In 2016, 50-year-old Shor Muluk embarked on a treacherous journey to Malaysia, fleeing violence against the Rohingya people in Rakhine state, Myanmar. Leaving his wife and three children behind, he paid smugglers to transport him to Thailand. He spent seven days languishing on a crowded boat before being taken to a camp deep in the Thai mountains. There, Rohingya people were beaten until their relatives sent the smugglers more money. Those whose families could not pay were killed, their bodies removed in the dead of night.
Having run out of money and fearing execution, Muluk planned his escape. He waited until nightfall then fled into the jungle, spending weeks walking without knowing where he was headed. Somehow, he reached Malaysia and was lucky enough to be taken in by a Rohingya family living there. He worked in construction until the leg injuries he sustained during his beatings in Thailand became too much to bear. “I don’t have enough money to pay for housing,” said Muluk. He’s now totally reliant on handouts from others. “I sleep where I can. I survive as best I can.”
No refuge for refugees
Muluk is just one of 177,690 registered refugees and asylum seekers in Malaysia, the vast majority of whom are from Myanmar. Some 97,750 are Rohingya refugees, making them the largest refugee group in the country. Rohingya have been coming to Malaysia to escape discrimination in their native Rakhine state since the 1990s, and with the overcrowded refugee camps in Bangladesh offering few prospects for the future, more continue to arrive.
They find very little in the way of safety nets. Just like many other countries in the region, Malaysia has not ratified the 1951 United Nations Refugee Convention, which means asylum seekers and refugees are effectively criminalized by domestic law. Refugees can register with the UN Refugee Agency (UNHCR), but they don’t receive much assistance, cannot legally work, and face limited access to education, health care, and other social services.
Living in constant fear of arrest, detention, and even deportation pushes refugees and other undocumented people underground. Most are reluctant to venture outside, and delay seeking health care even in emergencies in case hospital staff report them to immigration services. “In order to survive, many refugees are forced to turn to jobs in the informal sector, working dirty, dangerous, and difficult jobs such as daily work in construction or agriculture,” says Beatrice Lau, Doctors Without Borders/Médecins Sans Frontières (MSF) head of mission in Malaysia. They risk being exploited, blackmailed, or underpaid, and workplace accidents are common. “Undocumented people in Malaysia are trapped in a vicious cycle, which they pay for with their physical and mental health,” says Lau.
Collaborating to provide comprehensive care
To respond to the clear gap in services for this vulnerable group, MSF has been providing health care to Rohingya people and other refugee and undocumented migrant communities in the Malaysian state of Penang since 2015. In addition to running mobile clinics, MSF opened a fixed primary health care clinic in October 2018 in Butterworth, a Penang neighborhood where many undocumented migrants and refugees reside. From October 2018 to August 2019, we carried out 6,770 consultations at our fixed clinic and 1,996 at mobile clinics. Mental health education, psychosocial support, and counseling services are also available. MSF also refers particularly vulnerable refugees to the UNHCR; we made 489 such referrals since from October 2018 to August 2019.
MSF also provides health care services to other vulnerable groups in Malaysia, offering primary health care, referrals, and psychosocial and counseling services in five government protection shelters for survivors of trafficking in Kuala Lumpur, Negeri Sembilan, and Johor Bahru. In collaboration with the nongovernmental organization MERCY Malaysia, we also conduct mobile clinics and provide water and sanitation upgrades at Belantik detention center, where many refugees and undocumented migrants are held.
We also collaborate with other organizations, including UNHCR and MERCY Malaysia, and Malaysia's Ministries of Health and Home Affairs on longer-term improvements in access to health care for refugees. This work includes advocating for firewalls between health care provision and immigration enforcement at public health facilities and developing sustainable health financing schemes, such as health insurance. In addition, we are working to educate staff in Malaysia’s public health care system about the vulnerabilities and health care needs of undocumented patients.