We have passed the halfway mark of our 6-month internship in Kuala Lumpur at the Malaysian Social Research Institute, an NGO providing support programs for refugees and asylum-seekers. It’s not hard to believe, since the weeks feel like they go by so quickly, but leaving KL won’t be easy. I’ve already started feeling nostalgic, my stomach stressed at the thought of all the food I still haven’t eaten, places I haven’t visited, words I haven’t learned.
Many of the most memorable moments in the last 3 months have involved eating. Hot, crispy roti canai for breakfast from our favourite spot in Bukit Bintang. Greasy plates of mie and nasi goreng, available 24-7. Iced coffee on humid Saturday afternoons. But the best moments have also involved finding community, including crafting with Chow Kit Kids on Wednesday evenings, and taking in the fresh air and views atop Bukit Tabur and Bukit Broga.
Since I’ve been in Malaysia I haven’t suffered from any illness. I’ve been lucky that no food or water has upset my stomach. However, a month into my stay in KL I developed two itchy, round, red spots on my right leg. After a few days a recognizable red ring emerged along with a diagnosis: ringworm. On my next lunch break I went into the pharmacy around the corner from work where a pleasant pharmacist dropped a small tube of anti-fungal cream in my hand and I dropped 45 ringgit into theirs. At the time it felt like an inconvenience having to pay for it. Think of all the orders of roti that could be bought with 45 ringgit (the answer is 34).
Move forward two more months and my story was contrasted with a very different reality.
I have begun collecting success stories from MSRI clients about their experiences and involvement with our programs. My first opportunity to sit with refugees and hear their stories was with patients in the clinic waiting for their appointment with an MSRI doctor. In a small room labelled “staff room”, which doubles as a space for the volunteer nurse to administer treatments, I met separately with two patients. As I asked questions about their interactions with doctors, interpreters, alternative therapies, etc. one particular topic recurred in their answers: cost of treatment. When asked about why they value MSRI’s healthcare services, both said it was because the visits are free.
The 1951 Refugee Convention states that refugees should have the same access to health services as the host population, and under international law everyone has the right to a high standard of physical and mental healthcare. In Malaysia, while refugees can access public and private health services, there are many factors that impede this access, including cost, language barriers, and fear of moving in public to access these services.
For many refugees and asylum-seekers in Malaysia, basic visits to the doctor and common medication, such as asthmatic inhalers, are unaffordable at government and private clinics. I’ve been told that the cost of medication refill for one asthmatic patient at a private clinic is around 50 ringgit. At the MSRI clinic, this refill is free and if the patient stays far away, the doctors will provide 3-4 months supply.
One of UNHCR’s initiatives to address the challenges associated with access to healthcare in Malaysia was the institution of the Refugee Medical Insurance (REMEDI) that is accepted at all government hospitals. Since 2017, 12% of people registered with UNHCR have been enrolled under the REMEDI scheme. The insurance covers everything from in-patient treatment and intensive care, to surgical fees, specialist consultations, and ambulance fees.
According to UNHCR Malaysia website, “14 mobile enrolment campaigns have been conducted to reach out to the community members”. They do not specify which communities they reached out to, and we are left to assume it was to explain the REMEDI scheme. Since its inception, only 23,000 refugees registered with UNHCR have been enrolled in REMEDI, out of 155,000 UNHCR cardholders. Evidently, there are challenges impeding higher enrolment. Cost is a likely barrier. Another could be a lack of knowledge about REMEDI, or an unwillingness to sign up while still healthy.
The challenge of access to healthcare in Malaysia is exacerbated by a lack of legal status and the right to work, as well as exploitation and persecution by government authorities. The human rights violations facing refugees and asylum-seekers in Malaysia can be violent, stressful, and detrimental to their mental and physical well-being. It is in many ways no better than the countries they have fled.