The United Nations High Commissioner for Refugees (UNHCR Malaysia) began its operation in 1975 and is the leading humanitarian agency providing protection and assistance to the refugee communities in Malaysia.

Considering the need to better understand the interactive ecosystem of the UNHCR, and how it collaborates with governments and partners in Malaysia, a student-organised visit to the centre was made on the 10th of November 2022. The visit was graciously facilitated by Dr Susheela Balasundaram and Mr Jason Yeo from UNHCR. A total of 27 Master of Public Health (MPH) students participated in this visit. We were also grateful to have Dr Vincent Kahi, Senior Public Health Officer from the Regional Bureau for Asia and Pacific UNHCR, and Dr Tharani Loganathan, MPH Course Coordinator with us on this visit.

The visit began with a briefing on the challenges faced by refugees and the organisations that support them. Students were enlightened, on the journey refugees must go through, as well as the push factors, such as violence, war, discrimination, and civil unrest, that force them to flee from their country of origin to another country. In fact, as of the end of September 2022, there are some 183,430 refugees and asylum-seekers registered with UNHCR in Malaysia, with most being Myanmar nationals living in urban areas.

Multiple bottlenecks regarding the delivery of public health services were discussed. In particular, the efforts to curb the spread of Tuberculosis (TB) in the larger community. Despite first-line TB treatment being free for all in Malaysia, access to free treatment is only accessible once the diagnosis is confirmed. Screening tests to rule out TB incur a cost for refugees resulting in many being reluctant to come forward due to affordability issues. This and other similar procedural and policy gaps from the COVID-19 pandemic shed light on the need to include refugees and asylum seekers in the development of comprehensive public health strategies to break the chain of transmission of infectious diseases effectively.

Similarly, the social determinants of health of the refugees and asylum seekers differ vastly from the general population, largely due to the legal restrictions that limit their access to employment, education, and health facilities. To be recognised as a refugee, a person must go through a thorough individual case processing that requires multiple steps which include registration, and refugee status determination (RSD). RSD is a resource-intensive procedure that aims to determine whether a person seeking international protection is considered a refugee under internal, regional, or national law. RSD is an important step in helping refugees realize their rights under international law.

Although Malaysia has not acceded to the conventions that recognise the rights of people seeking asylum due to persecution, such as the 1951 Refugee Convention, its 1967 Protocol, or any relevant Statelessness Conventions, this does not prevent the government from formalising a national legal framework that governs and regularizes the protection of refugees and asylum seekers living in the country. In fact, the ongoing repatriation of Myanmar refugees and asylum seekers back to their home states contravenes international laws of non-refoulment. The UNHCR, therefore, seeks to capacitate the government towards adopting a more centralised state approach to deliver services for refugee protection and care.

This draws the attention and cooperation of young public health professionals in pushing for further integration and inclusivity of refugees in current and future policymaking. Policymaking however begins with good data and research output. With the current data on refugee health primarily being provided by international and non-profit organisations such as Médecins Sans Frontières, Malaysia, the UNHCR encourages more research output pertaining to refugee health, safety, and rights in Malaysia. All in all, the field visit was a great success. This was the first field visit organised by students since the lifting of the COVID-19 pandemic lockdown. It has been a great learning experience for all MPH students who participated.