The Employment Permit System: The most serious hazard to migrant workers’ health(Dec. 2024)

Jeong-ok Kong, MD

Occupational and Environmental Medicine Specialist

East Gyeonggi Workers’ Health Center

Korean Institute of Labor Safety and Health

Since 2022, I have met approximately forty migrant workers from Vietnam in South Korea to conduct a Fitness for Work Assessment(FFWA). The entire context of the FFWA consultation with migrant workers, from the background to the outcome, is completely different from that of consulting with South Korean workers. If the goal of the FFWA report for Korean workers is to manage or protect their health, the purpose of the FFWA report for migrant workers is more like an emergency rescue or escape from a dangerous situation.

The essence of FFWA is occupational health management

The purpose of a FFWA is to answer the question, “Given the worker’s health condition, can they continue the current job?” It is not a choice between fit or not fit, but rather an evaluation of whether the worker can continue to do his or her current job under certain conditions, or if they should only do it temporarily, or if they should permanently not do it at all. The basis for the evaluation and the conditions which must be met to perform the job are also described in detail. This is because the FFWA is a basic part of workplace health management to protect workers’ health from deteriorating due to work.

FFWA is not commonly done. Workers in larger companies, those with unions, or those from companies which have become sensitive to safety and health management due to workplace injuries, usually come for an assessment. It is also not uncommon for an assessment to be requested by the employer. They want an expert’s opinion on whether it is safe for the worker to continue doing his or her job when returning to work after an illness or when a medical examination reveals a problem. In rare cases, employers are concerned about the health of their workers and want to make sure that they can work safely. However, employers often try to avoid liability by saying that they were just following the expert’s opinion. Regardless of the employer’s mindset, it is the role of the system to ensure that the right health management direction is followed, so it is important that the assessment report reflects what is needed to improve the working environment.

Sometimes, workers ask me to write a letter stating that they can do the job because the company is considering changing their work assignment or renewing their contract due to health reasons. In such cases, I sympathize with the worker’s desire to maintain their current employment or wage level, but I also strictly analyze whether it is truly safe for them to continue working under the same conditions. When recommending improvements to the working environment, I carefully balance the tone of the report so that the employer is not overwhelmed and wants to avoid hiring the person.

People who need a doctor’s note to get out of a job that made them sick

Often, migrant workers come to me expecting a diagnosis that they should not continue in their current job. More precisely, they want to be told that their current health condition does not allow them to continue in their current job, but that they are fit to work in another job.

In my experience, migrant workers are not trying to use the FFWA because they simply want to change companies. Migrant workers are only allowed to change workplaces a maximum of three times during their three-year stay for the following reasons: 1) their employer does not renew their contract after it expires; or 2) the company goes out of business; or 3) the worker is declared unfit to work due to health reasons. After changing workplaces three times, migrant workers must leave South Korea or live in uncertainty as an unregistered worker, which is why many of them continue in their current jobs until the last minute.

As a result, many migrant workers endure their current jobs until they are at the point of no return. They do not come for medical evaluation until their bodies are at the point where it is not safe to continue working. When I ask them if it is better to file for workers’ compensation, they almost always shake their heads and say, “I can work, I need to earn money.” Later, they add, “Please, can I leave this company?” It is so outrageous that you have to go to a doctor and ask for a favor to get out of a job that is making you sick.

Korean society forces migrant workers to endure terrible working conditions

Mr. A, a 30-year-old man, works all day in a small factory making glass doors for sash windows. He lifts and carries 30 to 40 kilograms of products or materials with his bare hands, loading and unloading trucks. His back started hurting six months into his job. He took medication and went to physical therapy for more than a year. A few months ago, his South Korean coworker left the company due to severe back pain, leaving him alone to do the work they used to do together, and his back pain intensified. He tried expensive nerve blocking injections, but he could no longer lift heavy products like he used to. His boss said he would never let him go and told him to take an unpaid leave of absence when he was sick. But even on his days off, he still had to pay his boss for his dorm room. His boss also cut his wages on the days he went to work, saying he was not doing a good job. He wanted to get more injections, but it was too expensive, so he gave up.

Mr. B is quite short and thin. He has been working at a small stone factory with a total of three workers for five months. His job is to cut and transport road curb granite, which can weigh as little as 45 kilograms and as much as 130 kilograms. He bends at the waist to push, pull, lift, and move the stones lying on the floor, and he swings a sledgehammer 200 times a day to finish the cuts. He is constantly abused by his co-workers and the boss for his weakness. A week after joining the company, Mr. B began experiencing pain in his back, neck, shoulders, and upper arms that keeps him awake at night, but he does not seek medical attention. He cannot pay for his medication because his wages were cut for not working fast enough, and no one helps him when he wants to go to the doctor.

Mr. C has been in South Korea for more than three years. About two years ago, he started working for a second company that makes wooden doors. He peels off the paper from the surface of large wooden panels and lifts the panels, which are more than two meters long, one by one, twisting his back to stack them on a cart next to him. After about a year of doing this, he began to experience back pain, which gradually spread to his thighs and buttocks. Eventually, he was diagnosed with a herniated disc. He wanted to work until the end of his contract with his current company, but now he cannot work at all because he is in pain around the clock. Mr. C is afraid that his body will break down further at this rate.

Mr. D has been working in a paper sticker factory. His job involves pouring and mixing glue and thinner in large vats to apply the glue to the paper, pushing a rotating rod into the center of huge rolls of paper while bent at the waist, and stacking finished products on pallets well above his height, resulting in a back injury. At the end of the day, he would scrub the spinning rods to clean them of glue, using thinner on a washcloth. The cotton gloves provided by the company would quickly become soaked, so he worked with his bare hands. After doing this, the skin on the tips of all ten fingers peeled off in layers, and it was always sore. For a few weeks after he started, he broke out in severe rashes all over his body. Mr. D put ointment all over his body and took medication to get through it. He said he could live with the rashes and the pain of having all his fingertips peel off, but the back pain was unbearable.

Mr. E had previously worked in Korea for a total of 5 years. He came back to Korea and found a job at a candy factory. He scoops the candy that comes out of the machine into plastic bags while cooling it with a fan and transfers it to the packaging machine. It is a much more comfortable job than the shipyard and plastic injection factory he worked at before. But after he started working, he started to itch all over. His itching improved after he left work on Saturday afternoon and on his day off on Sunday, but it started again when he went to work on Monday morning. On weeknights, Mr. E could not sleep because he was scratching himself, leaving scratch marks all over his body. After taking a few days off over the holidays and seeing that his symptoms were almost gone, he decided to move his workplace. However, his boss would never let him leave, and threatened to report him for leaving the workplace and make him an “illegal immigrant” if he was absent. During the examination, Mr. E was underweight. I asked him if he was always skinny. He replied, “My boss pays me with lunch deducted from my wages, but I do not have enough money, so I starve myself for lunch. I have lost more than 10 kilograms since my health check-up when I came to South Korea two months ago.” I wondered if he was eating the other meals right, or if he had some other major illness. Shouldn’t he have been able to change companies before he got so thin?

The Employment Permit System is the most serious hazard

A worker can decide to endure and continue work even if it hurts. But it can only be called endurance if the freedom to leave is guaranteed. If a worker cannot leave at will even when it becomes unbearable, it is ‘forced labor’ or ‘slave labor’.

When I write a FFWA report for a migrant worker who wants to leave the workplace in order to survive, I cannot make specific recommendations on how to improve the working environment. I am afraid that any small improvements will be misused as shackles to further bind them. The existence of people who are not workers but slaves, and the absurdity of FFWA reports being written for emergency rescue rather than occupational health management, stems primarily from the current employment permit system in Korea.

If we were to apply the FFWA evaluation criteria to South Korean society, would the answer be that the country can continue to invite migrant workers under the current system, or if the current system should continue only temporarily, or if South Korea simply cannot continue to allow migrant workers under the current employment permit system? Based on direct experience with migrant workers, as long as the employment permit system exists, the answer can only be that South Korean society is not yet fit enough to invite migrant workers. The employment permit system is a serious hazard that threatens not only the safety and health of migrant workers, but also the entire workplace safety and health of South Korean society.