In late March 2023, Grace Nyambura received a voice message from her daughter Caroline in Saudi Arabia. Caroline said she could no longer see from one eye. The other was failing. She could barely move her neck. She had been begging her employer to take her to hospital for two weeks. The employer refused — it was Ramadan, and Caroline was expected to keep working.
Within a month, Caroline died from bacterial meningitis. She was 26 years old and died alone in a Saudi hospital. Caroline’s story is one of 15 highlighted in the first communications filed challenging the Kafala system under the Convention on the Rights of Persons with Disabilities (CRPD), part of a novel legal strategy undertaken by the International Human Rights Clinic at the University of San Francisco School of Law (where I serve as Director) and Global Justice Kenya.
My students and I met Grace in Nairobi, Kenya, this spring as part of a fact-finding trip in support of those filings. She is raising Caroline’s two sons alongside three other grandchildren. She works as a domestic worker herself to feed them. She has high blood pressure and ulcers that her doctor attributes to grief. She paid 400,000 Kenyan shillings — roughly $3,100 — to bring her daughter’s body home.
Caroline didn’t tell her mother she was going to Saudi Arabia until the work visa arrived. She was afraid Grace would stop her — Grace had seen reports on Kenyan television of workers in Saudi Arabia being denied their wages and tortured. But the family needed the money, and Caroline went.
Caroline left Kenya healthy. She had passed every required medical exam. She was promised a two-year contract to clean for a household of four, at around $207 a month. When she arrived, her employer confiscated her passport and she was put to work in a compound with multiple households, cleaning a two-story house from morning until midnight. She was not permitted to leave. This is the Kafala system — Saudi Arabia’s sponsorship arrangement that ties a domestic worker’s immigration status, mobility, and access to basic services entirely to her employer. Under Kafala, Caroline could not see a doctor without her employer’s permission. She could not go to the police. She could not leave.
Caroline started experiencing symptoms six weeks after arriving. Her employer gave her a painkiller and sent her back to work. As the headaches became unbearable, as she lost her vision, as she became unable to move her neck, she kept asking for medical care. For two weeks, no one took her to a hospital, and her employer told her to keep working. Caroline called her mother daily, and all they could do was pray.
Desperate to help her daughter, Grace called the recruitment agency in Kenya. For weeks, the agency did nothing. Only when the agency sent a replacement worker did the employer finally take Caroline to a hospital. By then, a treatable bacterial infection had become fatal.
Caroline is not an anomaly. At least 371 Kenyans — most of them domestic workers — died in Saudi Arabia between 2020 and 2024. A University of Chicago study found that over 98 percent of Kenyan migrant laborers returning from Gulf countries were victims of forced labor. The scale of Kafala abuse has been well documented, including in a New York Times investigative series. But what has gone largely unnamed is the health dimension: women who return with chronic conditions, permanent injuries, and psychological trauma — or who die of treatable diseases — because the system gives employers absolute control over whether a worker sees a doctor.
On April 28, World Day for Safety and Health at Work, we filed 15 individual communications with the United Nations Committee on the Rights of Persons with Disabilities on behalf of Kenyan domestic workers harmed in Saudi Arabia. Grace’s complaint, filed on behalf of her dead daughter, is among them. The 14 other complainants’ disabilities include lumbar spondylosis in a young woman from forced labor and beatings, permanent vision impairment from forced exposure to toxic chemicals without protective gear, cervical fibrosis from an untreated fall, second-degree burns inflicted as punishment for illness, chemical skin injuries, shrunken intestines from starvation, and chronic nerve damage.
These complaints represent the first time CRPD’s mechanism has been used to challenge what the Kafala system does to migrant workers’ bodies and minds. A favorable decision would establish that when a State constructs a legal system enabling private employers to deny medical care to workers who become disabled — with no independent avenue of complaint or exit — that State bears responsibility under the Convention. That precedent would reach well beyond Saudi Arabia, extending to every Gulf State operating a comparable sponsorship system.
The International Disability Law Framework
The legal argument operates on two levels. The first is causation: the Kafala system does not merely exploit workers — it disables them. Caroline arrived in Saudi Arabia healthy. She developed bacterial meningitis, a condition that, if treated promptly, is rarely fatal. Because her employer controlled her access to medical care and repeatedly refused to authorize it, a treatable infection became a death sentence. The same pattern repeats across the other 14 complaints: a woman develops lumbar spondylosis from forced labor and beatings and is denied treatment until the damage is permanent; another loses vision from toxic chemical exposure without protective gear; another’s surgical scar reopens from overwork and goes untreated until it dehisces. In each case, the disability is not incidental to the work — it is produced by a system that gives employers absolute authority over whether a worker can see a doctor.
But causation alone was not sufficient to file. The CRPD protects the rights of persons with disabilities — which means the violations we could pursue were those that occurred after a worker became disabled, when she was then denied medical care, access to information, freedom of movement, or access to justice. We did not file complaints in every case of serious injury, even devastating ones. One woman we encountered is permanently paralyzed — injured so severely that she could no longer work and was sent back to Kenya. Her situation is a human catastrophe, but because she was removed from Saudi Arabia rather than kept working while disabled and denied care, the discriminatory treatment the CRPD targets was harder to establish. The 15 complaints we filed represent cases where workers became disabled and the Kafala system then continued to operate against them — denying them the rights the Convention guarantees.
The second level is rights: once a worker is disabled — or in the process of becoming disabled — the CRPD’s protections apply, and Saudi Arabia has violated them. Article 25 of the Convention guarantees the right to health without discrimination on the basis of disability, and specifically requires states to ensure persons with disabilities receive health services they need. Article 27 protects the right to work in conditions that are safe and healthy, and prohibits forced labor. Articles 15 and 16 prohibit torture and cruel treatment, and exploitation and violence — including the failure to prevent such treatment by private actors when the State’s own legal framework creates the conditions for it. Article 13 guarantees access to justice. Caroline, who was going blind and could not move her neck, had no access to a doctor, no ability to file a complaint, and no way to leave. Saudi Arabia built and maintained the legal architecture that made this possible.
Article 5, read with Articles 3 and 4, also prohibits discrimination on the basis of race and national origin. The complaints document a pattern of racialized treatment: Kenyan workers were subjected to slurs, assigned the most degrading tasks, and treated as categorically inferior to workers from other countries — whose governments have sometimes actively advocated for them abroad. The Philippines, for instance, secured a bilateral agreement with Saudi Arabia guaranteeing Filipino domestic workers a minimum monthly salary, weekly rest days, non-withholding of passports, and a 24-hour assistance mechanism — protections Kenyan workers do not enjoy. The CRPD’s non-discrimination framework encompasses the intersecting grounds of racial and national origin discrimination, and Saudi Arabia’s failure to protect migrant domestic workers from racially discriminatory treatment by their employers engages its obligations under the Convention.
Article 6 specifically recognizes that women with disabilities face multiple and intersecting forms of discrimination based on both gender and disability. Every one of the 15 complainants is a woman. In Saudi Arabia, women — including foreign migrant domestic workers — are subject to a male guardianship system under which they are treated as legal minors for a range of official and legal purposes. Domestic workers seeking to file complaints with government authorities, access social services, or initiate legal proceedings without a male guardian risk being turned away or detained. Foreign domestic workers lack male guardians. Female migrant domestic workers are thus uniquely isolated, dependent, and excluded from legal protection.
Saudi Arabia ratified the Convention on the Rights of Persons with Disabilities and its Optional Protocol in 2008, accepting the Committee’s jurisdiction to hear individual complaints. And yet, in its submissions to the Committee, Saudi Arabia has never once acknowledged migrant domestic workers as a population that might include persons with disabilities — despite a foreign resident population of over 10 million.
The Unique Value of the CRPD Process
A reasonable question is why the CRPD, rather than frameworks more commonly associated with this kind of abuse? Saudi Arabia has not ratified the Convention Against Torture or the Optional Protocol for the Convention on the Elimination of All Forms of Discrimination Against Women, or the Convention on Protection of the Rights of All Migrant Workers, so the related treaty bodies cannot hear individual complaints. The U.N. Office on Drugs and Crime, which addresses trafficking, is limited to State-to-State claims —with no individual petition mechanism. International Labour Organization (ILO) complaints require trade union sponsorship and address State-to-State obligations (and a 2025 complaint against Saudi Arabia filed by African trade unions and the International Trade Union Confederation on behalf of African migrant workers broadly is currently before the ILO’s Governing Body).
The CRPD’s Optional Protocol is one of the only international mechanisms under which these women, as individuals, can compel a U.N. body to adjudicate their cases. But the value is not only jurisdictional. Framing these cases as disability rights claims names harms that labor and trafficking frameworks do not: the State’s responsibility for what the Kafala system does to women’s bodies and minds. It insists that these injuries are not collateral damage but violations of rights that Saudi Arabia must protect.
Existing Reforms Have Not Made Meaningful Change
Saudi Arabia will point to its reforms — and there have been some. In 2021, the government announced changes to the Kafala system that nominally allow certain migrant workers to change employers without their sponsor’s consent. It operates the Musaned platform — a digital system for managing domestic worker recruitment — and the Absher platform, through which workers can in principle access Ministry of Interior and Ministry of Labor services, including filing complaints. Saudi Arabia has also pointed to its Wage Protection Program and a domestic workers regulation, most recently updated in 2024, as evidence of a functioning compliance infrastructure.
But for domestic workers specifically, none of these reforms reach the core problem. The 2021 reforms do not extend to domestic workers in any meaningful way — they still require their employer’s consent to change jobs, leave the country, or access services. Domestic workers cannot directly access the Musaned platform; only employers and recruitment agents can login, meaning a worker can only file a complaint by asking the very agent who placed her — an agent with strong financial incentives not to antagonize Saudi employers. The Absher platform requires an iqama (Saudi identification document), which employers routinely withhold. The Wage Protection Program does not cover domestic workers, who are excluded from the Labor Law it implements. Finally, the Domestic Workers Regulation contains no complaint mechanism; there is no statutory right to file a complaint, no designated forum, and no right to a hearing.
Saudi Arabia will likely challenge admissibility on exhaustion grounds — arguing that complainants failed to pursue available domestic remedies before turning to the Committee. The reforms described above are precisely the remedies it will point to. The Optional Protocol itself provides that exhaustion is not required where remedies are “unlikely to bring effective relief” — and the Committee has applied this exception where remedies are structurally inaccessible in practice. And they do nothing for Grace, who buried her daughter and inherited her grandchildren.
Ultimately, Saudi Arabia may refuse to comply with any decision rendered by the Committee. But, these women have standing to be heard, and a public decision from a global body has value. The Committee’s findings will create a legal record that other institutions — the ILO, FIFA as it prepares for the 2034 World Cup in Saudi Arabia, and governments negotiating bilateral labor agreements — cannot easily ignore. The point is to make the human cost of this system visible and permanent.
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Grace told us that she worries every day about another daughter who is working as domestic help in Oman right now. She could not stop her — the family needs the money. This is the cycle the Kafala system feeds on: women so desperate to provide for their families that they will risk everything, employers so powerful they face no consequences, and governments so indifferent that a 26-year-old can die of a treatable infection without anyone being held responsible.
The CRPD Committee now has an opportunity to act on what these cases make plain. We ask the Committee to call on Saudi Arabia to undertake concrete structural reforms: extend independent access to medical care to domestic workers; require that workers hold their own iqama documentation rather than having it controlled by their employers; and give domestic workers direct routes to file complaints themselves. These are not aspirational asks — they are the minimum conditions under which the system Saudi Arabia has built could be said to respect the rights it has formally committed to protect. Beyond the Committee, Kenya must do more to regulate the export of its own citizens — conditioning labor agreements on verifiable protections. And FIFA, as it oversees Saudi Arabia hosting the 2034 World Cup, should be asking what it means to celebrate a nation’s hospitality while women imported to clean its homes die of treatable infections because they cannot see a doctor without their employer’s permission.
Every day, Grace remembers what Caroline told her the day she left for Saudi Arabia: “I am going to work so hard to give you a house.” The least the world owes Grace — and hundreds of others like her — is visibility and justice for what her daughter endured.
