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For migrant farm workers in Ontario, getting sick or injured can mean losing a job and getting deported, a practice that raises concerns for human rights and health equity, say researchers at the University of Toronto's Dalla Lana School of Public Health.

"Medical repatriation is about getting sick, fired and deported all at once," said Dr. Aaron Orkin, lead author of the study "Medical Repatriation of Migrant Farm Workers in Ontario: A Descriptive Analysis". (.)

"This is a phenomenon without comparators: there are few other Canadian settings where workplace injuries and illnesses result in both deportation and employment termination without further medical care or income security," he continued.

About 40,000 migrant workers, primarily from Latin America and the Caribbean, are approved to work in Canada's agricultural industry every year through the Temporary Foreign Worker Program, most through the Seasonal Agricultural Worker Program.

"Although [migrant] farm workers are entitled to receive health care before the termination of their employment and repatriation, in practice, workers are sometimes repatriated immediately, without receiving such care," said Dr. Orkin. Donald Cole, global health professor at the Dalla Lana School of Public Health, is the study’s senior author.

Among the study’s findings:

• Of the total 170,315 people who arrived in Ontario during the 11-year period, 787 migrant farm workers were repatriated for medical reasons
• Common reasons for repatriation were for medical or surgical conditions (41.3%), external injuries including tobacco poisoning (25.5%) or other (17.3%)
• Medical/surgical conditions included cancer, neurological conditions, back problems and gastrointestinal problems such as stomach pain, hernia operation and appendicitis. Three medical repatriations were attributed to pregnancy
• External injuries included broken or severed fingers, hands and wrists; sore or broken feet, ankles or legs; torn ligaments; and groin strains
• More than two-thirds of workers sent home were aged 30 to 49 years
• Only 2% of medical repatriations were because a worker asked to be sent home

The study, published in on September 17, is based on migrant farm worker data that is privately held by Foreign Agricultural Resource Management Services, not by Canadian public authorities. The study authors accessed records from 2001 to 2011 through a Freedom of Information request, after repatriation data were entered into evidence in an Ontario Human Rights Tribunal hearing into the 2002 death of migrant worker Ned Peart. The authors note that the source of information for this study is a private employment database and not a medical database, so it may not deliver ideal information about repatriation of migrant workers or their health conditions.

"Without any public records or statistics, there can be no oversight to ensure that sick and injured workers are treated fairly," said Dr. Orkin.

Migrant farm workers are considered to be at work while living at their employer-provided temporary lodgings in Canada and during travel to the farms where they work. Although they have health insurance during their employment in Canada, migrant workers face challenges in accessing health care. These include language barriers, long work hours, lack of knowledge about the health care system and limited transportation.

"This study sheds light on this complex occupational health phenomenon. Future research and interventions might aim to identify the health outcomes of migrant farm workers following medical repatriation and to enhance data quality and reliability and the validity of how medical repatriations are documented and coded," said Dr. Orkin.

Nicole Bodnar is a writer with the Dalla Lana School of Public Health at the University of Toronto.