Health care service is not a central concern of stateless young adult participants, although the stateless status has a significant impact on their health. On the other hand, stateless young adult participants focus on maintaining the health of their parents.
The different types of identity cards are connected to different benefits. Health care services are provided to ‘those with certain types of identity papers, but not to others’ (Schearf 2011). The Thai government recognises the right to health only for stateless people who are registered in the household registration. According to a cabinet resolution dated 23 March 2010, the Thai government recognised the right to guaranteed health, but it does not cover all stateless people.
For public health, Thai citizens are eligible for the government’s THB30 health policy, stated in the National Health Security Act B.E. 2545. Aliens such as registered ethnic minorities who are holding an ID card beginning with number ‘6’, ‘7’ and ‘0’ (of ethnic minority) have the right to access public health according to cabinet resolutions in 2010 and 2015. They are treated the same as Thai citizens. Thai citizens get free public health care according to the National Health Security Act B.E. 2545, whilst registered ethnic minorities get free public health care according to the cabinet resolution (Government officer, the Ministry of Interior, Bangkok, 2016).
Ethnic minorities are allowed to access public health services because the government believes that they have already assimilated into Thai society52, and registered children in an educational institution of Thailand can access the health care service provided by the
52 The Thai government believes that registered stateless people have lived in Thailand for a
very long time. They have assimilated to Thai society, and have made many social contributions to Thailand such as paying tax. ‘Therefore, they should not be discriminated against and denied the right to health’ (Napaumporn 2014, p.147).
Thai government, whilst those with number ‘0’53 are not eligible for the government’s health insurance (Napaumporn 2014).
6.4.1. INGO-based Clinics in Refugee Camps
On the other hand, the Thai government pays no attention to health care services in the camps. Refugees living inside the temporary shelter areas cannot access hospitals outside the camp, because they must get travel approval documents from the Thai authorities, if they wish to visit the hospital. Only refugee patients, who need emergency medical attention, are allowed to leave the camps (Werret 2014, p.12).
Before INGOs were allowed to work in the camps, refugees did not receive adequate health care services. Without citizenship documents, stateless children were unable to receive the free vaccines provided by the government at public health centres. Some children suffered from malaria and were undernourished because they did not have enough food. Refugees depended for food such as rice and clean drinking water on INGO assistance and the few agricultural crops produced in the camps.They lacked access to a variety of foods and the inadequate health care service resulted in malnourished children among the refugee population (a parent of stateless youth, in-depth interview, Mae Sot, Tak province, 12 September 2014).
Establishing a health centre requires medical knowledge. To be able to access the health care service, refugees have to rely on international organisations such as UNHCR and the International Rescue Committee (IRC). They play an important role in providing medical care for refugees, undocumented migrants and their stateless offspring. For example, the IRC provides approximately 23,000 residents of Ban Kwai and Ban Mae Surin camps in Mae Hong Son province and around 8,000 refugees in the Tham Hin camp in Ratchaburi province with health care, water and sanitation services. INGO-based clinics, established in the camp, offer reproductive health service, child health care and basic health care. Refugees receive additional training as health workers. With all the INGO assistance, the health status of refugees from Myanmar in the camps has improved (INGO representative, in-depth interview, Mae Sot, Tak province, 7 September 2014).
53
Figure 6.3: UN hospital in Mae La refugee camp
Source: Photo by Ladawan Khaikham, 12 September 2014
6.4.2. Community-based Clinics outside the Camps
Stateless people and their offspring, who have ID cards beginning with number ‘0’, are not covered by the government’s health insurance, because the government has no health insurance policies for stateless people and does not facilitate stateless children accessing health insurance. Stateless youth who attend non-government schools are excluded from the civil survey. Since they are not registered in the household registration list, they are not eligible for health insurance and cannot receive the treatment provided by public hospitals or health care centres. In addition, most health centres are located in the city, whilst most stateless people live in rural areas. This makes some local stateless people unable to access the medical services.
Stateless people are left to take care of themselves. The government allows stateless people, including transnational migrant workers from neighbouring countries such as Myanmar, Laos and Cambodia, to buy their own health insurance. However, they are unable to afford the cost. Since they work in low paid jobs, health insurance is not a high priority.
On the other hand, stateless people are not very proactive in accessing health care insurance. Most young adult participants pay little attention to the health care service for themselves, but focus on their parents’ health (stateless youth, FGD, Mae Sot, Tak province, 12 September 2014). Some stateless communities also do not understand the importance of the vaccine service for infants and the appropriate medical treatment for mother and child after birth. In addition, the limitation in language skills contributes to their difficulty in accessing public hospitals.
To be able to access health care services whilst avoiding contact with Thai government authorities, most stateless people in Mae Sot district prefer the nearby pharmacy, the private medical practitioner and local clinics over the public hospital for basic treatment.
My parents do not go to the hospital. I was born at our house in the village with a local midwife. My parents took me to a clinic when I was sick. Our health problems are not serious so the nearby pharmacy is enough. We do not need to go to the hospital (stateless youth, FGD, Mae Sot, Tak province, 12 September 2014)
The migrant population also has a few of its own health centres for basic health services. Mae Tao Clinic is a good example of a migrant community-based clinic in Mae Sot, Tak province. It plays a very important role in providing health care facilities and activities. As it is run by a forcibly displaced person from Myanmar, Dr Cynthia Maung, Mae Tao Clinic has gained more trust among legal and illegal migrants, including refugees and the stateless population. Every day 400–500 people come to the clinic to receive comprehensive health care services and child protection services. In total, over 150,000 displaced persons per year are treated at Mae Tao Clinic (NGO representative, in-depth interview, Mae Sot, Tak province, 16 September 2014).