scholarly journals Southeast Asian health system challenges and responses to the ‘Andaman Sea refugee crisis’: A qualitative study of health-sector perspectives from Indonesia, Malaysia, Myanmar, and Thailand

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003143
Author(s):  
Helena Legido-Quigley ◽  
Fiona Leh Hoon Chuah ◽  
Natasha Howard
Keyword(s):  
Southeast Asia ◽  
Health System ◽  
Health Systems ◽  
Asylum Seekers ◽  
Southeast Asian ◽  
Health Needs ◽  
Andaman Sea ◽  
Forced Displacement ◽  
Displaced People ◽  
Refugees And Asylum Seekers

Background Southeast Asian countries host signficant numbers of forcibly displaced people. This study was conducted to examine how health systems in Southeast Asia have responded to the health system challenges of forced migration and refugee-related health including the health needs of populations affected by forced displacement; the health systems–level barriers and facilitators in addressing these needs; and the implications of existing health policies relating to forcibly displaced and refugee populations. This study aims to fill in the gap in knowledge by analysing how health systems are organised in Southeast Asia to address the health needs of forcibly displaced people. Methods and findings We conducted 30 semistructured interviews with health policy-makers, health service providers, and other experts working in the United Nations (n = 6), ministries and public health (n = 5), international (n = 9) and national civil society (n = 7), and academia (n = 3) based in Indonesia (n = 6), Malaysia (n = 10), Myanmar (n = 6), and Thailand (n = 8). Data were analysed thematically using deductive and inductive coding. Interviewees described the cumulative nature of health risks at each migratory phase. Perceived barriers to addressing migrants’ cumulative health needs were primarily financial, juridico-political, and sociocultural, whereas key facilitators were many health workers’ humanitarian stance and positive national commitment to pursuing universal health coverage (UHC). Across all countries, financial constraints were identified as the main challenges in addressing the comprehensive health needs of refugees and asylum seekers. Participants recommended regional and multisectoral approaches led by national governments, recognising refugee and asylum-seeker contributions, and promoting inclusion and livelihoods. Main study limitations included that we were not able to include migrant voices or those professionals not already interested in migrants. Conclusions To our knowledge, this is one of the first qualitative studies to investigate the health concerns and barriers to access among migrants experiencing forced displacement, particularly refugees and asylum seekers, in Southeast Asia. Findings provide practical new insights with implications for informing policy and practice. Overall, sociopolitical inclusion of forcibly displaced populations remains difficult in these four countries despite their significant contributions to host-country economies.

scholarly journals Health System Responses to the Health Needs of Refugees and Asylum-seekers in Malaysia: A Qualitative Study

2019 ◽  
Vol 16 (9) ◽  
pp. 1584 ◽  
Author(s):  
Fiona Leh Hoon Chuah ◽  
Sok Teng Tan ◽  
Jason Yeo ◽  
Helena Legido-Quigley
Keyword(s):  
Health Systems ◽  
Asylum Seeker ◽  
Asylum Seekers ◽  
National Level ◽  
Refugee Health ◽  
Health Needs ◽  
Health Seeking ◽  
Policy Perspective ◽  
Comprehensive Health ◽  
Refugees And Asylum Seekers

Background: This study was conducted to examine the responses and challenges in addressing the health needs of refugees and asylum-seekers in Malaysia from a health systems and policy perspective. Methods: Twenty semi-structured in-depth interviews were conducted with key informants comprising experts, healthcare professionals and program personnel with professional experience in refugee health issues. Deductive and inductive analyses were conducted to identify themes. Results: Our study identified a broad range of actors involved in the response to refugee health locally, of which a greater alignment of interests, collaboration and sharing of responsibility is needed. From a health systems and policy perspective, financial constraints are among the key challenges in addressing the health needs of the refugee and asylum-seeker population in Malaysia. While participants reported high quality healthcare being present in Malaysia, this was not affordable to refugees and asylum seekers. Cultural and language discordance are also key challenges faced by healthcare workers in the delivery of services; accentuating the need for greater cultural competence and language support. Improved access to medication is needed for those with chronic illnesses in order to effectively address the comprehensive health needs of the refugee and asylum-seeker population. Conclusions: Suggested ways forward include adopting a comprehensive health advocacy strategy grounded in the right to healthcare for all; adopting a multi-sectoral approach; tackling the social determinants of health; seeking diversified funding at the global and national level; and improving coordination and collaboration between the various actors.

scholarly journals The May 2015 boat crisis: the Rohingya in Aceh

2016 ◽  
Vol 8 (2) ◽  
pp. 43-62 ◽  
Author(s):  
Graham Thom
Keyword(s):  
Asylum Seekers ◽  
Ad Hoc ◽  
Andaman Sea ◽  
Trafficking In Persons ◽  
Mass Graves ◽  
Aceh Province ◽  
Bangladeshi Migrants ◽  
East Asia Region ◽  
Refugees And Asylum Seekers ◽  
National Approach

The 2015 discovery of mass graves in Thailand’s Sadao district, on the border with Malaysia, led to a crack-down on people smugglers by the Thai and Malaysian authorities. Thousands of Rohingya (as well as Bangladeshi migrants) were left stranded in the Andaman Sea as smugglers abandoned their human cargo. Initially pushed back by the Thai, Malaysian and Indonesian navies, it was only after Indonesian fishermen rescued three boats that approximately 1,800 people were permitted to disembark in Indonesia’s Aceh province. The crisis in the Andaman Sea brought into sharp relief the fact that the South East Asia region lacks even the most basic regional protection (or cooperation) framework. While some states are still reticent, there have been attempts to improve government collaboration as demonstrated recently in the March 2016 Bali Declaration on People Smuggling, Trafficking in Persons, and Related Transnational Crime. This paper examines, however, how the ad hoc approach by Indonesia’s regions, in particular Aceh, to the treatment of the Rohingya who arrived in Aceh in May 2015, works against a comprehensive, national, rights-based approach to protect those seeking asylum in Indonesia. The paper explores the reasons why Aceh chose not to engage with the established practices for the treatment of asylum seekers in Indonesia and the human rights impacts this has had on those rescued. It concludes that the current situation in Aceh is not sustainable. The treatment of refugees in Aceh should be included in a broader national approach, commensurate with the treatment of refugees and asylum seekers throughout Indonesia, particularly if Indonesia is to develop a structured, rights-based approach to those seeking protection. This would then play a significant role in any future regional protection framework. 

scholarly journals Meeting the mental health needs of refugees and asylum seekers

2014 ◽  
Vol 204 (3) ◽  
pp. 176-177 ◽  
Author(s):  
Panos Vostanis
Keyword(s):  
Mental Health ◽  
Asylum Seekers ◽  
The Other ◽  
Health Needs ◽  
Therapeutic Approaches ◽  
Mental Health Needs ◽  
Service Models ◽  
Refugees And Asylum Seekers

SummaryMental health provision for diverse refugee populations is faced with a number of challenges, and requires the development and evaluation of flexible service models that maximise capacity and utilise existing non-specialist resources. Emerging therapeutic approaches should be applied in real settings, adapted to cultural needs and integrated with the other agencies involved.

scholarly journals Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

2020 ◽  
Vol 5 (4) ◽  
pp. e002272 ◽  
Author(s):  
Dell D Saulnier ◽  
Hom Hean ◽  
Dawin Thol ◽  
Por Ir ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health System ◽  
Health Systems ◽  
Public Health System ◽  
Health Needs ◽  
Structured Interviews ◽  
The Public ◽  
Pregnancy And Childbirth ◽  
Childbirth Care

IntroductionResilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.MethodsEight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.ResultsThe theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.ConclusionsThe community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods.

scholarly journals Multiculturalism and Compassion: Responding to Mental Health Needs Among Refugees and Asylum Seekers Comment on "A Crisis of Humanitarianism: Refugees at the Gates of Europe"

2019 ◽  
Vol 8 (12) ◽  
pp. 734-736 ◽  
Author(s):  
Emily Satinsky ◽  
Theodoros A. Filippou ◽  
Antonis A. Kousoulis
Keyword(s):  
Mental Health ◽  
Asylum Seekers ◽  
Culturally Relevant ◽  
Mental Healthcare ◽  
Service Design ◽  
Health Needs ◽  
Political Climate ◽  
Mental Health Needs ◽  
Refugees And Asylum Seekers

As Fotaki (2019) argues, the current political climate in Europe is threatening principles of humanitarianism, particularly among refugees and asylum seekers. This commentary builds on that argument, with a spotlight on mental health and culturally relevant service design. By addressing some of the barriers faced by refugees and asylum seekers in accessing mental healthcare, we can address inequalities and develop compassionate societies.

scholarly journals Forced Migration Governance in Southeast Asian Countries: ‘Same but Different’?

2020 ◽  
Vol 10 (1) ◽  
pp. 58-78
Author(s):  
Muhammad Riza Nurdin ◽  
Mala Rajo Sathian ◽  
Hanafi Hussin
Keyword(s):  
Middle East ◽  
Southeast Asia ◽  
Asylum Seekers ◽  
Recent Literature ◽  
Forced Migration ◽  
Southeast Asian ◽  
Asian Countries ◽  
Forced Migrants ◽  
Local Policies ◽  
Southeast Asian Countries

This paper examines the governance of forced migration in Southeast Asia. The region hosts about 2.5 million of forcibly displaced migrants from a worldwide total of 70 million (2018). The migrants include intra- ASEAN and non-ASEAN refugees or asylum seekers, notably from the Middle East.  Based on a review of recent literature, the paper investigates three main destination states in SEA that host the majority of the forced migrants; Indonesia, Malaysia, and Thailand. The paper examines (i) local policies in the governance of forced migrants and (2) the practice of non-refoulement principle. The findings reveal that in terms of forced migration governance, Indonesia, Malaysia, and Thailand are ‘same but different'; meaning that despite being similar, each country produces different outcomes.  

Mobility and Forced Displacement in the Middle East

2020 ◽  
Keyword(s):  
Middle East ◽  
Asylum Seekers ◽  
Public Discourse ◽  
Social Economic ◽  
Population Movements ◽  
Internally Displaced ◽  
Displaced People ◽  
Multidisciplinary Perspective ◽  
Refugees And Asylum Seekers ◽  
The Impact

The Middle East is currently facing one of its most critical migration challenges, as the region has become the simultaneous producer of and host to the world’s largest population of displaced people. As a result of ongoing conflicts, particularly in Syria, Libya, Iraq, and Yemen, there have been sharp increases in the numbers of the internally displaced, forced migrants, refugees, and asylum-seekers. Despite the burgeoning degree of policy interest and heated public discourse on the impact of these refugees on European states, most of these dislocated populations are living within the borders of the Middle East.This volume is the outcome of a grants-based project to support in-depth, empirically based examinations of mobility and displacement within the Middle East and to gain a fuller understanding of the forms, causes, dimensions, patterns, and effects of migration, both voluntary and forced. As the following chapters in this volume will demonstrate, through this series of case studies we are seeking to broaden our understanding of the population movements that are seen in the Middle East and hope to emphasize that regional migration is a complex, widespread, and persistent phenomenon in the region, best studied from a multidisciplinary perspective. This volume explores the conditions, causes, and consequences of ongoing population displacements in the Middle East. In doing so, it also serves as a lens to better understand some of the profound social, economic, and political dynamics at work across the region.

scholarly journals Assessing the impact of artistic and cultural activities on the health and well-being of forcibly displaced people using participatory action research

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025465 ◽  
Author(s):  
Clelia Clini ◽  
Linda J M Thomson ◽  
Helen J Chatterjee
Keyword(s):  
Focus Groups ◽  
Participatory Action Research ◽  
Asylum Seekers ◽  
Well Being ◽  
Participatory Action ◽  
Cultural Activities ◽  
Displaced People ◽  
Refugees And Asylum Seekers ◽  
The Impact ◽  
Health And Well Being

ObjectiveDrawing on a growing body of research suggesting that taking part in artistic and cultural activities benefits health and well-being, the objective was to develop a participatory action research (PAR) method for assessing the impact of arts interventions on forcibly displaced people, and identify themes concerning perceived benefits of such programmes.DesignA collaborative study following PAR principles of observation, focus groups and in-depth semistructured interviews.SettingLondon-based charity working with asylum seekers and refugees.ParticipantsAn opportunity sample (n=31; 6 males) participated in focus groups comprising refugees/asylum seekers (n=12; 2 males), volunteers (n=4; 1 males) and charity staff (n=15; 3 males). A subset of these (n=17; 3 males) participated in interviews comprising refugees/asylum seekers (n=7; 1 males), volunteers (n=7; 1 males) and charity staff (n=3; 1 males).ResultsFocus group findings showed that participants articulated the impact of creative activities around three main themes: skills, social engagement and personal emotions that were explored during in-depth interviews. Thematic analysis of interviews was conducted in NVivo 11 and findings showed that artistic and cultural activities impacted positively by helping participants find a voice, create support networks and learn practical skills useful in the labour market.ConclusionsThe study expanded on arts and well-being research by exploring effects of cultural and creative activities on the psychosocial well-being of refugees and asylum seekers. By focusing on the relationship between arts, well-being and forced displacement, the study was instrumental in actively trying to change the narrative surrounding refugees and asylum seekers, often depicted in negative terms in the public sphere.

Access to health-care policies for refugees and asylum-seekers

2020 ◽  
Vol 16 (1) ◽  
pp. 22-45
Author(s):  
Salma El-Gamal ◽  
Johanna Hanefeld
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Asylum Seekers ◽  
Access To Health Care ◽  
Host Countries ◽  
Content Type ◽  
Poor General Health ◽  
Access To Health ◽  
The Uk ◽  
Refugees And Asylum Seekers

Purpose The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries. Design/methodology/approach The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy. Findings Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations. Originality/value This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers.

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