A/HRC/14/30 standard of health.12 Such facilities, goods and services must be available, accessible, acceptable and of good quality.13 22. The element of accessibility stipulates that health facilities, goods and services must be physically and economically accessible by all sections of the population, especially vulnerable or marginalized groups, without discrimination on any of the prohibited grounds. To that extent, the principle of non-discrimination constitutes an important starting point, although migrants are often discriminated against, in law and in practice, while attempting to gain access to health care. Many host countries justify restricting migrants’ access to health care on the grounds of protecting their welfare systems from abusive claims and, increasingly, as a means of deterring migration. While this reasoning may look attractive and may be politically useful in host countries, several studies seriously question this premise and the desired deterrent effect of such measures. A. Health conditions of migrants 23. A number of reports indicate that migrants may be more vulnerable to poor health by virtue of their often low socio-economic status, the process of migration and their vulnerability as non-nationals in the new country. While studies in several countries that belong to the Organization for Economic Cooperation and Development have found that migrants generally may be of good health or initially gain benefits in improved health conditions from migration,14 such benefits diminish over time, partly due to the exposure to the adverse working, housing and environmental conditions that often characterize lowincome groups in industrial countries.15 Many migrants are often employed in the three “D” jobs (dirty, difficult and dangerous) in mostly informal and/or unregulated sectors with little respect for labour and other protection. Typically, such work is of intensive and temporary or seasonal nature, with significantly higher occupational hazards. 24. The mental health of migrants is also an issue of concern, as factors such as social isolation caused by separation from family and social networks, job insecurity, difficult living conditions and exploitative treatment can have adverse affects.16 While better economic opportunities may result in positive effects on migrants’ mental health, other reports indicate that migrants suffer a higher incidence of stress, anxiety and depression than residents.17 Further concerns are expressed about the mental health of migrants in detention, in particular with regard to the lack of access to mental health care and services, and inadequate allocation of resources to treat mental health ailments while in detention.18 25. The processes of migratory movement may also have a significant negative impact on the health of migrants before they arrive in the host country. The stricter restriction for 12 13 14 15 16 17 18 GE.10-12615 Committee on Economic, Social and Cultural Rights, general comment No. 14, para. 9. Ibid., para. 12. Steven Kennedy, James Ted McDonald and Nicholas Biddle, “The healthy immigrant effect and immigrant selection: evidence from four countries”, SEDAP [Program for Research on Social and Economic Dimensions of an Aging Population] Research Paper No. 164 (December 2006). Barry R. Chiswick, Yew Liang Lee and Paul W. Miller, “Immigrant selection systems and immigrant health”, Contemporary Economic Policy, vol. 26, No. 4, pp. 555–578 (pp. 561–565). United Nations Development Programme (UNDP), Human Development Report 2009 – Overcoming Barriers: Human Mobility and Development (New York, 2009), p. 56. Available from http://hdr.undp.org/en/reports/global/hdr2009/. Ibid. See for example Doctors without Borders/Médecins Sans Frontières, “Migrants, refugees and asylum seekers: vulnerable people at Europe’s doorstep”, 6 July 2009. Available from www.doctorswithout borders.org/publications/reports/2009/MSF-Migrants-Refugees-AsslymSeekers.pdf. 7