On 4th April 2023, 21 Master of Public Health (MPH) postgraduate students from Universiti Teknologi MARA (UiTM) Medical Faculty had the privilege of visiting the United Nations High Commission for Refugees (UNHCR) Malaysia, located in the heart of Kuala Lumpur.
As prospective public health physicians, it was a good opportunity to understand the role of UNHCR in dealing with the forgotten and forsaken health issues among migrant populations and their health-related challenges. Yet, our host, Mr. Jason Yeo, the assistant public health officer at UNHCR, posed a poignant question that would linger in our minds long after the visit ended.
“Imagine a scenario where your loved one falls ill, and you spend your last RM50 on a Grab car to rush them to a healthcare facility. However, upon arrival, you are told that treatment cannot be given for various reasons. How would you feel?” Mr. Jason proceeded to present a summary of health issues faced by the refugees, highlighting the stark differences between undocumented immigrants and refugees – undocumented immigrants still have the protection of their home countries and can return home, whereas refugees have no such privilege and cannot return home or risk persecution if they do.
He then shared staggering statistics with us, including the fact that there are approximately 100 million refugees worldwide and that Malaysia alone is housing 184,699 refugees and asylum seekers. Malaysia currently hosts refugees from over 60 countries, with the vast majority hailing from Myanmar. Unfortunately, more than a quarter of the refugees are children and people with medical needs. Malaysia has no refugee camps; hence, their presence can sometimes go unnoticed. Most reside in the slums or low-cost flats in metropolitan regions, with the highest concentrations in Kuala Lumpur and Penang.
Despite the availability of healthcare facilities, affordability remains a significant barrier to healthcare among refugees and asylum seekers in this country. The cost of living, along with the absence of prospects for official employment and lack of educational opportunities, exacerbate the difficulty in obtaining healthcare. It is evident that these displaced individuals were vulnerable to a wide range of health issues, many of which stem from urban poverty, including malnutrition, infectious diseases, and non-communicable diseases like hypertension, diabetes, and mental illnesses. Refugees in Malaysia have demonstrated remarkable resourcefulness by establishing their own support systems.
This includes helping one another to sustain their families, yet many still struggle to get needed services despite the initiatives and discounted healthcare fees. It is imperative that we address the root causes of these challenges, such as restricted employment and education opportunities to improve refugee health and well-being. Employment and education are important determinants of health, but refugees can neither work nor go to school legally.
A reliable income would improve their chances of getting proper healthcare. Education is key to securing employment to earn a living, allowing them to live healthier, consume better food and receive better quality healthcare. As we reflect on the situation of refugees in Malaysia, we must consider how we can best support them. This includes finding ways to enhance access to healthcare while also addressing the underlying social determinants of health that impact the lives of refugees. Through collaborative efforts, we can work towards creating a more equitable and just society for all.