Avoiding govt hospitals for fear of costs, arrests

In Part IV of this series on statelessness and its effects on mental health, we look at how government healthcare facilities treat the stateless as foreigners and impose charges few can afford. (Some names have been changed in this article at the request of the interviewees)

MIRI (Aug 7): Stateless individuals have limited access to public health services because most of them come from poor backgrounds and are therefore unable to afford the medical fees at government or private hospitals, as well as clinics.

Malaysia is one of the few countries that provide highly subsidised healthcare services, but only for its citizens. For non-citizens such as refugees, the stateless, asylum seekers, and illegal immigrants, the charges are very high.

The amendment to the Fee Act (Medical) 1951 in January 2016 saw medical fees imposed on non-citizens soar between 24 and 100 times more than citizens.

For instance, a Malaysian citizen pays a registration fee of RM1 at any government hospital or clinic, whereas for non-citizens, stateless individuals including MyKas holders, and undocumented individuals, the fee is RM40.

On top of that, foreign patients (which include stateless or undocumented patients) need to pay a deposit for every admission to a government hospital, as per Clause 14 of the Feeds (Medical) (Cost of Services) Order 2014.

Deposit required

Deputy Health Minister Datuk Lukanisman Awang Sauni told Parliament recently that foreign patients who are admitted to hospital for medical procedures need to pay a deposit of RM1,400 for third-class wards, and RM7,000 for first-class wards.

He said the government resorted to such a move because foreigners who had sought medical healthcare in Malaysia in the past failed to settle their bills which amounted to RM40.08 million as of 2023.

This financial burden further compounds the challenges faced by stateless individuals in obtaining essential healthcare services.

Marlyn, 45, from Baram said her parents used to live in constant fear of seeking medical care because of the expensive fees.

Before her parents were granted citizenship, she recalled how they literally feared for their lives whenever they wanted to seek medical services at government hospitals.

“I remember how they would refuse to go to the hospital even when they were very ill. Instead, they would try to get by with just over-the-counter medications from the pharmacy.

“It was traumatising for me as the eldest child to witness my parents suffering unnecessarily, their health deteriorating, all because they lacked legal status,” she said.

Dam Bilong, 30, who is still trying to apply for citizenship, told The Borneo Post how she had to fork out RM40 to pay for registration at a government clinic in Miri.

She said a few months ago, she went to a dental clinic in town to get her tooth extracted.

“When I was at the registration counter, the nurse said that I will have to pay RM40 for the registration alone because I am considered non-citizen. I did not have enough money that day so I just walked out without having my tooth checked or extracted,” she said.

Made to suffer

Breast cancer patient Mebpung Akup, 63, said even though she is still stateless, she was lucky that she could use her marriage certificate whenever she went for treatment and follow-ups at a government hospital.

With her marriage certificate, Mebpung said she was charged based on the Malaysian citizen rate.

“Even then, it was very difficult because I had to rely on my husband as a guarantor for my hospital treatment,” she said.

As for Dickson, his family had to raise money among themselves to pay for his sister Diana’s hospital bill and transportation.

Diana, who was diagnosed with Stage 4 cervical cancer and breast cancer in 2022, died of the illnesses at the end of last year.

“It was very painful for the whole family to witness her suffering the past few years, especially when we all are financially constrained. At times, we had to raise money among ourselves to pay for her bills and transportation to the hospital,” he said.

Jesica, 30, said that her mother had to pay RM600 following a two-night stay at a government hospital.

She said her mother was still stateless even though she had applied for citizenship several times.

“My mother was once hospitalised for chest pains. After two nights at the hospital, we faced an exorbitant amount of RM600.

“The reason? She only possessed a MyKas and her status in the document listed her as a non-citizen, therefore she was charged the non-citizen rate,” she said.

For a 58-year-old stateless man who wanted to be known only as A, he said “living life without an identity” has taken a toll on his mental health.

He said that several years ago, his wife and children, as well as an aunt who is also stateless, fell sick.

“I had to take leave from my job to care for them at home because I could not afford to bring all of them to a clinic or hospital for fear of the charges.

“I felt completely helpless that day and thought of ending it all as I could not imagine the future of my children who would have to go through what I went through when they grow up.

“If not for my faith, my family and I might not be here today,” he said.

Risk of arrest

In addition to the financial burden, stateless individuals also face the risk of being arrested by the authorities, which further prevents them from accessing proper medical treatment at healthcare facilities.

In a circular dated Sept 18, 2001, the Ministry of Health required its staff to report illegal immigrants to the police and immigration authorities.

Whilst the right to healthcare is a fundamental human right that should be available to everyone regardless of race, religion or nationality, stateless individuals seem to face barriers in obtaining healthcare services.

Statelessness also restricts free movement. Without documents, it is extremely difficult for them to cross the border or move from one town to another, which results in them having difficulty in finding jobs and accessing healthcare services.

Reduan Daniel Abu, 29, said that it was difficult to move around without identification documents.

He was born at Miri Hospital to an Indonesian mother who abandoned him when he was a baby. He was then adopted but his adoptive parents still could not settle his identification problems.

“I was only issued a birth certificate by the NRD (National Registration Department) in 2022 because when my mother gave birth to me, she could not pay the hospital bill which resulted in my birth certificate being withheld by the department.”

Jesica, meanwhile, also related how difficult it was for her stateless mother to travel without an identity card.

She said when her brother got married a few years ago in Sabah, all her family attended the wedding except for her mother.

“My mother was heartbroken as she could not travel to attend her son’s wedding because without documents, she cannot travel outside Sarawak,” she said.

For Belaweng Turau, 54, a Penan from Baram, he said every time his stateless mother-in-law Erang Ipoi, 80, fell sick, they were reluctant to take her to hospital or clinic for fear that there would be a police roadblock.

Other effects of statelessness include not being able to legally marry, have a bank account, obtain a driver’s licence, and even buying a mobile phone SIM card.

The examples of the cases above are just the tip of the iceberg of the hardships and sufferings endured by the stateless individuals in their daily lives.

Tomorrow: Does statelessness affect mental health?

Jenifer Laeng is a recipient of the Khazanah-Wolfson Press Fellowship 2024 at University of Cambridge in the United Kingdom.