Cross-border precarity: the complex strain on expatriates and their families amidst public health crisis

Globalization and Health (2025) 21:12 Mathew et al. Globalization and Health https://doi.org/10.1186/s12992-025-01098-4 Open Access RESEARCH Cross‑border precarity: the complex strain on expatriates and their families amidst public health crisis Jasmine Mathew1* , Shinto Joseph1   and Joseph Kuncheria1 Abstract This paper presents a conceptual model for understanding cross-border precarity during the COVID-19 pandemic. It examines how public health emergencies exacerbate the challenges faced by expatriates and their families in crossborder contexts. The case study illustrates the complex nature of precarity, emphasising how its various forms like systemic, institutional, economic, health, social, and psychological are interacted and intensified during the pandemic, leading to lasting instability for expatriates that extends beyond borders and impacts their families. Findings indicate that restrictive immigration policies, delayed repatriation efforts, and inadequate support mechanisms exacerbated expatriates’ hardships, which in turn amplified the economic and psychological strains faced by dependents in Kerala. This paper argues for integrating expatriate needs into the International Health Regulations (IHR) for managing public health emergencies, including comprehensive guidelines for repatriation and expatriate-inclusive country capacity assessments. This model serves as a tool to inform policymakers, social work practitioners, and public health professionals in designing interventions and policies that address the unique and intersecting forms of precarity in times of crisis, ultimately contributing to a more inclusive, transnational approach to public health resilience. Keywords Expatriate precarity, Public health emergencies, COVID-19 pandemic, Transnational impact, Gulf migration, Kerala diaspora Introduction According to the World Migration Report 2024, the India-United Arab Emirates (UAE) and India-Saudi Arabia migration corridors rank fourth and ninth among the top 10 global migration routes, highlighting the dynamics of globalisation and labour migration from developing countries to developed nations (McAuliffe and Oucho, 2024 [21]). These patterns of labour migrations are particularly significant for Kerala, a southern state in India, whose migrants comprise a considerable portion *Correspondence: Jasmine Mathew 1 Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Kochi‑683 104, Kerala, India of the Indian diaspora in the Gulf Cooperation Council (GCC) countries [27]. Most Indian migrants in the Gulf are unskilled and semi-skilled workers in labour-intensive sectors such as construction, transport, oil, supply, healthcare, and services [11]. Notably, among migrants from Kerala in these categories, secondary or lowersecondary education levels are commonly observed [31]. Moreover, Keralites in the GCC countries have long been a driving force behind Kerala’s economic growth, as remittances from this diaspora contribute substantially to the state’s economy [31]. Expatriates are individuals who temporarily relocate to a host country for work, with or without the support of an employing organisation [19]. The Kerala Migration Survey (KMS), 2018 confirms that 89.2 per cent of the Kerala diaspora resides in Gulf countries, a region © The Author(s) 2025. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Mathew et al. Globalization and Health (2025) 21:12 where the impossibility of citizenship for immigrants interposes a sense of temporality to their migration [17, 32]. This temporality, marked by the transient and uncertain nature of their stay, profoundly affects their social and economic stability [18, 24]. Moreover, the GCC countries follow the Kafala (sponsorship) system, which controls how migrants secure work permits [2]. It gives Kafeel (sponsor) disproportionate power and is at the heart of the widespread exploitation faced by expatriates, particularly low-income workers, with unpaid or underpaid wages being one of the many violations they endure [7, 9]. In addition, the recurrent omission of expatriates from narratives of home and host countries assumes them as spectral figures with a “non-present presence” ([24], p. 186). The COVID-19 pandemic unveiled the vulnerabilities of diverse populations, especially migrants from developing countries stranded in host nations lacking social welfare systems, a situation prevalent in the Gulf region (McAuliffe and Triandafyllidu, 2021 [22]). In the GCC countries, most of the population consists of foreign workers from South and Southeast Asia (United Nations [UN], 2020). Asians comprise approximately 12 million, or 80 per cent, of the estimated 15 million expatriates in the Gulf region [30]. The Joint External Evaluation (JEE) process, which assesses the Public Health Emergency of International Concern (PHIEC) country capacity, held an ambiguity in integrating migrants in response approach due to a lack of studies and evidence that defined the obligations of host and home countries [34]. These individuals, who had migrated in pursuit of better economic opportunities, suddenly found themselves navigating the complex interplay of restricted mobility, job loss, limited access to healthcare, and xenophobic racism [22, 28]. The lack of support from their host and home countries left expatriates in a precarious position [19]. The pandemic significantly exacerbated the issues of the Kerala diaspora living temporarily in the Gulf countries. With closed borders and delayed repatriation, many found themselves in “No-Man’s land” [23]: 2). In countries like the UAE, temporary migrant workers were locked up in their dormitories to control the virus spread, and their home countries were warned about potential consequences on future labour migration if they refused to repatriate their citizens [37]. Meanwhile, in Kerala, expatriates who were previously praised for their contributions were stigmatised as super spreaders [42], and the Kerala g (...truncated)