As a major regional meeting on migration health opens in the Thai capital today, Reuben Lim reports on the challenges migrants face in accessing healthcare in Asia and the efforts made to include them in national health systems.  

By Reuben Lim

Sixteen year old Sirichai Danwattana twiddles his thumbs as he and his mother wait outside the doctor’s office at IOM Thailand’s Migrant Health Assessment Centre (MHAC) in Bangkok. They travelled all the way down from the northeastern province of Udon Thani a day before and have just gone for his chest x-ray. They hope that the doctor will certify him as tuberculosis-free so that he would be eligible to apply for settlement in the United Kingdom.

“My mother has been living in the UK for 11 years with her husband and we feel that it’s time I join her”, he says when asked on why he is moving there. “I would like to go to university there, find a job there, and start a new life there. I have no intention to return to Thailand”, he adds.

Sirichai is one of roughly 7,000 people who pass through MHAC’s doors every year. Located on the 8th floor of a nondescript building along Bangkok’s Silom Road, the centre provides an oasis of calm away from the heat, noise and traffic while applicants conduct their screening. Set up in 2005, it provides health screening services for prospective migrants to the UK, Canada, Australia and New Zealand. Its health certificates are the only ones recognised by the UK Border Agency.

Fortunately for Sirichai, the MHAC doctor gives him a clean bill of health which enables him to obtain a visa for the UK, and be entitled to health services from the British government when there. He is considered a regular migrant, one who goes through formal channels with proper documentation when moving to another country.

The bulk of migrants from the region however, are irregular; Asia hosts the largest undocumented flows of migrants in the world and their health is a concern for many. Universal health coverage for all, including migrants, is a recurrent theme in discussions. Despite the compelling case for social inclusion on moral and public health grounds, many countries in Asia are unable to accept this discourse, let alone provide basic protection and adequate work injury compensation for them.

Such policy views stem from several misconceptions, one of which is that a strict regulatory environment for migrant health and safety would be too costly and a competitive disadvantage. Governments and general populations also perceive migrants to be carriers of diseases, and are a burden to health systems when the opposite holds true.

The majority of migrants enter the migration process young and are generally healthier than populations in receiving countries. They also tend to use health systems less often than the native population. It is only when they encounter difficult conditions during the migration process, often in the destination country, that they are exposed to various health risks. In countries that do provide migrants access to health systems, unintentional structural barriers such as high costs and language issues make it difficult for them to get the services needed.

Migrant health is a relatively new theme that has only become prominent in the past two decades, and IOM is at the forefront of promoting the cause. In 2010, IOM together with WHO, held the first Global Consultation on the Health of Migrants in Madrid to take action on migrant-sensitive health policies as requested by the 61st World Health Assembly Resolution. Its agreed principals now serve as a basis in addressing the health of migrants.

IOM believes that migrants and mobile populations benefit from an improved standard of physical, mental and social well-being, which enables them to substantially contribute towards the social and economic development of their home communities and host societies. In light of this, it provides extensive health services to migrants both regular and irregular across the region and the world.

IOM is also active in advocating for better access to health systems and migrant rights in destination countries, conducting regular conferences and panel discussions on the issue. One particular area of focus has been on partnerships between governments, the private sector and civil society.

Speaking at conference organised a fortnight ago by IOM and the Asia-Europe Foundation (ASEF), Dr. Phua Kai Hong of the National University of Singapore asserted that the idea of limiting healthcare only to citizens and excluding migrants is becoming increasingly costly and irrelevant in today’s globalised world. “It is cheaper to take care of the health of migrants than to exclude them” claims the health policy expert, citing a study in Singapore where the exclusion of migrants from the health system and loopholes in protection laws cost the tiny city state US $1.85 billion in 2013. “Migrant health is everyone’s responsibility”, he concluded.

This discourse, while still not dominant, is slowly gaining momentum in Asia. IOM recognises the importance of partnerships and promotes dialogue through regional mechanisms like the Joint UN Initiative on Migration and Health in Asia (JUNIMA) where it currently chairs the Secretariat. As regional organisations like the Association of Southeast Asian Nations (ASEAN) push towards greater economic, social and political integration, the importance of migrant health in policy making is increasingly receiving attention through such efforts. There is hope that access to affordable healthcare for migrants will happen one day, not just for those who go through proper channels like Sirichai, but also millions of others who don’t.