While we, Malaysians, are blessed to be under the care of one of the most efficient and advanced healthcare systems globally, refugees here are denied the fundamental right to basic healthcare. In 2018, the Ministry of Health (MOH) reported that health clinics had a density of 32.72 clinics per 100,000 population nationwide — and private health clinics triple the number of public ones in more densely populated areas[1].
With extensive support and funding from the Malaysian government, the country’s healthcare system has seen a massive improvement in the past decade — enough to be on par with well-developed countries[2]. Yet, for refugees and asylum seekers living in Malaysia, healthcare services are not a guarantee, especially when you don’t have the means to pay for them.
High Price Tag For Good Health
Refugees are considered foreigners in the country and they do not enjoy the same benefits of affordable Malaysian healthcare services provided by the government. The reality of this difference happens at the front door of hospitals – Malaysians pay a registration fee of RM1 at any government hospital while refugees pay up to RM100[3].
Life for refugees in Malaysia is very difficult. Because they are considered as illegal immigrants by law, they are unable to work legally in the country and are often unable to afford basic healthcare services.
Thomas Albrecht, UNHCR Representative in Malaysia
UNHCR, the UN Refugee Agency, is a global organisation set up to safeguard and protect the rights of refugees. They identified three main barriers to refugees receiving primary healthcare[3].
Fears of Detention and Arrest
Refugees who are able to afford healthcare bills have other challenges to deal with. They fear being arrested by law enforcement agents while trying to seek treatment. The Malaysian Immigration Act requires everyone to report the presence of undocumented foreigners to the police[4].
Additionally, refugees are not legally recognized until they are registered with the United Nations High Commissioner of Refugees (UNHCR) but due to the large number of refugees entering the country, the registration process is awfully slow — taking up to years-long[5].
Possessing the UNHCR Identification card, however, does not stop them from being deported. It may only provide for a reduced risk of arrest by the local law enforcement. The benefit of the UNHCR card however allows refugees to access basic healthcare services provided by UNHCR and its partner NGO[6]. Unfortunately, because the application process is slow, those non-cardholders are denied the same healthcare benefits.
The Act places an additional burden on the medical personnel by confronting them with an ethical dilemma as it is outside the patient’s interest to be reported to the police. Upon arrest, refugees are held in detention centres where they would await deportation.
Refugees have an innate fight for survival. They have thought of ways to get what they need.
Zaria — a refugee mother to four children — said she delivered her third child at an old house with the help of a ‘doctor’ and a ‘midwife’ among the refugees. She resorted to doing so after she was turned down at a local hospital for lacking proper documentation[7].
Several accounts show that refugees have sought medical advice from doctors within their own community. It is not uncommon for a doctor to be living amongst the refugees. However, these doctors are limited to resources, medical supplies and medical facilities needed for more serious illnesses.
COVID-19 Puts Them In Dire Straits
Recently, the COVID-19 pandemic has exposed flaws and shortcomings in existing healthcare systems around the world and Malaysia is among them. The inequality of access to healthcare in Malaysia was made evident as refugees are now stuck between a rock and a hard place.
A Somalian refugee, Ridwan, told FMT that refugees like her would say no to being tested for COVID-19 because they are afraid of being apprehended as they are refugees and migrants[8].
Circular 10/2001 that was issued by the government serves as a threat to refugees as they could be arrested while receiving treatment. On June 4, 2020, there were 270 COVID-19 cases discovered — involving refugees — at the Bukit Jalil Immigration Depot which made it the highest daily spike since the pandemic began[9]. The fear of detention would naturally force the refugee community into hiding. As they could not be tested, this creates a further risk of spreading within the community. As a result, positive cases could remain undetected causing the further spread of the virus[10].
A viable solution would be to repeal circular 10/2001 and establish a non-citizen healthcare act. Through this, refugees and asylum seekers would benefit from the availability of basic healthcare services on top of not needing to fear being arrested[11].
Healing Hands For Refugees
Instead of waiting for the government to make a move, many NGOs took it upon themselves to start refugee health clinics around Malaysia, many of the NGOs are also partnered with UNHCR in order to serve and provide the refugee community in Malaysia with adequate healthcare services. These are some of them:
- Mercy Malaysia organises refugee clinics offering basic healthcare services including mental health education and counselling.
- Global Doctors Malaysia and the United Nations High Commission for Refugees (UNHCR) collaborated to set up the Global Doctors Medical Care Centre to provide complimentary consultations and diagnostic services (e.g. CT Scans, X-Rays, Mammograms) for all refugees registered with the UNHCR. The cost of medication however is not free.
- Klinik Amar Muhajir set up by Dr Siti Noraida Habibullah provides almost free medical services to the refugee community. For a minimal amount of RM5 ringgit the refugee population will get access to medicines for communicable and non-communicable diseases, maternal and child health care, and medical aid to save lives, prevent complications, and to avert public health consequences.
- Doctors Without Borders (Malaysia) better known as MSF has a primary healthcare clinic in Penang and they also provide mental health services to refugees, particularly Rohingya people, who are effectively excluded from work, healthcare and other social services.
Explore Our Sources:
- Ministry of Health Malaysia: Putrajaya. (2018). Malaysian Health at a Glance. Malaysian Health Performance Unit. Link
- AIA. (2017). 6 Things You Should Know About Healthcare in Malaysia. Link
- UNHCR. (2017). Public Health In Malaysia. Link.
- The Star. (2020). Proposing a Non – Citizen Health Act for Malaysia. Letters. Link
- I. Sayed & J. Choi. (2018). Inside Malaysia’s Living Hell’ for Refugee Children. The New Humanitarian. Link
- UNHCR Malaysia. (2020). Registration. Link
- Borneo Post. (2016). Rohingya Refugees In Malaysia Remain Stateless. Link
- N. Mohsin. (2021). Fear and loathing makes refugees shun Covid-19 tests. Free Malaysia Today. Link
- CodeBlue. (2020). MOH Reports 270 Covid-19 Cases At Immigration Detention Depot. Link
- Vaisnavi Mogan Rao. (2020). Outdated healthcare policies for refugees, xenophobic decision making put all at risk. Malay Mail. Link
- F.F. Loh. (2020). Covid-19: Undocumented migrants still fearful to be screened, says Doctors Without Borders. The Star. Link
