Research Paper Patterns of abuse amongst Sri Lankan women returning home after working as domestic maids in the Middle East: An exploratory study of medico-legal referrals Kolitha Wickramage a, b, * , Malintha De Silva c , Sharika Peiris d a Migration Health Division, International Organization for Migration (IOM), 17 route des Morillions, CH-1221, Geneva, 19, Switzerland b Rajarata University, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Saliyapura, 50008, Sri Lanka c Judicial Medical Office, District General Hospital Negombo, A3 Rd, 11500, Sri Lanka d International Organization for Migration (IOM), 62 Ananda Coomaraswamy Rd, Colombo, 003, Sri Lanka article info Article history: Received 13 April 2016 Received in revised form 21 October 2016 Accepted 6 November 2016 Available online 9 November 2016 Keywords: Maid abuse Migrant worker abuse International migrants Violence and health Migration health Sri Lanka abstract Objective: Migrant worker abuse is well recognised, but poorly characterised within the scientific liter- ature. This study aimed to explore patterns of abuse amongst Sri Lankan women returning home after working as domestic maids. Methods: Sri Lanka has over 2 million of its citizens employed overseas as international labor migrants. A cross-sectional study was conducted on Sri Lankan female domestic maids returning from the Middle East region who were referred for medico-legal opinion. Results: A total of 20 women were included in the study. Average length of their employment overseas was 14 months. Complaints of physical violence directed mainly through their employers were made by 60% of women. Upon physical examination, two-thirds had evidence of injuries, with a third being subjected to repetitive/systematic violence. Eighty percent suffered some form of psychological trauma. Personal identity papers and travel documents had been confiscated by the employer in 85% of cases, with two thirds indicating they were prevented and/or restricted from leaving their place of work/ residence. Conclusions: Our study demonstrates that female domestic maid abuse manifests through multiple pathways. Violence against such workers span the full spectrum of physical, financial, verbal, emotional abuse and neglect, as defined by the World Health Organization. Findings from this exploratory study cannot be generalized to the large volume of migrant worker outflows. Further research is needed to determine incidence and define patterns in other migrant worker categories such as low-skilled male workers. © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. 1. Background and rationale for the study Globally an estimated 52e100 million people work as domestic migrant workers abroad, 75% of them women, with many having little or no access to legal, social and health protection schemes. 1 Many have limited or no access to legal, social and health protec- tion schemes. Despite being recognised as a critical issue at the nexus of development and human rights, migrant worker abuse is poorly documented in the scientific literature. 2,3 Nearly one in ten Sri Lankan citizens are employed overseas as international labor migrants (ILMs), with 93% employed in the Middle East region comprised of countries such as Saudi Arabia, Kuwait and Qatar. 4 Growing economic aspirations of such workers are driven by labour market demands of rapidly developing econ- omies of the world. ILMs from Sri Lanka have grown tenfold during the past decade, 5 with a total of 730 departing each day. 4 The percentage of registered women migrant workers has reduced from 79.9% in 1996, to 37% in 2014. A total of 81% of all registered female departures in 2014 were within the ‘low-skilled domestic maid’ category. 4 Migrant workers in ‘low skilled’ labour categories are engaged in what human rights organizations call 3D or ‘dirty, * Corresponding author. Migration Health Division, IOM headquarters, Geneva, Switzerland. E-mail addresses: kwickramage@iom.int (K. Wickramage), malinthadesilva@ yahoo.com (M. De Silva), speiris@iom.int (S. Peiris). Contents lists available at ScienceDirect Journal of Forensic and Legal Medicine journal homepage: www.elsevier.com/locate/jflm http://dx.doi.org/10.1016/j.jflm.2016.11.001 1752-928X/© 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Journal of Forensic and Legal Medicine 45 (2017) 1e6