Covid-19: Why India needs to vaccinate undocumented immigrants, refugees

For humanitarian reasons and to keep the rest of the population safe, India cannot afford to leave refugees and undocumented immigrants out of the Covid-19 vaccination drive

Riyaz*, a Rohingya refugee who lives in a crowded camp in Delhi along with nearly 300 others, is desperate to get himself vaccinated against COVID-19. But India's ongoing vaccination drive is only open to its own citizens or those with any of the 11 identity documents specified by the government.

All that Riyaz and the others in the camp have are the refugee cards issued by the United Nations High Commissioner for Refugees (UNHCR). "A few of us tried to get vaccinated but we were asked for Aadhaar cards," he told IndiaSpend. The lack of an Aadhaar card also means that refugees cannot get themselves tested for COVID-19.

Most people were able to earn Rs 500-700 a day earlier to support their family, but now they are not able to find any work. "We need free vaccination because we cannot afford to pay," he said.

Durgaram Sharma, 36, is a Nepalese security guard in an east Bengaluru apartment complex who has been living and working in India for 17 years. He has an Aadhaar card and can seek a vaccine in India but not his wife, Bindu, who has none of the requisite identity papers.

India's newly liberalised vaccine policy makes all its adult citizens eligible, but makes no mention of the undocumented immigrants and refugees who live and work here: India currently has more than 240,000 refugees and asylum seekers and nearly 3.8 million Nepali and Bangladeshi immigrants.

In 2019, 95.3% of India's immigrants originated in the same Sustainable Development Goal region (as per the United Nations' classification for its SDG Goals programme--Central and Southern Asia, the latter comprising neighbouring countries such as Bangladesh, Pakistan, Nepal, Bhutan, Sri Lanka, and Afghanistan). This number has not changed significantly from 1990 (96.8%), IndiaSpend reported in January 2021.

At a time when Indian citizens are facing difficulties due to vaccine shortages, the high cost of getting vaccinated in a private facility and glitches in the online registration and scheduling system, the lack of clarity in the official policy could leave millions of non-citizens out of India's vaccination drive, humanitarian groups warn. This could also endanger the health and lives of India's citizens and hamper its efforts to curb the pandemic, they add.

"The right to health is part of the right to life. If there are requirements for specific documentation, a large number of people will fall out of the vaccination process and face death," said Ravi Nair, executive director, South Asia Human Rights Documentation Centre (SAHRDC), a human rights network.

'Accept refugee documents for vaccines'

Salai Cung Dawt, a Chin refugee from Myanmar and a community leader and coordinator for the Chin Human Rights Organisation, is worried for his people in India. There are nearly 3,000 Chins in Delhi and most work in the informal sector earning between Rs 10,000 and Rs 15,000 monthly. Those who tried to register online are unable to because they do not have government identity cards, he said.

Many Rohingya refugees in India work as labourers, drivers, or at odd jobs. While they received support like essential items and medicines from the government and other multilateral agencies during the 2020 lockdown, that has not been the case during the current surge, said Riyaz. "It has been difficult to even keep our fast during the holy month of Ramzan."

Dawt, who is in India since 2008, has approached the UNHCR to resolve the question of documentation for the vaccine. "We coordinate with UNHCR for our needs and are yet to hear from them on COVID-related information," he said. "If they [India] include UNHCR cards for registration, it will be helpful for us."

UNHCR India declined to comment on India's specific strategy but reiterated its global position that it advocates for the inclusion of refugees and asylum-seekers in national vaccination plans, in line with other government criteria.

Chin refugees need access to free vaccine doses because they cannot afford private ones, Dawt told IndiaSpend.

"The government must provide universal vaccination to anyone in India. Anyone can transmit the disease; vaccination cannot be restricted to citizens," said Nair.

Nearly 20 countries are known to have begun inoculating refugees and this includes Nepal, Jordan and Rwanda, said an April 7 UNHCR report. "In many parts of the world, actual immunisation remains a challenge, largely due to the unequal availability of vaccines and the capacity of health systems," it added.

In Greece, immigrants are falling out of the vaccination net because its inoculation drive is linked to social security numbers.

India contributed $10 million to the SAARC COVID-19 Emergency Fund, to supply essential drugs, medical consumables, COVID-19 protection and testing kits, and other equipment. The press release did not specify vaccination plans. "We are ready to contribute to the quest for a vaccine; to make any such candidate vaccines at mass scale and at affordable price points," said Sanjay Bhattacharya, secretary (Consular, Passport, Visa and Overseas Indian Affairs) in July 2020.

The Ministry of External Affairs refused to comment on the issue of including refugees in the immunisation drive. "Ministry of External Affairs (MEA) is not the nodal ministry for the vaccination policy therefore I would request you to contact the Ministry of Health," said Yatin Patel, Officer on Special Duty (PR), MEA, in response to IndiaSpend's queries on the government's strategy for vaccinating immigrants and refugees.

IndiaSpend has written to and shared multiple reminders with the Ministry of Health and Family Welfare for its response. We will update the copy if and when they respond.

Seasonal migrants to India at peril

Seasonal immigrants from Nepal are likely to face a bigger problem securing vaccination in India because they are not entitled to Aadhaar cards or other government-issued identity documents. Migration to India from Nepal is largely seasonal, with workers spending nearly nine months before returning home, as per a 2017 World Bank report.

"These seasonal migrant workers fall outside of the ambit of any documentation in India, especially the Aadhaar card [since they cannot fulfil the residency criteria]," said Chitra Rawat, research assistant at India Migration Now (IMN), a migration research organisation. There are different drives initiated by the state governments for internal migrants and similar drives can be undertaken for immigrant workers as well, she added.

With a face shield strapped to his face and a mask to cover his nose and mouth, Durgaram Sharma, 36, is doing his evening rounds at an east Bengaluru apartment. He deals with nearly 100 residents and at least 10 vendors daily and his work leaves him--and his family--vulnerable to COVID-19.

Sharma, a Nepali who has been working in India for 17 years now, has an Aadhaar card that theoretically allows him access to the vaccine. But his wife Bindu would still be denied a jab. "It costs nearly Rs 7,000 to go back to Nepal, and borders are sealed. We cannot," he said.

An Aadhaar number is not a proof of citizenship, UIDAI had confirmed in February 2020. It can be obtained by any resident who has been in the country for 182 days over the previous 12 months from the date of enrolment.

On a monthly salary of Rs 10,000, Sharma said he could not afford vaccination from a private facility, where the charges range between Rs 600 and Rs 1,200. Since the pandemic broke, Sharma's wife has not been able to find a job as domestic help.

"Across the world, the International Labour Organization (ILO) advocates towards 'vaccination for everyone' including immigrant workers," said Shabarinath Nair, regional migration specialist at the ILO Decent Work Team for South Asia, which looks at policies on productive and fair employment. "Any lack of documentation should not restrict vaccination of any migrant worker, as it will potentially risk the remaining population. We strongly recommend governments to consider these aspects."

India is estimated to have more than half a million Nepali immigrants in India, mostly daily wage earners. The number could be as high as 3 million, according to The Kathmandu Post. Nepali migrants do not need work permits to find employment due to the open border ties between the two countries. India also receives Bangladeshi immigrants and in 2010 they constituted the single largest group (3.2 million) of international migrants in the global south, according to the United Nations. A more recent estimate from the think-tank Carnegie India, from 2016, put the number at 15 million.

During the COVID-19 surge in 2020, the Nepal government refused to allow Nepalis living in India to return home and this was a violation of human rights, said Nepal's August 2020 National Human Rights Commision report, Rights of Migrant Workers in the Clutches of COVID-19 Pandemic. Again, in May 2021, the Nepal government decided to close 22 border points due to the pandemic surge in India, and warned of the lack of hospital beds and vaccine shortages in Nepal. On April 26, Bangladesh too sealed its borders with India for two weeks over COVID concerns.

"Migrants are met with different barriers like no targeted outreach to meet their specific healthcare needs, or facilitation to access Indian healthcare system," said Rawat.

In providing vaccination to migrants, no special eligibility conditions for identity cards or other documents should be insisted on as many are unlikely to possess documents, said R. Ramakumar, economist, Tata Institute of Social Sciences, Mumbai. "To remove all forms of vaccine hesitancy on the part of migrants, this is very important. Further, it is also important that we provide vaccination free of cost to all migrants," he said.

International migrants in India face many obstacles to integration, and the country ranked last among 52 countries ranked on the Migrant Integration Policy Index (MIPEX) 2020. The index measures policies to integrate migrants in countries across five continents. Health along with anti-discrimination policies and political participation policies emerged as "particularly unfavourable" barriers for integration, it added.

'We can't afford private vaccination'

A few lanes from Durgaram Sharma's worksite, Hariprasad Joshi, 51, a Nepali from Kailali district, too works as a security guard. Joshi, who moved from Maharashtra's Ratnagiri district to Bengaluru seven years ago, has made three failed attempts to get vaccinated--twice at a government clinic and once at a private hospital.

"They told me that it was full and I would have to come back later," said Joshi. "I cannot afford to stay away from work as a security guard. I'll lose my job." The sole earner in the family, Joshi lives with his wife and daughter in a tiny room in the building where he works, earning Rs 9,000 a month.

"Failing to take migrants into account in our vaccination efforts would hamper the effectiveness of these campaigns and make it difficult to end the pandemic," said an April 23 blogpost from the International Organisation for Migration, a UN-related organisation.

Ganga, a domestic help from Nepal's Kanchanpur, has yet to register for the vaccine and has no clear idea how to get herself vaccinated. Her younger brother, Basu, pointed out that most of the immigrant fraternity lives on daily wages and cannot afford to pay for the vaccines. "All those who know how to register online can manage, but what about the poor who have no information or do not understand the language or process?" he asked.

Basu is already in debt after paying Rs 3,500 for his pregnant wife's medical-check up at a private clinic, he said. "She cannot find work, and I get Rs 10,200 a month. We cannot afford more than Rs 200 or Rs 220 for a dose, after borrowing cash," he said. If it is not provided for free, he would be forced to go without vaccination, he said.