www.jogh.org • 4 3 2 1 Hayatul NajaaMiptah Raudah services forrefugeesinMalaysia The needtomapexisting healthcare JOGH ©2021ISGH © 2021THEAUTHOR(S) The onlineversionofthisarticlecontainssupplementarymaterial. Electronic material: supplementary Department ofPathology,FacultyMedicine,UniversitiTeknologiMARA (UiTM),SungaiBulohCampus, Department ofPrimaryCareMedicine,FacultyUniversitiTeknologi MARA(UiTM),SungaiBulohCampus,Malaysia Department ofPhysiology,FacultyMedicine,UniversitiTeknologiMARA (UiTM),SungaiBulohCampus,Malaysia Department ofPublicHealthMedicine,FacultyUniversitiTeknologi MARA(UiTM),SungaiBulohCampus,Malaysia various non-statehealthactors. future planningandprogrammingby cally mappedoutto assist and inform ers inMalaysianeedtobesystemati vices for refugees and asylum-seek The current,existinghealthcareser MohdYunus doi: 10.7189/jogh.11.03024 los, without collaboration or coordination with other entities. While synchronization among stakeholders has has stakeholders among synchronization While entities. other with or coordination collaboration los, without etc) to work entities, si in private CSOs, (NGOs, providers of service some tendency the is deficit The first providers. service and actors on non-state mainly is focus Our country. this in for RAS services care of health mapping for need asystematic the propose thus and initiatives of existing efficiency the limited have may that or impediments of ‘deficits’ anumber paper, to highlight would we like this In programs. these alot of for room is in improvement there Still, (eg, transportation). free cards), transportation and registration without (eg, (eg, of those interpreter), provision accepting documentation barrier to language related issues address simultaneously services To these out-of-pocket extent, payment. some excessive without services care health to access Malaysia in of RAS thousands ahuge facilitating in step been development has positive This facilities. health of public or private to that compared at or amuch lower offered price of charge free mostly are which services care of health range awide established have (CSOs) entities private and organizations ety health. mental like studied, adequately not been have that issues health ing [ found 27.5% Lumpur Kuala in 11.5% and children underweight to be stunted Rohingya among study Another [ diseases 7% cardiovascular and had diabetes, 8% had hypertension, had Malaysia in of refugees adult 23.9% 2015 in that UNHCR reported the by Asurvey livelihoods. and education services, care to health cess [ country the in RAS tered D 5 ]. These however are likely conservative estimates, given the hard-to-reach nature of RAS and other exist other and of RAS nature hard-to-reach the given estimates, conservative likely ]. however are These lacks a clear socio-legal framework pertaining to RAS. To this date, there are close to 180 close are there To date, this to RAS. pertaining framework socio-legal aclear lacks [ countries Asian Southeast other to most compared (RAS) asylum-seekers and of refugees number largest the hosting espite 1

, NasibahAzme 3 , Awla MohdAzraai

2 ]. The vast majority are socio-economically marginalized and have restricted ac restricted have and marginalized socio-economically are ]. majority The vast - - - Refugees (UNHCR), non-governmental organizations (NGOs), soci civil organizations non-governmental (UNHCR), Refugees for Commissioner High Nations United the like stakeholders different sue, more [ many and literacy health poor differences, cultural and language of arrest, fear issues, documentation include these well-documented; been have facilities public health to accessing barriers [ employment formal from group this prohibits that law rent cur the and fees in increase continuous due to the exorbitant, remain tion reduc such following incurred expenses medical Nevertheless, hospitals. and clinics at government rate) foreigner’s (from subsidy to the 50% RAS a – provides of Health Ministry its – through government The Malaysian 2 1 , ], Malaysia is non-signatory to the 1951 UN Refugee Convention and and 1951 Convention to the Refugee UN non-signatory is ], Malaysia Xin Wee Chen 4 1

1 , Siti FatimahBadlishah-Sham refugees inMalaysia.JGlobHealth2021;11:03024. HN, AzraaiAM.Theneedtomapexistinghealth Cite as: YunusRM, Azme N, 2021 •Vol. 11 • 03024 8 Chen XW, Badlishah-Sham, ]. is To this mitigate 6 000 regis 000 , care services for care services 7 ]. Other Other ]. 3 , Miptah 3 , 4 ------] - -

VIEWPOINTS VIEWPOINTS 2021 •Vol. 11 • 03024 and healthdisparities(From theauthor’s owncollection,usedwithpermission). two posh condominiumbuildings are visible – an interesting image that implies inequality refugees facilities.Atthebackground, whomostlycannotaccesshealth care atgovernment Photo: Aslumarea inSentul,KualaLumpur, thatshowsthepoorlivingconditionofRohingya in ajustandequitablemanner. health ofthisvulnerablepopulation address thesocialdeterminantsof undermine themoreurgentneedto This call for mapping should not viders, a phenomenon that can be attributed to shortage of manpower and expertise, or other logistics issues. logistics or other expertise, and of manpower to shortage attributed be can aphenomenon that viders, pro service these among sharing or data collection data systematic rarely is there Lastly, services. care health to, similar access their of, and distribution and availability to the regards – with Perlis and Perak Kelantan, Terengganu, Pahang, – Kedah, states developed less six across scattered is that population RAS remaining (77.1% Johor) residence and Penang [ KL, , in to live reported are [ Johor and Bahru Sembilan Negeri Penang, Valley [ within areas in were refugees, targeted specifically that country) the in populations to marginalized services health provides that (one NGOs biggest of the Malaysia 2016, and conducted MERCY by 2004 between programs 70% of health of For Selangor. instance, cities adjoining several and (KL) Lumpur Kuala includes that conglomeration ban outpatient in unavailable –often needs specific address that services to find not easy it is Similarly, care. tiary or ter secondary in initiatives much lesser with level, preventive promotive and at the available are programs fewer needed, highly are these While level. care or primary acute/curative at the to cluster tend services lated health-re most work Second, and redundancy. services, and programs of health ‘replication’ the in resulted possibly has This sectors. across and ones, larger and smaller between NGOs, smaller among levels; at several [ years recent in improved definitely a comprehensive socio-legal framework and to address the social determinants of health of RAS in Malaysia. in of RAS of health determinants social the to address and framework socio-legal a comprehensive to provide need more pressing the should not eclipse mapping for systematic call this that to emphasize like would we but not least, Last system. geo-mapping newer the utilize or it may interactive and online is that map evidence of conventional form the come in can map Accordingly, the services. of these of many nature ambulatory the and needs, health in changes and complexity increasing the populations, of RAS mobility high the given key is updating Regular not static. dynamic, it is if impactful most is ‘map’ to say, this Needless policies. and programming future inform can that aspects fundamental –two sharing and collection data methodical encourage will programs and services care health of existing plotting systematic importantly, Most of services quality the enhance dundancy, and or re of resources efficiency, avoid wastage to drive crucial is This aid. mutual and collaboration planning,

Other than that, most services tend to concentrate in – an ur Valley –an Klang in to concentrate tend services most that, than Other diseases. of chronic management the of follow-ups hampers and to disruption leads of continuity Such lack straint. or budget con funding being reason common most the or seasonal, nature in one-off are services of some these Third, are. services the or how adequate is [ (HEI) Initiatives Equity Health and Malaysia (MSF), MERCY Frontieres Sans Medecins as such RAS, for services health mental to provide known are of NGOs anumber instance, For care. or dental health, reproductive health, mental as –such settings care 10 9 ] – especially among the larger actors – coordination is relatively limited limited relatively is –coordination actors larger the among ] –especially ]. In a similar vein, MSF had run most of its activities in , Kuala in activities of most its run had MSF vein, ]. asimilar In 11 2 ]. Even though these trends correspond with the pattern of RAS of RAS pattern the with correspond trends ]. these though Even

tween stakeholders (within and across sectors), across and giv by (within stakeholders tween be coordination for way greater the pave will vices ser care of health mapping Second, for RAS. services of provision the approach in amore holistic enabling and needed, most are they to where resources health (re)allocating programs, future their planning in ers provid service assist can knowledge This lacking. are – where and level –at which type(s) of service which gaps; the identify it can First, of benefits. range a wide give will for RAS services care of health The mapping cluster. mobile) (eg, vs they where and static programs of of nature service(s), scope the and level the offered, being of services types the providers, service actors/ health non-state relevant all at identifying should aim exercise out. This mapped systematically are tiatives programs/ini current if improved greatly be can laysia Ma in for RAS services care health future and Existing among service providers, resulting in better strategic strategic better in resulting providers, service among communication effective more and networking itate facil will regard this in information available Readily where. and what, doing of who is picture aclearer ing 10 - 12 ]. But it is unclear to what extent their coverage coverage their extent to what ]. unclear But it is 13 www.jogh.org • ], not much is known about the about the ], known not much is doi: 10.7189/jogh.11.03024 ------www.jogh.org • REFERENCES

13  12  11  10  3  2  1  9  8  7  6  5  4  doi: 10.7189/jogh.11.03024 html. Accessed:10September2020. UNHCR. FiguresataglanceinMalaysia 2020 2020.Available:https://www.unhcr.org/en-my/figures-at-a-glance-in-malaysia. does/#MHS. Accessed:10September2020. HEI. WhatHEIDoes:Reachouttotransformandheal.2020.Available:http://www.healthequityinitiatives.com/what-hei- malaysia. Accessed:25August2020. MSF. InternationalActivityReport2019:Malaysia.2019. Available:https://www.msf.org/international-activity-report-2019/ gust 2020. MERCY. Programme:Malaysia.2020.Available:https://www.mercy.org.my/programme/?country=Malaysia. Accessed:5Au Institute ofTechnology;2017. RefugeesInKlangValley,Malaysia.Cambridge:Massachusetts Hussain I.OvercomingChallenges:TheStoryofNGOsServing laysia: aqualitativestudy.IntJEquityHealth.2018;17:120. Chuah FLH,TanST, YeoJ,Legido-QuigleyH.Thehealthneedsandaccessbarriersamongrefugeesasylum-seekersinMa parative Education.2013:86-97. Journal of International and Com Letchamana H. Myanmar'sRohingya refugees in Malaysia: Education and the way forward. tive%20issued%20yesterday,of%20RM1%2C200%20for%20surgery. Accessed:1October2020. malaysia/2017/04/08/health-ministry-hikes-up-hospital-fees-for-foreigners-up-to-230pc/1351929#:~:text=In%20a%20direc Mail M.HealthMinistryhikesuphospitalfeesforforeignersto230pc.2017.Available:https://www.malaymail.com/news/ Teng TS,ZalilahM.Nutritionalstatusofrohingyachildreninkualalumpur. MalaysianJMedHeal Sci.2011;7:41-9. amongnon-camprefugeesinMalaysia.KualaLumpur:UNHCR, 2015. UNHCR. Ataglance:healthaccessandutilizationsurvey glected healthcareneed.GlobalHealth.2014;10:24. Amara AH,AljunidSM.Noncommunicablediseasesamongurbanrefugeesandasylum-seekersindevelopingcountries:ane Accessed: 10August2020. UNHCR. FiguresataglanceinMalaysia.2020.Available:https://www.unhcr.org/en-my/figures-at-a-glance-in-malaysia.html. UNHCR. Operations:SoutheastAsia.2019.Available:https://reporting.unhcr.org/node/39. Accessed:15August2020. the correspondingauthor),anddeclarenoconflictsofinterest. Competing Authorship Funding: Acknowledgment There wasnofundingforthisstudy. interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from interests: The authors completed theICMJE Unified Competing Interest form (available upon request from contributions: Allauthorscontributedequallytothismanuscript.

: The authorswouldliketothanktheUiTMFacultyofMedicinestafffortheiradministrativesupport. doi:10.14425/00.50.24

Medline:24708876 3

Medline:30111329

doi:10.1186/1744-8603-10-24

doi:10.1186/s12939-018-0833-x [email protected] Malaysia Universiti TeknologiMARA(UiTM) Sungai BulohCampus Jalan Hospital,47000 Faculty ofMedicine Department ofPublicHealthMedicine Raudah MohdYunus Correspondence to:

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