Protracted statelessness and nationalitylessness among the Lahu, Akha and Tai-Yai in northern Thailand: Problem areas and the vital role of health insurance status

Abstract

Thailand has one of the largest stateless populations in the world. Stateless people are denied access to basic rights and services, driving inequality and discrimination and threatening peace and security. This article aims to explore the problems that stateless people are facing in their daily lives, with a focus on healthcare services, health insurance coverage, and mobility. Primary data were collected in 2020 from 108 stateless and nationalityless adults in Chiang Mai province, belonging to three ethnic minorities, and analyzed using a mixed methods approach. The respondents are exposed to daily environmental stressors, the most serious being exclusion from the Universal Coverage Scheme, mobility restrictions and the absence of land rights. While out-of-pocket health expenditures increase financial vulnerability, a lack of health insurance is also associated with perceived poor quality of care and unmet healthcare needs. However, observed differences among the three ethnic groups highlight that some problems are specific to individual ethnic groups and not necessarily a consequence of citizenship problems. Given the experience Thailand has gained in achieving universal health coverage for Thai citizens, there is an opportunity to address the healthcare plight of Thailand’s stateless and nationalityless population through prioritizing the expansion and improvement of the existing Health Insurance for People with Citizenship Problems policy.

‘We are inferior, we have no rights’: Statelessness and mental health among ethnic minorities in Northern Thailand

“…Respondents from all three ethnic groups had experienced stigma and disrespect related to their ethnicity and their legal status. Stigma due to language barriers was found to particularly affect Lahu respondents as also discussed in Herberholz (2020) . ‘I have been insulted for being a “tribal man”, for not speaking Thai “correctly”, for being “inferior” than those living in the city.’ (23-year old nationalityless Lahu) ‘People call us with the name of our ethnic group – Tai-Yai – instead of our own name.’ (27-year old nationalityless Tai-Yai) ‘I faced stigmatization from primary school throughout high school.…”

“…Self-identified ethnicity was significantly associated with mental health (p = 0.01). Only about 31% of Akha respondents were in the low mental health group, despite the fact that they reported the largest number of serious problems (daily environmental stressors) on average ( Herberholz, 2020 ). In contrast, about 58% of Lahu respondents and 64% of Tai-Yai respondents were categorized in the low mental health group.…”

“…A two-stage sampling technique was adopted for the data collection as also described in Herberholz (2020) , who used the same dataset, but examined serious problems stateless and nationalityless respondents encounter in their daily lives, the focus being on healthcare services, health insurance coverage and mobility. Eight villages were purposively selected from one district in Chiang Mai province, based on existing records of a non-governmental organization (NGO) working with ethnic minorities to support citizenship applications.…”

“…Their possession, therefore, demarcates the scope of geographic and social mobility ( Cheva-Isarakul, 2019 ). Studies using data from Thailand, for example, demonstrated that legal status (as indicated by the possession of identification cards) affects education and health risk ( Koning, Flaim, Baldiga, & Feingold, 2021 ), access to healthcare ( Flaim et al, 2021 ; Herberholz, 2020 ), as well as access to land and credit ( Flaim, Williams, & Ahlquist, 2019 ), that is, more generally, the key factors that matter for social ascent. Experiences of in situ stateless populations in Southeast Asia further showed that protracted statelessness results in an intergenerational transmission of immobilization ( McAuliffe, 2017 ).…”

Status of the stateless population in Thailand: How does stigma matter in their life?

“…While some stigma is present at the individual or family level, specific groups are faced with stigma as a whole merely by virtue of belonging to the group, such as the stateless population in Thailand. In 2020, 479,943 people were classified as stateless people in Thailand [ 13 ]; these individuals live in distant and remote areas of Thailand where accessing information from the Thai government is very difficult [ 14 ].…”