Rising heat, failing kidneys: Climate’s hidden toll on migrant workers – grist.org

Report on the Intersection of Climate Change, Migrant Labor, and Public Health in Nepal

Executive Summary

This report examines the escalating public health crisis of Chronic Kidney Disease (CKD) among Nepalese migrant laborers returning from the Persian Gulf. The condition is directly linked to occupational heat stress, a consequence of climate change and inadequate labor protections. This crisis highlights critical challenges to achieving several Sustainable Development Goals (SDGs), including SDG 3 (Good Health and Well-being), SDG 8 (Decent Work and Economic Growth), SDG 10 (Reduced Inequalities), and SDG 13 (Climate Action). The findings indicate a systemic failure to protect vulnerable workers, resulting in a transfer of healthcare and economic burdens to low-income nations like Nepal.

Analysis of Key Sustainable Development Goal Challenges

SDG 3: Good Health and Well-being

The prevalence of CKD among returning migrant workers represents a significant threat to public health and undermines progress toward SDG 3, which aims to ensure healthy lives and promote well-being for all.

• Epidemiological Data: A silent epidemic of CKD is affecting laborers who work in extreme temperatures. At the National Kidney Center in Kathmandu, over 20% of patients admitted in a recent six-month period were former migrant workers from the Gulf.
• Causation: The primary cause is work-related heat stress, where physically demanding labor in temperatures reaching 50°C (122°F) leads to chronic dehydration and subsequent kidney failure. This aligns with global research showing a rise in renal disease hospitalizations correlated with temperature increases.
• Healthcare System Impact: Nepal’s healthcare system is overburdened. The government provides free dialysis, but facilities like the National Kidney Center face financial strain, receiving minimal reimbursement ($18 per session) and experiencing significant payment delays. This jeopardizes the provision of life-sustaining care and contravenes the goal of universal health coverage.
• Global Recognition: The World Health Organization (WHO) has recognized the need to prioritize kidney care, as CKD is projected to become the fifth largest cause of premature death by 2050.

SDG 8: Decent Work and Economic Growth

The experiences of Nepalese workers in the Gulf region reveal a severe deficit in decent work, directly conflicting with the objectives of SDG 8 to protect labor rights and promote safe and secure working environments.

1. Unsafe Working Conditions: Workers endure 12-hour shifts in extreme heat with insufficient access to water and rest, leading to life-threatening health conditions. This constitutes a fundamental violation of occupational safety.
2. Systemic Exploitation: Migrant laborers face systemic exploitation, including wage theft, passport confiscation, and inadequate housing. This power imbalance prevents workers from prioritizing their health for fear of job loss and deportation.
3. Economic Consequences: The pursuit of economic opportunity results in debilitating illness, rendering workers unable to support their families and trapping them in a cycle of poverty. The case of Kul Bahadur Dulal, whose son also had to migrate for work to cover his father’s medical costs, exemplifies this vicious cycle.

SDG 10: Reduced Inequalities & SDG 13: Climate Action

The crisis exposes stark inequalities between nations and highlights the disproportionate impact of climate change on vulnerable populations.

• Climate Injustice: The Persian Gulf is warming at nearly twice the global average. The wealth of these host nations is largely derived from fossil fuels, the primary driver of the climate change that sickens the migrant workforce building their infrastructure. This is what Dr. Barrak Alahmad terms the “double whammy of climate change,” where workers are displaced by climate impacts at home only to face climate-driven health risks abroad.
• Externalization of Costs: Wealthy host countries effectively transfer the long-term healthcare costs for sickened workers to their home countries. There is a staggering disparity in health budgets, with Saudi Arabia’s 2023 health and social development budget ($57 billion) dwarfing Nepal’s public health expenditure ($605 million).
• Inadequate Regulations: Existing labor protections, such as midday work bans, are insufficient. Experts advocate for regulations based on the wet bulb globe temperature (WBGT), which provides a more accurate measure of heat stress, but implementation is lacking.

Recommendations and Pathways Forward

Proposed Interventions for Worker Protection

Evidence-based solutions demonstrate that heat-related kidney injury is preventable, aligning with the proactive principles of the SDGs.

• The La Isla Network Model: A program implemented in Nicaraguan sugarcane fields proved highly effective. Key interventions included:
  • Mandatory breaks in shaded areas.
  • Guaranteed access to water and hydration solutions.
  • Reimagined work-to-rest ratios based on environmental conditions.
• Proven Results: This approach led to a 70% reduction in acute kidney injury incidents and a 19% increase in productivity, demonstrating a clear business case for prioritizing worker health (a “win-win” for SDG 3 and SDG 8).

Policy Recommendations

A multi-stakeholder approach is required to address the crisis and advance the SDGs.

1. Host Country and Employer Responsibility: Gulf nations and the companies operating within them must adopt comprehensive heat stress prevention programs, mandate regular health screenings for early detection of kidney damage, and provide life insurance for all migrant workers.
2. Home Country Action: Governments like Nepal should focus resources on prevention by implementing more stringent pre-departure health screenings and awareness campaigns on the dangers of heat stress and dehydration.
3. International Cooperation: The international community, including the International Labour Organization (ILO), must advocate for binding international standards on occupational heat exposure. Mechanisms should be developed to ensure host countries contribute to the healthcare costs incurred by workers’ home nations, fulfilling the principles of shared responsibility central to the SDG framework.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights several interconnected issues that are relevant to the following Sustainable Development Goals (SDGs):

• SDG 3: Good Health and Well-being

  The core of the article focuses on the health crisis of Chronic Kidney Disease (CKD) among Nepalese migrant workers. It details the causes (heat stress, dehydration), the progression of the disease, the need for treatment like dialysis, and the physical, emotional, and financial strain it places on individuals and their families. The article explicitly states that CKD is one of the world’s fastest-growing killers, directly addressing the goal of ensuring healthy lives.

• SDG 8: Decent Work and Economic Growth

  The article describes the exploitative and unsafe working conditions faced by migrant laborers in the Persian Gulf. It mentions long hours in extreme heat, systemic exploitation, withheld wages, and a lack of basic safety measures like access to water and rest. This directly relates to the goal of promoting decent work and protecting labor rights, especially for vulnerable groups like migrant workers.

• SDG 10: Reduced Inequalities

  A significant theme is the inequality between the wealthy Gulf nations that employ the workers and the lower-income countries, like Nepal, that bear the long-term healthcare costs. The article notes the “power imbalance with employers” and how sick workers are sent home, effectively “throwing the cost on countries like Nepal.” This highlights the goal of reducing inequality within and among countries, particularly concerning the rights and welfare of migrants.

• SDG 13: Climate Action

  The article establishes a clear link between climate change and the health crisis. It identifies rising global temperatures and extreme heat as the primary drivers of the surge in CKD among outdoor workers. It notes that the Persian Gulf is “heating almost twice as fast as the global average,” framing CKD from heat stress as an “ultimate marker of climate change” and underscoring the urgent need for climate action and adaptation strategies to protect vulnerable populations.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the following specific SDG targets can be identified:

1. SDG 3: Good Health and Well-being

   • Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.”
     
     The article directly addresses this target by focusing on Chronic Kidney Disease (CKD), a non-communicable disease (NCD). It highlights the rise in premature death from CKD and emphasizes the importance of prevention (“simple measures such as frequent breaks and access to drinking water could prevent thousands of deaths”) and treatment (dialysis and transplants). The emotional strain on patients is also mentioned, touching on the mental well-being aspect.
   • Target 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…”
     
     This target is relevant as the article discusses access to healthcare for CKD patients. While the Nepalese government provides free dialysis, the system is underfunded, with the clinic not being paid for months. This illustrates the challenge of providing universal health coverage and financial risk protection, especially when the burden of care is shifted from the wealthy host countries to the workers’ home countries with smaller health budgets.

2. SDG 8: Decent Work and Economic Growth

   • Target 8.8: “Protect labour rights and promote safe and secure working environments for all workers, including migrant workers… and those in precarious employment.”
     
     The article provides a clear case study of the failure to meet this target. It describes migrant workers toiling in “relentless heat” up to 122°F, facing “unsafe working conditions,” and lacking basic protections. The development of CKD as an occupational disease due to heat stress is a direct consequence of the unsafe working environment.

3. SDG 10: Reduced Inequalities

   • Target 10.7: “Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies.”
     
     The situation described in the article—where workers are exploited, get sick, and are sent back to their home countries without compensation or support for healthcare—points to a lack of responsible migration policies. The article states that Gulf states are “essentially treating these migrant workers who have kidney failure as disposable,” which is the opposite of the safe and responsible migration this target aims for.

4. SDG 13: Climate Action

   • Target 13.1: “Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.”
     
     Extreme heat is a climate-related hazard. The article shows a low adaptive capacity among migrant workers who are dangerously exposed to rising temperatures. The work of La Isla Network in Nicaragua, which implemented mandatory breaks, shade, and hydration to reduce kidney injury, is a direct example of building resilience and adaptive capacity in the workplace to combat the effects of climate change.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions or implies several quantitative and qualitative indicators that can be used to measure progress.

1. For SDG 3 (Good Health and Well-being)

   • Indicator for Target 3.4 (Mortality from NCDs): The article states CKD is on track to become the “fifth largest cause of premature death by 2050.” Tracking the mortality rate attributed to CKD among migrant worker populations would be a direct indicator.
   • Indicator for Target 3.4 (Prevalence of NCDs): The article mentions that CKD affects “roughly one in 10 adults” and that “20 percent” of new patients at the Kathmandu clinic had worked in the Gulf. Monitoring the prevalence of CKD in this demographic is a key indicator.
   • Indicator for Target 3.8 (Health Service Coverage): The article provides data on health expenditure disparity: Saudi Arabia spent “$57 billion” while Nepal spent “$605 million.” The reimbursement rate of “$18 for each dialysis session” is another financial indicator of the sustainability of health services.

2. For SDG 8 (Decent Work and Economic Growth)

   • Indicator for Target 8.8 (Occupational Disease Rate): The article links CKD directly to occupational heat stress. The rate of CKD diagnosis among migrant workers who perform manual labor in hot climates serves as a specific indicator for non-fatal occupational disease. The study finding that “one out of three male patients on dialysis had worked abroad in countries with hot climates” provides a baseline.
   • Indicator for Target 8.8 (Working Conditions): The article mentions that “70 percent of workers worldwide are exposed to excessive heat.” Measuring the implementation of protective measures (like those based on wet bulb globe temperature, as mentioned for Qatar) would be an indicator of progress in creating safer working environments.

3. For SDG 10 (Reduced Inequalities)

   • Indicator for Target 10.7 (Migrant Worker Protection): The article implies a lack of policies that hold employers accountable for the health of migrant workers. An indicator would be the number of bilateral agreements between host and home countries that include provisions for health insurance, healthcare costs for occupational diseases, and compensation, which the article suggests are currently lacking.

4. For SDG 13 (Climate Action)

   • Indicator for Target 13.1 (Adaptation Strategies): The article mentions that the Persian Gulf is heating “almost twice as fast as the global average.” An indicator of progress would be the adoption and enforcement of climate adaptation strategies, such as the comprehensive work-rest-hydration programs developed by La Isla Network, which reduced kidney injury by “70 percent.” The current “simplistic” midday work bans are presented as an insufficient strategy.

4. Table of SDGs, Targets, and Indicators

Source: grist.org