One of the most highly overlooked, but increasingly concerning, social crisis is the mental illness of Ethiopian migrants. Especially returnees from Gulf nations fall victim to the illness. After enduring aggressive and abusive employers in these oil-rich countries, the illegality and lower educational preparations of the young migrants is taking a toll on their mental health. Ensuing deportation or fleeing, returnees are too embarrassed to return emptyhanded to their families, further adding to their mental woes.
Despite generating close to a billion dollars in remittances, the Ethiopian government is unable to provide adequate treatment for returnees as well as secure their safe and fair employment status. EBR’s Samira Suleiman delves into the ordeal Ethiopian migrants face to win a dinar in a foreign, hostile culture as well as upon their return to unwelcoming hands.
Nima Ahmed (name changed upon request), 22, was among the first migrants expelled from Saudi Arabia in October 2020 when around 10,000 Ethiopians were deported monthly, following the panic that spread around immigrants during COVID-19.
“I had no time to process my salary or even pack my clothes properly. I left the employer’s house where I worked for almost two years without a thing. We were in terror of being imprisoned or even killed by the door-to-door search for foreign migrants,” she remembers.
Upon arrival in Ethiopia, Nima did not even have the courage to visit her family outside of Jimma. “I live in Addis Ababa with my friends. I left to help elderly family members and my younger siblings. I cannot go back to them without a thing in my hand. I broke down after learning of the raping and killing of two of my friends. Even if my family welcomes me, I cannot stand what the society will say.”
Nima is among house workers who were attracted by better payment in the Gulf nations, but only ended up with post-migration trauma and mental illness. “She left illegally and faced multiple problems. She was not lucky,” says Saliya Kedir, a friend of Nima who has more experience and stamina and has worked for six years as a housemaid in Saudi Arabia.
Saliya categorizes the abuses Ethiopian migrants face into three: while enroute, at employers’ hand, and after returning to Ethiopia. “Many unimaginable abuses are done especially onto Ethiopians. The traffickers even kill for their organs or sell them into slavery. The Arabs also consider Ethiopians as dirty in order to downgrade their self-esteem and not pay sufficient salary. They even give their houseworkers leftovers to eat. If you cooperate when they take away your mobile phone, then you have no way of reaching your agent when you are in trouble. Smarter Ethiopians hide their SIM cards.”
“I was one of two maids working at my employer’s house and we used to be yelled at and insulted by our employer and his wife. There were times where we would be denied food because one of us didn’t do our job right,” says Hanan, another returnee. “Sexual assault by employers is also extremely stressful.”
Saliya says that especially the cultural differences and abuses are major reasons for some women to become mentally ill after working in the Gulf countries. “If the Ethiopians are knowledgeable and are self-confident, the Arabs are afraid and will respect your rights.”
Prevalence of physical, mental, sexual, and economic abuses on Ethiopian domestic workers in the Gulf countries is exceptionally high, while the abuse takes on the magnitude of xenophobia in other destinations such as South Africa.
In a survey recently conducted on 1,036 migrants returning from the Middle East, 27.6Pct of respondents reported symptoms of common mental disorders. In another survey, 78Pct of returnees reported inabilities in engaging in productive work due to health problems, while 16Pct stated various health issues including 6.7Pct enduring psychological trauma, 4Pct chronic illness, and 2.9Pct physical disability. An International Labor Organization (ILO) assessment conducted with 1,152 returnees also highlighted high levels of verbal abuse on 52Pct, discrimination on 39Pct, physical violence on 23Pct, theft on 22Pct, and rape on 5Pct.
“Most of the returnees are coming with either bipolar disorder or schizophrenia and are usually outpatients. But we have those that are admitted as well,” says Selamawit Mengiste, Resident Psychiatrist at St. Amanuel Hospital. “Most of the migrants that return home are treated for severe mental health disorders.”
Asmeret Amdebirhan (MD, Psychiatry), is Owner of Lebeza Psychiatric Clinic based in Addis Ababa. The clinic threats hundreds of mentally ill returnees every year. “Some come with common mental disorders such as trauma, depression, anxiety, and psychological stress or are unable to communicate effectively with others. And then there are the severe cases such as bipolar and schizophrenia patients. The fact that these migrants are unable to adjust to the change in culture and environment causes them to be under an immense amount of stress. Some even want to return home after staying for a couple of months and being unable to cope. “The expectations their families have of them will often make them wonder if they would be accepted back if they returned.”
Asmeret opened the private psychiatry clinic specific to returnees from Gulf countries, after conducting a study on the area. “The IOM evaluates these migrants before sending them to a psychiatric center. The aim of bringing these migrants to a psychiatric center is to evaluate and treat them so that they can safely integrate back into society.
About 26.2Pct of returnees suffer from PTSD (post-traumatic stress disorder), according to Atinkut Zewdu (PhD), Clinical Psychologist. “The migrants often develop PTSD as a result of the long harsh working hours, dehumanizing treatment, physical and sexual abuse placed by their employees or employees’ family, and financial abuse as well. The repetitive trauma they face during their journey and upon arriving at their destination country leads to the development of various mental health disorders. Most of them have no choice. The deportation of various undocumented migrants follows severe human rights violations such as rape, beatings, arbitrary detention, theft of belongings, and death, causing trauma on those who return.” Over 60Pct of the mentally affected returnees are women. Migrants return to their country with this traumatizing memory and resentment.
“There is a lack of services in Ethiopia, especially in the mental health department, as well as a dearth of awareness and psycho education in the community. This in turn stigmatizes migrants with further mental health problems, making them unable to reintegrate with society. The stigma that surrounds mental health affects the patient’s willingness to cooperate. Most of the returnees do not share their worst experiences with their families or friends,” says Atinkut.
“Some prefer to see spiritual leaders or elders, rather than talking to psychiatrists. Spirituality can provide protection to people suffering with mental disorders but the religious leader should be trained on how to handle people with such disorders,” says Asmeret.
“Often times the returnees, that aren’t getting proper mental services, use substances as a coping mechanism. Substance abuse is majorly seen in returnees who try to escape the trauma they faced during their stay in the Middle East. Most males are seen with khat or cigarettes, while women use hookah/ shisha. The substances keep the users far from society and makes them unable to integrate with their environment. They often become dependent and eventually turn into addicts incapable of functioning properly in their day-to-day lives, thus keeping them further away from society,” said Atinkut.
Over 126,000 Ethiopians cross into the Gulf countries through illegal routes every year, especially since 2005. Some attribute the massive migration from regional corners of Ethiopia to conflicts, ethnic-political frictions, and internal displacement, alongside unemployment and economic issues.
According to an ILO and Addis Ababa University study, more than 30Pct of respondents did not receive information regarding the nature of their jobs and 54Pct left to travel without any prior information about their employer.
“There were 400,000 legal migrant Ethiopians working in Gulf countries just before COVID-19,” said Dejene Bekele, Employment and Labor Market Director at MoLSA. “We have no exact figure for informal migrants.”
Studies indicate that there are about 2.5 million Ethiopians outside the country who cannot be verified. Over 80Pct of the migrants are female.
International institutions concerned of human rights abuses in Middle East countries attribute the problem to the ‘Kafala’ sponsorship system which governs entry, stay, and exit of migrants in the region. As this system is filling the vacuum left by the absence of institutional regulation, it has escalated the magnitude of abusive treatment upon low skilled migrant workers.
Ethiopia generates over USD800 million from migrants’ remittance from Gulf countries. Although a National Bank of Ethiopia (NBE) report indicates annual remittances at USD6 billion on average, the figure includes both formal and informal means. Illegal migrants usually use informal remittance channels since they have no legal documents to remit legally.
The majority of Ethiopian domestic workers earn USD150 to USD200 per month, according to Bulti Gutema (PhD), in his research ‘Report on Migration, Return and Remittances of Ethiopian Domestic Workers from Lebanon’. In January 2019, Kenya signed an agreement with Saudi Arabia specifying a minimum wage of USD400., while Ethiopia did not negotiate.
According to World Bank estimation, although Ethiopians are living in 85 countries, the USA and Saudi Arabia are the top remittance sources for Ethiopia, followed by Israel, Italy, Sudan, Canada, the UK, and South Africa.
The government of Saudi Arabia decided to expel undocumented migrants since 2013, as part of the “Saudization” of the labor market aimed at creating job opportunities for young unemployed Saudis and a regularization of the labor market. Between November 2013 and March 2014, over 163,018 Ethiopian migrants were expelled, followed by over 360,000 that were ejected up until 2018. The deportation strategy worsened and shifted to detentions of up to 300 migrants in small rooms, as the Saudi government’s crackdown over migrants in fear of COVID-19 spread.
Even after the massive deportations, there were over 750,000 undocumented Ethiopians working in Saudi Arabia and nearly 250,000 in South Africa.
Just after the Saudization started, the Ethiopian government banned migration to the Middle East for work in 2013. Yet, in 2018 the Ethiopian government lifted the ban with new legislation placing minimum age and education requirements as well as mandatory training programs for the migrant workers before departure. Further, the government signed bilateral labor agreements with the UAE, Saudi Arabia, Jordan, Qatar, and Kuwait.
“In addition to this, I think a psychological fitness test should be performed before travel to see if they can cope with the change in environment and different cultural aspects” says Asmeret. She recommends evaluating migrants’ psychological history and fitness. “Even after leaving, there should be a way for them to get the psychological help they could need if they find themselves in a traumatic situation”.
“The situation in Saudi Arabia has recently worsened for Ethiopian migrants because the Saudi government has started to deport them due to concerns related with security, stability, and other various reasons. Deportation is high right now. If things go right, we will bring all Ethiopian migrants back soon. We are working on citizen diplomacy,” said Dina Mufti, Spokesperson of MoFA.
However, many say the Ethiopian government could not even do anything for Ethiopians who are legally living in Saudi Arabia and other countries, let alone illegal migrants.
“We are normalizing relations with Arab countries. We are also introducing a strict proclamation that mandates private agencies sending employees abroad to have certificates of competence. They cannot send employees before training them for three months and must also have representative offices in the countries where they send employees to. The agencies are also required to store capital in closed accounts which MoLSA will use if the employee fails to secure their salaries, get sick, or face problems during their travel,” said Dejene.
Further, Atinkut stresses that government must specify mental illness treatment for returnees in the National Mental Health Strategy. “The strategy has overlooked the massive mental illness cases observed in returnees.”
“People need to understand mental health is curable/ treatable and this can be done by giving a community-based awareness program across the country. There needs to be more trained people in order to be able to care for those with mental health disorders carefully and help them integrate socially and economically back into society. There aren’t any trained professionals and hospitals to treat mental illness cases of returnees. Their cases are deep, complicated, and require trained professionals,” adds Asmeret.
Experts advise a revision of legal frameworks between Ethiopia and Gulf countries, creating safe routes, legalizing informal brokers, creating job opportunities inside Ethiopia, forming intensive awareness within communities, establishing focal points in Gulf countries and also on local migrant corridors, skills training and intensive orientation and certification before migrants leave Ethiopia, negotiating migrants’ salaries at the national level, integration works for returnees, designing support schemes for the most vulnerable returnees, and channeling a proportion of migrants’ remittances to establish pension funds to be used when they return to Ethiopia. EBR
9th Year • Jun 16 – July 15 2021 • No. 99