Call for change to TB deportation law

A health official says the compulsory deportation law for expatriates with the disease is counterproductive.

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ABU DHABI // The law that requires compulsory deportation of expatriates with tuberculosis is counterproductive and should be changed, a senior health official said yesterday. Dr Ali al Marzooqi, the director of public health and safety at the Dubai Health Authority (DHA), said fear of deportation causes most expatriates with the disease to "disappear" once they are diagnosed.

Speaking at InnovHealth 2010, a two-day health conference in Abu Dhabi, Dr al Marzooqi also said the private sector should be allowed to treat patients with TB. Currently, only public hospitals and clinics are allowed to treat the disease. They are required to notify the concerned health authority of each diagnosis and refer it to public safety officials, who are required to follow up. Last year in Dubai alone, the DHA received 242 TB notifications mostly from the private sector. Nearly 60 per cent of those - 142 cases - were lost and could not be followed up.

"We don't know what happened to those cases, maybe they left the country and went back to their homes for two months or three or four to take their medication there, then come back," Dr al Marzooqi said. He added that patients tended to provide fake names or contact details to avoid deportation. "We have to allow the private sector to provide treatment for TB," he said. "In Dubai we are pushing for that, to put patients at ease. We need to let patients know that if you have TB, you will not be deported - no action will be taken against you."

Federal law says expatriates diagnosed with infectious diseases such as HIV/Aids and TB must be deported. But in Dubai, Dr al Marzooqi said, "we only deport newcomers, not long-term residents". A lack of co-ordination between health authorities, health providers and the Ministry of Health also makes the disease hard to control. Additionally, no reliable data is accessible. Since 1995, there has been a 17 per cent annual increase in the number of diagnosed cases of TB in Dubai but mainly among certain nationalities.

"Among the local population of the UAE, 24 cases out of 242 were registered in Dubai last year, and 20 cases in 2008 - so among Emiratis, the situation is more or less stable," Dr al Marzooqi said. Expatriate workers from countries where TB is endemic, such as India, Pakistan and the Philippines, account for most cases. These workers are "crucial to the economic growth of the GCC and probably Dubai most of all," Dr al Marzooqi noted.

The World Health Organisation estimates that TB affects 1.6 billion people worldwide. Most of these people were in Asia (55 per cent in 2008) and Africa (30 per cent). More mobile populations are helping the disease spread, and threatening many countries' national programmes to eradicate TB. In 2007, 3.44 million foreign nationals entered Dubai from countries requiring visa applications and approval prior to departure, which excludes all western countries.

"Because of this, and our huge dependence on tourism ... our different health systems are an issue and we need better work among all the health authorities when tackling this sort of a problem," said Dr al Marzooqi. He also stressed that treatment should be free "regardless of nationality" and all insurance providers should ensure that TB treatment is included in coverage. "TB is one of the few diseases that is completely curably and the medication is relatively inexpensive," he said.

In February, Dr Essa Kazim, the DHA's chief executive of health policy and strategy, said his department was planning to review certain health laws, including the one requiring automatic deportation for tuberculosis. No result of that review has been announced.