Health Equity Initiatives

September 11, 2015

Refugees at risk of infection and post-traumatic stress disorder

Filed under: Latest Updates — Tags: , , — admin @ 3:08 pm

The New Scientist

7 September 2015

While politicians argue over the details, European health services are gearing up to treat refugees from Syria and elsewhere. Many have a complex set of physical and psychological problems, and addressing these will be vital for helping refugees settle in the European Union, according to specialists in refugee health.

Physical toll

A whole range of chronic, non-communicable conditions can affect these people. A UN High Commissioner for Refugees (UNHCF) study from 2013 found that Syrians arriving at camps outside their country’s borders had high rates of diabetes and high blood pressure.

Respiratory infections, diarrhoea and gastrointestinal problems can also be common, and the collapse of healthcare systems back home means that children may not be up to date with vaccines against common childhood diseases like measles, says Sharuna Verghis, co-founder and director of the Health Equity Initiative, a refugee mental health charity based in Kuala Lumpur, Malaysia.

The long packed journeys to safer countries also take their toll on the musculoskeletal system. People who’ve had to squat in cramped conditions may be unable to walk once they’ve reached their destination, says Verghis. “They also suffer skin problems such as sunburn and exposure to salt if they’ve travelled by sea.”

Years of anxiety

So far this year, around 300,000 to 350,000 refugees have reached European shores. Many have already endured years of physical and mental trauma. “The vast majority come from conflict zones like Syria, Iraq or Afghanistan, and are simply running for their lives,” the UN High Commissioner for Refugees, António Guterres said on 4 September.

“This means they’re already carrying a considerable burden in terms of mental health issues,” says Verghis. This can include post-traumatic stress disorder (PTSD), mood and anxiety disorders, and panic attacks, she says, and can be exacerbated by uncertainties over a person’s residence or legal status once they reach a safer country.

The 2013 UNHCR study found that 21.6 per cent of Syrians in a refugee camp in Jordan were suffering from generalised anxiety disorders, while 8.5 per cent had PTSD.

Handling the crisis

People who have experienced serious persistent worries about their safety may be suffering from nightmares, intrusive memories and flashbacks, and may find it hard to trust those trying to help them. European health workers will need to take all this into account, according to a recent UNHCR report on Syrian mental health issues.

Healthcare workers are being encouraged to provide a safe and supportive atmosphere, so that people feel comfortable enough to talk about their lives and medical needs. Women who have suffered sexual violence may worry about being stigmatised if they describe their experiences, and some men may culturally feel unable to express fear or other emotions.

Verghis says identifying exceptionally vulnerable people will be a priority, including unaccompanied children, the elderly, disabled and those who’ve been tortured. But first, she says, very basic facilities must be provided for refugees while their needs are being assessed in their new countries – toilets and food, as well as sanitary towels for women, and diapers for babies.

Stop the Arrest and Detention of Asylum Seeking Women Accessing Maternal Health Care

Filed under: Latest Updates — admin @ 2:59 pm

Press Statement

03 April 2014

Last week, three asylum seeking women who were admitted to GHKL to deliver their babies, were informed that they would be sent to immigration detention after delivering their babies. Reportedly, the hospital personnel notified the immigration authorities about the two women. The immigration authorities in turn informed the husbands of the women that their wives would be sent to detention after delivering their babies. The women and their husbands experienced great anxiety while waiting for the babies to be born in addition to struggling with the usual fears associated with child-birth.

This week, an asylum seeker was sent to detention with her new born baby in spite of pleas to let the woman stay overnight at the hospital until UNHCR had the opportunity to intervene in the morning.

The previous week, an asylum seeking woman who delivered her baby in GHKL was sent to immigration detention while her baby remains in the hospital. The husband is concerned about his wife’s post natal care as well as the fact that the baby is missing its mother’s care.

New admissions of asylum seeking women to GHKL continue to be told that they will be detained after delivery, even those who have undergone a Caesarean section delivery.

Health Equity Initiatives is extremely concerned about this new development. Not only does it exacerbate the ongoing fears of refugees and asylum seekers while accessing health care; it also holds the strong possibility that this population would avoid an institutional delivery or resort to unsafe abortions if they get pregnant. Both these factors are risk factors for maternal mortality given the specific vulnerabilities of their lives in Malaysia.  Additionally, the risk of maternal morbidity including infection is exacerbated when postnatal care is lacking, especially for Caesarean births.

Malaysia has made a global commitment to reduce maternal mortality through the Millennium Development Goals (MDGs). In addition, the country has ratified the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), 1979. As such Malaysia is obliged to uphold the provision of elimination of discrimination against women in their access to health care throughout the life cycle, particularly in the areas of family planning, pregnancy and confinement and during the post-natal period, as stated in CEDAW and its General Recommendation No. 24.

Malaysia is regularly cited by international agencies including the World Health Organization (WHO) and the World Bank as a “good practice” for its success in terms of maternal health. The rapid decline in maternal mortality is especially attributed to expanded access to an integrated package of maternal and child health services and ensuring that such efforts reached the poor.  Yet, reports which identify a significant prevalence of maternal deaths among non-citizen women attribute it to their limited access to maternal health services.

The WHO emphasizes that the establishment and maintenance of breastfeeding should be one of the major goals of good postpartum care.  It states that breast milk is the optimal food for newborn infants and prevents infant morbidity and mortality caused by infections and malnutrition.  Malaysia’s National Breastfeeding Policy which was formulated in 1993 and revised in 2005 recommends exclusive breastfeeding for the first six months of life. Kementrian Kesihatan Malaysia also recommends placing the baby on the mother’s chest for at least 10 minutes for skin to skin contact and putting the baby to the breast for suckling within one hour after delivery.  Skin-to skin contact between mother and baby brings about many physiological and psychological benefits for the baby, including greater respiratory, temperature, and glucose stabilization, optimal brain development, protection from the negative effects of separation, maternal attachment, and improved infant neurobehavioral development.  As such, separation from the mother or placement in detention poses significant health risks to the new born.  Placement in detention would aggravate the newborn’s exposure to infections.

The Convention on the Rights of the Child (CRC) 1990 ratified by Malaysia requires State parties to ensure that discrimination does not undermine children’s health. Malaysia as a State Party to the CRC and having enacted the Child Act 2010, has a duty to protect the health of the newborn child. Importantly, CRC and its General Comment No. 15 emphasize the importance of access to health care, especially appropriate pre-natal and post-natal health care for mothers in order to reduce neonatal deaths.

Refugees and asylum seeking women experience specific and adverse sexual and reproductive health vulnerabilities and outcomes owing to exposure to conflict and military presence, gender and sexual based violence, and poverty.  They require the protection of the international community. Immigration policies of arresting and detaining such vulnerable women, especially at the time of child birth, make Malaysia and its policies appear cruel and inhumane. Additionally, such health care practices do not reflect the regard for science and evidence that underline Malaysia’s Ministry of Health policies in terms of maternal health.

In line with Malaysia’s international commitments to CEDAW, CRC and the MDGs, Health Equity Initiatives calls on the Malaysian government to immediately withdraw this new policy of arresting and detaining asylum seeking women accessing maternal health care. Instead we call on the government to make maternal health care, including family planning services accessible to refugees and asylum seekers and place their human rights at the centre of policies related to them. Undoubtedly, these are complex issues. Managing them requires robust technical and ethical guidance as well as integrated national and regional approaches to burden sharing. Health Equity Initiatives offers to work together with the Malaysian government, UNHCR, and other stake holders concerned about refugees and maternal health to find a durable solution to the issue of accessibility of refugees and asylum seekers to health care, including maternal health care.

Prepared by

Sharuna Verghis


Health Equity Initiatives

Endorsed by

All Women’s Action Society (AWAM)

Association of Women Lawyers (AWL)

Malaysian Care

Malaysian Social Research Institute (MSRI)

Pusat Kebajikan Good Shepherd (PKGS)

Reproductive Rights Advocacy Alliance Malaysia (RRAAM)

Shanthi Dairiam -  Former CEDAW Committee member


November 8, 2012

Australia still committed to Malaysia asylum policy

Filed under: Latest Updates — mike @ 1:49 pm

Australia said it remained committed to sending asylum-seekers to Malaysia for processing and insisted it is not necessary for Kuala Lumpur to be a signatory to the UN refugee convention. Canberra last year clinched a deal to send 800 boatpeople to Malaysia in exchange for 4,000 of that country’s registered refugees as a deterrent to people paying smugglers to make the dangerous maritime voyage to Australia. The plan was scotched in the High Court and was also opposed in the Australian parliament, which insists asylum-seekers should only be sent to countries that have signed the UN refugee convention. Malaysia has not.
But with Australia facing a record influx of boatpeople this year – more than 13,500 since January 1 – and an offshore camp in Nauru filling up fast, Foreign Minister Bob Carr said the plan needed to be revisited. Carr was in Malaysia this week and said the government in Kuala Lumpur remained committed to the deal and deserved credit instead of criticism for how they had dealt with asylum-seekers. “I confirm that we will continue to adhere to our commitment to take 4,000 refugees over four years,” he told ABC television late yesterday.
“The Malaysians could do without some of the bad-mouthing of their eminently good reputation that occurred when the matter was last debated (in parliament). Their sincerity on this can’t be doubted,” he added. He pointed out that Malaysia had about 100,000 refugees and around two million illegal workers. “So they feel great pressure but they deserve praise for taking an enlightened and an innovative approach to this problem, which affects the whole region, of people-smuggling,” he said.

No closer to signing UN convention

Carr acknowledged that Malaysia was no closer to signing the UN convention but said: “It’s very silly if that’s a stumbling block.
“As Malaysia sees it, they have two million illegal workers, they have 100,000 refugees, they’re dealing with this and they can deal with it without signing the convention,” he said. “We were more than happy with the assurances that they gave us when we negotiated the arrangement with them.” Following the collapse of the so-called Malaysia people swap deal, Canberra decided to send boatpeople to Nauru and Papua New Guinea’s Manus Island. Those sent to Nauru have been warned it could be years before their claims for asylum are processed and around 300 of them are in the seventh day of a hunger strike, according to refugee activists. The men, mostly from Sri Lanka but also from Afghanistan, Pakistan, Iran and Iraq, claim being on the remote island is affecting them physically and mentally.


March 14, 2012

Tenaganita: End crackdowns on migrants

Filed under: Latest Updates — Tags: , , , , — mike @ 1:37 pm

The deadline under the government’s 6P amnesty programme has been extended to April 10, but Tenaganita — an NGO which takes up women’s and migrant issues — is concerned that crackdowns on illegal migrants seem to be continuing. Tenaganita said that in a crackdown at Pasar Seni, Kuala Lumpur on Feb.11, over 100 migrants — including refugees — were arrested and detained in unknown places, and attempts to gain access to them failed. Tenaganita issued rounds of statements in the past weeks as three subsequent raids took place on Feb 24 in Kedah, Feb 29 in Johor, and March 3 in Melaka.

In the Kedah incident, 33 China refugees — including women and children — were arrested. Tenaganita received unconfirmed reports that in Johor, about 200 migrants were arrested and it was uncertain if there were refugees, minors or trafficked persons in the group. The number of migrants and refugees involved in Melaka raid was unknown, but two China refugee women were among those arrested and their families have been unable to locate or contact them. Read More..

February 21, 2012

Ministry to get tough against unregistered illegals and their employers

Filed under: Latest Updates — Tags: , , , — mike @ 12:34 pm

PUTRAJAYA: After all the coaxing and the extensions, the Home Ministry is ready to get tough. It will embark on the biggest ever operation against illegal immigrants in the country from next week. An estimated 1.3 million illegal immigrants failed to step forward under a special amnesty programme, codenamed 6P (Illegal Immigrant Comprehensive Settlement Programme), and the ministry will be going after them.

Employers harbouring such immigrants will also not be spared. The programme involved six phases starting off with registration (Aug 1 to 31, 2011), amnesty, supervision, enforcement, deportation and legalisation. The crackdown will start from the wee hours of Thursday, just hours after the close of the legalisation phase which kicked off on Oct 10. Read More

January 9, 2012

Draft Asean Human Rights declaration to be discussed with Suhakam, NGOs

Filed under: Latest Updates — Tags: — mike @ 1:40 pm

KUALA LUMPUR: Suhakam and non-governmental organisations (NGO) can look forward to consultations on the draft Asean Human Rights declaration this year. “We received a working draft of the declaration today and I will be conducting active consultation from now on,” said Datuk Seri Muhammad Shafee Abdullah, who is Malaysia’s commissioner in Asean’s Inter-governmental Commission on Human Rights (AICHR) . “I have so far only met with the NGO coalition Comango and the Bar Council,” he added yesterday.

He was asked to comment on a call by Amnesty International in the Jakarta Post on Saturday to make the draft public since human rights concerned every woman, man and child in the region. Amnesty said it was “disappointed by the secrecy surrounding the drafting process so far”. In the same report, Cambodian Human Rights Committee chairman Om Yin Tieng said Cambodia, which chairs Asean this year, aims to finalise the grouping’s Human Rights declaration this year. Read More..

January 5, 2012

Refugees have rights, too

Filed under: Latest Updates — Tags: , , , , — mike @ 9:59 am

ON Dec 10, 1948, these words were adopted in the Universal Declaration of Human Rights, “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” How we treat those who flee from danger and persecution and seek help at our doorstep is a reflection of the morality and humanity of our society. Malaysia’s refugee story began in 1975 with the arrival of Indochinese refugees by boat.  A majority of them were resettled to other countries and some returned home safely Read More..

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