Doctors Without Borders/Médecins Sans Frontières (MSF) has provided healthcare to refugees, asylum-seekers and undocumented migrant communities in Malaysia since 2015. Our operational presence in the country started as part of our broader response to the refugee crisis. The Rohingya people, fleeing prosecution in Myanmar, have been making the dangerous journey across the Andaman sea in small and overcrowded boats, for the past 30 years.
There are currently about 179,520 refugees and asylum-seekers registered with the United Nations High Commissioner for Refugees (UNHCR) in Malaysia, of which more than 100,000 are Rohingya people. Malaysian government sources estimate that there are about 200,000 Rohingya refugees in the country, including those who are undocumented. Refugees in Malaysia do not live in camps, but many live in urban environments and local communities.
Malaysia allows UNHCR to register refugees, but the country has not signed the 1951 Refugee Convention or its additional Protocols. This means that refugees and asylum-seekers lack legal status. Consequently, refugees are faced with numerous barriers to accessing medical care, while they are not permitted to participate in society by sending their children to regular schools or finding legal jobs.
A Rohingya man sells vegetables near the Pasar Baru market, Kuala Lumpur. © Arnaud Finistre
Those whose asylum claims are recognised and obtain a UNHCR card get discounted healthcare, but the discount is based on foreigners' fees. This means that refugees pay a much higher price than locals – nearly 100 times more.
A Rohingya farmworker is seen working in the middle of a small farm. Banding, Kuala Lumpur. © Arnaud Finistre
Those without documents or UNHCR status risk arrest and detention in raids, but also when seeking care at public medical care facilities, as healthcare providers are bound by the Ministry of Health's Health Circular 10/2001, which obliges them to report undocumented migrants to the police and immigration services.
I need medical attention for my injuries, but I can’t get it because of the financial barriers... We just have to die at home without healthcare.A Patient of Doctors Without Borders
Doctors Without Borders/Médecins Sans Frontières' (MSF) Response
Confronted with healthcare barriers, Doctors Without Borders/Médecins Sans Frontières (MSF) set up a programme providing primary healthcare, mental health services, psycho-social support and counselling for refugees and asylum-seekers in Penang.
Doctors without Borders established a fixed clinic in Butterworth in 2018. The clinic currently assists approximately 900 to 1,000 patients every month. Through weekly mobile clinics around the state, in partnership with local NGO ACTS (A Call to Serve), refugees in more remote areas of Penang also have access to our services. We collaborate with local clinics and hospitals to refer patients with specialised health needs. Also, we provide medical support to several Immigration Detention Centres (IDCs) in collaboration with local NGOs.
A Doctors Without Borders doctor listens to a Rohingya patient as he speaks through a translator at our mobile clinic in Bukit Gudung, Penang.
Through our advocacy and liaison activities, Doctors Without Borders assists refugees and asylum-seekers in need of protection. We refer asylum-seekers to UNHCR and work with Malaysian partners to identify additional gaps in services. Among other concerns, our teams have called for a repeal of Health Circular 10/2001 and the safe disembarkation of refugees in distress at sea. Doctors Without Borders also work alongside local partners and the relevant state institutions on longer-term improvements to refugees' access to healthcare.
Vithya, head of pharmacy at the Doctors Without Borders clinic in Penang, explains how to take a prescription to a patient’s wife.
Rohingya Refugees in Malaysia
Due to their lack of status and rights in Malaysia, refugees and asylum-seekers often delay seeking health care even in emergencies. With COVID-19 immobilising the country, Rohingya refugees have been greatly affected.
A homeless Rohingya sits on the floor in a suburb of Kuala Lumpur. © Arnaud Finistre
Initially, the Malaysian authorities opted for an inclusive response and invited undocumented migrants and asylum-seekers to seek healthcare without fear of arrest. However, following immigration raids, roadblocks and several targeted approaches, which started in May 2020, many were forced into hiding.
Doctors Without Borders observed the secondary consequences of the pandemic. Increased stigma against refugees and migrants, and movement restrictions or increased poverty have further prevented them from accessing medical assistance. This risked affecting patients who depend on regular access to drugs, for example, diabetes or HIV. Others risk a deterioration of their health condition because of delayed treatment.
Sometimes we can't afford to buy hand washing soap and sanitiser because I can see [my] children [..] crying for food daily. Food is more important than healthcare for us at the moment.A Patient of Doctors Without Borders
The lack of a stable income, and general exclusion from the public health response to COVID-19, has made wearing masks or buying soaps to wash hands a luxury for many marginalised groups. Moreover, many refugees and asylum-seekers live in small spaces, sometimes with several families, making physical distancing nearly impossible.
Nur, 27 years old (right), shares this container with seven other Rohingya workers employed on a massive construction site. Muhammad (left) shares the container with Nur. © Arnaud Finistre
COVID-19 Response
Since the pandemic, Doctors Without Borders have provided COVID-19 support to Penang's refugee communities. Using languages spoken by the refugee communities, including Rohingya and Burmese, we conducted daily health education sessions to explain necessary prevention measures and public health guidelines.
In March 2020, Malaysia was put on a movement control order (MCO) or lockdown, which led us to suspend some of our regular activities. This included our mobile clinics which affected, in particular, those living in more remote areas of Penang. As Malaysia entered another MCO in early 2021, the teams were ready to scale up livelihoods support and digital information campaigns based on last year's experience. While most mobile clinics were suspended again, Doctors Without Borders obtained permission to conduct at least a few.
A Rohingya patient has a consultation at Doctors Without Borders’ mobile clinic, accompanied by a translator. Bukit Gudung, Penang.
Doctors Without Borders has supported public hospitals by providing translation services through its network of Rohingya community volunteers. Based on the Rohingya community's input, we developed a COVID-19 health promotion campaign with R-vision, an online Rohingya news network with coverage around the world last year. The videos produced reached the Rohingya in Malaysia, Myanmar, Saudi Arabia, India, the camps in Bangladesh and elsewhere.
Together with local NGOs in Penang, we distributed food to vulnerable refugee families, and hygiene items were provided to several IDCs in the country. The detainees in the IDCs are at increased risk of catching the virus because of the limited space available in the often overcrowded centres, as was highlighted in the numbers of COVID-19 cases reported in detention and prisons.
Our advocacy has focused on a more inclusive COVID-19 response, allaying the fear of arrest and eviction within migrant communities. We have called on the government to halt targeting migrants, refugees and asylum-seekers in immigration raids. These raids only create fear and anxiety among these communities and do not contribute to Malaysia's much-needed public health approach.