Sunday, July 22, 2012


Managing Urban Refugees in Malaysia

Displaced- the numbers
•10.5 million refugees
•14.7 million internally displaced
•Stateless – lack of definitive statistics- est. 3.5 million
•Only one third of refugees in camps
•More than half are in urban areas


As of end May 2012, there are 98,644 refugees and asylum-seekers registered with UNHCR in Malaysia.
 92%, 90,326 are from Myanmar. 
The remaining numbers are refugees and asylum-seekers from other countries, including refugees from:
- Sri Lanka (4,529)
- Somalia (1,093)
- Iraq (782)
- Afghanistan (437)


Refugees live in cities and small towns in low-cost flats or housing areas.

Due to high cost, and for security, refugees often share living spaces in groups of sometimes up to 20 people or more.
Many also live near the construction sites or plantations where they seek employment.


Malaysia has not ratified the 1951 Refugee convention
No legal framework
Malaysian laws, in particular the Immigration Act 1959/1063, do not make a formal distinction between a refugee and an economic migrant.

The situation of refugees is complex as a result of their unofficial status in Malaysia.

They have no access to formal, legal employment.

Their children have no access to formal education.


Refugees face challenges in accessing healthcare due to factors such as:
Costs of medical care
Language barriers
Difficulties in physically accessing hospitals and clinics. In Malaysia, refugees access public healthcare services at a discounted foreigner’s rate and clinics run by NGOs.

Public health facilities
•Access to emergency services
•Second line care and deliveries
•MCH clinics- antenatal care and vaccinations
•Primary care services

Urban refugees health programming

Advocacy for integration into the national health system Advocacy for inclusion into country national programmes (e.g. TB, HIV, )

Urban refugees health programming
Support access to services and health information
  • primary care services
  • security issues
  • financial assistance
  • interpreter
  • health education
  • mental health services
  • referral care support

  • monitoring access public health services- hospitals, MCH clinics
  • monitoring communicable diseases

Summary of Approaches

•Where possible – entry into existing health systems
•Access to emergency services
•Provision for vulnerable groups
•Provision of services
•Community based approach – Help refugees help themselves

Second line treatment
•Requests for assistance for hospital admissions are mainly due to trauma related cases- Road accidents and industrial accidents

•Malaysia- Intermediate burden
•Incidence of 82/100,000
•MDR TB - % of new TB – 0.1 %
•Myanmar – 4 %
•IOM screening- 8.7%. ( 0.59 % active)

MOH and UNHCR Collaboration

• MOH and UNHCR collaborates
in resource sharing for refugees
with TB as shown in the flow
chart .
• UNHCR provides TB awareness,
screening, care, and support
directly through UNHCR staff
and refugee community
workers, and through
implementing partners.
• MOH provides TB diagnostic
and treatment, including


•422 refugees living with HIV . 258 on HAART.
•Adherence support program
•Cross sectional survey 2010 -Adherence is comparable to host population
•Risk groups


•Survey – 2010- 271 children
•75 % vaccinated in Malaysia , 12 % had vaccination in Myanmar
•Main barriers- knowledge, cost (for transport) , no documentation

Family Planning Baseline Study

•FP – Baseline study- household survey 2011- 422 respondents
•Contraceptive prevalence rate – 34.2 % for modern methods and 42.2 % for any methods
•Commonly used – OCPs and injectables

Pregnancy and Childbirth

•93.5% respondents had more than four antenatal care visits with the mean 9.97 ± 3.64 visits
•But most are still accessing care only in 2nd trimester- usually around 4 – 5 months.
•New refugees – sought care later, and less visits. – non familiarity, language and financial barriers


•IOM screening- 2011 (under 5s)
•12% wasting,8% stunting
•Assessment 54 homes - In-depth interviews during house visits
−socio economic (housing, employment, schooling)
−health ( birth, diseases, vaccines, growth monitoring)
−Feeding practices past and present (24 hours recall, food frequency)
−Family eating habits

Main problem areas

•Traditional eating habits are two soup based low energy dense meals
•Families are very traditional in the choice of food
•Food budget is kept to a minimum
•Almost half of parents are young and inexperienced without support
•No access to nutrition education messages because of language barrier

Main direct causes of nutritional status of child

•Energy density and feeding frequency
•Child with acceptance problems of food
•Breast feeding problems: inefficient suckling, breast problems
•Health problems : LBW, long sickness, teeth, allergies

Underlying causes of nutritional status

•Young and inexperienced parents: isolated mothers, no family support, little outings, language barriers
•Economic problems: no room for extras
•Caring problems: siblings, no interest in trying to adapt to specific needs

Substance Abuse

•Survey 2011 – 138 Chins
•Semi structured interviews
•Alcohol and tobacco
•‘Social norm’ ‘cultural habit (46)
•‘to suffer less from stress’ (42)
•45.9% of the substance users did have sexual intercourse while they had been using substances
92.3% had unprotected sex

Mental Health

•Survey by Health Equity Initiatives- 1,074 persons
•DASS -21 >60% had symptoms of Depression, Anxiety and Stress
•About half had moderate to severe levels of Depression & Anxiety
•Asylum Seekers – Higher anxiety levels than refugees
•Depression and Stress no difference.
•Unemployed- higher levels.
•Coping strategies – restraint, emotion focused, problem focused, mental disengagement.


•WHO estimates 2.3-3.3 million displaced persons are disabled and one third are children
•Improving identification and referral mechanisms
•Engaging more service providers

Source : UNHCR Malaysia