She was one of the Rohingya women in my study who delivered their babies at home because they could not afford maternal healthcare and/or lacked documents. Nur Farida’s husband, who had been arrested several times, was in detention at the time of her recent delivery.
To feed herself, her two children and unborn child, she cleaned houses and washed clothes for others, while she lived in a rundown house lacking running water and electricity. She had sought financial help from friends and family for her delivery.
With no help forthcoming, and not wanting to risk her life and that of her unborn baby, she decided to deliver the child at home. She boiled some water and sterilised an old pair of scissors. Although she delivered her baby, she failed to cut the umbilical cord successfully, and was rushed to a health facility by the mother of a friend who had come to help her in the delivery.
Nur Farida had not sought prenatal care because it was unaffordable. Delays in utilising healthcare, use of emergency care, and non-utilisation of healthcare – typical patterns of migrant and displaced populations – were found in the maternal healthcare experience of Nur Farida and several other Rohingya women in my study.
Nur Farida is one of several Rohingyas born in exile and whose children continue to be born in exile. Although she attended a few years of primary school in a mainstream school, she soon had to discontinue her studies because refugees in Malaysia lack the formal right to education. Like many refugee children, Nur Farida’s two older children do not go to school.
In a journal published by Universiti Putra Malaysia, research among Rohingya children in Kuala Lumpur showed their relatively poor growth status vis-à-vis urban Malay primary school children and preschool children from low-income households in the city.
There is an emerging body of evidence showing that material and environmental disadvantages experienced in childhood and accumulated throughout life have consequences on their health in adult and senior years. There is also evidence linking physical and mental health problems with the protracted non-resolution of the status of stateless people. As such, stateless populations like the Rohingya could stand to accrue untold health risks and poor outcomes over a single generation.
My research led me to a diverse group of Rohingya women: those born and raised in Malaysia; those who came to Malaysia a decade or two ago; recent arrivals; those who came from Rakhine in Myanmar; those who had lived outside Rakhine in Myanmar; and those who grew up in the refugee camps in Bangladesh.
The common thread running through their experiences is of lives trapped in limbo because of a lack of legal nationality and citizenship. An ethnic, religious and linguistic minority, the Rohingyas who hail from Rakhine were officially stripped of their citizenship by the country’s 1982 Citizenship Law. In addition to rights violations experienced by Myanmar’s ethnic minorities in general, the stateless Rohingya are subject to further repressive policies.
They are required to apply for permission and pay a fee to travel outside their villages, with the consequence that if they travel without permission or overstay their time pass, their names will be removed from the family list and/or they would be liable for prosecution under their national security legislation. Either outcome would necessitate their leaving the country. Rohingya couples seeking to marry are required to apply for permission and pay a fee besides providing a guarantee that they will not have more than two children.
They are required to register the birth of children against a fee, although the issuance of birth certificates has been stopped since 1994, thereby exacerbating their problem of statelessness. International rights groups report that the Rohingyas’ problems in accessing healthcare in Myanmar are worsened by restrictions that require permission to travel even for emergency care (and permission is often denied). The requirement of permission to marry often has dire consequences for women’s health. Rohingya women who become pregnant without acquiring government permission to marry often resort to unsafe abortions leading to maternal deaths, or abandon their babies after delivering them in Bangladesh, or are forced to flee the country.
There have been successive waves of exodus of the Rohingya from Myanmar since World War II, most notably after the 1978 and 1991-1993 military offensives whose purported aim was to root out foreigners. These offensives triggered a global humanitarian crisis. Over 300,000 fled to Bangladesh in 1978 where they endured squalid conditions, disease and starvation. Many returned to Myanmar without documents. More than 250,000 Rohingyas fled the 1991-92 offensives to Bangladesh which forced them back to Myanmar in a UN-supported repatriation process marked by extreme force and killings.
In May and June this year, ethnic conflicts between Buddhist Rakhine and Muslim Rohingyas displaced an estimated 90,000 people and claimed lives on both sides of the ethnic divide. Equal Rights Trust, an international NGO researching and advocating for the rights of stateless people, documented the violence endured by the Rohingya in its report Burning Homes, Sinking Lives. As the refugees fled their burning homes and villages, they reportedly found themselves pushed back into dangerous waters by Bangladeshi authorities.
The United Nations High Commissioner for Refugees (UNHCR) states that about 35,000 people have been displaced in the new outbreak of violence in Myanmar since Oct 21. This time, Kaman Muslims have been targeted along with the Rohingya. Currently, thousands are reported to be at sea and in the forests, desperately in need of humanitarian assistance, pointing to a political as well as a public health crisis for the region. Doctors Without Borders reported that displaced populations in Rakhine state are unable to obtain urgently needed medical care because of threats, intimidation, and acts preventing the organisation from providing care.
Undoubtedly, these are complex and difficult issues. However, resolution of the problems of statelessness and forced displacement in the region have been hampered by political foot-dragging, and policies that do not address the root causes of displacement and are blind to the much-needed long-term and regional approaches for a solution. In general, Asean has not shown the right leadership in addressing the massive human rights violations perpetrated against ethnic and religious minorities in Myanmar.
In recent months, Malaysia has admirably led regional and international calls and interventions to provide material assistance to the displaced Rohingyas and the Rakhines affected by violence in May to June. Currently, as thousands of Rohingya refugees flee their burning homes and villages and look across the ocean for refuge, Malaysia’s concern and international commitment to this issue will be tested. Equally, it will be challenged on the congruence of its position on the Rohingyas. For example, will the humanitarian aid provided to Rohingyas in Myanmar be forthcoming to the same people if they land on our shores where there is the absence of protection for them? India and China have strategic investments in roads, ports, and pipeline projects in Rakhine and, with Asean, compete to forge trade and economic ties with Myanmar. Increasingly, Western Europe, North America and Australia are vying for economic engagement with Myanmar.
In addressing this humanitarian crisis, these nations will be challenged to reconcile the pursuit of their economic agendas with their obligations as responsible members of the global community. Myanmar is also now challenged to show its commitment to democratic transition and social and economic reforms by restoring the rule of law and providing protection to those living in Rakhine, especially the Rohingyas, bringing perpetrators to justice, facilitating the delivery of humanitarian aid to the affected and restoring citizenship to the Rohingya.
Today, let us remember the thousands of stateless and displaced persons, and act to secure their health, rights and lives lest their only fate is to become further mortality statistics.
- ■ The writer is co-founder and director of Health Equity Initiatives in Kuala Lumpur and a PhD Candidate (Public Health) at Monash University Malaysia. Health Equity Initiatives is a Malaysia-based NGO that advances the right to health for marginalised communities.
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