Stop the arrest and detention of asylum seeking women accessing maternal health care

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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


World Refugee Day

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In conjunction with World Refugee Day, we call for the Malaysian government to accord the right to work for refugees and asylum seekers in Malaysia.

There are 98,100 refugees and asylum-seekers registered with United Nations High Commission for Refugees (UNHCR) in Malaysia, 92% of which are from Burma’s different ethnic groups. 8,200 are from Sri Lanka, Somalia, Iraq, Afghanistan and other countries.Refugees and asylum seekers are considered “illegal immigrants” under Malaysian law, specifically the Immigration Act 1959/63 (Act 155). Unable to work legally in the country, they survive by working in the informal and often unregulated work sectors, performing ‘3-D work’(dirty, demanding, dangerous) without legal protection.  This increases their vulnerability to forced labor and human trafficking and its negative consequences for ill-health.

This is evidenced in Health Equity Initiative’s research report Forced Labor, Human Trafficking and Forced Labor: The Experiences of Refugees and Asylum Seekers in Malaysia. This research revealed a high prevalence of forced labor and mental health distress whereby 61.2% of refugees and asylum seekers in the 1,074 study population who had worked full time had experienced forced labor. About 70% of the respondents showed symptoms of Depression and 68% showed signs of Anxiety. In-depth interviews revealed practices of deception and fraud, withholding of wages, physical confinement, non-payment of wages, threats of denunciation to authorities, induced indebtedness, physical violence, and sale into ownership by their employers.

The social and legal factors contributing to the mental ill health in this population living and working side by side with Malaysians needs to be urgently addressed. We therefore call on the Malaysian government to:

  1. Accord refugees and asylum seekers the right to work
  2. Recognize refugees and asylum seekers and ratify the 1951 United Nations Convention relating to the Status of Refugees and its 1967 Protocol Regulate the labor sector to prevent and protect against exploitation and forced labor
  3. Ensure that all persons who have experienced human trafficking and forced labor, regardless of their legal status,  have access to appropriate legal, medical and protection services and that they will not be refouled

Endorsed by:

1.       All Women’s Action Society (AWAM)

2.       Angkatan Belia Islam Malaysia (ABIM)

3.       Anak Muda Sarawak

4.       Community Action Network (CAN)

5.       Community Development Center (CDC)

6.       Education and Research Association for Consumers (ERA Consumer)

7.       Health Equity Initiatives (HEI)

8.       Jaringan Rakyat Tertindas (Jerit)

9.       Jaringan Utara Migrasi dan Pelarian (JUMP)

10.   Lawyers For Liberty (LFL)

11.   Malaysian Social Research Institute (MSRI)

12.  Persatuan Kesedaran Komuniti Selangor (EMPOWER)

13.   Persatuan Masyarakat Selangor dan Wilayah Persekutuan (PERMAS)

14.   Persatuan Sahabat Wanita

15.  Pusat Kebajikan Good Shepherd

16.   Pusat Komunikasi Masyarakat (KOMAS)

17.   Saya Anak Bangsa Malaysia (SABM)

18.   Tenaganita

19.   The National Human Rights Society, Malaysia (HAKAM)

20.   Women’s Aid Organisation (WAO)

Concerns over immigration related developments that jeopardize the security of refugees and asylum seekers in Malaysia

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We, the undersigned organizations who work closely with refugees and asylum seekers from Burma living in Malaysia, express our deep concern over two recent immigration related developments that jeopardize­­ the security of refugees and asylum seekers in Malaysia.

Firstly, whilst we laud the government for considering the issue of over-crowding at the detention centres, the detainee swap initiative between the Malaysian and Burmese government is not the appropriate solution to the problem. In fact, it could potentially put the lives of refugee and asylum seeker detainees at risk.

Ethnic and religious minorities in Burma have been experiencing ongoing persecution leading to the exodus of several hundreds of thousands of people over the past twenty years fleeing oppressive conditions of forced labor, confiscation of lands/homes, systematic rape, torture and other forms of religious and ethnic persecution. The majority of the population from Burma in Malaysia are persons fleeing such persecution.

Under the Malaysian Immigration Act 1959/1963, refugees and asylum seekers too are detained in immigration detention centres. Unlike migrants, refugees and asylum seekers have a well-founded fear of persecution in their homeland; hence they flee their country of origin and cannot return home. The principle of non-refoulement in Article 33 (1) of the 1951 Refugee Convention states that: “No Contracting State shall expel or return (’refouler’) a refugee in any manner whatsoever to the frontiers of territories where his life or freedom would be threatened on account of his race, religion, nationality, membership of a particular social group or political opinion.” The deportation arising from the swap with Burma for immigration detainees contravenes this principle because of the presence of detainees in detention centres who are potentially refugees and asylum seekers.

Secondly, during the registration of the 6P programme, it was highlighted that some refugee applicants received a “Slip Pendaftaran PATI,” which contained a line that said “Tujuan :Pulang ke Negara Asal” (Intention: Return to Home Country). This is despite the fact that they are refugees who are recognized by UNHCR. We call on the government to immediately rectify this error to prevent refugees from being refouled. We urge the government to recognize that any registration of refugees must be done in full collaboration with UNHCR, within a framework that will recognize and protect the rights of refugees.

We therefore call on the government to:

1. Work in close collaboration with UNHCR to ascertain and immediately release individuals who are refugees and especially asylum seekers who have yet to lodge an asylum claim with UNHCR in the detention centres.

2. Provide access to lawyers and NGOs to detention centres to represent detainees who seek to lodge an asylum claim.

3. Immediately rectify the errors in the 6P registration process of refugees and asylum seekers and cooperate fully with UNHCR to establish a framework for the recognition of the rights refugees.

Endorsed by:

1. Health Equity Initiatives (HEI)

2. Lawyers for Liberty (LFL)

3. Women’s Aid Organisation (WAO)

4. Tenaganita


6. Malaysian Social Research Institute (MSRI)

This letter was published in Free Malaysia today on the 19 October 2011,

6P Programme Redress Woes of Refugees

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Dear Editor,

Health Equity Initiatives (HEI) is an organization that works closely with refugee and asylum seekers in Malaysia. There are currently over 94,000 refugees registered with the United Nations High Commissioner for Refugees (UNHCR). Refugees are individuals who have a well-founded fear of persecution in their homeland; hence they flee their country of origin and cannot return home. 

We have deep concerns with respect to the current government initiated 6P Programme, particularly with regard to refugees and asylum seekers.  Over the last few weeks, HEI has been in close contact with refugee community organizations, and today HEI staff were on site in Putrajaya monitoring the registration process for refugees. We have observed the following:

  1. There has been a substantial lack of clarity around if/how refugees and asylum seekers can/should register for the Programme. August 23rd marked the first day refugees were told to register under the Programme. The process proved to be chaotic and lacking in organization.  Applicants were redirected to different registration locations for the registration process.
  2. Force (hitting with baton, pushing, and dragging by sleeve) was used in Putrajaya in attempts to organize the refugees for the registration process.
  3. Mothers with babies, the elderly and the ill had to stand and wait for long hours.
  4. It was also noted that some applicants received a “Slip Pendaftaran PATI,” which contained a line that said “Tujuan : Pulang ke Negara Asal” (Intention: Return to Home Country) despite the fact that they are refugees who are recognized by UNHCR and  cannot be returned to their country of origin.  The principle of non-refoulement in Article 33 (1) of the 1951 Refugee Convention states that: “No Contracting State shall expel or return (’refouler’) a refugee in any manner whatsoever to the frontiers of territories where his life or freedom would be threatened on account of his race, religion, nationality, membership of a particular social group or political opinion.”.
  5. To date, there has been minimal discussion of how asylum seekers will be addressed under this Programme.

The uncertainty surrounding the registration process is causing even greater anxiety and stress to this marginalized community that is already experiencing many mental health risks and problems.

HEI is also very concerned about how this Programme will impact asylum seekers who have yet to lodge an asylum claim with UNHCR. They do not have any recognized documents, and they are particularly vulnerable during the Enforcement Phase of the Programme. Under the Malaysian Immigration Act 1959/1963, authorities and RELA will treat them as undocumented migrants. This means they will be subject to criminal offences and deportation which is potentially a direct threat to their lives.

HEI calls on the Malaysian government to publicly clarify the procedures concerning the 6P Programme and to make a concerted effort to adequately communicate the Programme details with the refugee and asylum seeker communities as well as with all organizations that work with them. We also request that the government effectively address the vulnerability of asylum seekers within this Programme and immediately create a protection framework for this group in Malaysia.

Health Equity Initiatives

This letter was published in the News Straits Times, 26 August 2011.

Letter for the Minister for Immigration and Citizenship, Australia on the Refugee Swap Deal

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The Honourable Chris Bowen
Minister for Immigration and Citizenship, Australia
PO Box 6022
House of Representatives
Parliament House
Canberra, ACT 2600                                                                                                                                          24 August 2011

Dear Minister,

The refugee swap agreement between Australia and Malaysia is of deep concern to us because it undermines existing legitimate mechanisms for international protection of people fleeing persecution, and, exacerbates the problem of shrinking protection space for refugees and asylum seekers worldwide, and in the Asia Pacific in particular.


We deeply regret that Australia has decided to proceed with the transfer of the newly arrived asylum seekers who are currently being detained on Christmas Island, even considering the use of force, in spite of the traumatic experiences endured by these people in their country of origin and during the perilous boat journey.


We strongly urge Australia to refrain from sending all children, including unaccompanied minors and children traveling with their families to Malaysia.

Refugee children have generally not been exempt from arrest and detention in Malaysian immigration detention centers, and are often detained with adults. A 17 year old girl who was held in detention for 15 days with her 13 year old sister, and was traumatized by the experience and brought to the mental health services of Health Equity Initiatives (HEI) in 2009, presented with prominent symptoms of Post Traumatic Stress Disorder (PTSD) and Depression including reliving the detention experience, poor appetite, intermittent insomnia, low mood, frequent headaches, fatigue, negative thoughts about herself, and a fear of uniformed personnel.

The “private education arrangements in the community” (Annex-A: Operational Guidelines to Support Transfers and Resettlement; 3.3(a)), that transferees will have access to includes ill equipped and understaffed schools run by underpaid volunteers most of the time.  Given that these schools are not officially registered, refugee children are unable to graduate with certification.

Asylum Seekers with Mental Health Problems

We also ask that vulnerability assessments including mental health assessments be done in Australia, and those with mental health problems not be sent to Malaysia, to prevent an exacerbation of their condition, given the various stressors they will need to endure.

The following items related to the arrangement between the governments of Australia and Malaysia on transfer and resettlement do not provide for reliable guarantees of basic human rights of the transferees.

  • “Operations under this Arrangement will be carried out in accordance with the domestic laws, rules, regulations and national policies from time to time in force in each country…”  (Arrangement Between the Government of Australia and the Government Of Malaysia on Transfer and Resettlement; Clause 12)
  • “Transferees will enjoy an adequate standard of treatment, including having access to the same support as other asylum seekers and refugees in the community” (Annex-A: Operational Guidelines to Support Transfers and Resettlement; 3.0)

It is a known fact that Malaysia lacks an administrative and legal framework for refugee protection.  The lack of legal recognition of refugees and asylum seekers in the country constantly exposes them to the risk of arrest and impedes their access to education, legal employment, health care, and other social freedoms.

Further, there is no information to date on the modalities of how “(a) Transferees will have ongoing access to self reliance opportunities particularly through employment, and, (b) Transferees will be encouraged to become self sufficient as soon as possible. “ (Annex-A: Operational Guidelines to Support Transfers and Resettlement; 3.2)

Afghan Refugees

We also urge the Australian government to promptly and without delay determine the refugee status of those Afghan refugees on Christmas Island and to immediately release from detention all those who are found to be refugees.

A study by HEI in 2009 with 73 Afghan refugees and asylum seekers indicates that the majority of Afghan refugees in Malaysia belong to ethnic minorities (mainly Hazara, but also others like the Tajiks, Qizilbash) and religious minorities (Shiite) fleeing persecution by the Taliban.  Their religious status poses potential risks for them in Malaysia and impedes their integration locally.  Moreover, linguistic and cultural barriers make it extremely difficult for them to find employment and rent houses in Malaysia. Their lack of community support networks which are imperative for those surviving in subterranean spaces without a legal identity exacerbates the multi-dimensional poverty experienced by this group.

As a community that had endured decades of conflict and inter-generational refugeehood we believe that unless the humanitarian and security situation in Afghanistan improves, unless the strident efforts to compel Afghan refugees in Iran to return home to situations of insecurity are capped, and unless there is an increase in resettlement opportunities, they will continue to undertake precarious journeys further afield in search of more effective refugee protection and more sustainable life solutions.

We plead for a thoughtful and compassionate consideration of these above mentioned population groups requiring international protection.


There is a compelling body of evidence on the association between forced migration related policies and poor mental health outcomes. As such, we are constrained to draw attention to the potential negative health outcomes of policies such as the current arrangement and strongly urge Australia to:

  1. Refrain from sending all children, including unaccompanied minors and children traveling with their families to Malaysia.
  2. Give special consideration to the international protection needs of Afghan refugees, including promptly and without delay determining the refugee status of those Afghan refugees on Christmas Island and to immediately release from detention all those who are found to be refugees.
  3. Cease from sending those suffering from mental health problems to Malaysia.
  4. Recognize and integrate the special protection needs of refugees and asylum seekers within enforcement of border control, anti-trafficking and anti-smuggling strategies.
  5. Uphold its obligations under international law, especially in relation to the 1951 Refugee Convention

Please find attached to this letter the report of the study on Afghan refugees and asylum seekers in the Klang Valley.

Please feel free to contact us if you require any additional information.

Yours Faithfully,

  1. Health Equity Initiatives (HEI)
  2. Women’s Aid Organisation
  3. Lawyers for Liberty
  4. Tenaganita
  5. Suara Rakyat Malaysia (SUARAM)
  6. Malaysian Social Research Institute (MSRI)
  7. Pusat Kebajikan Good Shepherd
  8. Good Shepherd Sisters Malaysia


  1. Mr. Andrew Metcalfe, Secretary of the Department of Immigration and Citizenship (DIAC)
  2. Prime Minister’s Office
  3. Ms. Emily Johnson, Adviser, Office of Senator Sarah Hanson-Young
  4. Mr. Paul Power, Chief Executive Officer, Refugee Council of Australia
  5. Dr. Graham Thom, Amnesty International Australia
  6. Mr. Paris Aristotle, Director, Victorian Foundation for Survivors of Torture
  7. Ms. Michelle Dimasi, Director, Asylum Seekers Christmas Island

Baby Dumping: Allow for Termination of Pregnancy

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Dear Editor,

Health Equity Initiatives is very concerned about the current debates on baby dumping and infanticide that once again seems to adopt a moralistic approach, which has proved ineffectual in dealing with this long standing problem.

As such, we laud the call by Federal police CID director Commissioner Datuk Seri Mohd Bakri Zinin “to find a more effective mechanism to resolve this and all parties must play their part” (The Sun, February 9).

We support Reproductive Rights Advocacy Alliance Malaysia’s (RRAAM) call for women to have more control over their reproductive health and have access to the termination of pregnancy (TOP) services (The NST, February 13).

We do not view the termination of pregnancy as a means of nor as an alternative to contraception.  However, we do believe that the termination of pregnancy should be examined within the broader context of women’s lives, unequal power relations between men and women, the lack of access, especially for women, to accurate and appropriate sexual and reproductive health information and services, the development of technologies related to TOP, and importantly, evidence related to TOP.

Unsafe abortions come at a high cost to human life and material resources.   Unsafe abortions are one of the leading causes of maternal mortality and morbidity globally and treating complications that result from unsafe abortions brings unnecessary and avoidable costs to the health care system.  Studies indicate that the availability of legally induced abortion has reduced mortality due to abortion.  Further, high quality studies indicate no increased risk of mental health problems in women having a TOP.

The decision to terminate a pregnancy is never easy for any woman and alternative options to carry the pregnancy to term, childbirth, raising the child and/or giving the baby up for adoption comes with its own psychological, financial and social hardship.

As an organization working with marginalized communities, we notice that particularly in the case of non-citizen refugee women, TOP services while much needed are extremely difficult to access.  Undertaking risky journeys as they flee persecution, refugee women experience the risk of unwanted pregnancies as they are exposed to rape and sexual violence and lack access to emergency contraception.  Given their insecure legal status and lacking the formal right to work in Malaysia, they are barely even able to meet their own basic needs, including of security.  Carrying the pregnancy to term, accessing maternal health services via a public health system which charges extremely high foreigners’ rates, and, raising the baby after birth sans child care and social support within such an environment is extremely challenging.

In 2009 the United Nations recognized maternal mortality as a violation of human rights and reproductive health rights are enshrined in several international declarations and laws.  The exercise of judgment related to the woman’s body and personal morals should be the right of the woman – not of the family, the State, or even of the medical practitioner.  In the context of reproductive health services, General Recommendation 24 of the Convention on the Elimination of All Forms of Discrimination against Women (1979) which Malaysia has ratified states that “if health service providers refuse to perform such services based on conscientious objection, measures should be introduced to ensure that women are referred to alternative health providers”.

The failure of overly moralistic and legalistic approaches to the problems of baby dumping and infanticide in our country and the consequent loss of lives must strengthen our efforts towards greater dialogue and creating more spaces where these issues can be discussed openly, rationally and compassionately.

Health Equity Initiatives

This letter was published in the News Straits Times on 5 April 2011.

This letter was published in the Sun Daily on 4 March 2011.