Immigration and human rights in leprosy.

The World Health Organisation in the early 1990s set its goal as ‘the elimination of leprosy as a public health problem by the year 2000’. With multiple drug therapy freely available, over 15 million people have been cured since the 1980s and the elimination goal of less than one case per 10 000 population was reached at a global level by 2000 and all but a small number of countries had achieved the target by 2005. From 2006 to 2010 the WHO Global Leprosy Strategy rightly focused its attention much more towards reducing the burden of leprosy and ensuring the quality and sustainability of control activities. This enabled much more focus to be given to the issues of equity, social justice and human rights and indeed these continue to be prominent in the recent WHO Global Leprosy Strategy for 2011–2015 adopted by 44 National Leprosy Programme managers in New Delhi, India in April 2009. The promotion of human rights and social justice in dealing with people affected by leprosy remains vital in addressing the persistent problems of stigma and discrimination suffered by people affected and their families. In many developed countries leprosy is only encountered among people coming in from endemic countries either as migrant workers or as immigrants. Public health considerations are often brought to bear on States’ policies regarding health care of migrant workers and the admissibility of new immigrants. It is in relation to this that we find in many countries leprosy is still regarded as a notifiable disease the identification of which can have a direct impact on the rights of migrant workers and potential immigrants. During the lead up to the 2008 Olympic games in Beijing, the Chinese authorities issued a decree indicating that people affected by leprosy would not be allowed to enter the country. A vigorous and concerted lobby resulted in this ruling being withdrawn. However, a brief internet search revealed that a number of other countries also had policies in place citing leprosy as grounds for refusal of visas and for the inadmissibility of migrants or immigrants. Countries listed as having such discriminatory rulings included Barbados, Hungary, Iraq, Namibia, the Philippines, Russia, Taiwan, Thailand, South Africa, the United Arab Emirates, United Kingdom and USA. In recent WHO meetings of Leprosy Programme Managers from the Eastern Mediterranean region it has been reported that in some countries migrant workers diagnosed with leprosy are routinely deported or at best, offered one round of MDT before being sent home. It unlikely that there is follow up of those cases on their return to their home countries and there is a clear disincentive to workers to disclose or even present early symptoms.