Health Vulnerabilities of Migrants Crossing the Andaman Sea

Health Vulnerabilities of Migrants Crossing the Andaman Sea Addressing Health Vulnerabilities of Migrants in Large Migration Flows Inter-regional Roundtable Discussion Geneva 25 April 2016

1 H 2015: 31, 000 departures (↑ 34%) 2 H 2015: 1, 600 departures (↓ 96%) Deaths: ~370 (1. 1%)

The Malaysian Experience First cases at the end of 2012 Misdiagnosis Similar history Tip of the iceberg Response Individual Community Health authorities

* Hasan

• Malnourished – many severely, requiring immediate admission to intensive care units. • More than just thiamine deficiency- folate and B 12 deficiency • Injuries – from assault /torture

Presentation of Beri-beri cases • Wet Beri-beri and Dry Beri beri • A whole spectrum of severity • Neuropathy- paralysis of both upper and lower limbs • Heart failure- leg swelling, difficulty breathing • * total of 309 beri-beri cases from Jan 2013 - May 2015

Prognosis • Outlook is good if detected and treated early. • Nerve and heart damage from beri is usually reversible when it’s caught in the early stages. • Recovery is often quick once you begin treatment. • Outlook is poor with encephalopathy (Wernicke-Korsakoff syndrome)

Treatment • Balanced diet and water • Avoid high carbohydrate diet on arrival • Therapeutic doses of vit B 1 – Thiamine 100 mg daily – B 12 ( 500 mcg ) 3 x /day – Folate 5 mg /day • Distribution of B 1 to communities and detention centres • Inform health authorities

Mental health support • Traumatic experience of being trafficked, subjected to sexual violence. • Ensuring access to counselling support and establishing contact with family at home

Women and Children • Ensure access to interventions for survivors of SGBV • Children - appropriate interventions after screening for nutritional and medical conditions • Access to vaccinations for children

Lessons Learnt

Governments • Coordination of response – multidisciplinary teams • Allow safe, prompt disembarkation – to prevent further casualties • Provision of food and water • Quick triage of immediate medical needs and prompt referral for care

Governments • Allow access to relevant stakeholders to support response • Screen for protection needs(refugees) , other medical and psychosocial needs. • Specific needs for survivors of trafficking and sexual violence. • Seek alternatives to detention

IO and NGOs • Safe shelters for those with special needs • Ensuring access to asylum procedures • Convalescence care support for the cases with severe malnutrition ensure recovery • Ensure access to psychosocial support • Building community awareness to report such arrivals

Sustainable solutions for healthcare access. • Explore health financing mechanisms ( insurance, microinsurance) • To be all-inclusive ( in line with SDG) – irregular and regular migrants, refugees • Collaboration with development actors in view of protracted situations with joint analysis and multi-year planning