A Gap Between Ideals and Reality: the Right to Health and the Inaccessibility of Healthcare for Haitian Migrant Workers in the Dominican Republic

• Citation: Vol. 27 No. 2
• Publication year: 2013
• topic: Labor Law,Immigration Law,Health Law,Public Sector Law

A Gap Between Ideals and Reality: The Right to Health and the Inaccessibility of Healthcare for haitian Migrant Workers in the Dominican Republic

Stephanie Leventhal

A GAP BETWEEN IDEALS AND REALITY: THE RIGHT TO HEALTH AND THE INACCESSIBILITY OF HEALTHCARE FOR HAITIAN MIGRANT WORKERS IN THE DOMINICAN REPUBLIC

"Doctors are thieves. . . . Dominicans don't want to take you [at the hospital] if you don't have money. . . . Without money you cannot get healthcare, only God can help somebody."¹

—Anonymous Haitian Migrant Worker, Caobete, Dominican Republic, 2012

Introduction

The preceding quote is from an undocumented Haitian migrant worker who moved to the Dominican Republic in 2008.² Marie and her husband are poor and have money only for basic necessities. They live in a shack right next to a canal.³ The shack has no electricity, toilet, or running water, so they use the canal to shower and defecate.⁴ The first time Marie decided to go to the hospital was when she started bleeding for nine days straight and also feeling strong abdominal pains after missing her menstruation for several months.⁵ Finally, her husband convinced her to attend the nearest public hospital.⁶

At the hospital, the nurses told Marie that she had a cyst in her abdominal area and that an operation to remove it would cost about RD $60,000.⁷ She cannot, by any means, afford such an operation.⁸ She still has the cyst, and not only does it cause her pain, but it also prevents her from having children.⁹ Marie sees money, transportation, and lack of insurance as the greatest barriers

[Page 1250]

in seeking and receiving the medical care she needs.¹⁰ She describes her experience living in the Dominican Republic as "pure misery."¹¹ Marie's story exemplifies the impoverished lifestyle of most undocumented Haitian migrant workers in the Dominican Republic and some of the obstacles they encounter when trying to access healthcare, despite the country's efforts in 2001 to establish a universal healthcare system.¹²

Even though the Dominican Republic's laws and newly established 2010 Constitution oblige the government to provide healthcare for all persons in the country,¹³ the exclusion of Haitian migrants from this health system, as exemplified by Marie's story, proves that these ideals do not translate into practice.¹⁴ The problem seems to be one of lack of funding for the public health sector and lack of enforceability of the country's health laws. Hospitals are not providing free care to the poor and uninsured,¹⁵ despite being required by law to do so; employers are not complying with social security and labor laws, which require them to provide health insurance even to undocumented workers;¹⁶ and no institution is holding either one accountable for lack of compliance.¹⁷

This Comment examines the barriers that undocumented Haitian migrants face when accessing healthcare, despite their entitlement to health under the country's domestic laws. It then provides steps the Dominican Republic can take to begin moving toward its promise of universal healthcare. The existing health system is well structured and requires little modification. Instead, the

[Page 1251]

focus needs to be on raising extra funds to allocate to the public health sector and creating effective mechanisms to safeguard human rights, as will be described in Part V.

This Comment has five parts. Part I briefly describes the background of migration between Haiti and the Dominican Republic, the role Haitian migrants play in the Dominican economy, and how migrants' living and working conditions affect their health. Part II explains the basic framework and structure of the Dominican health system as established by the country's constitution, laws, and treaties. Part III describes how that health structure systematically excludes undocumented Haitian migrant workers in the country from accessing healthcare centers and treatment. Part IV explores the lack of legal enforceability that exists in the public health sector. Finally, Part V provides recommendations to ameliorate healthcare access, such as implementing mechanisms to incentivize closer enforcement of the country's health laws.

I. History and Background

Knowing some general history and background about the Haitian population of the Dominican Republic helps understand some of the issues explained in this Comment. Part I describes: (1) The long history of migration that exists between Haiti and the Dominican Republic; (2) the different labor markets that exist for Haitian workers; (3) the health risks that migrants face as a result of their arduous workplace and living conditions and how their health impacts the rest of the country; and (4) the complicated process of acquiring documentation.

A. History of Migration from Haiti to the Dominican Republic

Haiti and the Dominican Republic share a border on the island of Hispaniola.¹⁸ The immigration of Haitians to the Dominican Republic dates back to the early twentieth century when the Dominican Republic began to focus on labor-intensive sugar production, an arrangement heavily dependent

[Page 1252]

on Haitian manual labor.¹⁹ Since then, the number of Haitians moving to the Dominican Republic has varied over time,²⁰ though no precise number of the total Haitian population in the Dominican Republic exists.²¹ Due to often highly contentious and political undertones associated with such figures, and the largely untracked and undocumented status of most Haitians, estimates of their numbers range from five hundred thousand to more than one million.²² However, it is certain that after the earthquake in Haiti in january 2010, the number of undocumented Haitians in the Dominican Republic increased dramatically.²³

The reasons for Haitian migration to the Dominican Republic have been primarily economic. Haitians traditionally migrate to their richer counterpart in search of jobs and a better life.²⁴ In 2010, about forty-one percent of the Dominican Republic's population lived below the poverty line, and eighty percent of the population had access to an improved water source.²⁵ In contrast, in Haiti, seventy-seven percent of the population lived below the poverty line, and only forty-nine percent had access to an improved water source.²⁶ These statistics exemplify that there is less poverty in the Dominican Republic than in Haiti, which serves as an incentive for many Haitians to move there.²⁷

The labor migration of Haitians to the Dominican Republic has not been without hardships and hurdles. Part of the history of migration includes Dominican racial discrimination against Haitians, which has led to mass forced repatriations²⁸ and deportations throughout the years. Sometimes Haitians have

[Page 1253]

been denied the opportunity to show that they are legal residents or to express fear of being prosecuted in Haiti.²⁹ Many agricultural workers, lacking documentation, remain in their communities and do not seek necessary medical care when needed for fear of harassment by immigration authorities.³⁰

The word "immigrant" will not be used to refer to Haitian workers in the Dominican Republic. The word "immigrant" instead refers to "a person who comes to a country to take up permanent residence."³¹ A "migrant," on the other hand, is commonly used by the International Organization of Migration ("IoM") to include "certain kinds of shorter-term migrants, such as seasonal farm-workers who travel for short periods to work planting or harvesting farm products."³² Since it is known that many Haitians engage in irregular patterns of travel between the two countries—often dependent on seasonal work and the need to care for extended family in Haiti³³ —it is not true that all Haitians in the Dominican Republic seek to establish permanent residence. Thus, for purposes of this Comment, the word "migrant" as defined by the IOM is more applicable and will be used to refer to those individuals who move from Haiti to the Dominican Republic to better their lives or those of their family, without necessarily establishing permanent residency as connoted by the term "immigrant."

[Page 1254]

B. Haitian Labor in the Dominican Republic

Haitian workers are essential to the Dominican economy. The Dominican Republic is known for its sugar, coffee, and tobacco exports.³⁴ Although Haitian migrants historically worked in Dominican sugarcane fields, known as bateyes, they now work in other sectors including rice, tobacco, construction, and tourism.³⁵ For example, in 2010, Haitian labor made up about fifty-three percent and seventy percent of all labor utilized in the Dominican construction³⁶ and banana³⁷ industries, respectively.

Two types of labor markets exist for Haitian migrants—the formal and the informal.³⁸ Haitian migrants who are hired permanently by construction or agricultural companies subject to labor and social security laws form part of the formal labor market.³⁹ In contrast, Haitian migrants who work seasonally for different bosses and have no steady job form part of the informal labor market.⁴⁰ Although those who work in the formal labor market tend to have more job security, both groups often perform cheap labor and have employers who ignore minimum wage, health, safety, and employee benefit laws.⁴¹ Even though legal protections are available to all workers without regard to their immigration status, migrant workers are unaware of these legal rights, and underfunded government agencies lack the power or the will to enforce them.⁴²

[Page 1255]

Employers take advantage of workers' fear of deportation to evade following the law.⁴³

C. Risks to Health and Country Implications

The health of Haitian migrants is affected by their rough workplaces and living conditions. As a result of their employment in jobs with no contract and substandard pay, many of these workers can only afford to live in small shelters with dirt floors located in clandestine communities far from any healthcare facilities and schools.⁴⁴ Many workers are...