Photo Credit: EU Civil Protection and Humanitarian Aid
By Joyce Hu
The 1951 Refugee Convention states, “refugees should enjoy access to health services equivalent to that of the host population, while everyone has the right under international law to the highest standards of physical and mental health,” and the Rohingya refugees of Myanmar are no exception. The Rohingya is a Muslim minority group that has been described as “one of, if not the, most discriminated people in the world,” by UN Secretary-General Antonio Guterres. Because of extensive religious persecution from the Burmese military junta, hundreds of thousands of Rohingya have fled the country. In 2017, roughly 700,000 Rohingya began their exodus out of Myanmar after a militant group—the Arkan Rohingya Salvation Army (ARSA)—launched violent attacks in the Rakhine region along the western coast. Despite strong international calls for the democratic government to protect the Rohingyan people from this genocide, the Rohingya people continue to suffer from human rights abuses, discriminatory policies, and hostility. In February of 2021, after the National League for Democracy was reelected, a military coup backing the opposition party returned Myanmar to military rule. Amidst civil protests and demonstrations, Rohingya and other civilians were forced to flee from persecution again. It is estimated that there are now around 1.2 million displaced Myanmar people around the world.
For decades, Thailand and other bordering countries have hosted refugees of other ethnic groups from Myanmar. These groups qualify for refuge under the non-refoulement principle established by the 1951 Refugee Convention, making it illegal for states to return people to “a country where they face serious threats to their life or freedom.” As a non-signatory to the convention, however, Thailand has accepted displaced victims on a humanitarian basis but formally considers asylum seekers to be illegal immigrants. As a result of their stance on refugees, Thailand does not have strong national legislation for refugee rights, including rights to healthcare access. Instead, it pushes for repatriation whenever fighting ceases in the migrants’ home countries.
Under the Burma Citizenship Act of 1982, the Rohingya are not recognized as Burmese citizens, which renders them stateless. Unlike other ethnic minority refugee groups such as the Karen and Karenni people, who are issued formal identification from the Myanmar government, the Rohingya do not have official identification. Thus, they find themselves unable to go through the legal immigration pathways to obtain basic necessities that are provided to other refugees in Thailand. Under Thai law, the Rohingya are not recognized as requiring asylum in refugee camps along the border, making the community vulnerable to arbitrary arrest, detention, and bans from access to the medical resources that displaced refugees desperately need.
With the recent wave of Myanmar refugees, Thailand—which had previously tolerated the presence of refugees—is beginning to revoke its commitment of support. On May 3, a video released by the human rights group, Fortify Rights, showed Thai soldiers destroying a makeshift bridge along the Wa Le River that connected Thailand’s Tak Province with Myanmar’s Karen state. A spokesperson for the Thai Ministry of Foreign Affairs announced that the Thai government is only sending back migrants who are voluntarily returning to Myanmar. Still, the ongoing conflict in Myanmar makes the validity of voluntary repatriation claims contentious. A migrant on the Moei riverbank shared to a reporter from the Associated Press that they “have been living between [the Thai and Myanmar] riverbanks for more than two months. When fighting closes in on the Myanmar side, we cross the Moei River and stay on the Thai side. We are asked to return to the Myanmar side when the artillery shelling stops.” Beyond a lack of basic necessities and healthcare for those traversing the riverbanks, migrants have no stability and are passed back and forth between a country that does not want them and a country that seeks to kill them.
Unfortunately, without strong national legislation, migrants in Thailand are not afforded proper physical or mental healthcare. On the surface, there appear to be two formal health insurance schemes available for refugees migrating into Thailand. The first, Social Security Scheme (SSS), is a health insurance available for formal sector workers—those hired under official contracts—that requires registration through the nationality verification process, which legalizes undocumented migrant workers and allows them to have residence permits and legal work permits. The second option is the Health Insurance Card Scheme, designed for informal sector workers—such as seasonal workers—and dependents. It was mainly designed as an interim process for workers seeking to be nationally verified. However, for many Myanmar refugees, applying for either scheme comes with fear of deportation or retribution. Because of communication issues between the government and healthcare officials, there are problems with program implementation, as well as general misinformation surrounding the programs. Migrants may also miss out on formal healthcare because of cultural, linguistic, and physical barriers. Even in hospitals with Burmese translators, the recent wave of migrants might only speak their own native dialect. Moreover, since many migrants are concentrated in remote areas, unreliable public transportation and other issues exacerbate already limited access to formal healthcare.
Given that the current Thai government refuses to lend further assistance or create strong national legislation for refugee health, community-based ethnic health organizations (CBOs) have been established to fill the need. These community actors often rely on irregular aid from other countries. The Mae Tao Clinic (MTC) is an example of such an organization. It was founded by a refugee in Thailand and is composed of community health workers and professionals predominantly supported by international grants. MTC’s work is paramount as it is the largest provider of reproductive care for migrants in the Thai-Myanmar region, and thousands rely upon its services for stable care. The clinic also greatly subsidizes the cost of healthcare for their patients, many of whom do not have health insurance because of either their refugee status or other reasons.
As a community-based health organization, MTC is able to work closely with refugee communities and meet their cultural and linguistic needs. There is a greater level of trust and understanding between migrants and CBO staff members compared to that of healthcare professionals in government-run hospitals. Prior to the 2021 coup, as Myanmar began its democratic transition, external attention and funding shifted from supporting refugees in Thailand to repatriating migrants back to their homeland. As a result, MTC has experienced heightened financial constraints in recent years without the same level of financial support from international donors. In light of the recent conflict that has made it difficult for Myanmar nationals to return to their home country, more funding should be applied to these external CBOs.
The international community needs to induce Thailand and other Southeast Asian countries to open up their borders to victims of discrimination, displacement, and genocide. There needs to be a collaborative effort with CBOs to facilitate the healthcare refugees need. While bordering countries cannot be expected to bear the full responsibility of providing for refugees, national and international governments must work to ensure the safe passage for third-party organizations to provide aid and healthcare to refugees. As community-based health organizations are the intermediaries between refugees and international agencies, more attention needs to be brought to their work to ensure that access to healthcare for all people, regardless of what devastation life brings, is a fundamental right in practice and not simply in theory.