Malaysia: Lack of access to maternal healthcare services puts refugee women at risk

Lack of legal status limits access to healthcare

Malaysia is not a signatory to the 1951 Refugee Convention and does not have domestic laws recognizing and protecting refugees. This means that refugees do not have legal status in the country, which limits their access to healthcare, work and education. 

Refugees registered with UNHCR Malaysia are entitled to a 50 percent discounted foreigners’ rate in public healthcare services, but most refugees still cannot afford the reduced rate fee.

Nur (name has been changed), a Rohingya woman who is a refugee in Malaysia is  expecting her second child, shared that she could not afford maternal healthcare at a private or public healthcare facility, as it was too expensive.

“With my husband’s income, rental and family expenses are barely covered. If we book an antenatal check-up at a private clinic, we could spend up to MYR 600 (about €130),” she said.

Threats of arrest and detention when seeking healthcare

Furthermore, the Ministry of Health’s Circular 10/2001 requires healthcare providers to report undocumented migrants, including refugees and asylum seekers, to the police or immigration services. As such, refugees who lack UNHCR documentation risk threats of arrest and detention when seeking treatment at public medical care facilities, especially when they are unable to pay medical fees, resulting in fear and distrust of public healthcare staff.

Further obstacles refugees face in accessing maternal health care are the lack of health awareness as well as the language barrier preventing many pregnant refugee women from seeking maternal healthcare, until late in the term or not at all.

To address the needs of refugees and asylum-seekers in Malaysia, Doctors Without Borders / Médecins Sans Frontières (MSF) is providing free primary healthcare and mental health services through its clinic in Butterworth, its mobile clinics in Penang and in its activities in immigration detention centers.

Doctors Without Borders support to refugees in Malaysia

Doctors Without Borders refers patients to secondary and tertiary healthcare and supports an increasing number of sexual and gender-based violence survivors, including victims of human smuggling, both women and men. In 2022, the Doctors Without Borders team in Malaysia conducted a total of 4,081 sexual and reproductive healthcare consultations, including antenatal, postnatal care and family planning, at its clinic in Penang.

Doctors Without Borders also refers unregistered refugee patients with heightened medical or protection needs to UNHCR for expedited registration to facilitate their access to healthcare.

Healthcare services must be made more inclusive for refugees

“There is still a high number of consultations for late-in-term pregnancies we see in our clinics. Additionally, in the first quarter of 2023, around 15 percent of our consultations were related to teen pregnancies, which continues to be a concern as adolescent mothers are at greater risk of complications such as such as eclampsia (life-threatening high blood pressure in pregnancy), anemia, or increased risk of adverse outcomes such as premature birth or stillbirth. We know that the number of girls we see at the clinic is likely only a fraction of those in need of services."

While the number of antenatal consultations has increased in Doctors Without Borders' clinics, this is only a small number of women who have accessed the services they need, compared to the overall reproductive health needs of all refugees in the country.  

Doctors Without Borders has provided primary healthcare mental health services and response to sexual and gender-based violence for refugees and asylum-seekers in Malaysia since 2015. In 2018, Doctors Without Borders established a fixed clinic in Butterworth, which currently assists approximately 900 to 1,000 patients every month.