No need for immigration enforcement when seeking healthcare

Dr Tharani Loganathan, Public Health Medical Specialist was interviewed by Predeep Nambiar, of FMT News in an article published on the 6th of December, 2020 entitled “Grant amnesty for migrants going for Covid-19 tests, say experts”

Here is the full transcript of the interview:

In 2001, the offices of the Director-General of Health released guidelines for the reporting of undocumented migrants seeking care at MOH clinics and hospitals. This is the Circular of the Director-General of Health no.10/2001: Guidelines for reporting illegal immigrants obtaining medical services at clinics and hospitals. In this circular, health workers at public facilities were reminded of their duty as civil servants to report undocumented migrants including children, migrant workers, refugees and asylum seekers, to the police per the Immigration Act 1959/1963 (amend 1997). The circular explained the rationale for this policy in two ways. First, non-citizens were framed as a potential national security threat requiring collective action. Second, non-citizens were seen as taking up a large portion of the MOH budget meant for Malaysian citizens.

1) Do you think the circular ought to be struck off?

This circular creates a climate of fear around healthcare-seeking at public clinics, as undocumented migrants are liable for arrest and detention. Medical doctors are also placed in a difficult position of withholding care based on legal status, which is against the ethics of the medical profession. This policy is particularly unhelpful during a pandemic and is a significant barrier towards healthcare access.

2) There’s a lack of trust by undocumented workers in public healthcare. Do you think the govt ought to reach out to them and tell them it is okay you can come for a test we won’t report you?

The government can reach out and give reassurance, however substantial loss of trust has already occurred with the arrests and detention of undocumented migrants since May 2020. Reassurance is not enough.

Stronger measures are necessary to reassure migrants that it is safe to come forward and be tested.  One suggestion is the issuance of amnesty on immigration action throughout this pandemic, with a pathway towards regularization (issuance of temporary visa, work permit and health insurance). These reassurances should be made by the whole government (immigration and national security council), and not just by the Ministry of Health.

3) Given the situation in Sabah and elsewhere, what do you think is the best way to tackle the rise of the virus among foreign workers?

Covid-19 does not discriminate. It is a highly infectious viral disease that affects predominantly the poor and vulnerable populations worldwide, largely due to living and working conditions that are crowded, unhygienic and unsanitary.

The current outbreak of infections among foreign workers in places of detention, and construction and manufacturing industries, is indicative of these conditions (social determinants of health). These conditions make physical distancing and hygiene impossible, it makes following SOPs an impossibility- allowing for easy spread of COVID-19.

It is important to address the living conditions of migrant workers through the enforcement of Workers’ Minimum Standards of Housing and Amenities Act 1990 (Act 446). The government should ensure that employers provide living quarters to workers according to the provision of this law.