicted future profit lost.

Since it prevents workers from leaving employment, debt from loans taken to pay fees and the threat of repayment clauses increase workers’ vulnerability to other violations. Workers report being unable to leave mold-clad accommodation without basic cooking facilities or heating. They have also experienced excessive workloads including 20-hour work days, seven days a week, threats and intimidation from management, and systemic wage theft. In many cases, workers emphasized how these poor working conditions meant they were unable to deliver adequate care.

Chief Causes

There are a number of factors that have exacerbated the frequency of these abuses. First, the privatization and financialization of the care sector has led to profit becoming the key metric of success, overshadowing care quality and employee treatment. Local authorities are increasingly distanced from care workers due to outsourcing. The use of “flexible” contracts, including through labor suppliers contracting workers to care companies, has made care work precarious, irregular, and at times akin to zero-hour contracts.

Poor conditions are also driven by surging private equity investments, whereby the hollowing out of care services erodes working conditions through intense profit-maximizing strategies. Money-saving tactics lead to chronic understaffing, mass layoffs, and pay cuts. Private equity firms were linked to cases of abuse in our database, including CareTech (owners of Cambian Group) and Active Care Group.

Immigration policies increase migrants’ vulnerability to abuse. In the U.K., care workers are tied to a sponsoring employer, making them dependent on their employer for their visa status. This reduces the likelihood of grievances being aired amid the threat of deportation.

But these abuses go beyond immigration policy – both the payment of recruitment fees and the misuse of repayment clauses are enough to trap workers in exploitation. In the U.S., for example, abuses persist for Filipino migrant nurses despite the fact their visas enable them to change employers.

A Lost Opportunity?

Care worker migration could be a “win-win-win” scenario: workers from across Asia find opportunities for career development, acute labor shortages in the Global North are relieved, and sending countries receive remittances that can boost development.

Instead, migrant workers from South and Southeast Asia are left traumatized from abuse, while recruitment fees eat away at remittances with consequences for entire families and communities back home. In turn, the quality of care provided in receiving countries is compromised as staff are overworked and under-valued.

Health and social care companies at the top of supply chains have the leverage and responsibility to create change, filling the gap left by governments that fail to protect migrant workers. They must work urgently to identify, prevent, mitigate, and account for rights violations against all migrant workers employed in their operations and supply chains.