Born to Work: An In-Depth Inquiry on the Commodification of Indian Labour – A Historical Analysis of the Indian Indentureship and Current Discourses of Migrant Labour Under the Kafala System

Interpreting mortality trends in the GCC countries: The healthy migrant effect

This research explores the topic of labor migration in Gulf Cooperation Council (GCC) states – Bahrain, Oman, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates -- and seeks to determine how the subjugation of migrant laborers is initiated and perpetuated. The kafala (sponsorship) system has played a central role in the rapid economic development in the GCC states. Though it has allowed the Gulf States to obtain the resources necessary to develop both economically and cosmetically, the system has had an array of undesirable byproducts that have significantly altered the texture of Gulf societies. The kafalasystem promotes the rapid influx of migrants to meet the labor demand while simultaneously subjugating this imported population through its lax regulations and exclusion from the legal framework in Gulf States. As a result, the Gulf has witnessed an emergence of multi-tiered societies where locals are situated in the top tier and migrant populations consistently occupy the lowest rungs of society. The kafala system has produced structural inequalities in Gulf States and has resulted in grave human rights abuses against migrant laborers. Today, the effects of the kafala system are visible in every aspect of Gulf society. A case study of Dubai, United Arab Emirates is used to examine how legal norms produce and interact with the lived experiences of South Asian migrant laborers. The case study discusses how the kafala system unfolds in one of the most iconic cities in the world and seeks to articulate the lived experiences that are often omitted from modernization narratives.

BackgroundAsthma control is influenced by multiple factors. These factors must be considered when appraising asthma interventions and their effectiveness in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates [UAE]). Based on published studies, the most prevalent asthma treatment in these countries are fixed dose combinations (FDC) of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). This study is a rapid review of the literature on: (a) factors associated with asthma control in the GCC countries and (b) generalisability of ICS/LABA FDC effectiveness studies.MethodsTo review local factors associated with asthma control and, generalisability of published ICS/LABA FDC studies, two rapid reviews were conducted. Review 1 targeted literature pertaining to asthma control factors in GCC countries. Eligible studies were appraised, and clustering methodology used to summarise factors. Review 2 assessed ICS/LABA FDC studies in conditions close to actual clinical practice (i.e. effectiveness studies). Eligibility was determined by reviewing study characteristics. Evaluation of studies focused on randomised controlled trials (RCTs). In both reviews, initial (January 2018) and updated (November 2019) searches were conducted in EMBASE and PubMed databases. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklists.ResultsWe identified 51 publications reporting factors associated with asthma control. These publications reported studies conducted in Saudi Arabia (35), Qatar (5), Kuwait (5), UAE (3), Oman (1) and multiple countries (2). The most common factors associated with asthma control were: asthma-related education (13 articles), demographics (11articles), comorbidities (11 articles) and environmental exposures (11 articles). Review 2 identified 61 articles reporting ICS/LABA FDC effectiveness studies from countries outside of the GCC. Of these, six RCTs were critically appraised. The adequacy of RCTs in informing clinical practice varied when appraised against previously published criteria.ConclusionsAsthma-related education was the most recurring factor associated with asthma control in the GCC countries. Moreover, the generalisability of ICS/LABA FDC studies to this region is variable. Hence, asthma patients in the region, particularly those on ICS/LABA FDC, will continue to require physician review and oversight. While our findings provide evidence for local treatment guidelines, further research is required in GCC countries to establish the causal pathways through which asthma-related education influence asthma control for patients on ICS/LABA FDC therapy.

The prospective observational Dialysis Outcomes and Practice Patterns Study (DOPPS) was initiated in late 2012 in national samples of hemodialysis (HD) units (n = 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For many years, guidelines have recommended single pool Kt/V ≥1.2 as the minimum adequate dose for chronic HD patients. Here, we report initial DOPPS results regarding HD practices related to dialysis dose achievement in the GCC. A total of 928 adult HD patients were included in this analysis from 41 centers representing all six GCC countries. Baseline descriptive statistics (e.g., mean, standard deviation, median, interquartile range, or percentage) were calculated for the study sample. Results were weighted according to the fraction of HD patients sampled within each participating study site. Mean age varied between 51 years in Bahrain, Oman, and Saudi Arabia, 55 years in the United Arab Emirates (UAE) and Kuwait, and 62 years in Qatar. Mean body mass index (BMI) was the lowest in Oman patients (23.9 kg/m 2 , but the remaining GCC countries had mean BMIs of 25.7-28.9 kg/m 2 and substantial fractions of overweight patients. Median dialysis vintage ranged from 1.52 years in Kuwait to 3.52 years in Oman. Mean treatment time per session varied from 202 min in Saudi Arabia to 230 min in Qatar while mean blood flow rate (BFR) ranged between 267 mL/min in Oman and 310 mL/min in Saudi Arabia. Interdialytic weight gain varied considerably among GCC countries between 3.1 and 4.0 kg. Central venous catheter use was high among GCC countries, ranging from 29% in Oman to 56% in Kuwait, with other countries averaging 30-40% catheter use. Data were available only for 50-76% of patients in four GCC countries (Kuwait, Qatar, Saudi Arabia, and UAE) for calculating single pool Kt/V to indicate dialysis adequacy. When calculated for patients with vintage >1 year and dialyzing three times per week, mean single pool Kt/V was highest in Qatar and the UAE (1.50-1.51), intermediate in Kuwait (1.35), and lowest in Saudi Arabia (1.29). A higher risk of mortality was observed for patients having a single pool Kt/V <1.2 (vs. ≥1.2) [hazard ratio (HR) = 1.71, 95% confidence interval [CI]: 1.01-2.92]. Achievement of Kt/V in the GCC, although lower than in other DOPPS regions such as Europe/ANZ and North America, was similar to that in Japan. Japan and the GCC also share the practice of having a lower blood volume filtered per HD session per kg body weight. These findings suggest that increasing mean BFR and treatment time in the GCC, along with reducing catheter use, would substantially increase overall achievement of Kt/V >1.2 in the GCC, and hence, may improve survival. These mortality findings will need to be confirmed with up-coming GCC-DOPPS 6 analysis.

Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Findings on the Burden of Sickle Cell Disease and Impact on the Quality of Life of Patients and Caregivers in Gulf Cooperation Council Countries

The prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) initiated data collection in national samples of hemodialysis (HD) units (total of 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in late 2012. Here, we report initial results regarding mineral bone disorders (MBDs) and its management in the GCC countries. Forty-one randomly selected HD facilities, treating >23 HD patients each, were sampled and represent care for >95% of GCC HD patients. Descriptive results for the GCC countries based on a random sample of 20-30 HD patients in each study facility. Initial results for the GCC are from 931 HD patients treated at 41 dialysis units (ranging from 1 unit in Bahrain to 21 in Saudi Arabia). Results are presented as weighted estimates, accounting for the sampling fraction in each unit. Baseline descriptive statistics (e.g., mean, median, or percentage), weighted by facility sampling fraction were calculated for the study sample. For analyses examining the percent of facility patients having (a) serum phosphorus >6.0 mg/dL or (b) parathyroid hormone (PTH) >600 pg/mL, analyses were restricted to facilities having at least 10 HD patients with a reported serum phosphorus or PTH measurement, respectively. Logistic regression analyses of the indicated binary outcomes were based on the use of generalized estimating equations and were adjusted for GCC country, patient age category (<45 years, 45-65 years, and >65 years old), sex, and whether the patient was diagnosed with diabetes mellitus. Logistic models accounted for clustering of patients within facilities, assuming an exchangeable working correlation matrix. Mean age of HD patients in the GCC countries was 53 years vs. 61-64 years in the three other DOPPS regions. MBD markers showed slightly lower mean serum Calcium in the GCC countries, similar mean serum phosphorus, and intermediate median PTH levels compared with the three other DOPPS regions. Among GCC countries, the country mean value of MBD markers ranged from 8.6-9.0 mg/dL for serum calcium, 4.4-5.4 mg/dL for serum phosphorus, whereas median PTH ranged from 163-389 pg/mL. Similar to other DOPPS regions, PTH was higher among patients who were younger or without diabetes, and serum phosphorus was lower with older age (P <0.001 for each). History of parathyroidectomy was lower in the GCC countries versus other regions but did not differ when adjusted for age and dialysis vintage. Among treatments used for managing MBD, the GCC countries showed one of the highest uses of cinacalcet (24%) and phosphorus binder use (81%), whereas intravenous Vitamin D use (24%) was slightly higher than that in EURANZ. A much larger fraction of HD patients in the GCC countries had a dialysate calcium bath ≥3.5 mEq/L (43%) versus 0-4% in the three other DOPPS regions. Although many aspects of MBD management and MBD marker achievement are similar in the GCC countries to that seen in other DOPPS study regions, large variability was seen across countries and facilities in the GCC. Mean serum calcium was lower in the GCC despite the much greater use of dialysate Ca of ~3.5 mEq/L which may be due to the relatively low use of vitamin D and higher cinacalcet use, meriting further study. Future work will focus on GCC facility HD practices and patient characteristics most strongly related to the achievement of MBD target levels and associated outcomes.

The six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) are demographically unique in several ways. Non-nationals now comprise 47% of the total GCC population; nationals are a minority in all countries, except Oman and Saudi Arabia. Thus, aggregated data including both nationals and non-nationals provide a highly misleading picture of the evolving demographic situation. This paper describes socio-demographic changes among GCC nationals from the 1970s to the present, and outlines the trends in outflows from the six major sending countries. It then discusses the implications of the socio-demographic transitions among nationals for future migration to GCC countries from Asian countries, taking cognizance of the existing labor force patterns of the indigenous population, as well as the migration policies of the sending as well as receiving countries. GCC countries have among the lowest crude death rates, and infant mortality rates are generally less than 10 per 1000 live births. Fertility has declined but still hovers around 3-4 children per woman, resulting in very high rates of population growth and young populations. About 36-38% of the population in most countries are aged less than 15. These trends have several implications for unemployment rates and actions to replace foreign workers with nationals.

The Gulf Cooperation Council (GCC) countries consist of six countries located in the Arabian Peninsula between the north-east border of the African continent and the Persian Gulf. The countries are Kingdom of Bahrain, State of Kuwait, Sultanate of Oman, State of Qatar, Kingdom of Saudi Arabia (KSA) and State of the United Arab Emirates (UAE). The GCC is both a political and an economic organization with the objective of devising similar regulations in various sectors of the economy such as monetary, trade, customs, tourism, and military. One of the main areas of comparable policy among the GCC countries is labor market regulation of foreign workers. Expatriates and the labor force in the GCC countries are the key topics of this book. The following chapter briefly lays out the history of the GCC countries emphasizing more recent times with periods of strong economic growth and a massive demand for foreign labor. The objective of the chapter is to understand the reasons behind moving to the Gulf.

This paper examines the inequalities between national and non-national workers through class formation in the Gulf Cooperation Council (GCC) countries of Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. These inequalities are constructed over non-standardized salaries, work conditions, and the rights deprivations that arise from the kafala system due to demographic imbalances in the region. From this point of view, this paper’s main argument is that inequalities exist between nationals and non-nationals in the labor market. At the same time, this paper argues that Gulf states have made some arrangements such as extending the kafala system and controlling salaried payments to eliminate labor market inequalities. The secondary data, including the participation of nationals and non-nationals in the labor market and their minimum and maximum salaries, have been used to present the inequalities in the labor market. This paper uses qualitative analysis and the interpretive technique to provide clear understanding. This paper’s main finding is that although some strategies exist that have increased the rights of non-national workers in the Gulf countries, the salary and personal-rights inequalities in the labor market, as well as discrimination with respect to one’s home country to still exist. In this way, the article’s main objective is to make an essential contribution to the literature on the political economy of Gulf countries by presenting the current situation of nationals and non-nationals in GCC countries’ labor markets following the government regulations that strengthen the labor rights.

The human rights protection system in the Middle East, especially in the Persian Gulf states, is often discussed in the literature in the context of women’s rights or the use of torture and the death penalty. An important topic related to human rights in the modern world is the kafala system, which has been operating in the Gulf Cooperation Council (GCC) countries, i.e., Saudi Arabia, Bahrain, Qatar, Kuwait, Oman, the United Arab Emirates, Lebanon, and Jordan for years. The states have perceived it as a system of foreign worker protection. According to the latest data, it is estimated that 25 million migrants live and work in the GCC countries, 70% of the Gulf Cooperation Council workforce consists of migrant workers, and 49% of the total GCC population are migrants. The kafala system determines the dependence between a foreign employee and an Arab employer, which is often associated with the emergence of various types of violations of employee rights and threats to their lives and health.

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) Survey: Perspectives of Physicians in Gulf Cooperation Council Countries on Sickle Cell Disease

Laws and regulations are needed to regulate the growing online pharmacy (OP) services. The main objective of this work was to provide an overview of the laws and regulations for OP services in the Gulf Cooperation Council (GCC) countries. In addition, the perception of how these laws and regulations in Saudi Arabia (SA) affect the online ordering of medications and health-related products from national and international OPs was explored. A secondary data collection through emails and a qualitative descriptive analysis was used to gain insight into the OP regulations in the GCC countries. Then, a qualitative study was carried out with semi-structured interviews to investigate the impact of these regulations on the practice and the market from the OP service providers' perspective. The interviews were carried out with a sample of major OP service providers in SA, to represent the GCC countries. During the interviews, multiple open-ended questions were used to explore opinions about the OP regulations and how these regulations affected the practice. The interviews were then transcribed and thematically analysed. Responses were mainly received from regulators in SA, Bahrain, Oman and United Arab Emirates (UAE). SA and UAE allow for offering of OP services as add-on service for existing community pharmacy, while UAE also allows for standalone OP providers. SA, Bahrain, and Oman allow online ordering of both over-the-counter (OTC) and prescription-only medications (POM) from international OP; a prescription is required for POM and quantities allowed should be no more than 3months' supply in case of SA and Oman while this was not specified in case of Bahrain. Invoice of purchase was also required for any POM to be released from customs in SA and Bahrain but not in Oman and UAE. Controlled medications were prohibited to be ordered online in SA, UAE, and Bahrain while it was allowed in Oman if the prescription was issued within 6-month, and the quantity dispensed was for 1month only. Apart from online ordering of medications in these countries, no specific regulations existed to regulate ordering of other health-related products from local or international OPs. Whether Kwait and Qatar have regulations for OP could not be established due to lack of response. Two of the four interviewed representatives of OP service providers in SA were not aware of the existence of specific regulations for OP services. The representatives who were aware of these regulations were satisfied with them and found them beneficial for their business and for the patients at the same time. However, representatives raised concerns regarding the enforcement of regulations on international OP providers. The existing regulations for online ordering of medications are somewhat comparable between the GCC countries, with no specific regulations for ordering of other health-related products from local or international OPs. In SA, there is limited awareness of the existing regulations for OP services by providers. Nevertheless, the need for detailed regulations on certain aspects of OP services was highlighted, such as regulations for international OPs and importing medications for personal use.

BackgroundThe Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world. This study aimed to estimate the recent prevalence of obesity among school-age children and adolescents in the GCC States.MethodsThe literature search for obesity prevalence data was carried out in July 2017 in Google Scholar, Physical education index, Medline, SCOPUS, WHO, 2007–2017, and updated in November 2018.In addition, 22 experts from the GCC were contacted to check the search results, and to suggest studies or grey literature which had been missed. Eligible studies were assessed for quality by using the Joanna Briggs Institute (JBI) tool for prevalence studies. Conduct of the systematic review followed the Assessment of Multiple Systematic Reviews Tool (AMSTAR) guidance. A narrative synthesis was conducted.ResultsOut of 392 studies identified, 41 full-text reports were screened for eligibility; 11 of which were eligible and so were included, from 3 of the 6 GCC countries (United Arab Emirates, Kuwait, Saudi Arabia). Surveillance seems good in Kuwait in compared to other countries, with one recent national survey of prevalence. Quality of the eligible studies was generally low-moderate according to the JNBI tool: representative samples were rare; participation rates low; power calculations were mentioned by only 3/11 studies and confidence intervals around prevalence estimates provided by only 3/11 eligible studies; none of the studies acknowledged that prevalence estimates were conservative (being based on BMI-for-age). There was generally a very high prevalence of obesity (at least one quarter-one third of study or survey participants obese according to BMI-for-age), prevalence increased with age, and was consistently higher in boys than girls.ConclusionsThe prevalence of obesity among school-age children and adolescents appears to have reached alarming levels in the GCC, but there are a number of major gaps and limitations in obesity surveillance in the GCC states. More national surveys of child and adolescent obesity prevalence are required for the GCC states.Trial registrationPROSPERO registration number CRD42017073692.

To identify the primary risk factors contributing to stroke incidents and deaths, analyzing the trends and changes in regional stroke statistics between 1990 and 2021 in the Gulf Cooperation Council (GCC) countries. This longitudinal time trend study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, from June to August 2024. The data were recorded from the Institute for Health Metrics and Evaluation (IHME) and the Global Burden of Diseases (GBD) datasets. The incidence, mortality, and disability-adjusted life year (DALY) rates of stroke in the GCC countries, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE), and their association with environmental pollution, dietary, and metabolic risk factors were documented from 1990 to 2021. From 1990 to 2021, the GCC countries exhibited varied trends in stroke incidence, mortality and DALYs. The UAE had the highest stroke incidence rate in 2021 (106.01 per 100,000). The mortality rates due to stroke decreased in the GCC, except in Kuwait, where they increased by 14.4%. DALYs decreased in GCC countries, with the highest decline in Qatar (56%). Qatar experienced a 59.9% decrease in death rates and a 53.4% reduction in DALYs for hypertension. In GCC countries, hypertension, air pollution, and dietary factors are dominant risk factors for stroke, stroke-related deaths, and DALY rates. The UAE had the highest stroke incidence rate in 2021. However, mortality rates decreased in all GCC countries except Kuwait.