Ethnicities, Occupations and Locations of Migrants

Migrants’ Vulnerability to HIV/AIDS

Barriers to Health Services

Migrant Children and Communities                                                                   

 

 

 

Migrants in Thailand

 

Thailand is a major receiving country for migrants in Southeast Asia. In July 2004, 1,276,837 migrants including laborers and their family members attempted to register under the state registry of Thailand known as the Tor-Ror 38/1. Of that number, 1,161,013 officially completed their registration. Estimates by Government and NGOs, however, point to the actual number of migrants present, including those registered, as possibly exceeding two million (not including the 117,000 official refugees). Of those migrants working in Thailand, 849,552 registered for a work permit in 2004, and only 810,730 fully completed the issuing process for work permits. Many more migrant laborers do not have work permits, and new migrants are crossing the border for work every day.

 

Migrants in Thailand predominantly come from the neighboring countries of Myanmar (Burma), Cambodia and Lao PDR, and fill the low-paying “three D” jobs (dirty, dangerous and degrading). Limited economic opportunities in their home countries and high rates of poverty act as push factors that drive many young or able bodied men and women to cross into Thailand to make money to support their families or to build their future. Pull factors include numerous job opportunities for migrants in Thailand, primarily in sectors that Thais have abandoned, such as fishing, construction, factories, domestic work and agriculture. (See Table 1)

 

Thais left these demanding jobs because of the poor work conditions and the low pay rate. Even though these jobs are considered low paying to Thais, generally, migrants can receive up to five times the wage they would receive working in their home country. [The 2003 Gross National Income per capita in USD for these countries is as follows: Cambodia - $310; Lao PDR - $320; Myanmar - $220; Thailand - $2,190. Thailand's gross domestic product accounted for 91% of the combined GDP of Thailand, Burma, Cambodia and Lao PDR in 2003. (ESCAP, 2003)] Moreover, migrants' tolerance level of poor working and living conditions is high considering the poverty they face at home, their limited options for gainful employment, and the fact that few are aware of, understand or are able to defend their rights.

 

In source communities (communities where migrants come from in their countries of origin), migration has been fueled by the perception that working abroad is a mechanism for improving a family’s financial well being through visible displays of wealth, such as new houses, televisions or motorcycles - much of which has been purchased with remittances from Thailand. Migrants who return to their home communities have also perpetuated migration by taking new recruits back with them. Reportedly, some former migrants have become agents or brokers who actively recruit and assist people to migrate to Thailand for work. These agents are part of a network that smuggles people into the country, commonly including Thai officials and police. Unfortunately, in many cases, migrants have also returned home with HIV/AIDS, and many of these source communities are now disproportionately suffering from high rates of HIV compared to other parts of their country.

 

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Ethnicities, Occupations and Locations of Migrants

 

Migrants from Cambodia; Migrants from Lao PDR; Migrants from Myanmar (Burma)

 

Only migrants from the three neighboring countries of Myanmar (Burma), Lao PDR and Cambodia are currently allowed to register as migrant workers in Thailand, with the pronounced majority coming from Myanmar.

 

Results from the Thai Government’s state registration of migrants in July 2004, which included migrant workers and dependents, showed that out of the total 1,284,920 migrants that entered the registration system, almost 72 percent (921,492) came from Myanmar, while those from Cambodia made up just over 14 percent (183,541), and those from Lao PDR constituted just under 14 percent (179,887). (See Chart 1) The nationality of migrants registering for work permits was proportionately similar. (See Tables 1 & 2)

 

Chart 1 - Proportion of Migrants (Workers and Dependents) Registered

in Thailand by Nationality (2004)

Source: Office of Foreign Workers Administration, Department of Employment, Ministry of Labour, 2004

 

Migrants congregate in certain occupations around Thailand, in part, influenced by geographic factors and chain migration. (See Table 1) As Myanmar has the longest contiguous border with Thailand and most migrants come from Myanmar, migrants from Myanmar can be found working throughout most of the country. (See Table 2)

 

Table 1 - Nationalities of Migrants Registered for Work Permit

by Occupation (2004)

 

Work Category

Myanmar

Cambodia

Lao PDR

TOTAL

Percent

Agriculture

125,723

17,761

13,506

156,990

18%

Household worker (includes domestic worker, home care, gardener…)

86,109

8,104

32,156

126,369

15%

Construction

87,807

27,673

9,310

124,790

15%

Seafood processing and related industries

68,834

5,228

1,055

75,117

9%

Fishermen (Ocean)

31,542

22,542

2,100

56,184

7%

Rice Milling, Brick Factory, Ice Factory, Goods transport (docks and warehouses), Mining, Fresh Water Fishing

21,256

4,355

2,045

27,656

3%

Animal husbandry

19,704

2,382

3,597

25,683

3%

Misc. (may include general laborer, service industry, and sex work)

192,717

22,556

41,490

256,763

30%

TOTAL

633,692

110,601

105,259

849,552

100%

 

75%

13%

12%

 

 

 

 Source: Office of Foreign Workers Administration, Department of Employment, Ministry of Labour, June 2005

 

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Migrants from Cambodia

 

Migrants from Cambodia are primarily all of Khmer ethnicity. Cambodian migrants speak the Khmer language, which is generally a uniform language, however, literacy rates in Cambodia are only around 68 percent. (UNICEF, 2001) The Khmer language has some similarities with the Thai language, and many Cambodians are able to learn to speak Thai, especially those who stay in Thailand a considerable time or those who lived and worked at the Thai border prior to entering the country. Many of the Cambodians working as fishermen come from the provinces of Prey Veng and Kompong Cham - some of the country’s poorest provinces adjacent the Vietnam border.

 

Cambodians work in small factories and in agriculture in the eastern provinces of Thailand close to the Cambodian border, and in construction in Bangkok and adjacent provinces. Many Cambodian men work as fishermen, which makes them highly mobile. As a result, Cambodians are prominent at southern ports along the eastern Gulf coast, with a considerable presence in the southern provinces of Pattani and Songkhla. Almost 70 percent of working-age migrants from Cambodia are male. (See Chart 2)

 

Chart 2 - Distribution of Registered Migrant Workers over 15 Years of age by Sex and Nationality (2004)

 

 

 

Migrants from Lao PDR

 

Although Lao PDR has numerous ethnic hill tribes, according to NGOs working on migration in Lao PDR and Thailand, most of those crossing into Thailand for work are reportedly lowland Laotians. Many lowland Laotians are able to speak Thai, attributable to Laotian culture and language being closely related to Thailand’s, and being inundated by Thai media. Literacy rates in Lao PDR are around 65 percent. (UNICEF, 2001)

 

Being able to communicate easily in Thai and having similar facial characteristics and skin tone as Thais, Laotians are generally inconspicuous as migrants. Geographically, migrants from Lao PDR are likely to work in east and northeastern provinces of Thailand in agriculture and as general laborers. As borne out by registration statistics (See Tables 1 & 2), the greatest concentration of Laotians is in Bangkok and the adjacent provinces, where they do general labor including working in factories, with a considerable number of women doing domestic work. Laotian migrants have a small presence in eastern coastal areas where some work in the seafood industry. Out of those registered as a Lao PDR national, women constitute about 55 percent of those of working age. (See Chart 2)

 

Table 2 - Migrants Registered for Work Permits in Thailand

by Region and Nationality (2004)

 

Region

Myanmar

Lao PDR

Cambodia

Total

Percent

Bangkok

105,779

40,182

17,709

163,670

19%

Central

157,234

24,877

23,883

205,994

24%

East

35,159

15,278

54,283

104,720

12%

West

46,685

3,850

2,105

52,640

6%

North

130,434

3,121

947

134,502

16%

Northeast

2,832

11,635

1,465

15,932

2%

South

155,569

6,316

10,209

172,094

20%

TOTAL

633,692

105,259

110,601

849,552

99%*

*(due to rounding)

Source: Office of Foreign Workers Administration, Department of Employment,

Ministry of Labour, June 2005

 

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Migrants from Myanmar (Burma)

 

Over 900,000 of the migrants registered under Thailand's state registry, including dependents and family members, come from Myanmar, and there are many more present who are undocumented. Migrants coming from Myanmar encompass the variety of cultures and languages present in Myanmar’s multi-ethnic landscape. Although Burmese has been imposed on the country as a lingua franca, many ethnic nationalities still prefer to speak their indigenous language. Purportedly, there is a literacy rate of 85 percent in Myanmar (UNICEF, 2001); however, it seems that migrants who come from poorer areas generally have low education levels, as indicated by a 35% gross-secondary school enrolment rate for both males and females. (ESCAP, 2003)

 

Myanmar’s military government has imposed oppressive conditions that affect all civilians, blurring the lines between political and economic migration. Accordingly, no one group solely represents the majority of migrants leaving the country. Whole families are more likely to migrate from Myanmar than the other countries due to this pressure, with many migrants congregating in communities at provinces bordering Myanmar. (See Table 3) Some groups being targeted by the military have been granted official refugee status in Thailand, but most have not, forcing those who may have crossed the border for refuge into the labor stream, and compromising their security by leaving them vulnerable to potential arrest and deportation.

 

Shan (also known as Tai Yai), Lahu, Lisu, Karen, Burmese, Kachin and Ahkka ethnic groups from Myanmar are mainly found in the northern provinces in Thailand, most prominently in Chiang Mai. The variety of ethnicities in this province is as varied as the work that they do: agriculture and animal husbandry, construction, daily labor, factories of all sizes ranging from mass production to handicrafts, domestic work, small shops and restaurants, selling flowers, as well as being prominent in sex work. While the other groups, especially hill tribe groups, may have trouble with Thai language, the Shan (or Tai Yai) people can quickly integrate, as their language and facial features are similar to Northern Thais. Their ability to integrate, however, does not improve their circumstances or guarantee their rights. (Myanmar’s military government is heavily targeting the Shan, yet they receive no formal refugee status. Assimilation is a survival strategy for Shan people, but this has also contributed to a sense of cultural erosion.)

                                                                          

Along Thailand’s western border, most specifically in Mae Sot in Tak Province where there is a concentration of factories with special tax benefits, Karen and Burmese (also known as Burman) groups have a strong presence working in factories (mostly in the garment industry), agriculture, construction, and as general laborers. Being close to the border, some crossing daily for work, or being cloistered at their place of work, few migrants learn to speak Thai.

 

The Mon group start becoming prominent along the southern half of the border with Thailand starting at Kanchanaburi, and can be prominently found working as fishermen in most central and southern coastal provinces, as well as being prominent in the seafood processing industry in Mahachai in Samut Sakorn Province. Mon people are known to be able to learn to speak Thai quickly and are reluctant to speak Burmese or identify themselves as being of “Burmese” nationality. 

 

There is a strong presence of Tavoy (Dawei) in the south working in fishing, agriculture, and construction; and in coastal areas along the northwestern corner of the Gulf of Thailand, there are pockets of Burmese, Karen and Arakanese (Rakhine), primarily working in the seafood industry and related jobs. Sex workers from Myanmar’s various ethnic groups can also be found scattered throughout ports in the south, with higher concentrations at the border.

 

Various groups from Myanmar are also found working in different capacities throughout Bangkok with numerous young women working as domestic laborers as well as in sex work. The actual composition of ethnic groups from Myanmar working in the Bangkok metropolitan and central provinces is unclear, although it is believed that Burmese, Karen and Mon make up the majority of these groups.

 

Table 3 - Provinces with the Highest Numbers of Migrants Registering, Receiving Work Permits and Taking the Health Exam (2004)

 

Province

Total # of Migrants Entering State Registration System (includes dependents)

Total # of Migrants Taking Health Exam *^

Total # of Migrants Receiving Work Permits

National Total

1,276,837*

884,634

810,730

Bangkok

203,488

180,057

156,888

Tak**

124,523

52,184

60,564

Samut Sakhorn

103,126

84,786

63,468

Chiang Mai**

83,058

45,656

44,084

Ranong**

55,769

32,077

29,630

Samut Prakarn

51,450

27,023

44,359

Chonburi

49,963

40,680

32,239

*Actual number completed registration was 1,161,013

**Border province with Burma

*^ Health exam also indicates those purchasing health insurance

Source: Office of Administration Commission on Irregular Immigrant Workers, Ministry of Labor and Social Welfare – June, 2005

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Migrants’ Vulnerability to HIV/AIDS

 

Inconsistent Condom Use; Sex Workers; Migrants Living with HIV/AIDS

 

Migrants’ vulnerability to HIV/AIDS is increased by a complex set of factors. Foremost, there is still a large amount of misunderstanding or lack of proper knowledge about HIV among migrant populations. While there is limited access to condoms, there are numerous opportunities to engage in risky behaviors. Even when migrants have a clear understanding of HIV prevention, condom use is still inconsistent, especially among spouses and sweethearts, which sometimes includes indirect sex workers.

 

Structural barriers, such as language differences, the location of services, documentation, and concerns of arrest or harassment, hamper migrants’ ability to access proper reproductive and general health services, including condoms. As a result, untreated STIs contribute to migrants’ HIV/AIDS vulnerability, and unplanned pregnancies result in unsafe abortions and other reproductive health problems. 

 

 

 

 

Inconsistent Condom Use

 

A growing number of migrants are becoming more aware of HIV/AIDS and proper prevention methods. Misconceptions are still common however, as is inconsistent condom use.

 

Limited access to condoms greatly contributes to inconsistent or low rates of condom use among migrants. When migrants are confined to their work areas or in remote communities, it makes it difficult to access condoms unless they are provided by the employer or a health office, which is rare. Currently, Public Health offices do not count migrants when procuring or distributing condoms, with the exception of sex workers. Thus, except for the efforts of NGOs in localized areas, migrants generally have low access to condoms.

 

Although there are still some innocuous misconceptions, such as fears that HIV can be transmitted from a toilet or through mosquitoes, other misconceptions negatively influence condom use. Occupations filled by migrants that have the highest risk behaviors include fishermen and sex workers. After being on a boat for long periods without sexual release, a practice enforced by superstition, it is common for fishermen to band together, get drunk and visit sex workers during shore leave. Although drunkenness influences inconsistent or improper use of condoms, negative attitudes towards condoms, which are reinforced by uninformed beliefs about HIV/AIDS, play a greater role in inconsistent or low rates of condom use among migrant men. Negative attitudes and misinformation about HIV/AIDS are common among all migrants, however, they seem especially prominent among fishermen, including feelings that condoms are uncomfortable and unnatural, or that the need for a condom can be determined on the basis of empirical factors that indicate a sex worker’s HIV status, such as the temperature or color of her skin.

 

Some migrant fishermen, especially from Myanmar, have enhanced their penises by injecting hair oil or inserting glass beads under the foreskin, something that is done on boats as a bonding ritual, and under the misconception that it gives women pleasure. Unfortunately, these practices may considerably increase the risk of HIV transmission among fishermen and their partners, as HIVas penile implants make condoms fit improperly or break, cause abrasions in the vaginal walls of their partners, and may lead to infections in the penis.

 

Table 4 - Sample Rates of HIV among Fishermen* (2002-04)

                                 (Migrants not separated from Thais)

 

Province

Primary Nationality of Migrants Present

2002

2003

2004

Chumpon

Burma

4.9%

0

9.4%

Pattani

Cambodia and Burma

4.5%

4.8%

4.5%

Phuket

Burma

9.3%

0

5.6%

Ranong

Burma

10.0%

6.5%

3.3%

Rayong

Cambodia, Laos and Burma

N/A

N/A

N/A

Songkhla

Burma and Cambodia

9.4%

9.8%

3.4%

Trad

Cambodia

2.2%

3.9%

N/A

 

Source: Ministry of Public Health, Disease Control Center Thailand: 2001-2004

*Note: Sample sizes for fishermen are often small, making it unclear whether representative cross-samples are made up of different boats. Moreover, fishermen are highly mobile, which compromises the ability to show progression of prevalence rates over time, and instead simply gives a snapshot of prevalence.

 

                                  

Limited access to condoms greatly contributes to inconsistent or low rates of condom use among migrants. When migrants are confined to their work areas or communities that are remote, it makes it difficult to access condoms unless they are provided by the employer or a health office, which is extremely rare. Currently, Public Health offices do not count migrants when procuring or distributing condoms, with the exception of sex workers. Thus, except for the efforts of NGOs in localized areas, migrants generally have low access to condoms.

 

Even when migrants do have access to condoms, one factor that compromises consistent condom use is issues of familiarity and trust (although this is not exclusive to migrants). Accordingly, condom use with spouses is generally low to negligible among migrants (again, a phenomenon that is not specific to migrants). Meeting women at indirect sex establishments, such as karaoke bars or coffee shops, may give men the impression that the women are not sex workers, while in many cases, the women working in these venues do not identify themselves in this way either. Issues of trust and intimacy then override practical issues, such as their or their partner’s sexual history and previous condom use, resulting in low to inconsistent condom use. Regardless of the venue where they meet, when a man goes to the same sex worker regularly, even at a brothel, the couple may develop feelings for each other, which may also lead to inconsistent or no condom use.

 

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Sex Workers

 

Rows of karaoke bars, coffee shops and the occasional brothel are commonly found at or near fishing ports, while karaoke bars are often found right next door to large construction sites and factories - occupations with a large presence of migrant workers. Migrant sex workers are present in these venues to varying degrees depending on the geographic proximity to the border and the size of the migrant population at that location. Generally, if available, male migrant workers will seek out karaoke girls or sex workers who are of the same language group in order to communicate more easily, but are also known to visit Thai sex workers as well.

 

Although HIV surveillance by Thai authorities does not distinguish between Thai and migrant sex workers, rates of HIV found among sex workers at border provinces can provide a general indication of rates of HIV among migrant sex workers, because migrant women are more likely to work in the sex industry in high concentrations at border areas.

 

Table 5 - Rates of HIV Found among Direct and Indirect Sex Workers

at Border Provinces (2003-04)

 

Province

Bordering Country

Direct Sex Workers 2003

Direct Sex Workers 2004

Indirect Sex Workers 2003

Indirect Sex Workers 2004

Ranong

Myanmar

25%

28.8%

4.0%

7.3%

Kanchanaburi

Myanmar

10.3%

6.9%

1.6%

4.1%

Tak

Myanmar

14.8%

4.0%

-

-

Chiang Mai

Myanmar

-

8.5%

1.7%

2.6%

Trad

Cambodia

23.5%

38.7%

3.3%

6.6%

 

Source: Ministry of Public Health, Thailand: 2003-4

 

Migrant sex workers’ vulnerability to HIV/AIDS increases when they lack accurate information, are unable to access condoms, or lose the power to negotiate for safer sex. Sex workers’ access to condoms is problematic if owners are reluctant to provide condoms on the premises because they feel that it acts as incriminating evidence that there is commercial sex available, which is illegal. Language barriers are another factor in HIV vulnerability, as their ability to learn about condoms or potentially negotiate condom use with clients is diminished if they are not of the same language group. If a migrant sex worker is in a situation where there is coercion, threat or force by her employer, including the inherent threat of being an undocumented migrant, then her ability to negotiate for condom use is further reduced. Moreover, if a woman is required to take numerous customers in one day and is not provided lubricant, condoms may cause chaffing, resulting in either condoms breaking or women taking condoms off their customers due to discomfort.

 

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Migrants Living with HIV/AIDS

 

A persistent cough or wasting is one of the signs that many migrants assume indicates AIDS. Those PLHA (People Living With HIV/AIDS) who have families with them are reportedly taken care of by family members; those without family often suffer alone, and eventually die alone. Some migrant PLHAs have wanted to go home to die as their last wish and have voluntarily gone to the border; others have been forcibly repatriated because they are unable to work or have been arrested as an undocumented migrant. In many cases, those sick from HIV/AIDS only make it as far as the border, where they find they are not strong enough to make the trip home. These people may remain at the border until they pass away; the lucky ones are given refuge at safe houses or temples.

 

Although migrants with symptomatic HIV/AIDS are supposedly able to receive palliative care at hospitals, the ability of migrants to actually receive these services is confounded by issues of documentation and payment. Moreover, ARV treatment (ART) at subsidized cost is not available to migrants, making ARVs prohibitively expensive for migrants. Although ARV for prevention of mother to child transmission (PMTCT) is supposedly available to all pregnant mothers, including migrants, actual numbers of migrant women in this program are low. Moreover, once the child is delivered, neither the migrant mother nor the child is currently eligible for ART at a subsidized price. Complicating issues of PMTCT is the fact that VCT is only available in Thai language unless an NGO or trained volunteer assists in translation.

 

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Barriers to Accessing Health Services

 

Numerous barriers limit migrants’ access to health services, and increase migrants’ vulnerability to HIV/AIDS and reproductive health problems. Some of the most prominent barriers to accessing health services include:

 

Ø       Language barriers that frustrate proper treatment (explaining symptoms or receiving instructions on treatment)

Ø       Health insurance regulations, such as the requirement of going to “assigned health providers,” may not be explained to migrants or may be confusing

Ø       Assigned health service providers (to obtain flat fee of 30 Baht) may be inconvenient to reach or far away, adding the expense and arrangement of transportation

Ø       Time of service provision by health providers may conflict with working hours of migrants

Ø       Many employers keep migrants’ ID cards as a form of “insurance,” restricting migrants’ mobility and making them reliant on their employers to receive the benefits of the health insurance they have paid for

Ø       Fear of arrest or harassment deters some migrants, especially those who are undocumented

Ø       Negative attitudes of health providers towards migrants makes migrants reluctant to seek treatment from public service providers

 

Facing these barriers, migrants often resort to traditional remedies, which may result in delayed treatment for conditions such as malaria or TB, or they may seek out traditional healers, some of who may have unsafe practices. Migrants also go to private clinics, which are convenient but expensive, or to NGO clinics, which, although are inexpensive and convenient, are few and far between.

 

Due to barriers in accessing public health services, migrants are generally unable to seek proper testing and treatment of STIs. Similarly, it is difficult for migrant women to pursue effective courses of contraception, resulting in high rates of unplanned pregnancy and related reproductive health problems, including unsafe abortion. Access to a standard set of health services is limited, making it that much more difficult to obtain specialized services such as VCT (voluntary counseling and testing). Even when migrants do access counseling services, ART (Anti-Retro-Viral Treatment) is currently unavailable at subsidized rates, placing treatment out of reach of migrants.

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Migrant Children and Communities

 

Migrants have communities of varying sizes in Thailand. Usually these communities are near or in work sites, such as in port areas, near factories or on construction sites. In other cases, they may be hidden in remote or undesirable locations to avoid attention. Many communities are exposed to swamps or marshy land, industrial effluent, or excessive amounts of trash. These conditions make migrants more vulnerable to outbreaks of mosquito-borne diseases such as dengue fever. Housing is often over-crowded, making migrants highly susceptible to other contagious diseases, especially tuberculosis, while in other cases housing may consist of ramshackle shanties, leaving migrants exposed to the elements. Access to clean water is also problematic with the worst conditions being at construction sites and in agriculture, where bathing water is often contaminated with runoff or pesticides. 

 

Children of all ages are present in many migrant communities (in 2004 there were 93,082 migrants under age 15 registered – See Table 6). Thai law does not provide citizenship for children born in Thailand, nor are official birth certificates provided. Although the law states that all children have a right to education, and there is no prejudice barring migrant children from schools, practical barriers, such as language differences, prevent migrant children from attending school. Migrant children often receive preventative health only though vaccination campaigns, or mobile clinics. When parents go to work, migrant children may accompany them and end up helping their parents, or they may be left alone at home. When migrant children become adolescents yet are unable to complete their education, they are more likely to enter the work force at a young age, leaving them vulnerable to the gamut of rights violations and related health problems, including unplanned pregnancy and HIV/AIDS.

 

Table 6 - General Registration of Migrants by

Nationality, Age and Sex (2004)

 

 

Age

Male

Female

Total

Cambodia

0-11

3,052

2,980

6,032

12-14

895

922

1,817

15 and older

122,535

53,157

175,692

Total

126,482

57,059

183,541

Lao PDR

0-11

2,388

2,399

4,787

12-14

991

2,427

3,418

15 and older

76,720

94,962

171,682

Total

80,099

99,788

179,887

Myanmar

0-11

33,271

29,883

63,154

12-14

7,277

6,597

13,874

15 and older

462,210

382,254

844,464

Total

502,758

418,734

921,492

 

Source: Office of Foreign Workers Administration, Department of Employment, Ministry of Labour, 2004

 

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