Sunday, November 9, 2014

Are undocumented migrants the sole cause of disease spread in Malaysia?


The government and the MMA could curb the spread of contagious diseases by opening up accessibility to medical treatment and health care for all, without discrimination, says Angeline Loh.


Chin refugees from Burma in Malaysia – Photo credit: hmanthlak picasa

In late September, the Malaysian Medical Association expressed its worry over the ‘rise in infectious diseases’ brought in and spread by migrants illegally entering the country (theSun, 29 September 2014).

Although it is true that health-screening measures imposed by the government are inadequate to stem the spread of infectious diseases carried by foreigners illegally entering Malaysia, the MMA president’s statement is somewhat sweeping. It fails to take account of the difficulty undocumented migrants face in seeking medical treatment at public hospitals.

It is common knowledge that foreigners are required to pay hospital fees set at over 100 per cent more than what locals have to pay for out- or in-patient treatment at government hospitals. Even if Malaysians are exempted from paying for minor treatment, foreigners are not exempted from having to fork out at least RM10 for the same minor medical treatment or check up.

Pregnant foreign women are charged over RM1,000 for normal delivery of their babies, whilst surgery and other more complex treatment can run into tens of thousands of ringgit or more. For foreign workers, the ability to meet these costs depends on their employers. Sustaining injury in an employment-related accident will determine their future ability to earn a living. Some may be sent home with or without proper medical treatment, damaging forever their capacity to make a living and live a normal life.

If foreign workers who have legal status here face such uncertainty in receiving adequate and proper medical treatment, accessibility to medical treatment for undocumented migrants in public hospitals is far more difficult.

Government policy and immigration regulations which render undocumented migrants ‘illegal’ pose barriers to accessing proper medical treatment. The first obstacle to medical attention is the foreigners’ charge i.e. the high medical fees imposed on foreign patients across the board without any consideration of economic means. Second, the threat of arrest and detention in an immigration detention camp, police lock-up or prison, if they fail to meet demands by the hospital for payment.

Even refugees under the protection of the United Nations refugee agency do not find access to medical treatment easy. The denial of the right to engage in proper employment to support themselves and their families keeps many of them impoverished, having to depend on doing odd jobs or daily paid temporary work, without any protection under labour law.

Without the means to pay for necessary medical treatment, many choose to stay away from government hospitals, where even the 50 per cent discount on foreigners’ fees for confirmed refugees doesn’t lighten the financial burden on their meagre resources.

Private practitioners who may open their clinics to UNHCR-registered refugees are small in number, and non-governmental organisations providing medical treatment also have limited capacity. Arguably, international organisations like Doctors without Borders (MSF) may provide much needed medical facilities to refugees.

But this depends on the whim of national administrations and conditions demanded for permission to operate within a country’s borders. MSF also looks to its own protocols and SOP (standard operating procedures) in prioritising needs in a country. So, there is no certainty that refugees can have ready access to medical treatment or even basic health care in Malaysia.

Moreover, the legal status of confirmed refugees and asylum seekers remains an anomaly under Malaysian law, which still views them as “illegal immigrants” despite the UNHCR official they hold. They are thus as vulnerable to arrest and detention in secure facilities as undocumented migrants.

In existing circumstances, where accessibility to medical treatment and basic health care hinge on the ability to pay, the quality of treatment given to foreign as well as local patients is questionable. Regrettably, there have allegedly been incidents of government hospitals refusing to treat terminally ill foreign patients, who are merely sent home with pain killers or antibiotics, apparently without any understandable explanation.

If Malaysia’s migration policies and laws continue to deny easy and ready access to health services, making medicine-for-profit a top priority, the infectious diseases may be more likely to be spread across borders. Blaming undocumented migrants entering the country for the spread of infectious diseases is only dabbling in useless rhetoric of no help to citizens or foreigners within these borders.

In view of the current Ebola epidemic in West Africa being carried by returnees or visitors to the United States and Europe, the need for better health screening and easier access to medical services for all, including undocumented migrants, is urgent. This would also serve to closely monitor the entry of other infectious diseases possibly brought into the country, not only by migrants from other countries but also by returnees to Malaysia from overseas.

The government and the MMA should be more proactive in their efforts to eliminate the spread of contagious diseases by opening up accessibility to medical treatment and health care for all, without discrimination based on nationality, ethnicity, immigration status, or religion.

As affordability plays a large role in the decision to seek medical treatment, this obstruction to accessing health services in government hospitals and clinics should be replaced by subsidised or free services to bring down costs for patients. Subsidies for health services would be taxpayers’ money well spent for the good of the rakyat and the country as a whole.

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