Social determinants of health and well-being among irregular migrant workers in Malaysia: A case study of Chin people from Myanmar

doi:10.21203/rs.3.rs-2080254/v1

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Research Article

Social determinants of health and well-being among irregular migrant workers in Malaysia: A case study of Chin people from Myanmar

https://doi.org/10.21203/rs.3.rs-2080254/v1

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Background

Malaysia is the second-most popular destination for regular and irregular migrant workers from Myanmar. They contribute to the economic prosperity of both the host and home countries; yet, their social determinants of health and physical well-being, particularly among irregular migrants remain neglected and unexplored. This study looked at how Myanmar irregular migrant workers' daily challenges, workplace exploitation and conditions, and coping strategies related to the social determinants of their health and well-being.

Methods

Two interview techniques were used in this study: semi-structured interviews with nine participants (n = 9), and three Focus Group Discussions with sixteen participants (n = 16). Participants were recruited through referrals from NGOs and snowball sampling due to the nature of the hidden population.

Results

The findings revealed that a variety of factors are affecting participants' health and well-being. Among the most pressing issues is their irregular immigrant status, which exposes them to various forms of exploitation and prevents them from accessing services. They suffer from depression, overthinking, worries about their families, and insomnia as a result of such conditions. Some relied on religious devotion (prayer), ignoring their sadness and dedication to support their families, while others relied on cohabitation or drinking alcohol, damaging their physical and mental health.

Conclusions

The findings suggest that Myanmar and Malaysian governments should collaborate to regularize existing irregular migrants in Malaysia and establish zero or low-cost recruitment policies to eliminate irregular migration for prospective workers since their labour contributions play a significant role in both countries' economies.

Myanmar

coping behaviours

social determinants of health

irregular migrant workers

Malaysia

Chin people

Migration is not a new phenomenon; but an inevitable part of socioeconomic transformation globally for every individual. It can be driven by economic reasons or fleeing tragic situations such as conflict, persecution, natural disasters, and others migrating for family regrouping and studying (1). In general, the migrant population engaged in the labour market that contributes essential labour and skills to host countries for economic growth and their home countries' economies by sending remittances and developing new skills to utilize when they return (2). They are commonly employed in low-skilled occupations that the host population does not want, categorized as dirty, demanding, dangerous, and long hours for poor payment (3) which significantly affects their health (4, 5), and causes depression (6). For example, existing research indicates migrant workers in the global south suffer from poorer mental health and well-being due to poor working conditions, being economically disadvantaged, being in debt, or not having access to services (7), and are disproportionately vulnerable to mental distress due to financial barriers to accessing healthcare (8).

Despite the various vulnerabilities in destination countries, international migration has increased rapidly due to different push and pull factors. The number has almost doubled over the last three decades, from 150 million in 1990 to 280 million by mid-2020, representing 3.6% of the world's population. More than 86 million international migrants live in Asia, making it the second-largest destination after Europe (9). More than 169 million international migrants were engaged in the labour sector in their destination, representing 4.9% of the labour force in their destination countries (10).

In East Asia Pacific, Malaysia stands for the fourth-highest percentage of migrant workers, representing 15% of its labour workforce. Malaysia's economy has been heavily dependent on low-skilled migrant labour from neighbouring countries since 1990 due to the country's industrialisation and urbanization development and its population attainment of higher education. Although accurate data is unknown, the World Bank estimated the number of international migrant workers in Malaysia ranged from 2.96 million to 3.26 million, of whom 1.23 million to 1.46 million were irregular migrant workers in 2017 (11).

Over the years, Myanmar has become a significant cheap labour supplier of 4.25 million labour to different countries; because of its political and economic instability (12). Malaysia became the second most popular destination for Myanmar migrant workers and an estimated 140,461 Myanmar regular migrants in 2019 (13). The number of irregular migrants appears to be much higher; however, it was unclear.

The Malaysian government distinguishes migrant workers into skilled and technical workers and semi-skilled or unskilled workers. The regular and professional group is minimal, and they are properly recruited. However, on the other hand, the unskilled category comprises many irregular migrants who have entered the country irregularly for several reasons (14). Irregular migrants are defined as ‘migrant workers or members of their families, who are not authorized to enter, to stay or to engage in employment in a State” (15). Globally, their labour and remittances assist in meeting the needs of their family members and contribute to sustainable development goals (SDGs). In Malaysia, existing studies have focused mainly on the healthcare barriers facing refugees and asylum seekers (16) and regular workers (17, 18). In particular, no research has been conducted on the social determinants of Myanmar's irregular migrant workers in Malaysia. The purpose of this study was to investigate how their daily experiences, workplace conditions, and coping strategies related to the social determinants of their health and well-being.

2.1 Participants' selection

Myanmar has a population of 54 million people and is one of the world's most ethnically diverse nations. The Chin ethnic group is one of eight major ethnic groups in Myanmar, mainly residing in mountainous areas. Chin State remains the poorest state due to structural and institutional discrimination by the central government for the past half-century. Hence, Chin people are prompted to immigrate to neighbouring states to seek a decent living, as reported by(2) Although no reliable updated demographic statistics were available, an estimated 10 %of Chin people from Myanmar were international migrants mainly to Malaysia (27,016), followed by the United States (12,117) and India (5,880) according to the 2014 population census (12). The number of "Chin irregular migrant workers" CIMWs in Malaysia is unknown; nevertheless, they appear to increase dramatically over time due to numerous factors.

For this case study, the CIMWs population was purposefully chosen due to time and financial resource limitations. Besides, the researcher himself is of Chin ethnicity, and fluent in diverse Chin dialects, enabling a more accessible approach to gatekeepers and participants. In this study, the CIMWs refer to Chin people from Myanmar who migrated irregularly and worked unlawfully in Malaysia. Chin asylum seekers and UNHCR cardholders were not considered in this study, although the government of Malaysia recognised them as irregular migrants or illegal migrants.

2.2 Data collection

This study employed two interview techniques: semi-structured interviews (n = 9) and three Focus Group Discussions with a total of (n = 16) participants. Given the hidden nature of the population and employment, the researcher identified participants through a referral from Chin NGOs in Malaysia and the snowball sample approach. Data was collected in Kuala Lumpur, Malaysia's capital city, between December 2018 and January 2019.

Participants in the study were informed of the research procedure. The study's primary objective was to understand better the challenges they face and coping mechanisms and how these affect their health and well-being. The interview guide and ethical clearance were assessed and approved by the research ethics committee from the Asian Social Institute (ASI), Manila, the Philippines. The researcher sought and obtained written consent from all the participants before conducting an interview and audio recording aligned with the research ethics. The researcher assured confidentiality to all the participants and used pseudonym in the analysis.

All individual interviews were conducted in the migrant worker's dormitory at midnight between (12 A.M- 2 A.M) due to the migrant workers' long working hours. The majority of participants work 12 to 15 hours a day. Though several restaurants close around 10 p.m. or 11 p.m., they clear the whole store before returning to their dormitory. The researcher sometimes eats dinner at the restaurant where the participants worked while waiting to be followed to the dormitories for the interview. The average length of the individual interviews lasted between 35 minutes – 1 hour. After the services, the FGDs were conducted on Sundays at three separate community gatherings for church services. The researcher relied on the church leader or pastor to recruit the participants—the average length of an FDGs interview lasted around one hour.

In both semi-structured interviews and FGDs, participants were asked similar questions like the following

(a) What challenges do you confront daily as an irregular migrant worker in Malaysia?

(a) What kinds of exploitation do you face at the workplace?

(d) To what extent do these challenges and exploitation, coping mechanisms influence your health and well-being?

All interviews were audio-recorded, and field notes were taken during the interview. The medium of instruction and discussion was Burmese and Chin dialects such as Tedim, Falam, Hakha, and Mizo. The Chin people of Myanmar inhabit mountainous areas, and some are not fluent in Myanmar's national language, "Burmese." Being a researcher who is also a Chin ethnicity and proficient in multiple Chin dialects offered an advantage. During the interview, the researcher conducted in-depth interviews in the language the participants spoke and established trust.

2.3 Data Analysis

All audio recording interviews were manually transcribed and translated into English by the researcher. All names and identifying information were omitted during transcription, and each transcript was assigned a number. All English transcripts and translations were cross-checked with the audio record to ensure the narrative's authenticity. To avoid any errors in translation, the audio tape was repeatedly played and the translation was checked line by line. The data was then manually processed using theme analysis, one of the most often utilized qualitative research analysis approaches (19).

2.4 Participants' characteristics

The study included 25 (16 meals and 9 females) participants. All participants were aged between 20 and 37 and had low educational attainment (high school). They were primarily unemployed in their home state of Chin, Myanmar. They are all Christian in terms of religion. They have big family members and dependents at home. They have worked in Malaysia for at least three (3) years in blue-collar jobs. They often work 12 to 15 hours each day, with some having one day off per week and others having one day off per month. They were paid between USD 300 and USD 488 each month.

3.1 Social determinants of health: Daily experiences in Malaysia

3.1.1 Agony and health in detention

The majority of the participants migrated irregularly, crossing the Thai-Malaysian border with the help of brokers. They relied on brokers since their living conditions were impoverished at home. They lacked adequate financial resources for applying for a legal work permit due to the high cost and lengthy process, and a lack of a service centre in their local region. Some of them were able to find work after successfully migrating to Malaysia. Some, however, were caught at the Thai-Malaysian border and imprisoned. Four major themes were identified as the key determinant of their well-being during their detention experience.

First, worries and depression were reported as they lacked contact with their family and relatives back home about their condition due to the non - availability of cell services and internet in the detention centre. They have trouble sleeping, feel furious and depressed, and are worried about how the family back home will survive as their members are hoping for remittance for better living and repaying debt. Some of them borrowed money and sold their land, house, and property to pay for the broker's facilitation cost to migrate to Malaysia. Their experiences are illustrated in the following quotations:

"I got arrested on the day I arrived at the Malaysian border. I was imprisoned for about five months. I did not have any connection with my family and relatives due to a lack of connection and language barrier." P2

"Despite many hardships in prison, I was so worried about my family, especially that I could not contact them. I was worried about my family's living situation as we have so much debt." One from FGDs

Second, poor physical health and well-being were reported in the detention centre due to lack of healthcare access, inadequate food, unclean water, and unhygienic living conditions.

"There were only two meals a day in the detention centre. Breakfast is sometimes provided at 2 P.M., while supper is sometimes served at 9 P.M. Sometimes a half-egg served for a meal and didn't have lunch. There are no drugs for sick detainees unless you have a critical condition. To get even one paracetamol pill is so difficult. There is no soap and no clean drinking water. Drinking water is also from the toilet; there is no separate toilet, bathroom and sleeping area." P5

A third factor that negatively influences their mental health and distress is loneliness and abuse from other detainees. They came from remote mountain areas and had limited educational attainment; they had no connections with Chin NGOs or social networks with others who had migrated to Malaysia early to seek assistance. They were vulnerable to various violations in detention, including being beaten by older detainees due to language barriers, an inability to understand different cultures, and an absence of friends or social networks.

"Sometimes I got beaten by some prisoners since I did not understand anything about what they were asking to do. I was so angry, but I could not react or defend myself as I had no people on my side to support me." One from FGDs

Additionally, their broker abandoned them and could not reach them for assistance. The participants could be released or repatriated early if they paid the authority around 9000 RM ($3,000). As they migrated for a living, such an option was not affordable, and they were detained until they gained support to be released.

3.1.2 Exploitation of money and personal belonging from police in an exchange of charge

Some participants have been arrested and forced to pay money to the police to be released. The police searched their bodies and seized any cash they found. Some of them paid more than 300 RM (USD100) in charges to the police when they were arrested. Some police often do not wear a uniform and appear suddenly. Hence, whenever they go out in public, they always carry money inside their underwear in their private parts to prevent themselves from losing money to the police. Despite being vigilant, some encountered money confiscated by police as described below:

"The police arrested me around KL centre while I was on my way to meet with the person I usually asked a favour for transferring my money to family back at home. The police brought me to a small room and asked me to take out my clothes and check my body. They took all my money, 3400 RM ($835), which I saved for about three months for my father's medication fee. The cops gave me the option to surrender all the money or go to the detention centre. Even if I decided to go to jail, I would not get my money back. I begged the police by crying with my heart not to take all my money. Then, the police only gave me back 100 RM for my taxi fare and told me not to come out again to the public." P3

"I was so careful not to be arrested. One early morning of June 2016, while I was going to my workplace, the police suddenly appeared and stopped me. They asked for my passport and UNHCR card as my proof. The police handcuffed me and slapped my face because I had no documents and could not understand any language. Fortunately, I was released after my boss gave money to them." P2

Other participants stated that the police acted like robbers. They would even take our mobile phones and only give our sim cards back if they found no cash on our bodies. On the other hand, some employers pay money to the police in return for their workers' release and deduct later from their income. However, not every employer provides this service.

"The cops arrested me in front of my dormitory building when I returned from work. They warned me that they would not release me until I paid some money. Go into your room and get some cash. While you're gone, give us your phone, and we'll return when you provide us with money. Unfortunately, the cops took my phone and ran away when I returned. I lost my Samsung phone, which I had only recently purchased. It made me upset, and I couldn't sleep for many days." P1

3.1.3 Living with worries and insomnia

Participants indicated getting a higher wage and more stable employment in Malaysia enabled their family to live. However, they never have a peaceful mind and are always frightened and worried about when the police will raid their dormitory. They worry for their family members if they are detained since they have large family members who mainly rely on remittance to fulfil the basic living.

"I always think of what shall I do if the police arrest me tonight or today? Who will take care of my family if I get detained in jail etc.? Such an instance makes me fear the police; it makes it hard to sleep at night. I feel like I am insane sometimes. My mental health is so much affected because I have seen many irregular migrants get arrested in my neighbourhood almost every day." P4

Furthermore, this study found that participants have been traumatized by hearing about police crackdowns and everyday imprisonments of irregular migrant workers despite some not having encountered it.

"I rarely sleep peacefully although I did not have any personal encounters with the police, I got trauma, and I am living in fear to survive. Since my whole family depended on me, I could not afford to be arrested. I don't know when it will be my turn? My sleeplessness is affecting my health and work." P7

3.1.4 Language barriers and discrimination healthcare service

Participants often reported difficulties in seeking healthcare and discrimination due to their irregular status and ongoing arrest. They could only rely on private clinics, but they must pay double or triple the medical cost higher than refugees and the general public.

"I got seriously sick for a week due to lack of sleep and long working hours. Since I have no legal documents, I cannot go to the public hospital. I approached a clinic. I paid 100 RM (25-USD) for just the registration fee, whereas only 50 RM (13-USD) cost for refugees and a Malaysian National, they pay only 2 RM (half USD). P2

"My son often gets sick. I cannot access the public hospital. Due to my irregular migrant status, the clinic's medical cost was always double. I pay 100 RM, whereas the refugee pays 50 RM for the registration. My husband cannot get a leave from his full-time job. It was so challenging to bring since I could not speak and understand Malay, Chinese and English languages," One from FGDs

The participant additionally stated that the medical doctor and nurse discriminate against them due to their language barriers and being a Myanmar citizen despite the extensive cost. Due to their language barrier, they must also pay a considerable amount to hire an interpreter. Furthermore, pregnant mothers, in particular, have difficulties in bearing a child owing to high costs and their irregular status. Some participants described hearing an incident about an infant and a mother being detained soon after childbirth from a hospital and fleeing or escaping before official discharge from the hospital as they couldn't afford the bill and were afraid of being reported to the authorities.

3.1.5 Lack of freedom to travel

The majority of participants often refrain from joining social networking and activities at Church with other migrants due to being highly at risk of being arrested by the police. They were aware that such social activities could help them help their depression and emotional trauma. Some of the participant's quotations are elaborated below:

"One life without a legal document is so challenging in Malaysia. I understand socialization is very vital to release psychosocial problems. But, to avoid encountering the police, I never joined any social gathering and fellowship services at Church to meet with fellow migrant workers." P2

"My biggest challenge is not having a legal passport. I cannot go to Church like a regular migrant worker and be involved in some activities to help me cope with my social and emotional problems. Seeing and hearing many irregular migrant workers arrested every day brings me trauma, and I cannot sleep peacefully every day." P4

3.1.6 Unable to access education for children

Participants' children lack rights to public education. Consequently, some of the participants plan to return home for the sake of their children's education, as one participant reflected below:

"Now, my son is growing up, and I start worrying about how to send him to school. I wanted him to study here in Malaysia to continue living and working. But, I could not enrol him in any public school because of my irregular status. I may have to return to my home country for the sake of my son's education." P9

Conversely, some indicated no school and no livelihood opportunities in their native village, Myanmar. Thus, some prefer to send their children to migrant community schools in Malaysia, although no accreditation and recognition by any government. Some consider not having children due to education constraints, which influences the fatality rate and the women's health due to long-term contraceptive usage.

3.2 Social determinants of health: Working condition and exploitation

3.2.1 Language barriers

The language barrier was the most significant obstacle at the participants' workplace among numerous difficulties.

"When I first started working, my first difficulty was language. My co-workers do not understand my language, and I neither understand theirs. I didn't know how to negotiate for my salary, and I worked more than 10 hours a day with only one day off every month." one from FGDs

"My first job was as a cleaner at a Thai restaurant. I was the only migrant worker from Myanmar. Language barriers were significant in my workplace. I faced numerous rejections from co-workers and challenges because I did not know any of these languages, Thai, Malay, Chinese, and English." P3

3.2.2 Exploitation from employer

Participants often encountered miscommunications with their employer and co-worker due to the language barriers. They were repeatedly insulted or yelled at when they could not interpret what they were asked to do.

"My employer's wife is very judgmental, and she yelled at me for almost all the work I do." P5

Participants reported unpaid wages and pay reductions, but they were afraid to demand it because they feared losing their jobs and reporting to the authorities.

"I experienced being underpaid two (2) times by an employer who owns a Chinese Restaurant. Due to my irregular status, I was afraid to demand it." P7

Similarly, one participant from FGDs said:

"I kept working patiently with unpaid extra work because I was afraid of losing my job if I refused."

3.2.3 Exploitations from a co-worker

Co-worker exploitation and oppression were reported as significant challenges in the workplace. Some participants described being discriminated against based on ethnicity from their co-workers who have legal work permits.

"I faced numerous exploitation and discrimination in my workplace, especially from some of my co-workers. They are Burma ethnic, and they hold a legal work permit. They treated me as an irregular migrant worker; also, I am a Chin ethnic. I cannot speak the Burmese language well as I came from the very remote village of Chin State, Myanmar. "One from FGDs

Participants do not have access to banking services to transfer remittances due to their irregular status. Furthermore, it is risky for them to go outside to meet with some brokers in the city. Some seek assistance from their co-workers who have a legal work permit; however, they rarely receive considerate help and are frequently exploited, such as being forced to pay a percentage of the amount they wished to transfer.

"One of the difficulties I encountered was a lack of access to banking services. Whenever I wanted to transfer remittance, I counted on some of my co-workers who had legal documents. They've always taken advantage of my irregular status by forcing me to pay in percentages, but I don't have any other choice than to bear such exploitation." P6

3.2.4 Long working hours

Another significant problem was the long working hours, ranging from 12 to 15 hours every day. Some participants who work as chefs at the restaurant depart their dormitories about 3:30 A.M. and work until 3 P.M. Still, they are regularly asked to work overtime another two hours and are underpaid. Other participants who work as waiters leave their dormitories and work from 9:30 A.M. to 11 P.M midnight. Besides, they have to clean and sweep the entire store after closing. Participants who had a family member and did not stay in the employer's provided dormitory are at a higher risk of being arrested by police on their way home, owing to being very late. Such conditions exacerbate their mental health and stress daily.

3.2.5 Unstable meal routine

Participants indicated no fixed arrangements for lunch or supper. They typically have to eat when there aren't many customers around. Breakfast and lunch are sometimes served at about 2 P.M., while supper is served around 10:30 P.M. after the store closes before cleaning. Some of them stated that the unstable meal routine had impacted digestion and their health.

3.2.6 Precarious living condition

Furthermore, most participants who are single stay in the employer-provided dormitory. The living quarters are overcrowded, with polluted air and unsanitary conditions that are likely to harm their health.

3.3 Social determinants of health: Coping Strategies

3.3.1 Determination to tolerant problems

Participants attempt to endure all obstacles to cope with their problems. They stated that difficulties exist everywhere, and Malaysia is better to earn money. All of the challenges in Malaysia are not new to them. They have prepared to face all the potential difficulties before migrating to Malaysia.

Before I migrated, I already knew that I would be facing different kinds of problems in Malaysia. I grew up with so many difficulties since my childhood. I have prepared to confront it for the sake of money. Some situations were not easy to tolerate; I tried to ignore and avoid all adverse treatments. Moreover, I remind myself that I am just a migrant worker and just here to work for money. P4

Similar, one of the participants from FGDs share:

"I confronted all my suffering and difficulties by accepting that I am just a migrant worker and slave in Malaysia. Whenever I want to give up working in Malaysia, my conscience reminds me, "what will you do in Myanmar? Be patient; you come here to work for money".

3.3.2 Commitment to support the family

Participants emphasized that living and working in Malaysia is very precarious as an irregular migrant. Nevertheless, they have a solid commitment to continue working in Malaysia for better income that enables sending their children to school, paying medical fees, and supporting their family daily living. Their psychological commitment to their family and realizing that their family can meet their daily needs through their support gives them the energy to endure hardships.

"I bear in mind that everything requires sacrifice to earn money. I prayed the Rosary in my heart to cope with my various problems. I am happy to see my family have daily food and smile because of my remittance. Such circumstances gave me the strength to continue working whenever I lost motivation. I can overcome my daily struggles because of my commitment to my family and the blessing from God." P8

Participants stated that they must continue working in Malaysia despite several hardships because of no employment opportunities and no land for livelihood in Myanmar to support their families.

"I faced so much hardship and also cried many times. But, I kept working in Malaysia because there are no job opportunities and only a meagre wage in Myanmar compared to Malaysia. We have no land to farm in the home state (Myanmar). I want to continue my family's basic needs and my children's education by working here" P6

3.3.3 Prayer

The majority of participants were Christians. They have a deep faith and devotion in religion to deal with their problems and protect their family members.

"I have strong faith in God that nothing is impossible with Him. I always pray to God to show me the way." P2

"I swallowed all my difficulties, pain, loneliness and; I cried deep in my heart. I pray whenever I get free time. Through my dream and faith in God, I will have a peaceful reunion with my family one day to start a new life together. That is why I can persist in my problem and sustain my life in Malaysia amidst various issues.' One from FGDs

3.3.4 Cohabitation

Notably, participants reported that many migrant workers are living together with someone whose background they do not know so well because of vested interests like minimizing the expenditure of housing and overcoming their multiple challenges in the new environment. Consequently, there were many women migrant workers who had returned to the home country after an unwanted pregnancy, HIV, and AIDS sickness,

"I have seen many women cohabit with men and other women got married to someone they do not know well about their family background. Then later, they are left or divorced to find out that they are infected with HIV and AIDS. "One from FGDs

3.3.5 Consuming Alcohol

Participants emphasize that many immature migrant workers misused alcoholic drinking as a coping mechanism and did not save money.

"Those immature migrant workers usually look for an immediate solution for their problem, and it is dangerous. They do not have a clear plan. They drink alcohol and smoke to cope with their problem." P1

This is the first study that explores the impact of daily experiences, workplace conditions, and coping strategies on the physical health and well-being of CIMWs in Malaysia. The study identified significant factors associated with social determinants of physical and mental health well-being among CIMWs, as shown in Table (1).

Table 1

A summary of the themes that influence the social determinants of CIMWs in Malaysia
Social determinant	Theme
Daily condition in the community
	Health-related condition in a detention centre	Trouble sleeping, felt furious, depressed, worries for family and relatives back home due to unable to contact No healthcare service, inadequate food, unclean drinking water, and unhygienic conditions in a detention centre Loneliness and several cases of abuse from other prisoners Lack of support and social network
	Live in terror day and night	Fear of arrest and detention, and fear of money confiscation from police in an exchange of charge
	Living with worries and insomnia	Unpeaceful mind and too much thinking about for family living if arrested anytime
	Challenge in healthcare-seeking	Language barriers, discriminate treatment, expensive charges, no rights to access public healthcare
	No right to travel	Lack of legal status and deployment police everywhere
	No right to education	Unable to access public education for children, worries for children future
Work and living conditions
	Workplace condition	The language barrier, long working hours, abuses from co-workers and discrimination, irregular meal time
	Employer condition	Exploitation from employers, underpaid wages, deprivation of the right to claim and fear of being reported to authorities, no paid sick leave
	Living condition	Overcrowded, unhygienic and polluted air
Coping behaviour
	Commitment	Bearing, dedication for family, daily prayer to God
	Relied on other person and material	Cohabitation to minimize housing costs and cope with challenges that result in unwanted pregnancy, HIV and AIDS, Consuming alcohol and smoking

5.1 Social determinant of health: daily life in the community

The study found that Malaysian detention centres lacked healthcare, insufficient food, unclean drinking water, unsanitary conditions, and several cases of abuse, which is consistent with prior reports (20). Such situations put individuals at increased risk of loneliness, insomnia, frustration, and depression exposing their health and well-being worsen. Moreover, depression was a significant factor affecting individuals' well-being in this study unlike the early findings. Some of the participants in this study were abandoned by their brokers and had experienced difficulty to communicate with their family back home as they lacked social connections, friends, and organizations to seek help.

Aside from the detention centre’s misery, Malaysian authorities' crackdown elsewhere and arrest irregular migrant workers daily, making living and working conditions challenging. The findings in this study indicated that irregular migrant workers live in terror day and night as they could be arrested and be held in jail for an uncertain day. Additionally, cops were deliberately hunting irregular migrant workers from various street blocks to exhort money in exchange of release from arrest. Regardless of how cautious they were in their movements; their safety is unpredictable. Some cops did not wear uniforms, making it impossible to determine if they were cops or ordinary citizens.

Moreover, participants' psychological trauma and depression were highly correlated with fear of money confiscation from police in exchange for a charge. Since their family members mostly live off remittances, the irregular migrant workers in this study are afraid of arrest and imprisonment, worrying about how their families would survive if they were detained. Similar studies also reported that migrant mental health and stress were related to poor social networks, economic hardships, and worries about family back home (21, 22), but not to fear of money confiscation by police like the present study.

The study also found that irregular migrant workers in Malaysia faced barriers to accessing healthcare services that influenced their health in a key way. This is due to a lack of legal documentation, high fees, language barriers, the high cost of hiring interpreters, discrimination, and distances, which are consistent with other research findings (23, 24). Moreover, the finding of this study revealed that irregular migrant workers must pay double or triple at clinics due to their irregular status, where refugee cardholders are entitled to a 50% discount on healthcare bills. In particular, finding reported that irregular migrant women who give birth often leave hospitals before being officially discharged because of concerns about high medical costs. Additionally, this this discovered that some irregular migrant women were pressured to use contraception to avoid pregnancy, which had a negative impact on their physical health and well-being as they were concerned about their children's future since irregular migrants’ children do not have access to attend accredited or public schools.

5.2. Social determinant of health: workplace condition and exploitation

This study identified that participants' mental health problems have significantly increased due to their ethnicity and language barriers, putting them at different forms of risk, discrimination and exploitation from their employers and co-workers, as existing research has indicated (25, 26). Especially, the participants in this study are highly susceptible to money exploitation as they need to rely on their co-workers for transferring remittances to their families unlike regular workers who can transfer through bank channel. In addition to the costs of using brokers, meeting with them can be extremely risky due to the possibility of getting held up.

On the other hand, this study also found that participants are vulnerable to a low wage, are often underpaid or do not get paid at all by employers. A similar study reported that irregular migrant workers are vulnerable to deprivation of fundamental human rights, fear of being reported to authorities, fear of losing their jobs, and fear of deportation due to their informal nature of employment (27, 28). As describes by (29), such deplorable living circumstances and exploitation exposed the participants to poor health and mental issues.

According to this study, participants are exposed to considerable health risks that lead to physical and psychological conditions as a result of poor working conditions, long working hours, and irregular or unstable mealtimes. According to a similar study, Myanmar migrant workers in Malaysia suffer from poor sleep quality in a high percentage (62.5 per cent) (30). Further, participants' poor mental health was associated with financial hardship and a lack of support from their employers which is similar to other findings (31) Additionally, a survey study reported that Myanmar migrants in Malaysia have the highest rate (96.7%) of household food insecurity due to lack of money that affect their well-being (32).

5.2. Social determinant of health: coping behaviours

This study revealed that participants engaged in positive and negative coping behaviours to deal with their depression and various issues. The study found that that participants avoided social networking or physical activities with other migrants to avoid the possibility of getting arrested by police while outdoors. They demonstrated religious devotion, determined to face whatever challenges to support their family's basic needs education for their siblings or children, as there were no job opportunities in their home state Myanmar. Conversely, existing research on Latino migrants' depression positive coping behaviours includes shopping, listening to music, watching television, sleeping 8 hours per day, seeking help from a counsellor or physician, and physical activities such as game soccer among younger workers (22).

Moreover, the present study also reported that some individuals are more likely to pursue negative coping behaviour such as cohabitating with someone without marriage to reduce housing costs and to cope with their mental and various challenges, leading to various health determinants such as unwanted pregnancy, HIV, and AIDS. Furthermore, other individuals use alcohol and smoking to deal with their problems that determine their health and well-being, as revealed by previous research among Myanmar migrant workers in Thailand (33) among Filipino irregular migrant workers in Korea (34).

According to the findings, lack of legal documentation is a key social determinant of health and well-being among the participants, placing them in various forms of exploitation and marginalization. To enhance the working and living conditions and end migration irregularly, the governments of Malaysia and Myanmar should promote zero cost or minimize the cost of obtaining a regular work permit for their labour. Furthermore, the Malaysian government should offer to regularize irregular migrant workers, contributing to tax revenue through registration fees and remittances, which always get lost in the hands of brokers or illegal financial institutions.

The Malaysian government needs to recognise, ratify, and protect the rights of all migrants and their families under the International Convention on the Rights of All Migrant Workers and Members of Their Families to end practices that turn irregular migrants into targets of abuse that worsen their health situations. Moreover, the Malaysian government should allow all migrant workers, regardless of status, to purchase health insurance monthly or yearly instalments at an affordable rate since the right to healthcare is a fundamental human right.

On the other hand, this study found that many individuals have relied on negative coping behaviours that harm their health. Therefore, prospective migrant workers should be mature, self-disciplined, capable of dealing with their difficulties, not be extravagant, work hard and migrate with legal process.

Additionally, as a signatory of the Convention on the Rights of the Child (1989) and the ASEAN Declaration on the Rights of Children in Context of Migration, Malaysia's government has a legal responsibility to offer all children in Malaysia free and adequate education and health care, regardless of their nationality and status.

There are several limitations to this study. First, the results were not generalisable because only a limited number of participants were interviewed due to time and budget constraints. Second, due to the qualitative nature of the research, there would be some mistakes in the transcription and translation of audio recorded from Chin dilates and Myanmar languages into English. Third, since the study is descriptive, the findings were confined to demonstrating the correlation between the key determinant factor and the participant's health and well-being outcomes. Therefore, another study or comparative study using mixed methods with other ethnic or national migrant populations can be considered for future research to understand the similarities and differences of their determinants of health and coping behaviour. Fourth, participants reported barriers to accessing public schools or accredited schools for their children's education. However, this research was unable to investigate how the irregular migrant workers from Indonesia, the Philippines, and other nationalities in Malaysia send their children to school. A comparative study of migrant children's education from different nationalities and the type of education system established between their home and the Malaysian government would bring informative policy debates to achieve universal education.

The findings of this study demonstrate that participants have encountered different problems/challenges that have affected them psychologically, such as fear of police officers because of what they have personally experienced (physical inflicted pain or extortion of money) or from what they heard. They have also encountered many other problems in relation to the language barrier, which caused difficulty in the work relations, that is, exploitation or being taken advantage of by their employers and co-workers. Other challenges include the following: long working hours, irregular mealtime and cultural differences, dilapidated and unsafe accommodation, no access to banking, no access to education for their children and no access to the public hospital. These challenges that make irregular migrant workers very vulnerable in Malaysia started at the onset when they dared to opt to take the route of irregular migration. Some adopted positive coping strategies are religious devotion (praying), ignoring their sadness and difficulties; they focus on their work while others consume alcohol, which affects physical health and well-being. Therefore, the Malaysian government must address irregular migrants' social determinants of health and well-being by providing them with labour replacement services at zero or affordable costs. Allowing existing irregular migrants to register at an affordable price in an easily accessible way or offering them an amnesty to buy health insurance.

Ethical approval and consent to participate

The ethical approval was obtained from the Asian Social Institute (ASI) research ethics committee in Manila, Philippines. Written consent from all participants were obtained before conducting an interview and audio recording aligned with the research ethics. The researcher assured confidentiality and all the participants names were assigned pseudonym. All methods well carried out in accordance with relevant guidelines and regulations.

Availability of data and material

All data generated or analysed during this study are included in this published article.

Competing interest

The author of this manuscript declares no conflict of interest regarding the publication of this paper.

Consent for publication

Not applicable

Funding

No specific funding was obtained for this study.

Author’s contribution

The author conducted the following activities: literature review, study design, data collection, data transcription, and data analysis.

Acknowledgement

The author would like to acknowledge his sincere gratitude to all the participants and individuals who assisted during data collection in Malaysia. This manuscript it part of master thesis to obtained master’s degree in Social Services and Development at the Asian Social Institute (ASI), Manila, Philippines. The author is indebted to master thesis supervisor, Prof. Wilma C. Abig, and to all panel members Dr Mina M. Ramirez, Dr Erlinda G. Acierto, Dr Erlinda K. Natocyad Prof. Dennis Y. Batoy for their valuable comments and suggestions.

International Organization for Migration. World migration report 2022. 2021 1 December.
Global Commission on International Migration. Migration in an interconnected world: New directions for action. The Commission; 2005.
Fernández C, Ortega C. Labour market assimilation of immigrants in Spain: employment at the expense of bad job-matches? Span Econ Rev 2007 Aug 18,;10(2):83–107.
Marmot M. Social determinants of health inequalities. The Lancet (British edition). 2005;365(9464):1099–104.
Hargreaves S, Rustage K, Nellums LB, McAlpine A, Pocock N, Devakumar D, et al. Occupational health outcomes among international migrant workers: a systematic review and meta-analysis. The Lancet Global Health. 2019;7(7):e872–82.
Lindert J, Ehrenstein OSv, Pribe S, Mielck A, Brahler E. Depression and anxiety in labor migrants and refugees–a systematic review and meta-analysis. Social science & medicine; 2009.
Meyer S, Robinson W, Chhim S, Bass J. Labor Migration and Mental Health in Cambodia: A Qualitative Study. J Nerv Ment Dis. 2014 Mar;202(3):200–8.
Ang JW, Chia C, Koh CJ, Chua BWB, Narayanaswamy S, Wijaya L, et al. Healthcare-seeking behaviour, barriers and mental health of non-domestic migrant workers in Singapore. BMJ Glob Health 2017 March 09;2(2):e000213-000213. eCollection 2017.
United Nations Department of Economic and Social Affairs. Population Division. International Migrant Stock 2020. 2020.
International Labour Organization. ILO global estimates on international migrant workers: results and methodology. Third Edition ed. Geneva: International Labour Office; 2021.
World Bank. Who is Keeping Score? Estimating the Number of Foreign Workers in Malaysia. The Malaysian Development Experience. Malaysia.: World Bank; 2020.
Ministry of Immigration and Population. The 2014 Myanmar Population and Housing Census. Ministry of Immigration and Population 2015;2.
International Labour Organization. TRIANGLE in ASEAN Quarterly Briefing Note. 2021 19 August.
Jones S. Making money off migrants: the Indonesian exodus to Malaysia. Hong Kong: Asia 2000 Limited; 2000.
International Organization for Migration editor. Glossary on migration. 2nd ed. ed. Geneva; 2011.
Chuah FLH, Tan ST, Yeo J, Legido-Quigley H. The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study. Int J Equity Health. 2018;17(1):1–15.
Sohrabi M, Osman AF, Tumin M. Barriers in obtaining primary health care services from public clinics by non-citizen labors in Malaysia. Malaysian J Med Res. 2018;2(1):52–60.
Pocock NS, Suphanchaimat R, Chan CK, Faller EM, Harrigan N, Pillai V, et al. Reflections on migrant and refugee health in Malaysia and the ASEAN region. BMC proceedings 2018;12(Suppl 4):4–5.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2008;3(2):77–101.
Ananthalakshmi A. Exclusive. More than 100 die in Malaysian immigration detention camps in two years. Reuters 2017-03-30.
Chen W, Hall BJ, Ling L, Renzaho AM. Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect of post-migration stressors: findings from the first wave data of the BNLA cohort study. The Lancet Psychiatry. 2017;4(3):218–29.
Winkelman SB, Chaney EH, Bethel JW. Stress, Depression and Coping among Latino Migrant and Seasonal Farmworkers. International journal of environmental research and public health 2003 May 3,:1815–1830.
Loganathan T, Rui D, Ng C, Pocock NS. Breaking down the barriers: Understanding migrant workers’ access to healthcare in Malaysia. PloS one 2019 Jul 3,;14(7):e0218669.
Kassim A, Zin RHM. Policy on irregular migrants in Malaysia: an analysis of its implementation and effectiveness. 2011.
Girling A, Liu J, Ward C. Confident, equal and proud: A discussion paper on the barriers Asians face to equality in New Zealand. 2010.
Hammond WP, Gillen M, Yen IH. Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees. Race Soc Probl 2010 Mar 16,;2(1):19–30.
Trade Union Congreso. Overworked, underpaid and over here. London; 2003.
OHCHR UN. The economic, social and cultural rights of migrants in an irregular situation. 2014.
Benach J, Muntaner C, Delclos C, Menéndez M, Ronquillo C. Migration and" low-skilled" workers in destination countries. PLoS Med. 2011;8(6):e1001043.
Aye L, Arokiasamy J, Barua A, Yadav H, Onunkwor O. Prevalence and Determinants of Poor Sleep Quality among Myanmar Migrant Workers in Malaysia: A Cross-sectional Study. British journal of medicine and medical research 2017 Jan 10,;19(12):1–9.
International Organization for Migration. Food Security, Nutritional Status and Household Income of Migrant Workers in Klang Valley, Malaysia. 2016.
Htay MNN, Latt SS, Maung KS, Myint WW, Moe S. Mental Well-Being and Its Associated Factors Among Myanmar Migrant Workers in Penang, Malaysia. Asia-Pacific journal of public health 2020 Sep;32(6–7):320–327.
Soe TZ, Hongsranagon P, Havanond P. Determinants and Consequences of alcohol consumption among male adult Myanmar migrant workers in Ratchaburi Province, Thailand. J Health Res. 2012;26(Special):27–32.
Lepaopao MF, Kim CH, Kim N. The Influence of Perceived Stress on the Alcohol Consumption of the Filipino Migrant Workers in South Korea. Asian Journal of Humanities and Social Studies (ISSN: 2321–2799) 2019;7(04).

No competing interests reported.

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Social determinants of health and well-being among irregular migrant workers in Malaysia: A case study of Chin people from Myanmar

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Abstract

Background

Methods

Results

Conclusions

1. Background

2. Methods

2.1 Participants' selection

2.2 Data collection

2.3 Data Analysis

2.4 Participants' characteristics

3. Results

3.1 Social determinants of health: Daily experiences in Malaysia

3.1.1 Agony and health in detention

3.1.2 Exploitation of money and personal belonging from police in an exchange of charge

3.1.3 Living with worries and insomnia

3.1.4 Language barriers and discrimination healthcare service

3.1.5 Lack of freedom to travel

3.1.6 Unable to access education for children

3.2 Social determinants of health: Working condition and exploitation

3.2.1 Language barriers

3.2.2 Exploitation from employer

3.2.3 Exploitations from a co-worker

3.2.4 Long working hours

3.2.5 Unstable meal routine

3.2.6 Precarious living condition

3.3 Social determinants of health: Coping Strategies

3.3.1 Determination to tolerant problems

3.3.2 Commitment to support the family

3.3.3 Prayer

3.3.4 Cohabitation

3.3.5 Consuming Alcohol

4. Originality

5. Discussion

5.1 Social determinant of health: daily life in the community

5.2. Social determinant of health: workplace condition and exploitation

5.2. Social determinant of health: coping behaviours

6. Practical Implications

7. Research Limitations/implications

8. Conclusion

Declarations

References

Additional Declarations

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