'Killed by the situation': a qualitative study of structural violence and Rohingya healthcare access in Malaysia

Many Rohingya in Myanmar fled targeted violence to Malaysia, where ∼120 000 now live. They lack legal status and access to education, formal employment, and affordable healthcare. We aimed to explore Rohingya perspectives and the lived experiences of their socio-legal environment and how this impacted their access to healthcare, to better understand the root causes of poor health outcomes and inform refugee health policies and interventions.

This qualitative study used a structural violence lens and included 49 semi-structured interviews with purposively sampled Rohingya men and women in Malaysia. We used abductive thematic analysis, including inductive and deductive coding.

We generated four themes: (i) national policies; (ii) societal discrimination and identity obligations; (iii) humanitarian aid provision; and (iv) healthcare access. The first two included the socio-political barriers that the Rohingya experienced in accessing livelihoods, education, and healthcare, with women experiencing compounded oppression due to structural and community norms limiting their capabilities. The third highlighted inequitable aid-refugee power relations driven by unregulated and marketized responses. The fourth examined healthcare access outcomes.

Structural factors impacted healthcare access for the Rohingya, significantly limiting their ability to achieve good health in Malaysia. Efforts to promote inclusivity require a paradigm shift from conventional to social justice-driven approaches, with regular monitoring and reconfiguration of activities to ensure effectiveness.