MSF assisting Burmese migrant workers in Thailand

Three years after the Tsunami, Phang Nga province, near the popular island of Phuket in Thailand, is undergoing an impressive economic recovery.  Luxury hotels and resorts have been rebuilt and many migrants have come from nearby Myanmar to work in construction sites, rubber plantations or fisheries. Yet despite their contribution, few are granted their basic rights such as access to health care.

MSF began working with the migrants in late 2004 after observing the precarious situation they faced. Since then, an estimated 10 000 have been offered free health care in three sub-districts of Phang Nga province. Two Primary Health Care Unit Mobiles clinics are regularly visiting sites where they work.  MSF teams are following up patients with HIV/AIDS and TB through home visits and providing antenatal care for pregnant women and vaccination for their children.   Whenever possible, MSF is also helping migrants obtain health insurance cards and delivery certificates for newborn babies.

MSF head of mission in Thailand Paul Cawthorne, gives an overview of the situation in Phang Nga

What progress have you seen since the beginning of the project three years ago?

Since we've started working in Phang Nga after the Tsunami, we've made some significant strides forward in helping migrants access health care in the area where MSF is working. For example, when we first began working in Phang Nga, we did surveys of the vaccination coverage of children and virtually no Burmese migrant children had completed their vaccination schedule. Today, about 80% of the migrant children in the target area where we work now have full vaccination coverage. And that's not just thanks to MSF, that's working along with the local health authorities. So we do see some major progress, but in the small area where MSF has now been working for almost three years.

What is preventing migrant workers from seeking or accessing health care?

There are many barriers. One of them is the fact that migrants need documents to be able to access health care without fear and the first step in that documentation process is for the employer to apply for permission for the migrant to work. Without that permission it's very difficult for the migrant to take the next step of applying for a health card, which will provide free access to a basic package of health care through the ministry of health's system.

That's why it's important that MSF and other organisations continue lobbying to de-link being able to apply for a health care card from registration or a work permit.

Other problems are that if migrants don't have documentation, then even travelling to the hospital they could potentially be stopped by the police and arrested as illegal migrants and deported to where they came from. In the case of Phang Nga that would be Myanmar.

There are also simple things like language barriers. Most Burmese migrants don't speak Thai. One of the things we do to ease this problem is to place interpreters who speak both Thai and Burmese in the hospital and health stations.

Why do you think it's important to increase access to healthcare to these vulnerable populations?

I think for migrant workers in Thailand or anywhere, it's very important that they are able to access a basic standard of health care in the country in which they are working. It's important both for the health of the migrant and the migrants' family. But it's also important for the health of the host population. For example it's important that migrants are able to get their TB treated. If it's not treated, it's a public health problem. It's also important that migrants get health education, for example regarding HIV or sexually transmitted diseases. So we're talking about major health problems in a migrant community if there is not a basic package of health care either free or at a very reduced or affordable cost.