Keywords
Migration, labour exploitation, forced labour, modern slavery, health outcomes, healthcare access, Eastern Mediterranean Region, Türkiye
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Sawah E, Kielmann K, Admassu M et al. The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: A scoping review. [version 1; peer review: 1 approved]. F1000Research 2025, 14:375 (https://doi.org/10.12688/f1000research.162563.1)
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Study Protocol
The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: A scoping review.
[version 1; peer review: 1 approved]
PUBLISHED 01 Apr 2025
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Sociology of Health gateway.
This article is included in the Human Migration Research gateway.
Abstract
Corresponding author:
Engy Sawah
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2025 Sawah E et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Sawah E, Kielmann K, Admassu M et al. The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: A scoping review. [version 1; peer review: 1 approved]. F1000Research 2025, 14:375 (https://doi.org/10.12688/f1000research.162563.1)
First published: 01 Apr 2025, 14:375 (https://doi.org/10.12688/f1000research.162563.1)
Latest published: 01 Apr 2025, 14:375 (https://doi.org/10.12688/f1000research.162563.1)
Background
Labour exploitation, as a social determinant of migrants' health, acts as both a risk factor for poor health outcomes and a direct barrier to accessing healthcare (Boufkhed, 2020; Boufkhed et al., 2024). It is conceptualised along a continuum between decent work and forced labour and is characterised by, amongst other aspects, poor working conditions and safety, wage exploitation, underpayment and job insecurity (Skrivankova, 2010; Zwolinski, 2012). Migrants can experience various forms of exploitation within an acceptable work situation that can aggravate to situations of forced labour and sexual exploitation. Forced or compulsory labour affects around 27.6 million individuals worldwide across various industries (What Is Labour Exploitation? | End Labour Exploitation, n.d.). Notably, migrant workers globally face a substantially higher vulnerability to such exploitation, with their risk being three times greater than that of non-migrant workers (What Is Labour Exploitation?|End Labour Exploitation, n.d.).
Forms of labour exploitation have been sporadically associated with migrants' ill health and lack of/delayed access to healthcare (Guillot-Wright et al., 2022; Misra et al., 2021; Quandt et al., 2021; Rothe et al., 2021; Zimmerman & Kiss, 2017). Migrants’ fears regarding exploitative work situations – such as the risk of termination or potential impact on future employment contracts exacerbated health disparities and delayed access to healthcare (Giordano et al., 2021; K Jagdev et al., 2021; Quandt et al., 2021; Xiuhtecutli & Shattuck, 2021). Labour exploitation can also manifest structurally as legislations concerning the rights of undocumented migrants, asylum-seekers, and refugees were discovered to push migrants into hardships, heightening their susceptibility to labour and sexual exploitation (Berg et al., 2022; Gebreyesus et al., 2018). For example, specific visa regimes for refugees and asylum seekers created conditions for employers to abuse their workers, forcing them into situations of labour exploitation (Berg et al., 2022).
The Eastern Mediterranean region and Türkiye serve as a crucial transcontinental geopolitical juncture connecting Asia, Africa, and Europe. This region has become a major hub for diverse migrant and refugee populations, driven by a combination of economic opportunities, fleeing war zones, and other interconnected factors. In some instances, these migrant populations significantly outnumber non-migrant residents (International Organization for Migration, 2024). Despite this reality, most countries in this region are not signatories to the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (United Nations, 1990). Further, the region is characterised by a substantial, often unregulated, informal labour market and acts as a destination market for human trafficking (Amnesty International, 2024; Office of the United Nations High Commissioner for Human Rights, 2023; Toksöz et al., 2012). Some existing migration regulatory systems, for example, the Kafala (sponsorship) system, which is prevalent in parts of the region, grant employers disproportionate powers over their migrant employees (Amnesty International, 2019b, 2024; Médecins Sans Frontières, 2023). This leaves migrant workers vulnerable to exploitation and abuse and restricts their access to healthcare and legal protections (Amnesty International, 2019a; K Jagdev et al., 2021; Médecins Sans Frontières, 2023). Despite the limited research and data available, the International Labour Organisation (ILO) reported in 2013 that 600,000 are victims of forced labour, with a prevalence rate of 3.4 in every 1,000 of the region’s inhabitants (Harroff-Tavel & Nasri, 2013).
Labour exploitation is situated at the intersections of prejudice, discrimination and vulnerabilisation based on sexuality, gender identity, race, ethnicity, religion, power imbalances, migratory status and socioeconomic status (Arun & Olsen, 2023; Green, 2015; Palumbo, 2023; Tomaselli, 2024; Yurdakul, 2022). Labour exploitation is also highly gendered and is considered as both a precursor and an outcome of gender-based violence (GBV) (Gebreyesus et al., 2018; International Organisation of for Migration, n.d.). Women and girls constitute the majority of forced labour victims, making up 58% of the total victims, and strikingly account for 99% of victims of forced labour in the commercial sex industry (International Labour Organization et al., 2022) Further, highly educated female migrants are more likely to work in low-skilled and poorly paid jobs compared to their non-migrant counterparts (Bauder, 2003; Chicha, 2012; Pecoraro, 2016; Riaño, 2011), and are at increased risk of experiencing exploitative and forced labour practices. More than 75% of those in state-imposed forced labour are males, and more than 3.3 millions of forced labour victims are children (International Labour Organization et al., 2022). Nevertheless, existing data on labour exploitation and forced labour is limited in its disaggregation by gender identity, leaving a gap in understanding the situation for gender minorities.
Exploitative labour practices to which migrants are exposed can be conceptualised along the intersecting yet distinctive overarching forms of violence: symbolic, interpersonal and structural (Acharya & Behera, 2023; Di Marco, 2023; Min, 2024; Müller, 2024; Zwolinski, 2012). Further, labour exploitation is intricately tied to race, where racialised minority migrants are confronted with reduced pay, prohibition of holidays and precarious working conditions ( European Union Agency For Fundamental Rights, 2019; Fernandez, 2021). These populations are recognised as being disproportionately susceptible to labour exploitation, and therefore, information related to their experiences will be given particular attention in the study.
Labour exploitation remains a complex phenomenon, particularly due to its implicit nature, being unrecognised by law enforcement despite its detrimental impact on victims' mental and physical health. Globally, efforts have been invested in covering specific gaps in research related to migration, working conditions and health. The WHO global research agenda on health, migration and displacement has underlined the significance of generating multisectoral research on addressing the determinants of the health of migrants and identified the impact of living, working conditions, and policies on the health of migrants as the highest priority research gaps (World Health Organization, 2023). The O’Neill-Lancet Commission on Racism, Structural Discrimination and Global Health has emphasised that certain health inequities are preventable if the problem of racism in health is addressed (Erondu et al., 2023). Further, The Work and Health Lancet series sheds light on the narrowed focus on occupational hazards and safety within the health community, disregarding working conditions as a social determinant of health (Burdorf et al., 2023; Frank et al., 2023; Merino-Salazar et al., 2023; Pega et al., 2023; Rugulies et al., 2023).
Despite growing attention to labour exploitation, the current landscape reveals a gap as policies and research heavily focus on its most severe forms, framing the issue primarily through a criminal perspective (Boufkhed et al., 2024; Cockbain & Brayley-Morris, 2018; Davies & Ollus, 2019). Little attention has been given to milder forms of labour exploitation ( European Union Agency for Fundamental Rights, 2016; European Union Agency For Fundamental Rights, 2019). The lack of clear recognition of labour exploitation in existing laws and protection policies further diminishes its visibility in both policy discourse and academic literature.
Moreover, existing evidence often conceptualises labour exploitation as a binary condition—either categorised as decent work or modern slavery—overlooking the continuum that exists between these two extremes. Studies to date have predominantly examined its severe forms (David et al., 2019; International Labour Organization et al., 2022), including modern slavery, forced labour and trafficking for sexual exploitation in relation to health. Yet, a thorough examination of exploitative practices and milder forms or routine cases of exploitation and their implications for migrants' access to healthcare and their overall health outcomes has received little consideration. Furthermore, research on labour exploitation and migrants' health in the Eastern Mediterranean region remains scarce.
Our proposed review will unpack the dynamics and complex mechanisms that underline health-related aspects of labour exploitation in migrant populations in the Eastern Mediterranean region. The nexus of labour exploitation and migrant health spans multiple disciplines, including public health, labour studies, migration research, and the field of human rights. A scoping review would help integrate insights from these diverse fields and promote more holistic approaches to understanding this complex issue. A scoping review will synthesise existing knowledge on health-related aspects of labour exploitation, identifying structural factors that enable exploitation and highlighting promising practices and recommendations for protecting migrant workers' rights and health.
To this purpose, we aim to delineate the nexus of labour exploitation and health across the structural, symbolic, and interpersonal forms of labour exploitation described in the literature, and along the continuum between decent work and forced labour (Krug et al., 2002; Montesanti & Thurston, 2015; Skrivankova, 2010). This framework of violence was selected because its interconnected forms span from the individual experiences to the systemic and implicit manifestations of violence. Thus, it can capture the full spectrum of exploitative practices, their underlying causes, and their impact on migrant workers’ health. The definitions of these concepts are provided in the ‘scope and key definitions section’. In addition, we explore the intersectionality of prejudice, discrimination and vulnerabilisation based on migratory status, sexuality, gender identity, race, ethnicity, religion, disability, power differentials and socioeconomic status. We believe this intersectional lens is required as it will highlight how overlapping identity factors and systemic inequities create risks for health outcomes. By situating labour exploitation within these broader inequities, we provide a framework for understanding the nuances of multilayered and multifaceted health related to labour exploitation. We will construct a conceptual model illustrating the different forms of violence and intersecting identities, creating interlinked pathways through which labour exploitation is associated with health outcomes and access to healthcare aspects.
For the assessment of access to healthcare, we will use Tanahashi’s framework for health service coverage, which encompasses the dimensions of availability, accessibility, acceptability, contact and effectiveness coverage (Tanahashi, 1978), guided by the evidence synthesis framework of the WHO’s handbook for conducting assessments of barriers to effective coverage of health services (World Health Organization, 2024). Tanahashi’s framework is well suited for this review as it assesses coverage from the allocation of resources to accomplishing desired outcomes.
Scope and key definitions
To ensure clarity of concepts, the next section will define the terms utilised in this protocol and provide justification for the choice of terms before presenting our methodology, results, and discussion.
1. A ‘migrant’ has not yet been defined in international law, and existing definitions are not universally agreed upon. A migrant, according to the United Nations Department of Economic and Social Affairs (UN DESA), is “any person who changes his or her country of usual residence” (International Migration Law Glossary on Migration, 2019). This definition encompasses those who migrate for a combination of reasons, including economic opportunities, fleeing persecution, war zones, natural disasters, and other interconnected factors.
2. Labour exploitation: For the purpose of our study, we define labour exploitation as the abusive practices imposed on workers in the workplace for profit (What Is Labour Exploitation?, n.d.). We specifically selected this definition as it encompasses forms of labour exploitation that occur across the continuum from decent work to forced labour.
3. Decent work is defined by the ILO as “productive work under conditions of freedom, equity, security and dignity, in which rights are protected, and adequate remuneration and social coverage are provided” (Ghai, 2006).
4. Forced labour is defined as "all work or service which is exacted from any person under the threat of a penalty and for which the person has not offered himself or herself voluntarily" (International Labour Organisation, 1930).
5. Health is defined by the WHO as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1946).
6. Health outcome refers to the effects on health that arise from a specific condition, event, or intervention. These effects can be assessed in terms of social, psychological, and physical well-being, particularly focusing on the individual’s personal perception of a fulfilling life. Various factors may be included in health outcomes, such as reproductive and sexual health, substance use and abuse, mental health issues, and overall physical health and wellbeing (Bowling, 2004; Gibson Parrish & Cdc, 2010; Yang Chan, 2019).
7. Access to healthcare is defined as “the ability to obtain the timely, affordable and appropriate health services to achieve the best possible health outcomes” (Gold, 1998).
Tanahashi framework dimensions:
8. Availability coverage refers to the extent to which services are present and can meet the population in need. It also refers to the healthcare system’s capacity relative to the population size (Penchansky & Thomas, 1981; World Health Organization, 2024).
9. Accessibility coverage goes beyond mere presence as it refers to the financial and physical accessibility of services as well as organisational and informational accessibility (Tanahashi, 1978).
a) Physical accessibility includes aspects such as the distribution of facilities, travel duration, the distance from residences to these services, transportation availability, and the state of the roads leading from homes to health facilities (Penchansky & Thomas, 1981; Wong et al., 2020).
b) Financial accessibility defines the connection between the expense of a service and the user's capacity to afford it, taking into account any relevant financial protection arrangements or benefits (Penchansky & Thomas, 1981).
c) Organizational and informational accessibility pertains to how healthcare providers organise their services to accept patients—such as their operating hours, appointment scheduling systems, timeliness in service delivery, administrative procedures for accessing care, and available information about their services—and how well the population can adjust to or accommodate these factors (Penchansky & Thomas, 1981; World Health Organization, 2024).
10. Acceptability coverage refers to the segment of the population for whom services are deemed acceptable (United Nations Committee on Economic, 2000). It emphasises that all healthcare facilities, services and products should be culturally appropriate and comply with medical ethics. This means they must honour the cultural backgrounds of individuals, minority groups, and communities, while also being mindful of gender and life stages. Additionally, it's important that these services maintain confidentiality and aim to enhance the health status of those they serve (United Nations Committee on Economic, 2000).
11. Contact coverage indicates the direct interaction between the care provider and an individual when services are available, accessible and acceptable (Tanahashi, 1978).
12. Effective coverage relies on the successful establishment of the availability, accessibility, acceptability, and contact dimensions. This concept encompasses both the "initiation" and "continuation" of service utilisation (World Health Organization, 2024). It includes elements like maintaining care continuity over time, facilitating seamless referrals and follow-ups, promoting self-care empowerment, adopting shared decision-making into health co-production strategies, and providing people-centred services that consider comorbidities while coordinating across different types of services.
13. Structural violence is defined as violence ingrained within societal systems and upheld by institutions, through inequitable social, political, or economic structures, which creates and sustains disparities among social groups based on specific characteristics such as gender, sexuality, race/ethnicity, religion, ability, economic status, and migratory status (Montesanti & Thurston, 2015). This type of violence emerges from unequal power dynamics, resulting in uneven access to information, resources, influence, autonomy, and representation (Galtung, 1969; Lee, 2019).
14. Interpersonal violence is defined as violence that encompasses acts carried out by individuals, including violence directed towards family members, intimate partners, in the workplace, and within the community (Montesanti & Thurston, 2015; World Health Organisation & United Nations Entity for Gender Equality and the Empowerment of Women, 2019).
15. Symbolic violence refers to non-physical forms of violence characterised by power imbalances among societal groups. It cuts across ideologies, sexualities, genders, ethnic identities, language, actions, and non-verbal cues that perpetuate and validate hierarchical power structures. Symbolic violence is constructed and maintained by both dominant and dominated groups and is therefore not recognised as violence (Bourdieu, 1979; Hourani et al., 2021).
16. Vulnerabilisation is an ongoing mechanism that is not inherent to individuals or groups but constructed through individual, social, relational and institutional dynamics, making individuals or groups vulnerable in various ways, including by inflicting, prolonging, or aggravating the vulnerability of these individuals or groups (Carel & Kidd, 2024).
Review objective
We aim to capture a range of sources to map the scope and nature of the most relevant topical literature on the nexus of labour exploitation and health in migrant populations in the Eastern Mediterranean region and Türkiye. We will summarise key themes in this body of knowledge, pinpoint major substantive areas where further evidence generation is required, and disentangle the health-related aspects of labour exploitation in migrant populations.
Review questions
a. What are the direct and indirect consequences of labour exploitation on migrants’ physical and psychosocial health?
b. What are the existing barriers and challenges in accessing healthcare and support services for migrant victims of labour exploitation in the Eastern Mediterranean region and Türkiye?
c. What are the existing systems, policy interventions, and promising practices addressing the health of migrant victims of labour exploitation?
Inclusion criteria
Participants included in selected studies
Studies refer to migrants residing in the Eastern Mediterranean region and Türkiye, irrespective of their age, nationality, gender, ethnicity, and migration status, who experience any form of labour exploitation along the continuum of decent work and forced labour and experience associated health issues or barriers to accessing to healthcare due to their labour exploitation experience.
Concept
Labour exploitation: We will focus on all forms of labour exploitation transpiring on the continuum from decent work to forced labour, as depicted in Figure 1 below (Council of Europe, 2021). Consequently, the review will include and refer to all forms of abuse and exploitative practices, including underpayment within a typical job, to forms of coercion and workplace violence leading to forced labour.
Figure 1. The continuum of Exploitation from decent work to forced labour. This figure has been reproduced with permission from the Council of Europe © (Council of Europe, 2021).
Health-related aspects: will include the health outcomes of migrant victims of labour exploitation and barriers to accessing healthcare along the dimensions of availability, accessibility, acceptability, and contact as defined and delineated in the ‘scope and key definitions’ section above.
Context
Our review will focus on the WHO-designated Eastern Mediterranean region and Türkiye. List of countries include: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates, Yemen, and Türkiye.
This region presents an ideal model for studying labour exploitation and health due to multiple key factors: a diverse migrant population, varied migration and settlement patterns, and varying levels of health systems development. Most notably, there are evident cases of labour exploitation, yet there is a limited understanding of its implication for migrants' health (Dedeoğlu & Ergin, 2016; McCormack et al., 2015). These characteristics combined make the region uniquely suited to offer a comprehensive lens and a broader perspective to examine labour exploitation and its linkage to health. Our operational and research experience in this region provides critical contextual insights, enhancing the relevance of our study.
Types of evidence sources
This scoping review will incorporate a wide range of research designs. It will include experimental designs such as randomised controlled trials, as well as quasi-experimental approaches such as non-randomized and randomised controlled trials, pre-and-post studies, and quasi-experimental time series analyses. The review will also consider analytical observational research, encompassing both prospective and retrospective cohort studies, analytical cross-sectional, and case-control studies. Furthermore, the scope will include descriptive observational research such as case series and descriptive cross-sectional studies.
The review will also take into account (systematic) reviews that meet specific eligibility criteria. Qualitative or ethnographic research methodologies, such as case studies, narrative analysis, phenomenology, grounded theory, participatory research, content analysis, and action research, will likewise be considered. Furthermore, grey literature will be included, including technical reports, government documents, theses or dissertations, and research reports. Reports published on the websites of international organisations, including the ILO, the United Nations Children's Fund (UNICEF), UNHCR, the World Bank, UN Women, and Save the Children, will also be part of this review.
A detailed table of inclusion and exclusion criteria is available from (Sawah et al., 2025b).
Methods
The review protocol is designed in alignment with the updated Joanna Briggs Institute (JBI) guidelines for designing scoping reviews (Peters et al., 2015), and will adhere to the Updated methodological guidance for the conduct of scoping reviews (Peters et al., 2020), and will be reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., 2018). The review protocol will be registered on F1000Research.
Search strategy
Our review will employ a comprehensive approach to identify published and grey literature using a three-phase search strategy. An initial limited search in PubMed and Google Scholar was undertaken to refine the search terms, improve the precision of the search, identify additional useful terms and finalise the data sources before formal searches are undertaken. We analysed the titles and abstracts of pertinent articles to extract key terms and index words. This process informed the development of a robust search strategy, which was tailored to suit the selected databases and information sources. Our search strategy and syntax have been reviewed and tested by our institute’s librarian. The detailed search strategy protocol is available from (Sawah et al., 2025d). To ensure thoroughness, we will examine the reference lists of existing systematic reviews on related topics to uncover additional relevant studies.
Information sources
A literature search will be conducted using the following databases:
- Cochrane https://www.cochranelibrary.com/central/about-central
- PubMed https://pubmed.ncbi.nlm.nih.gov/
- Web of Science www.webofscience.com
- SCOPUS www.scopus.com
- Institute of Tropical Medicine (ITM) library’s discovery service https://research.ebsco.com
- For grey literature, including relevant policy documents, we will use Google Scholar https://scholar.google.com/ and Overton https://www.overton.io/ as a secondary source, and we will take the 200 first results of each, as recommended by Haddaway et al., (2015).
- Reports published on websites of international organisations such as the International Labor Organization, UNICEF, World Bank, UN Women, and Save the Children.
Timeframe: This review will consider articles published after March 2011—marking the onset of the Syrian revolution and extending to the present day, including the European Union (EU)-Türkiye deal in 2016 (Council of the European Union, 2016; The United Nations Refugee Agency, 2022). This timeframe is appropriate as it captures two significant developments over the past decade. Firstly, the eruption of the Syrian revolution and the subsequent civil war has caused the world’s largest refugee influx, as more than 14 million have been displaced. This displacement has created patterns of migrants' and refugees' vulnerabilisation in the host country, intensifying their precarity to exploitation (International Centre for Migration Policy Development, 2015; Kavak, 2016). Secondly, the EU-Türkiye deal, which is a migration restriction regime designed to externalise the issue of migration by keeping migrants outside of Europe. This deal was employed by governments to contain migrants within their borders, instrumentalising migrants' vulnerability to retain them in cheap labour, thereby increasing their susceptibility to labour exploitation (Demirbaş & Miliou, 2024).
Languages: The review will be limited to full articles published in English or Arabic or available in English or Arabic translation, as these are the languages covered by the members of this team.
Evidence screening and selection
After completing the search, all identified references will be gathered and imported into Zotero, and duplicate entries will be eliminated. Following a preliminary test, three separate reviewers will examine titles and abstracts to determine if they align with the review's inclusion criteria. The review will document the reasons for excluding titles and abstracts during this screening process. Any discrepancy between reviewers throughout the selection process will be determined through reasoning and discussion or by involving a third reviewer. Sources deemed potentially relevant will be obtained in full, and their citation information will be entered into COVIDENCE (Covidence Systematic Review Software, n.d.).
Three independent reviewers will thoroughly examine the full text of selected articles based on the established inclusion criteria. The scoping review will document and report the reasons for excluding any full-text sources that don't meet these criteria. Any discrepancies between reviewers during this process will be settled through discussion or with the help of a third reviewer. The final outcome of the scoping review will provide a comprehensive report of the search results and study inclusion process, including a PRISMA flow diagram for visual representation (Page et al., 2021).
Data extraction
Using a custom-designed data extraction tool, two independent reviewers will excerpt data from the selected papers. This tool will capture specific information about participants, concepts, context, study methods, and key findings relevant to the review questions. The tool was designed after a preliminary search of relevant literature on labour exploitation in migrant populations. The data extraction instrument is available from (Sawah et al., 2025a).
The initial data extraction tool will be piloted, modified, and refined iteratively as necessary during the title and abstract screening process. Further modifications may occur during the data extraction process from full-text sources. All amendments will be recorded in the scoping review. Any discrepancies between reviewers will be tackled through reasoning among the reviewers or by including additional reviewers. If necessary, the reviewers may reach out to study authors to request missing or supplementary data.
The main variables included in the data extraction sheet are:
a. Study/document characteristics: Author(s), Affiliations, Title of paper, Year of publication, Origin/country of origin (where the source was published or conducted), Document type, Study population source, Sample size, Methodology/methods.
b. Participants characteristics: Age group, Sexuality, Gender identity, Race and/or ethnicity, Country of origin, Host country, Migratory status, Employment status, Language, relevant sociocultural factors
c. Concept:
• Labour exploitation perpetrator, typology, characteristics, industry or sector involved
• Mental, physical and social health outcomes.
• Access to healthcare dimensions using the evidence synthesis framework of the WHO’s Handbook for conducting assessments of barriers to effective coverage with health services (World Health Organization, 2024).
• Identified coping strategies and promising practices.
d. Context includes the country and the setting where the study is conducted.
Data analysis
We will analyse quantitatively and qualitatively the available evidence, and we will map the available evidence related to labour exploitation and its health impacts on migrant populations in the Eastern Mediterranean region.
Quantitative Analysis: a descriptive analysis will be conducted to provide an overview of the included studies: number of studies by country, types of study designs, publication years, sample sizes, and demographic characteristics of migrant populations.
Qualitative Analysis: an inductive content analysis approach will be used to synthesise the qualitative data extracted from the included studies. Key themes to be explored will include forms of labour exploitation, health outcomes associated with exploitation, and barriers to accessing healthcare. When available, the review will also incorporate data specifically pertaining to vulnerabilised populations who are at higher risk of experiencing labour exploitation. These groups include children, older adults, racial and ethnic minorities, gender and sexual minorities, other marginalised subgroups, individuals with lower levels of education, people with disabilities, and those engaged in informal work. We will delineate how these variables and other contextual-related factors contributed to the risk of experiencing labour exploitation and related health impacts as appropriate.
Mapping of Evidence: the analysis will also involve mapping the evidence to identify gaps in research and areas of concentration. This will include: a) Geographical distribution of studies, b) Sectors of employment most frequently studied, c) Underrepresented migrant groups, d) Understudied health outcomes, e) Understudied types of access to healthcare, and f ) Recommendations for future research and implications for policy and practice.
Data presentation
The results of the scoping review will be presented using a combination of structured narratives and visuals (tables, maps, and figures as suited) and the appropriate software, such as Power BI.
A comprehensive narrative summary will be provided, structured around the key themes identified in the analysis. This will include an overview of the current state of research, a description of major findings related to labour exploitation and health impacts, and a discussion of trends, patterns, and gaps in the literature. Subsequently, a comprehensive populated labour exploitation continuum framework incorporating practised forms identified in the literature will be developed within which associations to health outcomes and access to healthcare, and influencing factors aspects will be drawn.
A dedicated section will present gaps and future directions: research gaps identified through the mapping process, promising practices, recommendations for future research directions, and implications for policy and practice.
Visual presentations to complement the narrative synthesis, various visual aids will be employed:
1- PRISMA Flow Diagram: Illustrating the study selection process.
2- Tables:
3- Figures may, for example, include:
4- Conceptual Frameworks:
a. A diagram illustrating the relationships between labour exploitation, health outcomes, and influencing factors
b. A populated labour exploitation continuum framework incorporating practised forms identified in the literature and drawn associations with health outcomes and access to healthcare aspects
5- Word Cloud: Representing frequently mentioned/used terms related to health impacts and forms of exploitation.
Conclusion
This scoping review will be the foundation for larger-scale studies to understand the nexus of labour exploitation and health among migrants in the Eastern Mediterranean region and Türkiye. We aim to contribute evidence towards a better understanding of the role of exclusion in health outcomes (Erondu et al., 2023), and inform policies and interventions to improve migrants’ lives and well-being in the Eastern Mediterranean region and Türkiye. The findings of this research have the potential to influence research, interventions, and policy directions, particularly in healthcare. This review will fill a gap in understanding how, where, and when exploitative labour practices affect migrant health in the Eastern Mediterranean region and Türkiye, and provide an overview of promising practices and interventions. Our intersectional and holistic approach ensures that our research identifies labour exploitation health-related issues and offers tangible recommendations to address them, fostering a more inclusive and supportive environment for migrants in the Eastern Mediterranean region and Türkiye.
Dissemination
The review findings will be disseminated through a publication in a peer-reviewed journal and presentation in relevant fora and conferences.
Software and code
COVIDENCE software is available from https://www.covidence.org/. A free alternative to COVIDENCE is CADIMA and is available from https://www.cadima.info/.
Reporting guidelines
Zenodo: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist for ‘The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: a scoping review’ https://doi.org/10.5281/zenodo.14959607 (Sawah et al., 2025c).
Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).
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how to cite this article
Sawah E, Kielmann K, Admassu M et al. The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: A scoping review. [version 1; peer review: 1 approved]. F1000Research 2025, 14:375 (https://doi.org/10.12688/f1000research.162563.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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How to cite this report:
Zimmerman C. Reviewer Report For: The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: A scoping review. [version 1; peer review: 1 approved]. F1000Research 2025, 14:375 (https://doi.org/10.5256/f1000research.178785.r375354)
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NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 26 Apr 2025
Cathy Zimmerman,
Gender Violence Unit, LSHTM,, London, UK
Approved
VIEWS 6
This is a VERY well-justified review with an extremely strong background section. I am very excited to see the results of this review. The only question that i had was that I wondered if the inclusion/exclusion criteria and search terms
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Zimmerman C. Reviewer Report For: The nexus of health and labour exploitation among migrant populations in the Eastern Mediterranean region and Türkiye: A scoping review. [version 1; peer review: 1 approved]. F1000Research 2025, 14:375 (https://doi.org/10.5256/f1000research.178785.r375354)
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https://f1000research.com/articles/14-375/v1#referee-response-375354
https://f1000research.com/articles/14-375/v1#referee-response-375354
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