What Happens To The Stateless When They Fall Sick?

Imagine fracturing your shoulder and the only medical care you can afford is just painkillers. Going to the clinic or hospital is out of the question because you know it will cost you hundreds of ringgit just for registration. This is a common predicament for stateless (undocumented) individuals living in Malaysia. 

Imagine the only possible remedy to high fevers, infections and so on, are cheap over-the-counter drugs that may have long-term side effects if taken in excess and do not solve the root problem in more serious illnesses. Imagine pregnant mothers having home birth as the only option when delivering their child because they simply do not have thousands of ringgit to spend on childbirth. Even if they had enough money to pay, stateless individuals have a lingering fear and concern of being stopped by authorities and spending time behind bars because of the lack of identification. 

Source: Aliran

Anyone without legal identification stating they are Malaysian is considered as ‘non-citizen’ and therefore have to pay 24 to 100 times more than a Malaysian citizen when accessing public healthcare facilities[1]. This is because of the Fees Act (Medical) 1951, which was amended for foreigners in January 2016[2].

Additionally, the Immigration Act requires everyone to report the presence of undocumented foreigners to the police. This creates an ethical dilemma for medical frontliners who are simply trying to save lives. 

For many of us, we take our healthcare system for granted. We may not always complete the prescribed medication given to us by the doctor for free. Middle-class and higher-income households may avoid public healthcare altogether, opting for private healthcare facilities because of the privilege of having insurance coverage. Regardless, the everyday Malaysian has options when it comes to healthcare services. In fact, in 2021, Malaysia ranked top 10 on the Health Care Index in Asia 2021[3], just under Thailand and Singapore. 

The stateless however, although abiding and living in the same country have almost no health rights and cannot meaningfully access Malaysia’s health system either public or private. 

Traditional Trouble For The Stateless

A well known stateless community is the Bajau Laut, otherwise known as the “Sea Nomads of Sabah”. During the pre-British period, their life at sea was well established as part of their civilisation and was not an issue with other peoples in the land-based territories. As the community has finally returned to land, they are regarded as stateless by the Malaysian government. 

Being vulnerable and easily exploited, the Bajau Laut survive on a day-to-day basis; they cannot afford hospital visits. Their main form of income is from fishing, which is enough to get them by. For this reason, they prefer traditional medicine or simply riding it through[4].

Source: Archdaily

Children of the “sea nomads” are also prone to skin infections, hookworm or skin lesions. This could be due to poor sanitation and hygiene practices as a result of poor living conditions (houseboats) and the lack of clean running water. Simultaneously, the most serious health problems amongst adults are malaria, typhoid and tuberculosis[4].

Source: United Nations | Flickr

Home births and traditional medicine are commonly practised by the Bajau Laut. They generally avoid going to the hospital. Consequently, their children do not have birth certificates. The cycle of statelessness is then passed on to their offspring, who are also not eligible for medical aid. 

Looming Pandemic Problems For The Stateless 

With world-class healthcare services and sophisticated infrastructure, the country’s medical services are well-financed by the government. But not everyone can enjoy its benefits. So what happens when the world is going through a global health hazard? The citizens of Malaysia are assured that they will be taken care of; if they do catch COVID 19, healthcare costs can present an insurmountable barrier. Language and cultural barriers may also impede access to services. Thankfully when the pandemic hit, the government announced the COVID-19 tests would be free for foreigners as well as for Malaysians, albeit for a short period of time[5]

However,  the announcement was not clear whether free tests were available for undocumented immigrants or whether those who are found to be ill will have to pay the “foreigner fee” for treatment. 

Source: Malaysiakini

The two towns in Sabah with the highest reported coronavirus cases are Lahad Datu and Tawau, both with large populations of migrants and stateless people. For many migrant populations, the potential risk of a serious outbreak is compounded by inadequate sanitation, lack of running water, and small, crowded houses that typify these communities. 

Source: MyMetro

In February 2021, Malaysia’s COVID-19 Vaccine Supply Access Guarantee Committee said that Malaysians will be prioritised to receive the vaccination doses, however, when Putrajaya rolls out its immunisation programme, foreigners living in Malaysia will receive the COVID-19 vaccine for free. Although this is great news, again there is no specification if the stateless community is included in this movement[6]

Without being able to take proper care of this community during the pandemic, hopes to officially overcome the virus seem out of reach. 

Non-Citizen Healthcare Act

Another problem faced by the stateless is the mentioned Immigration Act[7] leaving stateless individuals fearful of stepping into local hospitals. The said Act requires everyone to report the presence of undocumented foreigners to the police and the police are obliged to arrest the sick stateless and put them behind bars for several days. Doctors and nurses are constantly put in a hard place having to decide between saving lives and upholding the law.

In 2019, some medical frontliners came together and urged the government to pass the Non-Citizen Health Act in order to prescribe basic health rights for all non-citizens, starting with vaccinations, maternal and antenatal care, child health up to the age of five and treatment for certain communicable diseases such as pulmonary tuberculosis[7].

Source: The Straits Times

The act proposed that those seeking medical attention were not to be criminalised whilst undergoing treatment and that these services be free or nearly free. It allows doctors and nurses to do what is necessary for the patient’s benefit[7].  

There are countless arguments on why an Act like this should be approved. Other than the fact that it is a basic human right to access healthcare, children and mothers are among the most vulnerable populations. Stateless communities must no longer be deemed as invisible. They are part of the fabric of Malaysian society. 

In 2019 the Department of Statistics Malaysia estimated that there are 3.2 million non-citizens[8]. This number is inclusive of both legal and illegal migrants, refugees and stateless communities.

If Malaysia continues to pretend that non-citizens do not exist, we may see more outbreaks and the spread of unnecessary diseases in the country. Above all, we will be responsible for lives that could have been saved – if only the stateless are seen and heard.  

Explore Our Sources: 

  1. Letters. (2020). Proposing a Non-Citizens Health Act for Malaysia. The Star. Link. 
  2. MOH. (1951). Fees Act 1951. Link.
  3. Numbeo. (2021). South-Eastern Asia: Health Care Index by Country 2021. Link. 
  4. W. HASSAN, W. S., & PETERS, D. (2020). THE VULNERABILITY OF BAJAU LAUT AS STATELESS PEOPLE IN SABAH. Jurnal Kinabalu, 183. Link. 
  5. CodeBlue. (2020). Malaysia Tested 73,000 Foreigners For Coronavirus, 3.7% Positive. Link. 
  6. A. Yusof. (2021). Foreigners living in Malaysia to receive COVID-19 vaccine for free. Link. 
  7. MalaysiaKini. (2020). Proposing a Non-Citizen Health Act for Malaysia. Link.
  8. Department of Statistics Malaysia. (2019). Non-citizen population. Link.

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