KUALA LUMPUR, Oct 6 – Refugees seeking in-patient treatment at government hospitals in Malaysia need at least RM5,000 for medical fees, says activist Jaw Tu Hkawng.
Tu Hkawng, a native of Kachin State in Myanmar, said although public hospitals provide a 50 per cent discount off the foreigner’s rate for refugees and asylum-seekers in Malaysia who are registered with the United Nations High Commissioner for Refugees (UNHCR), the base rate for foreigners are multiple times higher than what Malaysians pay.
“You have to prepare at least RM5,000 if you want to be in-patient, and then there are a lot of other fees as well,” said Tu Hkawng during a panel discussion at the webinar launch of the “Left Far Behind: The Impact of Covid-19 on Access to Education and Healthcare for Refugee and Asylum-seeking Children in Peninsular Malaysia” report by the Institute for Democracy and Economic Affairs (IDEAS) Malaysia and the United Nations Children’s Fund (UNICEF) Malaysia last week.
“Yes, we are grateful that the government provides a 50 per cent discount but it (the medical fee) is still a lot for us because we don’t have that income to provide our children with the health screenings or medical care that they need. Because it’s 50 per cent from the foreigner’s rate, which is 10 times higher than the local rate,” Tu Hkawng added.
Many refugees and asylum-seekers in Malaysia struggle to find work. Coupled with the government’s move to impose full fees on foreign patients in 2016, the situation makes it extremely difficult for this vulnerable group to access basic health care.
It was previously highlighted in the IDEAS-UNICEF report that barriers to health services for refugee and asylum-seeking children include financial barriers, sociocultural barriers, fear of arrest, inconsistent application of harmful policies, xenophobia and discrimination, lack of knowledge of health care services, and lack of state support.
Of all the challenges identified, cost was the primary barrier to health care access.
Health Insurance For Refugees
Tu Hkawng highlighted the availability of health insurance for refugees five years ago, which he said was very helpful.
“Health insurance is very important. In 2017-2018, there was the Remedi health insurance that helped refugees a lot. When they are required to be admitted into government hospitals, all they have to do is show their insurance card. Now, when you go to the hospital, you need to prepare at least RM5,000,” Tu Hkawng said.
In 2017, the UNHCR in collaboration with RHB Bank launched the Refugee Medical Insurance (REMEDI) for refugees. However, only 12.2 per cent of UNHCR card holders were enrolled. The low rate of enrolment and high rate of payouts have incurred significant losses to the partnering bank, which led to the cessation of the insurance policy scheme in June 2018.
According to the UNHCR’s Guidance Note on Health Insurance Schemes for Refugees and other Persons of Concern to UNHCR, health insurance is a key component of protecting refugees and other forcibly displaced persons, as it not only protected their finances and their health, but may protect refugees from harassment against authorities and give refugees a sense of belonging and security.
Dr Siti Noraida Mohamad Habibullah, founder and medical director of Klinik Amal Muhajir, a refugee community-centred charity clinic, said the continual reliance on non-governmental organisations (NGOs) to provide aid for vulnerable communities is unsustainable and that the government needs to step in if meaningful change is to be achieved.
“I mean, that 50 per cent discount on hospital admission is a huge blessing. But if you’re not earning, you don’t have a steady income, you’re not allowed to work, even if you give a 90 per cent discount, it’s still a burden.
“So, I’m sure, as you know, every time there is an admission or a refugee needing surgery, there will be a request for funding, a request for donations because it’s just not sustainable.
“I think, it’s wishful thinking, but I think the first step is still the ministry. They should at least get their representatives to come together and discuss this refugee issue and come up with a top-down solution. As NGOs, we will keep doing whatever we can at our level, but to what end,” said Dr Siti Noraida, who is also senior lecturer at the Jeffrey Cheah School of Medicine and Health Sciences at Monash University Malaysia.
She said backlogs in the processing of asylum-seekers and refugees by the UNHCR during the Covid-19 pandemic has left many asylum-seekers and refugees without the required documents which prevented them from getting the 50 per cent discount.
Some refugees and asylum-seekers who require urgent attention, however, could apply for an urgent UNHCR protection letter that would allow them to get the medical attention they need.
“And so that’s regarding documentation. But the other thing is there are many organisations that do help with funding and assisting in terms of surgeries and stuff like that,” Dr Siti Noraida said.
Tu Hkwang said many refugees and asylum-seekers have yet to be registered with the UNHCR. He proposed that international NGOs provide more health care education to the refugee community.
“Not everyone is registered. It also depends on your case. So it’s a lot more difficult. I think what is also needed is awareness training by international NGOs for the refugee community to be more aware of their health and how, in their daily life, they should live and the food they should eat, things like that,” said Tu Hkawng.
Xenophobia Created Greater Risks For Refugees During Covid
Access to health care for refugee children was greatly affected during the pandemic, as these children are highly dependent on their parents’ legal status.
“Access to health care has been challenging to the refugees even before Covid 19, especially for children. I think because they’re dependent on the state of the parents, whether the parents are legal, whether they dare to venture out or whether they have the finances to seek treatment.
“Most NGOs only offer primary care. So the moment there are referrals to secondary, it’s usually not seen through due to financial reasons, and again, of course, due to financial fear of detention,” said Dr Siti Noraida.
Drawing from her individual experience, Dr Siti Noraida said xenophobia and corruption in Malaysia have led to the arrests of both undocumented and documented refugees.
“Everyone said that during Covid, putting yourself out there in the open was actually a very high risk endeavour in terms of security. There were problems of being caught, bribery was involved.
“And even if you’re a documented migrant, it doesn’t mean that you’re safe. I’ve had many patients who were stopped on the way to the hospital despite having documents,” Dr Siti Noraida said.
Apart from the fear of arrest, refugees and asylum-seekers were also afraid of the stigma attached to Covid. Many hid their symptoms and illnesses during the Covid-19 pandemic out of fear they would be evicted.
“I think one of the main issues was the problem of stigma which actually caused many refugee patients to hide the symptoms from us during the screening process.
“Refugees have the risk of social isolation. They can be driven out of their flats if they have the slightest association or anything to do with Covid-19 sometimes. So, you cannot blame them for this because of the stigma,” said Dr Siti Noraida.
The panel concluded with a need for both a top-down and bottom-up approach in tackling legal issues and creating programmes that would better aid refugees and asylum-seekers.
