Migrant Worker Dormitories Research Articles

Living at work: migrant worker dormitories in Malaysia

The COVID-19 pandemic in Malaysia drew attention to the extremely poor living conditions of the country’s approximately 2.5 million migrants from South and Southeast Asia working in manufacturing, construction, services, and agriculture. International media reports throughout 2020 and 2021 highlighted the overcrowded, unsanitary, and unsafe accommodations provided by employers, including cramped hostels, stacked containers, and rented apartments. This article addresses how migrant worker accommodation in Malaysia is utilised by the state and by employers as a spatial mechanism of control to regulate migrant labour. This case study draws on over a hundred in-depth interviews with Nepali migrant workers, recruitment agents, employers, and policy officials in Malaysia. We detail how the Malaysian government’s requirement for migrants to live in employer-provided housing forms part of intensified immigration controls implemented by the federal government. This policy effectively transforms employers into ‘landlords’, bringing migrants’ ‘private space’ under their control, thereby enabling employers’ increased surveillance of their activities. We found that employers utilised the opportunity to discipline their workforces and intensify work regimes. We therefore argue that housing has become a double-layered regulatory tool to deepen labour control among migrant populations, perpetuate a state of temporariness, and reinforce visible boundaries between citizens and non-citizens. In the process, migrants’ living quarters (spaces of social reproduction) have been subsumed into the organisation of production, serving the demands of the low-wage, highly-controlled, political economy of Malaysia.

Building a healthy migrant workforce in Singapore – A cross-sectional study to understand health-seeking behaviours of male migrant workers

BackgroundThe healthcare policies for migrant workers in Singapore had a traditional focus on improving occupational health and preventing workplace injuries. The COVID-19 pandemic led to a rapid paradigm shift in the provision of healthcare for migrant workers, with an urgent focus on improving the accessibility and affordability of primary and preventive health services and strengthening public health surveillance. The purpose of this study is to identify areas for improvement, so that policy makers can improve the implementation effectiveness of healthcare policies for migrant workers. This is achieved by establishing a baseline understanding of (a) the health-seeking behaviours of migrant workers in Singapore, (b) how they consume primary and preventive health services, and (c) systemic gaps in the delivery of services. MethodsA cross-sectional study was conducted at five migrant worker dormitories and two community spaces in Singapore, between August and November 2022. 1101 male migrant workers participated in a survey and 1089 valid responses were analysed. Multivariable logistic regression was used to identify sociodemographic factors associated with health service utilisation and awareness of the new healthcare financing plan introduced for migrant workers, called the Primary Care Plan (PCP). ResultsThe mean age of participants was 34 years. Most of them were of Indian or Bangladeshi nationality. At least 82 % of participants reported that they could access varying health services in Singapore and 73 % were satisfied with the costs of healthcare. However, a lower percentage of the participants (54 %) had seen a doctor, mostly for respiratory, fever or musculoskeletal conditions, and only 7 % saw a dentist at least once in a year. This was attributable to their low perceived need to see a doctor (91 %) or dentist (71 %). While the prevalence of chronic diseases (4 %) was low among the participants, about one-third of participants smoked (26 %), consumed alcohol (32 %), or resorted to self-treatment or medication (39 %). ConclusionThis study corroborated with previous observational studies where migrant workers in Singapore only sought care during an acute episode of illness. While participants perceived healthcare in Singapore to be accessible and affordable, there was limited evidence to suggest that preventive health care was prioritised. This indicates possible gaps in current outreach programmes and further development of new targeted programmes to increase the health literacy and awareness of primary and preventive health services among migrant workers in Singapore.

1875. Continued demographic shifts in hospitalised COVID-19 patients from migrant workers to a vulnerable and more elderly local population at risk of severe disease

Abstract Background In the early months of the COVID-19 pandemic, the vast majority of infected persons were migrant workers living in dormitories who were young and with few medical co-morbidities. In 2021, this shifted to the more vulnerable and elderly population within the local community. We examined trends amongst the hospitalised cases, in order to demonstrate changes in disease severity in association with the evolving demographics. Demographic shifts in hospitalised patients with COVID-19. Proportion of hospitalised patients with COVID-19 requiring intensive care over time in Singapore Methods All patients with PCR-positive SARS-CoV-2 admitted from February 2020 to October 2021 were included, and subsequently stratified by their year of admission (2020 or 2021). Demographics were also classified by sex, ethnicity, as well as mode of transmission, namely i) imported cases, ii) locally-transmitted cases outside of migrant worker dormitories, and iii) migrant worker dormitory cases. We compared the baseline clinical characteristics, clinical presentation and outcomes. Results A majority of cases were seen in 2020 (n=1359), compared with 2021 (n=422), due to the large outbreaks in migrant worker dormitories. Nevertheless, the greater proportion of locally-transmitted cases outside of dormitories in 2021 (78.7% vs 12.3%) compared with 2020 meant a significantly older population with more medical co-morbidities were exposed to COVID-19. This led to an observably higher proportion of patients with severe disease, presenting with raised inflammatory markers, need for therapeutics, supplemental oxygenation and higher mortality. Baseline characteristics of hospitalised patients with COVID-19 in Singapore over time. Conclusion Changing demographics and the characteristics of the exposed populations are associated with distinct differences in clinical presentation and outcomes. Understanding demographic shifts may be crucial in appropriate allocation of healthcare resources in managing hospitalised patients with COVID-19. Disclosures All Authors: No reported disclosures.

Continued demographic shifts in hospitalised patients with COVID-19 from migrant workers to a vulnerable and more elderly local population at risk of severe disease

Objectives: In the early months of the COVID-19 pandemic in Singapore, the vast majority of infected persons were migrant workers living in dormitories who had few medical comorbidities. In 2021, with the Delta and Omicron waves, this shifted to the more vulnerable, elderly population within the local community. We examined evolving trends among the hospitalised cases of COVID-19.Methods: All patients with polymerase chain reaction-positive SARS-CoV-2 admitted from February 2020 to October 2021 were included and subsequently stratified by their year of admission (2020 or 2021). We compared the baseline clinical characteristics, clinical course, and outcomes.Results: A majority of cases were seen in 2020 (n = 1359), compared with 2021 (n = 422), due to the large outbreaks in migrant worker dormitories. Nevertheless, the greater proportion of locally transmitted cases outside of dormitories in 2021 (78.7% vs 12.3%) meant a significantly older population with more medical comorbidities had COVID-19. This led to an observably higher proportion of patients with severe disease presenting with raised inflammatory markers, need for therapeutics, supplemental oxygenation, and higher mortality.Conclusion: Changing demographics and the characteristics of the exposed populations are associated with distinct differences in clinical presentation and outcomes. Older age remained consistently associated with adverse outcomes.

Exploring COVID-19 circuit breaker (CB) restrictions at a migrant worker dormitory in Singapore: a case study and nested mixed-method analysis of stress management and mental health

IntroductionMeasures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease...

Resilient by design: Informing pandemic-safe building redesign with computational models of resident congestion

This paper describes a computational design-support tool created in response to safe-distancing measures enforced during the COVID-19 pandemic. The tool was developed for a specific use case: understanding congestion in crowded migrant worker dormitories that experienced high rates of COVID-19 transmission in 2020. Building from agent-based and network-based computational simulations, the tool presents a hybrid method for simulating building resident movements based on known or pre-determined schedules and likely itineraries. This hybrid method affords the design tool a novel approach to simultaneous exploration of spatial and temporal design scenarios. The paper demonstrates the use of the tool on an anonymised case study of a high-density migrant worker dormitory, comparing results from a baseline configuration against design variations that modify dormitory physical configuration and schedule. Comparisons between the design scenarios provide evidence for reflections on pandemic-resilient design and operation strategies for dormitories. A conclusions section considers the extent to which the model and case study results are applicable to other dense institutional buildings and describes the paper’s contributions to general understanding of configurational and operational aspects of resilience in the built environment.

Prevalence of measles antibodies among migrant workers in Singapore: a serological study to identify susceptible population subgroups

BackgroundIn 2019, two clusters of measles cases were reported in migrant worker dormitories in Singapore. We conducted a seroprevalence study to measure the level of susceptibility to measles among migrant workers in Singapore.MethodsOur study involved residual sera of migrant workers from seven Asian countries (Bangladesh, China, India, Indonesia, Malaysia, Myanmar and the Philippines) who had participated in a survey between 2016 and 2019. Immunoglobulin G (IgG) antibody levels were first measured using a commercial enzyme-linked immunosorbent assay (ELISA) test kit. Those with equivocal or negative IgG results were further evaluated using plaque reduction neutralization test (PRNT).ResultsA total of 2234 migrant workers aged 20–49 years were included in the study. The overall prevalence of measles IgG antibodies among migrant workers from the seven Asian countries was 90.5% (95% confidence interval 89.2–91.6%). The country-specific seroprevalence ranged from 80.3 to 94.0%. The seroprevalence was significantly higher among migrant workers born in 1965–1989 than those born in 1990–1999 (95.3% vs. 86.6%, p < 0.0005), whereas there was no significant difference by gender (90.8% in men vs. 89.9% in women, p = 0.508). 195 out of 213 samples with equivocal or negative ELISA results were tested positive using PRNT.ConclusionThe IgG seroprevalence in migrant workers was below the herd immunity threshold of 95% for measles. Sporadic outbreaks may occur in susceptible individuals due to high transmissibility of measles virus. Seroprevalence surveys can help identify susceptible subgroups for vaccination.

Testing strategies to contain COVID-19 in migrant worker dormitories

IntroductionCOVID-19 transmission within overcrowded migrant worker dormitories is an ongoing global issue. Many countries have implemented extensive control measures to prevent the entire migrant worker population from becoming infected. Here, we explore case count outcomes when utilizing lockdown and testing under different testing measures and transmissibility settings. MethodsWe built a mathematical model which estimates transmission across 10 different blocks with 1000 individuals per block under different parameter combinations and testing conditions over the period of 1 month. We vary parameters including differences in block connectivity, underlying recovered proportions at the time of intervention, case importation rates and testing protocols using either PCR or rapid antigen testing. ResultsWe estimate that a relatively transmissible environment with fortnightly PCR testing at a relatively low initial recovered proportion of 40%, low connectivity where 10% of contacts occurred outside of the infected individuals’ block and a high importation rate of 1100000 per day, results in an average of 39 (95%Interval: 9–121) new COVID-19 cases after one month of observation. Similar results were observed for weekly rapid antigen testing at 33 (9–95) cases. InterpretationOur findings support the need for either fortnightly PCR testing or weekly rapid antigen testing in high population density environments such as migrant worker dormitories. Repeated mass testing is highly effective, preventing localized site outbreaks and reducing the need for site wide lockdowns or other extensive social distancing measures within and outside of dormitories.

Contrasting SARS-CoV-2 epidemics in Singapore: cohort studies in migrant workers and the general population

ImportanceSince January 2020, Singapore has implemented comprehensive measures to suppress SARS-CoV-2. Despite this, the country has experienced contrasting epidemics, with limited transmission in the community and explosive outbreaks in migrant worker dormitories. ObjectiveTo estimate SARS-CoV-2 infection incidence among migrant workers and the general population in Singapore. DesignProspective serological cohort studies. SettingTwo cohort studies — in a migrant worker dormitory and in the general population in Singapore. Participants478 residents of a SARS-CoV-2-affected migrant worker dormitory were followed up between May and July 2020, with blood samples collected on recruitment and after 2 and 6 weeks. In addition, 937 community-dwelling adult Singapore residents, for whom pre-pandemic sera were available, were recruited. These individuals also provided a serum sample on recruitment in November/December 2020. ExposureExposure to SARS-CoV-2 in a densely populated migrant worker dormitory and in the general population. Main outcomes and measuresThe main outcome measures were the incidences of SARS-CoV-2 infection in migrant workers and in the general population, as determined by the detection of neutralizing antibodies against SARS-CoV-2, and adjusting for assay sensitivity and specificity using a Bayesian modeling framework. ResultsNo evidence of community SARS-CoV-2 exposure was found in Singapore prior to September 2019. It was estimated that < 2 per 1000 adult residents in the community were infected with SARS-CoV-2 in 2020 (cumulative seroprevalence: 0.16%; 95% CrI: 0.008–0.72%). Comparison with comprehensive national case notification data suggested that around 1 in 4 infections in the general population were associated with symptoms. In contrast, in the migrant worker cohort, almost two-thirds had been infected by July 2020 (cumulative seroprevalence: 63.8%; 95% CrI: 57.9–70.3%); no symptoms were reported in almost all of these infections. Conclusions and relevanceOur findings demonstrate that SARS-CoV-2 suppression is possible with strict and rapid implementation of border restrictions, case isolation, contact tracing, quarantining, and social-distancing measures. However, the risk of large-scale epidemics in densely populated environments requires specific consideration in preparedness planning. Prioritization of these settings in vaccination strategies should minimize the risk of future resurgences and potential spillover of transmission to the wider community.

Operational requirements of medical posts in migrant worker dormitories during the COVID-19 outbreak in Singapore.

Operational requirements of medical posts in migrant worker dormitories during the COVID-19 outbreak in Singapore.

Enhancing frontline workforce volunteerism through exploration of motivations and impact during the COVID-19 pandemic

ObjectivesDuring a pandemic, healthcare workers are requested to volunteer for potentially high-risk frontline duties outside of usual hospital and primary care clinic settings in order to better serve vulnerable communities. Examination of volunteer motivations and impact of such experiences can drive more effective pandemic response efforts with regards to volunteer recruitment and retention. This study aims to explore the motivational factors underlying healthcare worker volunteerism in COVID-19 pandemic response operations in the community, and to describe the impact of such operations on volunteers, in order to highlight important volunteer recruitment strategies and ensure volunteer sustainability. MethodsA qualitative phenomenological approach is taken in this study through the use of semi-structured individual interviews of healthcare staff, to provide in-depth exploration of personal experiences. Staff were purposefully sampled to ensure diversity of personal and professional backgrounds. ResultsA total of 35 staff, consisting of 17 males and 18 females from medical, nursing, allied health, and administrative backgrounds, who participated in COVID-19 community-based operations in migrant worker dormitories and swab isolation facilities were interviewed. The main motivational factors were volunteer functions of values, understanding and enhancement. Participants were positively impacted on personal and professional levels, including self-growth, societal awareness, as well as skills development in leadership and team management. ConclusionsHealthcare organizations should consider volunteer functions in matching individual motivations to volunteer opportunities. Additionally, personal narratives and role-modelling by senior staff can serve as useful adjunct strategies to volunteer recruitment, while providing pre-pandemic preparedness, reassurance of safety, support, and recognition.

Data “Objectivity” in a Time of Coronavirus: Uncovering the Potential Impact of State Influence on the Production of Data-Driven News

News reports on the Covid-19 pandemic have largely been data-driven, with coverage on infection numbers, deaths, recoveries, tests administered, economic impacts and vaccine trials; data for these stories tend to be disseminated from top-down, by governments and public health organizations, and often viewed as scientific and precise. This article examines critically the “objective” nature of data and discusses the social constructionist nature of data journalism, where data access and presentation may be shaped by power and social relations. This study focuses on Singapore, a global city in Asia that received praise in international media at the start of the pandemic when it was able to keep its infection numbers low while other cities went into lockdown; the turning point came when numerous infection clusters developed in the migrant worker dormitories on the island. Through in-depth interviews with newsworkers, this study maps out the potential extent of state influence on press coverage and journalistic sensibilities during the coronavirus pandemic through the stages of news production – from the news gathering and selection stages, to the newswriting and presentation stage – and offers an assessment of how data “objectivity” may be a powerful tool to shape public opinion in times of crisis.

Contrasting SARS-CoV-2 Epidemics in Singapore: Cohort Studies in Migrant Workers and the General Population

Background: From January 2020, Singapore implemented comprehensive measures to suppress SARS-CoV-2. Community transmission has been limited, although explosive outbreaks have occurred in migrant worker dormitories.Methods: We conducted longitudinal SARS-CoV-2 serology studies among 478 residents of a SARS-CoV-2 affected migrant worker dormitory between May and July 2020, and 937 community-dwelling adult Singapore residents with sera collected before September 2019 and in November/December 2020. We tested sera for SARS-CoV-2 neutralising antibodies and used Bayesian methods to estimate infection incidence accounting for test sensitivity and specificity.Findings: We estimated that Conclusions: Our findings demonstrate that SARS-CoV-2 suppression is possible with rapid implementation of border restrictions, case isolation, contact tracing, quarantining and social distancing measures. However, the risk of large-scale epidemics in densely-populated environments requires specific consideration in preparedness planning. Prioritising these settings in vaccination strategies should minimise risk of future resurgences and potential for spillover to the wider community.Funding: This work was funded by the Wellcome Trust grant (221013/Z/20/Z), the NUS Efforts Against COVID-19 fund and the Singapore National Medical Research Council (STPRG-FY19-001 and COVID19RF-003).Declaration of Interests: L-FW and WNC are co-inventors of a patent application for the cPass test kit. The remaining authors declare no competing interests in relation to this work.Ethics Approval Statement: The community cohort study was approved by the National University of Singapore Institutional Review Board (reference H-20-032).

Remote monitoring of marginalised populations affected by COVID-19: a retrospective review

ObjectivesThe COVID-19 outbreak in Singapore has largely centred around migrant worker dormitories, comprising over 90% of all cases in the country. Dormitories are home to a culturally and linguistically distinct,...

Demographic shift in COVID-19 patients in Singapore from an aged, at-risk population to young migrant workers with reduced risk of severe disease

ObjectivesThe vast majority of COVID-19 cases in Singapore have occurred amongst migrant workers. This paper examined trends in the hospitalised cases and tested the assumption that the low severity of disease was related to the relatively young affected population. MethodsAll patients with PCR-positive SARS-CoV-2 admitted from February to April 2020 were divided into: (i) imported cases, (ii) locally-transmitted cases outside migrant worker dormitories and (iii) migrant worker dormitory cases. They were examined for underlying comorbidities, clinical progress and outcomes. ResultsImported cases (n = 29) peaked in mid-March 2020, followed by local cases (n = 100) in mid-April 2020; migrant worker cases (n = 425) continued to increase in late April 2020. Migrant worker cases were younger, had few medical comorbidities and less severe disease. As the migrant worker cases increased, the proportion of patients with pneumonia decreased, whilst patients presenting earlier in their illness and asymptomatic disease became more common. ConclusionSingapore experienced a substantial shift in the population at risk of severe COVID-19. Successful control in the community protected an aging population. Large migrant worker dormitory outbreaks occurred, but the disease incurred was less severe, resulting in Singapore having one of the lowest case fatality rates in the world.

SARS-CoV-2 in migrant worker dormitories: Geospatial epidemiology supporting outbreak management

BackgroundMigrant worker dormitories—residential complexes where 10–24 workers share living spaces—account for the majority of cases of SARS-CoV-2 infection in Singapore. To prevent overspill of transmission to the wider population, starting in early April 2020, residents were confined to their dormitories while measures were put in place to arrest the spread of infection. This descriptive study presents epidemiological data for a population of more than 60 000 migrant workers living in two barracks-style and four apartment-style dormitories located in western Singapore from April 3 to June 10, 2020. MethodsOur report draws from data obtained over the first 50 days of outbreak management in order to describe SARS-CoV-2 transmission in high-density housing environments. Cumulative counts of SARS-CoV-2 cases and numbers of housing units affected were analyzed to report the harmonic means of harmonic means of doubling times and their 95% confidence intervals (CI). ResultsMultiple transmission peaks were identified involving at least 5467 cases of SARS-CoV-2 infection across six dormitories. Our geospatial heat maps gave an early indication of outbreak severity in affected buildings. We found that the number of cases of SARS-CoV-2 infection doubled every 1.56 days (95% CI 1.29–1.96) in barracks-style buildings. The corresponding doubling time for apartment-style buildings was 2.65 days (95% CI 2.01–3.87). ConclusionsGeospatial epidemiology was useful in shaping outbreak management strategies in dormitories. Our results indicate that building design plays an integral role in transmission and should be considered in the prevention of future outbreaks.

Desiring political opposition beyond COVID-19 pandemic in Singapore

ABSTRACT Beginning in January 2020, the world has struggled to contain COVID-19 pandemic. Initially lauded as the “gold standard” for containment of the pandemic, Singapore was suddenly confronted with a massive outbreak of infection in the migrant worker dormitories. To date, migrant workers accounted for 95 percent of the almost 60,000 infected, while outside the dormitories infection was relatively well-contained and overall extremely low fatalities. As to be expected, “successful” containment of the spread of the viral infection should generate electoral support for the incumbent government, as in the case of South Korea in April 2020. Accordingly, the long-governing People’s Action Party had called an earlier election during the pandemic in anticipation of overwhelming electoral support. However, the relative success in infection containment within the national community produced the opposite electoral effect. The ruling party received the second-lowest popular votes in its uninterrupted history in government. This counter-intuitive outcome warrants plausible explanations.

Health system resilience in managing the COVID-19 pandemic: lessons from Singapore

Singapore, one of the first countries affected by COVID-19, adopted a national strategy for the pandemic which emphasised preparedness through a whole-of-nation approach. The pandemic was well contained initially until...

Measles Ring Vaccination in Dormitories: An Outbreak Containment Measure and Simulation Study

Background: Two measles outbreaks occurred in migrant worker dormitories in Singapore in 2019. We report the outbreak investigation and use of ring vaccination to contain transmission. Methods: We collected clinical and epidemiological data from laboratory-confirmed measles cases and conducted field investigations to examine the interactions between dormitory residents. Two measles seroprevalence studies were performed using 1136 residual sera obtained from Bangladeshi, Chinese and Indian workers previously enrolled in 2016-19 for a study on latent tuberculosis and 101 samples prospectively collected from healthy workers residing on the same level as the index cases. We administered measles, mumps and rubella vaccine to close contacts and dormitory residents residing on the same level as a case (ring vaccination). The effectiveness of ring vaccination in a dormitory of varying contact patterns and population immunity was also evaluated using simulation models. Findings: From Jun 14 to Jul 29, 2019, there were 12 laboratory-confirmed cases of measles from two distinct dormitory outbreaks and 214 close contacts along with 1532 dormitory residents were vaccinated. Measles Immunoglobulin G was detected in 99.5% (95% CI 98.9 – 99.8) of the residual sera and in all blood samples. Outbreaks simulated in a dormitory of 24 194 people, with 90% immunity and an average of 25 contacts per person, revealed a significant reduction in the final outbreak size from 2026 (IQR 1986–2058) cases to 8 (IQR 3– 26) cases when ring vaccination was implemented. In addition, vaccinating each person would avert two new cases. At higher population immunity of 93% and an average of 15 contacts per person, the maximum outbreak size was reduced by 50% with ring vaccination. Interpretation: Measles outbreaks can occur in densely populated areas with high contact rates despite high population immunity. Ring vaccination may be a strategy to protect susceptible contacts to minimise the risk of large outbreaks. Funding Statement: The authors stated: None. Declaration of Interests: The authors declare no competing interest. Ethics Approval Statement: All epidemiological investigations and outbreak containment measures were implemented under the Infectious Diseases Act, which provides for the use of outbreak investigation data for analysis and evaluation.