The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study

Abstract

BackgroundIn Malaysia, refugees and asylum-seekers are a vulnerable group that often face circumstances in which their health and wellbeing can be compromised. This qualitative study sought to examine the key health concerns and barriers to healthcare access among refugees and asylum-seekers in Malaysia through the lens of healthcare professionals, program staff and experts on refugee and migrant health.MethodsWe conducted 20 semi-structured in-depth interviews with experts, healthcare professionals, program managers or executives from UN agencies, public healthcare facilities, civil society organizations, and academic institutions in Malaysia. Interviews were transcribed and analyzed both deductively and inductively using thematic analysis.ResultsParticipant narratives highlight that the health needs of refugees and asylum-seekers in Malaysia are complex. As reported, access to healthcare is underpinned by numerous social, cultural and economic determinants compounded by a legal environment that lacks inclusivity of refugees and asylum-seekers. Apart from the health risks associated with the migration process, limited access to comprehensive healthcare post-arrival remain a problem for refugees and asylum-seekers in Malaysia. Key barriers to healthcare access are linked to poor health literacy and the lack of awareness on one’s right to healthcare; language and cultural differences; protection issues resulting from a lack of legal status; and an inability to afford healthcare due to inadequate livelihoods. Overall, poor access to healthcare is perceived to have detrimental consequences on the health status of refugees, asylum-seekers and its host population, and may incur greater costs to the health system in the long run.ConclusionComprehensive efforts in practice and research that tackle the social, cultural and economic determinants of health, and more inclusive health policies are crucial in strengthening healthcare access among refugees and asylum-seekers in Malaysia. Practical recommendations include improving the health literacy of refugees and asylum-seekers for better navigation of the health system; bridging language and cultural gaps through translation support and inter-cultural orientation; implementing policies grounded in the right to healthcare for all regardless of legal status and in the interest of public health; and establishing a larger evidence base to drive policy development and implementation for refugee health within the Malaysian context.

Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar

“…Our study looked at the inter-relationships between health, social connections, work and education. The complex nature of health and relationship with non-biomedical factors as highlighted in previous literature [11][12][13][21][22][23][24][25] was demonstrated in our research, and further supported the SEM, which challenges researchers and practitioners alike to think broadly about all influencers of health including social and environmental factors [29]. However, those currently implementing changes to improve the health and wellbeing of refugees are healthcare or social support service providers.…”

“…Participants in our study described the numerous difficulties and challenges during the settlement process, such as low literacy in the host language, challenges accessing services (including healthcare) and low income and unemployment. The challenges identified in this research echo that of other studies relating to refugee settlement [2,16,[22][23][24]43]. Many of the challenges that refugees face stem from their transition to a new environment and the need to adapt to different systems, environment, people and more [44].…”

“…Lack of access to health services in their new home country [10,14,15] presents an additional challenge that is influenced by language barriers, lack of transport, and unfamiliar health service systems [2,[16][17][18][19][20]. Several studies suggest that people from refugee backgrounds have low health literacy, which poses both a barrier and a deterrent to accessing health services [16,[21][22][23][24][25][26][27]. Difficulties accessing health services is compounded by the difference in cultural beliefs among each refugee community group and how culture may influence their view of health [16,21,25,28].…”

Urban-Rural Disparity: The Utilization of Primary Healthcare Centers Among Elderly in East Java, Indonesia

“…The more barriers they face, the longer they tend to delay treatment. Thus, they are unable to hold back anymore (Carrillo et al, 2011;Chuah et al, 2018;Laksono, Nantabah, and Wulandari, 2018).…”

‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities

“…While free clinics operate to assist refugees with basic primary health needs, those with more complex or ongoing needs are more likely to rely on the financial and sometimes logistical assistance of UNHCR or the International Organization for Migration (IOM) (in Indonesia). In Malaysia, major concerns include the spread of communicable diseases, especially multi-drug resistant forms of tuberculosis, due at least in part to the cramped and poorly ventilated living conditions, and conditions in immigration detention facilities [42].…”