Covid-19 Exclusives: Doctors Without Borders Working in Penang

A little Rohingya girl at the entrance of the family home, wearing a T-shirt with the French words C'est la vie.

THE SECESSION OF Biafra – a southeastern coastal territory populated by the Igbo people – from the newly independent country of Nigeria in 1967 sparked a three-year civil war.

As the Nigerian army blockaded the southeastern region, a number of French doctors volunteering with the French Red Cross decided to enter the territory to offer aid to the Biafra people who were being pushed into famine. From Day One, these doctors were subjected to attacks, as they witnessed the mass starvation caused by the blockade and violent acts committed by the Nigerian army.

It was in response to this horrifying catastrophe that Médecins Sans Frontières (MSF) was born, as an independent medical organisation with the belief that the world needed to know about these atrocities. MSF was founded in 1971 by a group of doctors and journalists. One of the co-founding doctors was Dr. Bernard Kouchner, who later became Foreign Minister in President Nicolas Sarkozy’s cabinet. The organisation recruits doctors, nurses and other staff to provide medical assistance to victims of conflict, epidemics, disasters or have been excluded from healthcare.

Establishing a Presence in Malaysia

MSF Malaysia came into being in 2015 and focuses primarily on basic healthcare for refugees and for asylum-seeking and undocumented migrant communities. Since 2018, it has been running a clinic in Butterworth, treating between 900 to 1,000 patients each month, and also provides psychosocial support and counselling services.

In mainland Penang, young Rohingyas play Carrom, a popular game in Myanmar.

On weekends, mobile clinics also travel to rural localities further away from the Butterworth clinic. For this, MSF works alongside the local NGO, A Call To Serve. Patients in need of specialised care are referred to government clinics and hospitals for further examining and treatment.

In partnership with MERCY Malaysia and SUKA Society, MSF expanded its healthcare services via monthly clinics to include detainees at the Immigration Detention Centres (IDCs) in Belantik and Juru.

Besides medical care, the organisation also supports the IDCs with other urgent needs. “Since 2019, we have been working to upgrade the water and sanitation systems at these centres, where many refugees and undocumented migrants are held,” says Dirk van der Tak, MSF Malaysia’s Head of Mission.

The organisation has become a leading advocate for healthcare and protection for refugees and asylum-seekers in Malaysia. Since Malaysia is not a signatory of the 1951 Refugee Convention and its protocols, the status of these individuals remains unrecognised. As a consequence, they are faced with many barriers in accessing the public healthcare and education systems, and are unable to seek legal employment.

MSF is among the few NGOs that are able to directly refer asylum claims to the United Nations High Commissioner for Refugees (UNHCR). Obtaining a UNHCR card affords refugees some level of protection from arrest and grants a discount on healthcare based on Malaysia’s foreigner rates. “This is one of our key activities to support refugees in obtaining at least some basic protection in Malaysia,” Dirk emphasises.

Maintaining Neutrality

MSF is present in more than 70 countries. One of its major challenges lies in maintaining neutrality while helping those in dire need of medical assistance. In being vocal in its public denouncement of atrocities and human rights violations, the organisation needs to consider the risk of upsetting state actors on whom they rely for permission to help suffering populations.

“We have in the past expressed our concerns about how the Rohingya refugees are turned away by the Malaysian authorities, but we must consider our relations with the Ministry of Health, Immigration and other state organisations as well,” says Dirk.

Dirk van der Tak, MSF Malaysia’s Head of Mission.

Many of MSF’s field missions worldwide are set up in active or post-conflict zones; and the safety and security of its personnel are often on the line. MSF ascertains that comprehensive security management systems consisting of detailed safety regulations and security plans are put in place following an in-depth analysis of the local environment, before its personnel move in. The security plans are regularly reviewed with the help from local stakeholders, while upholding MSF’s main principles of neutrality, independence and impartiality remain key considerations.

“As an independent medical organisation, we refrain from aligning ourselves with armed forces for protection, be it the US-led Coalition forces during our operations in Iraq or those involved in localised conflicts. It would negatively impact how the population perceives us. There is always a risk of aid delivery being regarded as a hostile act if rival forces are involved in delivering humanitarian assistance,” he explains.

In some places, procuring vital medical supplies can be quite a challenge. During Covid-19 times, things have been difficult, but with cooperation from the international community and NGOs in particular, some vulnerable groups have nevertheless been able to gain access to support.

Public support for NGOs like MSF are crucial to ensure that these operations can continue. MSF strives for independence, and it accepts only very limited government funding. “Our teams put in all efforts necessary to secure predictable and sustainable funding in maintaining and improving the quality of our programmes,” says Dirk.

The Government’s Responsibility

Measured by expenditure, MSF has the largest presence in the Democratic Republic of Congo (DRC), followed by South Sudan, the Central African Republic, Bangladesh and Syria.

In DRC the organisation responded to the country’s largest outbreaks of measles and Ebola to date. In Bangladesh MSF remains a main provider of medical humanitarian assistance to Rohingya refugees, approximately one million of whom live in Cox’s Bazaar, the largest refugee camp in the world. More than two years have lapsed since the initial emergency, but these refugees still live in overcrowded bamboo shelters, entirely dependent on aid, and with little hope for the future.

Rohingyas play a game of Salong (known as sepak takraw in Malaysia), a very popular sport in Southeast Asia.

“Generally speaking, MSF intervenes in situations where population groups are systematically targeted and persecuted, directly or indirectly affected by violence, deliberately excluded, socially marginalised and neglected, or where the state or other actors are unable to respond and address disproportionately high levels of health inequities,” says Dirk.

“While MSF’s main reason in remaining in Malaysia has been our response to the needs of the Rohingya refugees arriving from Myanmar and from the refugee camps in Bangladesh, we also provide healthcare to other refugee and asylum-seeking populations.”

Despite the numerous supporting organisations based in KL and the Klang Valley, access to healthcare for refugees and undocumented migrants in other parts of Malaysia is limited. Whether MSF will be able to respond to needs outside of Penang depends on their resources, capacity and agreed priorities.

“Considering that Malaysia is a stable country with a strong healthcare system, our starting point is that the authorities hold the primary responsibility to fill the gaps in its healthcare for these vulnerable groups. This also concerns their inclusion in Malaysia’s vaccine roll out, which will benefit Malaysia’s overall public health response to combat the Covid-19 outbreak,” Dirk concludes.

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