Including Immigrants is Good Policy Not Just During the Pandemic, but Afterwards Too

COVID-19 is amplifying the exclusion of immigrants around the world, including refugees, migrant workers, and undocumented communities. Immigrants have been excluded from accessing healthcare in Iran and Lebanon, scapegoated in Italy, and arrested en masse in Malaysia. Deportations continue—including at least 186 Guatemalans from the United States who later tested positive for the coronavirus—while other migrants have been stranded in the Persian Gulf and across Africa. New immigration has fallen sharply, as countries have closed their borders even to those seeking asylum.

In some cases, however, countries have taken a decidedly different approach by including existing immigrant communities in their pandemic response. Several governments have expedited certifications for foreign-born healthcare workers, extended healthcare access to immigrants populations, and, in a few cases, provided for immigrant participation in domestic social safety net programs.

Amidst the pandemic, inclusion is both the moral approach and essential to a robust and effective response that protects citizens. Singapore provides a cautionary tale. During the country's widely celebrated initial efforts to manage the disease, the government largely excluded migrant workers from its response, which contributed to a second wave of cases and required a subsequent nationwide lockdown.

Inclusive policy changes spurred by COVID-19 have so far been limited and temporary, but as governments chart a path to recovery, immigrants and citizens alike would benefit from their extension well beyond the pandemic. This blog highlights two areas—access to the labor market and healthcare—where pandemic-related inclusive responses for immigrants should continue, expand, and pave the way for long-run positive change.

Labor Market Access

In nearly all countries, immigrants face employment restrictions, including the majority of refugees and asylum seekers, those holding visas that limit work, and those who are undocumented. Healthcare workers are no exception; trained doctors and nurses are often compelled to wait for an asylum decision to pursue employment, forced into informal practice, or pushed out of the medical field entirely.

Even during the pandemic, some of these barriers remain, and others have been added. In the United States, for example, residency requirements have prevented foreign doctors from practicing where they are needed, and asylum seekers will soon be denied work authorizations for one year.

Inclusive Policy During COVID-19

Some governments, however, are recognizing the important potential of migrants during COVID-19 and allowing more immigrants to work, especially in essential industries. Portugal has granted the right to work to all with pending immigration applications. Ireland, Germany, France, the United Kingdom, Spain, Australia, Colombia, Chile, and Argentina have fast-tracked authorizations for trained healthcare workers, many of whom are refugees awaiting asylum decisions.

Outside of healthcare, Italy is granting six-month, renewable permits for undocumented farm and home care workers to continue in jobs that policymakers worry would otherwise go unfilled. In the United States, where more than half of farmworkers are undocumented, the Department of Homeland Security has issued letters for undocumented immigrants to carry noting their "critical" role, without directly addressing contradictions in policy.

Short- and long-run positive impacts

Temporary measures granting immigrants greater labor market access in essential sectors should be made permanent. Farm work is a critical job that most citizens of high-income countries will not do, at least at wages that allow farmers to stay in business. Similarly, even before COVID-19, half of all countries were facing a shortage of healthcare workers. Turkey provides one model of inclusion, integrating Syrian medical professionals into the health workforce before the pandemic, and our CGD colleagues have proposed additional solutions to the shortage.

The current attention on immigrants in essential industries is an opportunity to highlight the need for labor market access more broadly. A substantial body of evidence indicates that access for immigrants across a range of industries benefits both citizens and immigrants on net.

In the United States, previous reforms to legalize undocumented immigrants raised wages for immigrants, and similar initiatives today are projected to raise average incomes of Americans. (Meanwhile, deporting undocumented immigrants—at significant expense—reduces employment for Americans.) In Europe, removing initial bans on employment for asylum seekers would improve their long-run outcomes and save taxpayers millions of euros by increasing tax revenue and lowering welfare expenditures.

In Kenya, the World Bank estimates that full economic integration of refugees in Turkana would increase per capita incomes of hosts by 6 percent. The effects, however, depend on the context and precise policies. In a forthcoming paper on Colombia, Dany Bahar, Ana María Ibáñez, and Sandra Rozo find that granting job permits to 442,000 undocumented Venezuelan migrants had no significant effects on labor market outcomes for either Colombians or Venezuelans.

The global recession, often used to justify exclusionary policy, actually magnifies the value and importance of labor market access. The mechanisms that drive these net benefits—business and job creation, occupational upgrading and differentiation, increased productivity, a multiplier effect, and minimal crowd-out, among others—have been demonstrated across a range of settings and unemployment rates, including the Great Depression. Inclusive policies would therefore contribute to a faster recovery and should be considered part of the necessary stimulus.

We at the Center for Global Development, along with colleagues at Refugees International, are expanding our work on labor market access for refugees in low- and middle-income countries, so continue to watch this space for further discussion and policy ideas.

Access to healthcare

Thailand and Spain are two of the only countries that offer full access to healthcare regardless of immigration status. While many countries provide immigrants some access to publicly provided healthcare, health service provision is usually subject to "limitations related to legal status."

Even where migrant workers and refugees have legal rights, administrative and financial barriers to access health services are significant. Insurance coverage is often linked to employment, excluding those without formal status or those working in the informal sector. Displaced populations may be asked to cover prohibitively high user fees despite official policies mandating free care, while migrant health workers in the UK still have to pay to access NHS services. Additionally, a 2018 analysis found only three of twenty-one randomly selected pandemic influenza preparedness plans in low- and middle-income countries "identified at least one migrant group within their respective national plans." Several of these barriers persist during COVID-19.

Inclusive Policy During COVID-19

However, the pandemic has also spurred a few countries to temporarily extend healthcare services to immigrants. For example, Portugal has extended access to its national health service to those with pending immigration applications. Israel announced that asylum seekers with coronavirus would be treated as citizens "for lack of choice." In the United States, immigration authorities have stated they would not conduct enforcement operations at or near healthcare facilities, although other measures like continued deportations and detentions undermine efforts to encourage undocumented immigrants to seek care.

Before the first cases of COVID-19 were reported among Rohingya refugees in Bangladesh, the Ministry of Health had begun to develop a preparedness and response plan in coordination with UN agencies. In Thailand, USAID and UNICEF are partnering with the government to provide information on health and hygiene practices to migrant communities, in addition to psychosocial support and other social services.

Short- and long-run positive impacts

In both the short- and long-term, continuing to expand healthcare access for all immigrants is critical. In addition to compelling rights-based arguments, inclusive healthcare policies will have positive spillovers for citizens. In the short term, slowing the spread of COVID-19 among immigrants clearly helps protect both immigrants and citizens. This principle extends to other communicable diseases as well. Sufficient vaccination coverage among refugees and citizens alike is essential to attain—and sustain—herd immunity in order to prevent outbreaks of measles, cholera, and other vaccine-preventable diseases.

Inclusive policies also yield economic benefits. For example, extending primary healthcare services can result in direct cost-savings for the health system by avoiding more costly hospital-based treatment at later stages. Similarly, access to prenatal and preventive care for undocumented mothers in the United States can significantly improve the health of their American babies.

Understandably, it may be politically difficult for governments to enact these policy changes and financially challenging to expand healthcare coverage. This is especially true in low- and middle-income countries where the majority of the world's displaced population lives. Citizens may themselves have limited access, health systems may be overstretched, and public budgets face enormous fiscal constraints.

Accordingly, the international community has an important role to play in supporting immigrants' health needs and protecting the most vulnerable communities. Funders should support the Global Humanitarian Response Plan for COVID-19—currently funded at 20 percent—and press for this money to reach frontline organizations faster. Where feasible, donors should look to incentivize inclusion both in the short and long run, including through compact models.

Moving Forward

While COVID-19 has spurred some expansion of access to certain labor markets and healthcare services, critical policy gaps remain. In the short term, countries must establish permanent firewalls between health information systems and immigration enforcement to encourage undocumented immigrants to seek care. Countries should safely re-open to asylum seekers and new immigrants, especially as testing becomes more readily available. Following the lead of Portugal, Spain, Ireland, and California, governments should expand social protection programs to include migrants and work to make benefits portable. Greece, Libya, the United States, and other countries must immediately release the thousands of people in detention for immigration offenses.

In the long term, the benefits of inclusive policies extend well beyond the outcomes discussed here. Documentation has reduced dropouts from high school, hit-and-runs, thefts and robberies, childhood mental illness, and other issues that affect citizens directly, while of course allowing immigrant families to live a more comfortable, secure life. The limited inclusive policies emerging during COVID-19 hopefully provide an opening to realize these benefits over the long term and enact permanent, positive change.

We appreciate helpful comments from Kalipso Chalkidou, Michael Clemens, Erin Collinson, and Helen Dempster.