The Malaysia-Australia Refugee Swap Deal: Healthcare Ethics versus Public Relations

When Malaysia announced a month or two back that they would take Australia's refugees, I was reeling. The first reason was because I automatically knew that it was a violation of international law and that Malaysia would basically be complicit in Australia's illegality. The second was that I knew that Malaysia would likely be unprepared to deal with these refugees/asylum seekers in regard to health matters. The fact is, asylum seeker healthcare ethics is a delicate and multi-antecedent discipline for which experts must be consulted. Am I confident that experts were consulted? And am I confident that Malaysia has a healthcare plan for the asylum seekers? I can say right now that I am not.

The Malaysian Prime Minister and Malaysian Health Minister have not responded to my tweets on this issue, and I have found no newspaper articles on how exactly the Malaysian government is planning to ensure that the refugees/asylum seekers are given adequate healthcare – and that includes perinatal care (as some of the asylum seekers may have gotten pregnant during their journey to Australia or here), contraceptives, and most importantly, psychiatric care.

What people forget (and this includes politicians) is that asylum seekers generally arrive at a country severely damaged. They are usually forced to leave their country due to difficult and/or dangerous circumstances, and endure a harrowing journey by boat to the country of their choice. During this journey they are often separated from their family members and most definitely do not have adequate healthcare. As a result of these difficulties, asylum seekers often suffer from various psychiatric illnesses, which includes depression.

I am writing on this issue (finally) because of the recent court injunction that the High Court of Australia has issued. The injunction puts a temporary hold on the transfer of 800 refugees/asylum seekers to Malaysia on grounds that it is potentially illegal under international law, which makes sense. It is a basic human right that persons who are persecuted in their own countries have the right to seek asylum elsewhere. And it is this principle that has been ignored. But once again, as this is a health law website, I shall focus on the health law.

In his 2005 article, Richard E Ashcroft says: ‘The treatment of asylum seekers is a medical ethical issue.’[1] It should not be an issue of public relations between two countries. It is an issue of medical ethics.

So we’ve established that. The second issue is that there are significant cultural and structural barriers to provide adequate healthcare to asylum seekers.[2] Has there been enough capacity-building for Malaysia to adequately provide for asylum seekers? The article by Marie Norredam et al clearly establishes that even in Europe, language barriers, for one, cause significant barriers in the provision of healthcare.[3] As a result, doctors cannot provide adequately for each patient. It should be remembered that each asylum seeker has different circumstances and may require entirely different regiments of treatment.

Am I for the injunction? Yes.

And am I confident that Malaysia knows how to provide for these asylum seekers healthcare requirements? No.

Has Malaysia signed this deal with one-dimensional considerations? Yes.

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[1] Richard E Ashcroft, ‘Standing Up for the Medical Rights of Asylum Seekers’ (2005) 31 Journal of Medical Ethics 125 at 125

[2] Marie Norredam, Anna Mygind and Allan Krasnik, ‘Access to Healthcare for Asylum Seekers in the European Union – A Comparative Study of Country Policies’ (2005) 16(3) European Journal of Public Health 285 at 287

[3] Ibid