In Thiruvananthapuram on April 21, 2026, Kerala's top officials and international labour experts gathered in a quiet but urgent conversation: how to protect the women and men who have become the backbone of the world's care systems, yet often remain invisible to policy.
The care economy is reshaping global labour markets. Hospitals in Ireland, care homes in Germany, and medical facilities across the Gulf nations depend increasingly on migrant workers—especially women nurses, domestic workers, and care assistants. Kerala has become one of the world's largest sources of this essential workforce, accounting for almost 75 per cent of emigration clearances granted to nurses from India alone. Yet these workers, despite their profound contribution to foreign economies and to Kerala's own development through remittances, face systematic vulnerabilities: unsafe migration pathways, unregulated employment, recruitment fraud, and scant access to social protection or grievance redressal.
Recognizing this gap, the ILO and NORKA-ROOTS, Kerala's government agency for Non-Resident Keralites, convened a stakeholder dialogue to chart a new course. The gathering brought together representatives from the Kerala Nursing Council, the Kerala Academy for Skills Excellence, the State Women's Development Corporation, employment agencies, and other key institutions. They reflected on findings from an ILO-commissioned study by the Centre for Development Studies examining migration patterns, recruitment dynamics, and policy implications.
The research surfaced a troubling landscape. Care workers from Kerala navigate recruitment malpractices, occupational downgrading—where qualified nurses are placed in roles below their credentials—inadequate language training, and the complete absence of legal protections for those who migrate through informal channels. For domestic workers especially, the vulnerability is acute. Ajit Kolassery, CEO of NORKA Roots, spoke directly to the stakes: unsafe migration, irregular recruitment pathways, high recruitment costs, uneven working conditions, and the fundamental lack of access to social security and mechanisms to seek justice when wrongs occur.
Yet the dialogue moved beyond diagnosis toward commitment. Participants proposed concrete recommendations to strengthen collaboration between the ILO and Kerala in promoting decent work standards. Kolassery pledged that the Kerala government would translate these recommendations into "time-bound institutional actions," working with the ILO to develop a joint work plan. Michiko Miyamoto, the ILO's Regional Director for South Asia, underscored the moral clarity: "Migrant care workers from Kerala are at the heart of global care systems and deserve governance frameworks that match their contribution."
Perhaps most stirring was P. Sreeramakrishnan, former Speaker of the Kerala Legislative Assembly, asking an uncomfortable question of his own state: "The men and women we are discussing today have sustained the economies of Gulf nations, staffed care homes in Germany and hospitals of Ireland, and sent home remittances that have educated our children and strengthened our state. They have given enormously. The question before us is whether our institutions have given back in equal measure." That question now drives action—not just in Kerala, but in conversations between governments and the ILO about what safe, ethical, rights-respecting migration for care work actually demands.