East African care workers in the Gulf face deeply entrenched systems of exploitation

Equidem has published a briefing paper highlighting the systemic cycles of abuse experienced by East African care workers in Saudi Arabia and the United Arab Emirates (UAE). Researchers gathered first-hand accounts from nurses and domestic workers which detail widespread experiences of forced labour, gender-based violence, and racial discrimination, exacerbated by systems of tied employment and a lack of access to citizenship.

The demand for migrant care workers in Saudi Arabia and the UAE is rising, as the countries continue to expand and privatize their healthcare sectors. This growth has been fueled by foreign direct investment in healthcare, responding to the region’s ageing population, a push to strengthen medical tourism, and mandatory health insurance policies. In turn, this has driven a greater reliance on migrant care workers, particularly domestic workers and nurses from Ethiopia, Kenya, and Uganda – foreign workers make up 96 per cent of healthcare staff in Abu Dhabi and 90 per cent in Dubai, while in Saudi Arabia migrants account for 57 per cent of nurses and 60 per cent of doctors, the report states.

While this expansion presents employment opportunities, it also exposes migrant workers to severe risks. Forced labour remains deeply entrenched in care work across the UAE and Saudi Arabia, with workers facing severe restrictions on movement, excessive working hours, and deprivation of basic needs, the authors say. Equidem’s interviews further document rampant gender-based violence and harassment (GBVH), including physical violence, psychological harm, and sexual assault. And care workers also detailed three primary forms of racial discrimination in the workplace: wage disparities, racial segregation at work, and exclusion from grievance mechanisms.

Restrictive labour policies and structural inequality exacerbate workers’ vulnerability – by supporting systems of tied employment, blocking legal avenues for collective bargaining, and denying long-term security, both Saudi Arabia and the UAE create situations in which migrant workers are entirely dependent on their employers and cannot change jobs, exit exploitative workplaces, or return home without employer consent. Although some labour reforms have been introduced in both countries in recent years, they fail to cover domestic workers and do not fully dismantle employer dependency.

Migrant workers are also deliberately excluded from pathways to citizenship, keeping them in a state of permanent legal precarity despite their essential role in the economy, and leaving them with no political representation, no formal support systems, limited access to social protections and legal rights intermediaries, and forced to take salary advances from their employers, leading to dependency and debt bondage.

Meanwhile, the findings show that climate, development, and conflict-related displacement are the main drivers of unsafe migration – 57 per cent of the migrant care workers interviewed left climate-affected regions where economic and environmental pressures made livelihoods unsustainable. Moreover, limited access to information in both origin and destination countries prevents workers from making informed migration choices, while unregulated recruitment and recruitment debt further increase vulnerability, with 55 per cent of interviewees relying on informal networks.

To address the systemic abuses faced by East African migrant care workers in Saudi Arabia and the UAE, comprehensive and enforceable measures must be implemented by governments, businesses, and investors, the authors say. They recommend that the governments of Ethiopia, Kenya and Uganda regulate and monitor recruitment agencies; improve access to information on safe migration; ensure transparent and fair bilateral labour migration agreements; and ratify and implement key international labour standards. The governments of Saudia Arabia and the UAE, meanwhile, should enforce migrant workers’ right to decent work and job mobility, recognize freedom of association and collective bargaining; strengthen protections against forced labour and GBVH; ensure access to justice and legal protections; and end workplace confinement.

Furthermore, businesses and investors in Saudia Arabia’s and the UAE’s health sectors must ensure decent work standards for all care workers; demand transparent and accountable bilateral labour agreements; require the recognition of freedom of association and collective bargaining; promote ethical recruitment practices; and hold employers accountable for work-place rights violations, the report suggests.

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