In the past year, a number of circulars have been issued by the treasury and other government departments that have the potential to adversely affect the health of some children in Malaysia, especially stateless children or the children of immigrants. These circulars deal primarily with an increased enforcement of a fees schedule for medical treatment and are now fully enforced in 2015.

The Malaysian Cabinet is concerned with the rising cost of health expenditure spent on immigrants. Many in government believe that allowing care to continue with no action is opening our health services to even more abuse from immigrants. In the past this problem was confined to Sabah and, to a lesser degree, Sarawak. Now this same issue is becoming a significant problem in peninsular Malaysia.

The recent responses taken by the government include:

1. Enforcing mandatory notification of all illegal immigrants coming for healthcare

All government medical staff at hospitals and health clinics are required to inform the Immigration Department and police about every illegal immigrant that comes for health care. If we do not report, we are not following government policy and are open to disciplinary action. The Immigration Department and police will act to deport these individuals of families.

A recent example:

In 2014 there was the detention of pregnant asylum seekers after these mothers had given birth at Hospital Kuala Lumpur. This resulted in a forced separation of child and mother immediately after birth. New admissions of asylum-seeking, pregnant women to Hospital KL are told that they will be detained after delivery, even after a Cesarean section.

2. Enforced in- and out-patient care charges for legal immigrants

All legally residing non-Malaysians now face very high charges to access any health care, even primary health care like immunisation and antenatal services. They will have to pay a deposit of RM600 to 1,200 (depending on condition) before they can even be admitted.

It now costs quit a bit for every single test done (http://www.moh.gov.my/english.php/pages/view/153). In addition, laboratory personnel have been instructed not to run tests on specimens from non-Malaysians and doctors are not allowed to carry out any procedures until they have verified the full deposit is paid.

Similarly, ward nurses and pharmacists are not allowed to issue medication to patients or allow transfer to other hospitals until the bill payment has been settled. To cap it all, a surcharge will be imposed on any medical staff who offers care but fails to ensure payment.

A recent example:

A 3-month-old child of daily paid immigrant workers comes to the emergency department. She has been unwell for the past 4 days and has a bad case of pneumonia. We want to admit her to our paediatric ICU and the parents are keen, but they cannot afford the deposit before admission and the ward charges. The Hasil (payment) section says no deposit, no admission. Welfare department says they cannot help as the child is an immigrant. UNHCR says they are not illegal immigrants or asylum seekers, so they also cannot assist. Do we allow this child to die?

This is becoming a common concern for doctors all over the country and we are facing many similar situations. Ill children of legal immigrant parents all over the country are now denied access to basic health care because their parents cannot afford to pay the rates charged.

3. Out-patient medical care for legal immigrants

Another government circular states that we are no longer allowed to prescribe long-term medication for foreigners (including children) with chronic illnesses. We are allowed to complete a course of antibiotics, but for all other conditions (diabetes, iron deficiency, thalassaemia, disability medication, epilepsy, etc) we are to give 5 days’ drugs and they then have to get their own care from private services. This is a crisis for children whose lives depend on medication, eg. insulin dependent diabetics, asthmatics, epileptics, etc.

An argument (view) from the other side:

In trying to present a fair picture of the situation and to see the bigger picture of these problems, let us offer some arguments and view points from “the other side”.

The problem of illegal and legal immigrants using our health care is longstanding, and has been a crisis in the state of Sabah for decades. It has now become more widespread. Imagine for a moment if you, as a Malaysian, have a newborn baby which is premature and needs intensive care in one of our Nicus. But you cannot get a place because it is full – more than half the babies in the Nicu at that time are illegals and legal immigrants (the current situation in Sabah). How would you feel as a Malaysian? What would your response be?

In addition, the actual cost of intensive care is large and much is borne by tax payers. A one-day admission in our Nicu or Picu may cost in excess of RM2,000. Parents do not pay for these costs. Currently we, Malaysian taxpayers, are funding illegals and legal immigrants. If we offer more care, will more immigrants turn up at our doorstep?

A balanced and compassionate view:

We need to maintain a humane approach. It is obvious that these circulars are against any definition of basic human rights. We must respect human rights and the UN Convention on the Rights of Children. Our own Child Act 2001 requires that we support all children in our country. Good data also shows that denying basic healthcare to immigrant children affects the heath of the local children, especially with respect to infectious epidemics. Also remember that some of the children who will be denied care are stateless and those from unregistered marriages between Malaysians and citizens from other countries.

We recognise these are large issues that require a concerted effort and are not easy to resolve. The key issue is that the Immigration Department should deal with the influx of immigrants, illegal and legal. Employers of legal immigrants must ensure that they have a decent wage and medical insurance to cover themselves and their families. This is expected of any responsible employer.

It is important not to undermine the basic moral code of doctors. We are not policemen or immigration officers. Our job is to heal and care. Our role as medical personnel is to support all children, regardless of their nationality or status. Any less will mean that we corrupt our profession. No child should be denied care.

We appeal to the government to support the healthcare of all children in Malaysia.

Note: In the past few days we have had some good news that infectious disease conditions will be exempted from fees but this still leaves many sick immigrant children without care.

By Amar Singh

Source: The Malaysian Insider.