Experiences of the Migrant Farmworkers during the Syndemic Due to COVID-19 in Spain

Abstract

The present article addresses the COVID-19 syndemic, that is, the interaction of SARS-CoV-2 with other diseases that interact and are determined by patterns of social inequality. The living and working conditions of migrant farmworkers increases the transmission of COVID-19. Descriptions of the experiences of migrant farmworkers provided by the professionals from different organizations that tend to them allowed the authors to discover the syndical nature of COVID-19. This study is based on qualitative descriptive research. Seventeen workers from different organizations participated in the study, through in-depth interviews between January and June 2022. A thematic analysis was performed to analyze the qualitative data. Two main themes emerged: Non-compliance with the collective labor agreement, and non-compliance with workplace health and safety standards. The results suggest that the adverse living and working conditions of the migrant farmworkers increased their risk of COVID-19 infection, due to the lack of compliance with the health measures decreed. The vulnerability experienced by migrant farmworkers increased work conflicts and prompted their mobilization to fight for their rights.

1. Introduction

The coronavirus respiratory syndrome (SARS-C0V-2), the cause of the coronavirus disease (COVID-19), resulted in a worldwide pandemic (Greenaway et al. 2020). By September 2021, this disease had infected almost 223 million people and caused the death of more than 4 million people (Bacigalupe et al. 2022). The World Health Organization (Organización Mundial de la Salud 2022) declared a worldwide pandemic in January 2020. In Spain, this created a health and socio-economic crisis, which affected more than 12 million people due to COVID-19 and resulted in 105 thousand deaths (Dong et al. 2020). To limit the transmission of COVID-19, the Spanish government declared a health State of Alarm to manage the health crisis, ordering Royal Decree 463/2020 on 14 March 2020 (Gobierno de España 2020). which included prevention and control measures. These measures included the mandatory use of face masks, at-home confinement, social restrictions, and mobility restrictions to first-need activities, such as travel to work (Dhama et al. 2020; Gónzalez Pérez and Piñeira Mantiñán 2020). These measures affected highly informal sectors such as agriculture, which has a high percentage of Migrant Farmworkers (MFs). Spain has a de-centralized system of hiring which makes the calculation of the MF population difficult. The MFs with temporary employment have a below-average salary, no vacation rights, unpaid overtime, and live in unhealthy conditions. During the first period of confinement, the demand for employment by MFs exceeded the supply, so they were forced to live in precarious conditions (Reid et al. 2021).

Singer highlighted that the origin of the COVID-19 pandemic did not occur in isolation, but had a syndemic character. The COVID-19 syndemic is the interaction of the SARS-CoV-2 virus with a series of non-transmissible chronic diseases (severity factors of COVID-19) that interact and are determined by social inequality patterns, which exacerbate the adverse effects (Bacigalupe et al. 2022). The influence of COVID-19 is not unilateral, as the socio-political context of each society exposes the most vulnerable social groups to social exclusion, such as the MFs who live in conditions that pose direct risks to their health (Barbosa et al. 2022). Different studies have underlined high rates of COVID-19 prevalence confirmed among undocumented migrants, with precarious contracts and housing (Hayward et al. 2021). Guijarro et al. (2021) pointed out that the risk of COVID-19 infection of migrants, especially those from Sub-Saharan Africa, was greater than the Spanish population, with rates of 8.71 and 6.51 per 1000 inhabitants, respectively (p < 0.001). The living and working conditions, such as housing, the type of employment, or the ability to move, have an effect on the chances of acquiring COVID-19. The MFs very often live and work in unhealthy and overcrowded conditions, which makes the compliance with the COVID-19 prevention measures difficult, thus increasing the risk of transmission (Allande-Cussó et al. 2022). Other measures such as social distancing and the reduction in activity or mobility, had a strong impact on individuals with less qualified work, such as the MFs, who did not have the opportunity to work online (Bacigalupe et al. 2022). Despite the postponement of the temporary permits to provide a response to the pandemic, the MFs with temporary residency statuses lost their social rights. The possibility of regularization of undocumented migrants in an irregular administrative situation was also discarded, which lead to the deterioration of the economic and work conditions of the MFs (Martín-Díaz and Castellani 2022). Due to the school closures, many women were affected, as they had to quit their jobs to care of their children (Hernández et al. 2021).

Understanding COVID-19 as a syndemic provides us with strategies for understanding how social inequalities such as precarious living or working conditions, the impossibility of real isolation, or problems with travel permits to go to work, among others, together with the pre-existing health problems, exacerbate the appearance of illnesses and health problems (Barbosa et al. 2022). At the start of the COVID-19 pandemic, many local organizations coordinated their actions to provide the available resources to support the MFs mitigate the effects of COVID-19(Martín-Díaz and Castellani 2022). Although studies exist on the impact of COVID-19 in the migrant population (Shi and Liu 2020), the living and health conditions in settlements (García Padilla et al. 2021) or socioeconomic inequalities during COVID-19 (Bacigalupe et al. 2022), not many studies have analyzed the experiences of the MFs during the COVID-19 pandemic. Knowing the perspective of professional workers from different organizations that work with the MFs collective could provide information to health systems, allowing them to better understand the syndic nature of COVID-19, in order to confront it from a perspective of equality. The objective of the present study is to discover and describe the experiences of migrant farmworkers (MFs) during the COVID-19 syndemic, through the professional workers from the organizations that care for them.

2. Materials and Methods

2.1. Design

A descriptive qualitative study was conducted, as it allows for describing little-known phenomena from a naturalist paradigm, and their interpretation through the experiences of the protagonists in their natural environment (Kim et al. 2017). The approach proposed is adequate for discovering the experiences of the MFs who work in the fruit and vegetable sector, and how the COVID-19 syndemic has affected them (Thorne et al. 2016). The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed (Tong et al. 2007).

2.2. Participants and Environment

The study took place in the offices from various organizations in the South of Spain. All the study participants were professionals from six countries. Their mean age was 37.47 years old. Of these, 56.25% were men, and 43.75% women. The participants were recruited through intentional sampling. The met the following inclusion criteria: being a worker from an organization with a minimum of 4 years of experience caring for MFs, speaking Spanish, and providing a signed informed consent form. The exclusion criteria was not wanting to participate in the study. To recruit the sample, one of the researchers invited the workers to participate through a phone call, and a meeting was set up. In total, 19 workers from different organizations were invited to participate, although two rejected the invitation due to lack of time. The final sample was composed of 17 workers. The sociodemographic characteristics of the participants are shown in

Table 1. Socio-demographic characteristics of the participants (N = 17).

Participant	Age	Sex	Country	Level of Education	Organization	Years of Experience
P1	47	Man	Ivory Coast	Higher Education	NGO	26
P2	49	Man	Senegal	Higher Education	NGO	22
P3	45	Man	Spain	Secondary School	Agricultural union	22
P4	35	Man	Morocco	Secondary School	Agricultural union	12
P5	55	Man	Morocco	Higher Education	NGO	32
P6	25	Man	Guinea Conakry	Higher Education	NGO	5
P7	32	Man	Morocco	Higher Education	NGO	6
P8	41	Man	Spain	Higher Education	NGO	7
P9	33	Man	Senegal	Secondary School	NGO	6
P10	38	Woman	Mali	Higher Education	NGO	8
P11	42	Woman	Morocco	Secondary School	NGO	14
P12	29	Woman	Morocco	Secondary School	NGO	7
P13	32	Woman	Morocco	Higher Education	NGO	5
P14	33	Woman	Spain	Secondary School	NGO	10
P15	27	Woman	Senegal	Secondary School	NGO	6
P16	39	Woman	Spain	Higher Education	NGO	12
P17	35	Woman	Morocco	Higher Education	NGO	8

.

2.3. Data Collection

The collection of data included 17 in-depth interviews (II) given between January and June 2022. The interviews were given in the respective offices of the organizations where the workers performed their work. The mean duration of the II were 46 min. All the II were performed by three researchers trained in qualitative research, following a semi-structured interview guide, previously practiced with pertinent questions (

Table 2. Interview protocol.

Stage	Themes	Content/Possible Questions
Introduction	Objective	To discover the experiences of the MFs during the Syndemic due to COVID-19.
	Ethical matters	Provide information on their voluntary participation, recording, consent, possibility of withdrawal and confidentiality.
Start	Introductory question	Could you talk to me about your experience with working with migrants?
Development	Interview guide	How do you think the syndemic has affected MFs? How did the measures decreed by the government influence their working conditions? Could you talk to us about the situation of the MFs who worked in the agricultural sector during the confinement? How do you think the living and work conditions influenced the spread of the syndemic?
Closing	Final question	Is there anything that you would like to add about the subject we discussed?
	Acknowledgements	Give thanks for their time. We are at your disposal if you need anything from us.

). Before starting, the sociodemographic data were collected, the protocol was explained to participants, the confidentiality of the data were guaranteed, and the informed consent forms were signed. The interviews were in Spanish, audio recorded, and transcribed verbatim in Spanish. The researchers noted the non-verbal aspects of communication. At the end, the participants had the opportunity to read the transcriptions to verify the content. The collection of data was interrupted when, after the analysis of the data, new information was not provided, due to the saturation of data.

2.4. Data Analysis

The data analysis was performed utilizing the II transcriptions and field notes taken by the researchers. These were incorporated into a hermeneutic unit and analyzed with the qualitative data analysis software Atlas.ti 9. The thematic analysis followed the steps described by Braun and Clarke (2021): (1) Familiarization with the data: this consisted of the complete reading of all transcriptions to obtain a global understanding of the experiences of the participants and for attaining their initial ideas; (2) Generation of initial codes: the most representative quotes were codified, by systematically assigning them with codes of interesting characteristics; (3) Search for themes: the codes were associated and grouped into themes with similar patterns of meaning associated with a main idea; (4) Review of themes: three researchers independently verified that the themes were coherent with the codes and quotes, to agree on the results of the themes and subthemes; (5) Definition and nomenclature of the themes: the researchers analyzed and sharpened the details of each theme; (6) Write the report: the researchers selected the most representative quotes and described the themes and subthemes. Next, they perfected the report by selecting the parts related with the objective of the study and created the final report.

2.5. Rigor

To ensure rigor, we adopted the following criteria from Guba and Lincoln (1994): (a) Credibility: the data collection process was detailed and interpreted with support from the triangulation of the data from the researchers; (b) Transferability: detailed information about the participants, the study surroundings, the context, and the method were provided; (c) Reliability: the analysis of the data was reviewed by various members of the research team with experience in qualitative research; (d) Confirmability: the verbatim translations of the participant’s experiences were incorporated into our results through the use of quotes, and the participants were provided with a copy of the data analysis to be able to clarify the interpretation of the data extrapolated from the transcriptions.

2.6. Ethical Considerations

The Research Ethics Committee from the Department of Nursing, Physical Therapy, and Medicine at the University of Almeria ratified the research protocol (number EFM 115/2021). The anonymity and confidentiality of the participants was guaranteed by assigning a code for each participant. All records were created considering the precepts established in the current legislation on the protection of personal data found in Organic Law 3/2018 from 5 December, with respect to the protection of personal data and guarantee of digital rights. The participants were informed of the purpose of the study and the voluntary nature of their participation. Before starting the study, their informed consent was obtained, and they were asked for permission to record the interview. The study was conducted according to the ethical principles of the Declaration of Helsinki.

3. Results

Two themes and five subthemes emerged from the inductive analysis, allowing for the description and understanding of the experiences of the MFs during the COVID-19 syndemic (

Table 3. Themes, subthemes and units of meaning.

Theme	Subtheme	Units of Meaning
Non-compliance with the collective labor agreement	Labor irregularity	Fraudulent contracts and contributions Workers without work permits Without extraordinary regularization
	Unfavorable working conditions	Workday Family conciliation Salaries Sick leave
Non-compliance with Workplace Health and Safety standards	Difficulties in complying with the protection measures against COVID-19	Lack of protection equipment No physical distancing Police controls and transport limitations Work conflicts
	Unhealthy living conditions	Difficulty in accessing potable water Without face masks Overcrowding
	Increase in work unrest	More unrest at work Increase awareness about the situation

).

3.1. Theme 1: Non-Compliance with the Collective Labor Agreement

This theme shows the most relevant matters related to compliance with the collective agreements and measures decreed by the government that protected the population during confinement. Our participants underlined the lack of compliance with these measures among the MFs, as well as an increase in the underground economy, such as the hiring of undocumented migrants or MFs without a contract.

3.1.1. Subtheme 1: Labor Irregularity

The participants of this study pointed out that in the fruit and vegetable sector, fraud was frequent in the hiring of workers. They highlighted the presence of many MFs without contracts or who had signed contracts that were unlawful.

“There were a lot of people working in warehouses with a fieldwork contract, with them paying for their own insurance, you barely see permanent workers in the business (…) You work 25 days and they indicated less, when there was a work inspection, the farmers told the workers not to come”.

(P15)

“Many did not have benefits or aid, which points to fraud in employment history, they put less (tax) contributions from the workers”.

(P2)

According to our participants, a characteristic of the fruit and vegetable sector in the area of study is the normalization of workers without work permits, which result in situations of work exploitation and infringements on workers’ rights.

“We get new people from the boats, who start to work a few days later. There are thousands of workers “without papers”, who look for work to survive. They go out in the morning around the area, and the farmer sets the price, if they don’t want it, there are many others”.

(P7)

“Those who lost their jobs because of a lack of transport were substituted by other undocumented individuals; agriculture cannot stop”.

(P6)

Our participants highlighted the fact that Spain did not adopt any extraordinary measures to regularize the undocumented migrants who worked in the fruit and vegetable sector. As one of the participants stressed, Spain could have followed the example from surrounding countries who regularized many of the workers who worked in this essential sector:

“They did not legalize those “without papers”, they were kept without rights, they could have regularized the workers as in Portugal and Italy”.

(P2)

3.1.2. Subtheme 2: Unfavorable Working Conditions

Given the different factors, such as the precarious migrant status, lack of knowledge about the laws, or their condition as undocumented individuals, many of the MFs accepted abusive working conditions, with long workdays that implied high physical demands. Therefore, the participants underlined that the MFs have very little labor rights, and are not able to reject work, even if it is under precarious conditions.

“There were (food) manipulation companies where they worked more than 10 continuous hours, they knew at what time they started, but not when they could go back home”.

(P10)

We must add other factors to these unfavorable work conditions. According to the study participants, the MFs were paid less than the salary established by the collective agreement in the agricultural sector, they very often work extra hours without extra pay, or they are not declared. As one of the participants pointed out:

“In the agreement, the salary was 58.24€, 7.28€/h in the field and manipulation, although they really earn 32 and 42€ on average in the field. In manipulation, there is a greater lack of compliance with the base salary, although there are many warehouses that pay 5€ an hour, what is difficult is to get paid for the extra hours worked”.

(P14)

During the first waves of the COVID-19 pandemic, most of the population remained confined to their homes to protect themselves from the disease. However, MFs, as essential workers, worked in adverse conditions. As the study participants pointed out, many MFs were fired due to COVID-19 cases between workers, or for living with infected individuals. They highlighted that this infringement on their labor rights, such as sick leave due to COVID-19, led to many MFs hiding their disease or their cohabitants’ for fear of being fired. Also, as one participant indicated, many business owners rejected testing them to detect the disease.

“In a shantytown, there were a few infected individuals, and they did not want to test the rest. The business owners knew this, but they did not want to stop production and the migrants needed to work. Many of them were fired because of being under quarantine”.

(P5)

Women were strongly affected during the pandemic, having to quit their jobs. Family conciliation was difficult due to school closures or the care of family members infected with the disease. As one of the participants pointed out, the infractions of the measurements decreed forced women to adapt or reduce the workday to be able to care for children or people confined individuals, led to many women losing their jobs.

“Family conciliation is already a problem for business owners, and with COVID-19, we found cases of women who were fired for having to care for their children. The company did not show any sign of sensibility”.

(P4)

3.2. Theme 2: Non-Compliance with Workplace Health and Safety Standards

The MFs who worked in agriculture had a greater risk of exposure to COVID-19. These essential workers worked without basic hygiene measures, without safety equipment, and shared work tools. Also, many of them lived in informal settlements in unhealthy and overcrowded conditions. The results of the study show the lack of compliance with the measures of safety and hygiene found in the labor agreement, such as that decreed by the Government for the control of the infection of COVID-19 in the workplace, which lead to the propagation of the syndemic.

3.2.1. Subtheme 1: Difficulties in Complying with the Protection Measures against COVID-19

According to the participants, at the start of the pandemic, there was no personal protection equipment (PPE) at work, and the prevention measures decreed were not considered. This situation improved in some companies in time due to the pressure from unions.

“There were a few PPE available when the phytosanitary compounds were applied, many workers sign as if they received them, although it was not the case. At the start of the pandemic, there was no equipment, there were union reports, and it improved somewhat (…) many infections were propagated in the fields due to the lack of compliance with safety and hygiene measures.

(P3)

“In the warehouses, the measures were not complied with, then some companies began to apply the measures of separation of groups during lunch, they could not heat their food in the microwave or eat together, and the entrance and exits were organized”.

(P13)

Police controls took place around farm areas to ensure the compliance with the measures implemented by the government, such as confinement and travel restrictions. The impact of these measures severely impacted the MFs, who could not work online and who had transport limitations to go to and from work. As many participants highlighted, many MFs were dependent on private transport or their company’s transport, and lacked alternatives that could solve these problems. This situation had a greater effect on women, especially those who were undocumented, as they did not have work contracts that could justify their travel.

“They took the company’s bus away, they had to use the interurban bus, which was more limited and had worse schedules”.

(P12)

“The private cars also had limitations, and the “pirate” taxis (without a license) were no longer available due to the police control. Many lost their jobs. Those who were undocumented could not work, and if they were stopped by the police, they had problems”.

(P7)

The participants highlighted that as time passed and the need for farm hands for harvesting increased, the restrictions in farm areas were loosened, allowing the mobility of undocumented workers.

“We detected that the undocumented migrants were ignored. They were allowed to reach the greenhouses, they know that without them, they cannot harvest”.

(P11)

3.2.2. Subtheme 2: Unhealthy Living Conditions

The living conditions of the MFs, many of which are undocumented, are very precarious. Many of these individuals live in informal settlements; small homes built from cheap materials in which a large number of people live in overcrowded conditions. They do not have access to basic resources such as potable water, basic sanitation, or power. As many participants pointed out, in such unhealthy conditions, the prevention measures against COVID-19 were impossible to comply with without resources to protect themselves.

“The people work without protection measures. In the shantytowns, they live in overcrowded conditions, “boat” houses in popular neighborhoods, in houses and areas without power or potable water”.

(P4)

“In the beginning, due to the scarcity of facemasks and the high cost of hydroalcoholic gels, they could not get them. Many did not have money to buy them. The government should have given facemasks to these people”.

(P12)

The participants highlighted the support from some organizations during the first waves of the pandemic. First-need products were provided in coordination with some city halls to palliate the situation of vulnerability experienced by many MF.

“Many did not even have money to feed themselves, from the union, we gave food and hygiene products in some informal settlements during the confinement”.

(P3)

“City hall, together with many NGOs, opened a COVID-19 shelter, where the male workers in the agricultural sector spent their quarantine, as they could not do it at their homes due to the overcrowded conditions”.

(P1)

3.2.3. Subtheme 3: Increase in Conflict at Work

During the unexpected situation provoked by the syndemic, the work precariousness, the lack of compliance with work legislation, and the lack of prevention measures favored the collective unification of the MFs to fight against work precariousness. As one of the participants pointed out, this increased work conflict in the fruit and vegetable sector.

“There were important work conflicts during the confinement, such as one with a group of workers due to the union elections, which the company impeded, and was declared illegal (…). This event increased the unrest until after the confinement…such as the strike in the manipulation plant”.

(P3)

The confinement required the public administrations to provide services online, which had a negative repercussion in the judicial defense of work rights. However, this situation of social and economic exclusion experienced during the syndemic, especially among workers with a precarious and informal employment, such as the MFs, led to a change. As one participant highlighted, many MFs became aware of the work condition exploitations, and fought to improve their conditions and rights.

“The state of emergency was transformed into a state of exception at the level of worker rights, as they led to the collapse of the courts, where the complaints were filed”.

(P3)

“Some of the workers learned about the fraud in their contributions, which impeded them from obtaining unemployment or help. There were many cases where the business owners had to make their workers permanent or give them contracts due to all the complaints made”.

(P4)

4. Discussion

The objective of our study was to describe and discover the experiences of the migrant farmworkers (MFs) during the COVID-19 syndemic, through the professionals working in organizations that tended to them. The COVID-19 syndemic increased the social, workplace, and health inequalities of the MFs (Bacigalupe et al. 2022); this descriptive qualitative study allowed us to discover the experiences of the MFs from the perspective of the professionals of the organizations that catered to them. During the COVID-19 syndemic, a lack of compliance was observed with the labor laws, the health measures decreed (Pham et al. 2022), the collective agreement in the agricultural sector, and their contributions (Martín-Díaz and Castellani 2022). There was a greater lack of social protection for the MFs, which increased their vulnerability and social exclusion, especially of women (Martín-Díaz and Castellani 2022; García-Pazo et al. 2022). As in other studies, the participants highlighted that the MFs faced work obstacles such as a lack of compliance with labor guidelines with respect to the work and rest days, salaries below that stipulated in the agreement, lack of contributions or lack of action by the work inspectors (Castillero Quesada 2021; Pedreño Cánovas 2020). Many MF women were negatively affected when they were not given the option to reduce their workday to tend to their children, when the schools were closed during the COVID-19 syndemic (Hernández et al. 2021; Castellanos-Torres et al. 2020). The MFs had difficulty complying with the quarantines to avoid being fired (Bacigalupe et al. 2022), given the lack of compliance by the business owners with respect to sick leave laws (Rodríguez-García-de-Cortázar et al. 2021). The COVID-19 syndemic led to the stagnation of the administrative paperwork in processes of legalization or asylum applications, which resulted in situations of great vulnerability for undocumented migrants or those having temporary documents. We are in agreement with Martín-Díaz and Castellani (2022) in that an efficient measure for guaranteeing the work of the MFs in activity considered essential, such as the fruit and vegetable sector, would have been the regularization of undocumented migrants, such as what was done in Portugal or Italy (Corrado and Palumbo 2022).

Our results corroborate the finding that the living and working conditions of the MFs increased the risk of diseases such as COVID-19 (Corburn et al. 2020). These conditions limit the compliance with the preventive measures against the disease, such as confinement or social distancing (Allande-Cussó et al. 2022; Da Mosto et al. 2021). In a context in which travel was restricted to those who worked in essential activities, many of the undocumented MFs were not able to go to work, as they did not have a legal document that accredited employment (Martín-Díaz and Castellani 2022; Page et al. 2020). These situations in which it is difficult to comply with the safety measures and the coverage of workers’ basic needs is denied due to a lack of employment motivate the actions and support of the local administrations, in coordination with NGOs, to provide emergency resources and distribute first-need materials (Bacigalupe et al. 2022; Corburn et al. 2020; Jiménez Lasserrotte and Ruiz Fernández 2021). During the syndemic, the MFs became aware of their working conditions, increasing work conflicts and motivating workers to demand an improvement to their work rights (Martín-Díaz and Castellani 2022; Pedreño Cánovas 2020).

Limitations

This study had many limitations. The study participants were influenced by socio-cultural factors and work ideologies. All of our participants were professional workers from organizations in the South of Spain, and the inclusion of other organizations at the national level could have modified the results. This study motivates us to keep delving into new studies on the reality of the MFs in the south of Spain, from the repercussions on their physical and mental health, to the effects of their living and working conditions.

5. Conclusions

During the COVID-19 syndemic, the work by MFs in the fruit and vegetable sector was essential for production in Spain. However, the results of our study suggest that the MFs had a greater risk of COVID-19 exposure in an unsafe working environment. Many of the MFs in the study worked without protection equipment, without basic measures of hygiene, with the pressure of not having a work contract and hiding their illness to continue working. The government rejected the regularization of the undocumented MFs, which created a situation of great vulnerability, as they could not access work or social programs. This syndemic has brought to light the difficult situation of the MFs in agricultural work. At the level of work, we found a lack of compliance with the collective agreement in the agricultural sector and the safety measures decreed by the Government against COVID-19, mainly for undocumented migrants.

The adverse conditions in which many of the MFs live and work increased the risk of infection with COVID-19. The lack of compliance with the safety and hygiene measures increased the risk of infection with COVID-19 at the same time that the living conditions of the MFs degraded. The situation of social and workplace vulnerability experienced by the MFs led to the creation of a worker movement in this population to fight for their rights. The MFs put their health and safety at risk during the COVID-19 syndemic, performing essential work for society. It is fundamental to understand that the interaction of the social determinants of health, such as housing, poverty, or employment, and the syndemic due to COVID-19, increase the impact of contracting this disease among the MFs. We hope that the present study helps with the identification of public health problems faced by MFs during the ongoing pandemic. Policies are needed that improve the hiring conditions of MFs and their housing resources, including their right to health, and that comply with work and safety standards.