1. 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

2. 1H2015: 31,000 departures (↑34%) 2H2015: 1,600 departures (↓96%) Deaths: ~370 (1.1%)

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

5. * Hasan

6. Malnourished – many severely, requiring immediate admission to intensive care units. More than just thiamine deficiency- folate and B12 deficiency Injuries – from assault /torture

7. 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

8. Prognosis Outlook is good if detected and treated early. Nerve and heart damage from beriberi 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)

9. Treatment Balanced diet and water Avoid high carbohydrate diet on arrival Therapeutic doses of vit B1 –Thiamine 100 mg daily –B12 ( 500 mcg ) 3x /day –Folate 5 mg /day Distribution of B1 to communities and detention centres Inform health authorities

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

11. 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

12. Lessons Learnt

13. 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

14. 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

15. 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

16. 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