A/HRC/23/41 arrangements in the construction industry denies coverage, which is otherwise available. 107 For severely injured workers, compulsory or voluntary repatriation may mean access to a lower standard of health care and inability to hold duty bearers in receiving States accountable. Agricultural work 50. Agricultural work is associated with particular occupational health risks. For example, exposure to pesticides and other farm chemicals has been linked to elevated distress levels,108 depression, neurological problems and miscarriages. 109 Heavy and repetitive manual work also places great strain on the body, with associated risks of musculoskeletal injuries. Such risks must be addressed legislatively through enforceable occupational health and safety regulation and mechanisms for remedial action. 51. As with other 3D jobs, informal arrangements and lack of coverage under labour and occupational health and safety laws are common, leaving little room for migrant farm workers to negotiate working and living conditions necessary to facilitate the realization of their right to health.110 Inadequate and unhygienic living conditions, food insecurity, underpayment of wages and excessive hours among migrant farm workers111 increase the risk of illness and work-related injuries, while decreasing their capacity to access health care. High vulnerability to HIV has been recorded among migrant farm workers in some regions, due to lack of access to information and knowledge about HIV, availability and use of condoms, voluntary testing and health care.112 52. Even when workers‟ compensation and health insurance are available, irregular migrant farm workers have been found to be less aware of their rights, 113 and therefore less likely to make a claim and seek medical attention. This indicates the need for both sending and receiving States to provide accessible and comprehensible information about rights to health care, insurance and workers compensation for migrant farm workers. 53. Difficulties commonly experienced by migrant workers in accessing health care are exacerbated for farm workers because of high mobility driven by seasonal work and rural or remote settings. The migrant and community health centre is a successful model for providing physically and economically accessible health care for migrant farm workers. Programmes and services are tailored to a mobile multicultural population by way of outreach clinics, community health workers, patient navigation systems, out-of-hours services and low-literacy education. Participation has been key to the success of such 107 108 109 110 111 112 113 16 HRW, “Are You Happy to Cheat Us?”, p. 64 (see footnote 102); Marc B. Schenker, “A Global Perspective”, p. 331 (see footnote 104). Jennifer Griffin and Varda Soskolne, “Psychological distress among Thai migrant workers in Israel”, Social Science & Medicine, vol. 57, Iss. 5 (September 2003), p. 773. Ann E. Hiott and others, “Migrant Farmworker Stress: Mental Health Implications”, Journal of Rural Health, vol. 24, no. 1 (2008), pp. 32-39. Amnesty International (AI), Exploited Labour: Migrant Workers in Italy’s Agricultural Sector (2012), p. 16. Ibid.; Kristen Borre, Luke Ertle and Mariaelisa Graff, “Working to Eat: Vulnerability, Food Insecurity, and Obesity among Migrant and Seasonal Farmworker Families”, American Journal of Industrial Medicine, vol. 53, No. 4 (2010), p. 444. IOM, Briefing Note on HIV and Labour Migration in Mozambique, (n.d.), p. 4, available from http://www.iom.int/jahia/webdav/site/myjahiasite/shared/shared/mainsite/events/docs/Briefing_Notes _HIV_Mozambique.pdf. Don Villarejo and others, “The Health of California‟s Immigrant Hired Farmworkers”, American Journal of Industrial Medicine, vol. 53, (2010), p. 395.