By Antje Missbach | Issue 26
In early 2024, the United Nations High Commissioner for Refugees (UNHCR) in Jakarta, Indonesia, proudly proclaimed that as of December 2023, 9,380 refugees had received the first dose of the Covid-19 vaccine while 8,163 of them had been fully vaccinated (68.2% of the total population of refugees eligible for vaccination). To make this happen many bureaucratic hurdles had to be overcome, sometimes requiring creative solutions, as refugees needed to be registered under a national system. Given the vaccination programme’s relative success, is there a chance to include refugees in Indonesia’s wider public health system?
With less than 14,000 people of concern officially registered with the UNHCR, the refugee population in Indonesia – home to more than 260 million people – is relatively small, both in absolute and relative terms. Thailand and Malaysia, Indonesia’s nearest neighbours, host ten times more refugees.
Most refugees in Indonesia are indeed registered with the UNHCR in Jakarta, because registration offers many incentives compared to remaining undocumented. An identity card issued by the UNHCR provides its holders with minimum protection measures, and for those considered most vulnerable, it may also offer some minimal financial support. Despite the long waiting times for resettlement, often five years or more, resettlements from Indonesia to third-countries nonetheless proceed faster than elsewhere. More importantly, compared to Malaysia and Thailand, Indonesia fares better regarding its overall treatment of refugees. Immigration detention was abolished in 2018 in favour of accommodation in community shelters that are financed by the International Organisation for Migration (IOM).
However, despite these achievements, Indonesia is not a signatory to the 1951 Refugee Convention and does not offer durable solutions for refugees. Most importantly, local integration is out of the question, at least in official terms. Unofficially, the long duration of stay of refugees in Indonesia has nurtured a de facto integration in social and economic terms. Even before the pandemic hit, some refugees set up refugee schools with the help of international funders in order to educate their children. Meanwhile, other refugee parents were able to send their children to local schools, this informal practice was eventually regularised in 2019.
Access to healthcare is a fundamental issue for refugees. Particularly during the pandemic, refugees in Indonesia suffered from their social marginalisation and blocked pathways to care. Unlike the regulations to education, which was eased by the fact that Indonesia has ratified the International Convention on the Right of Child, considerations to allow refugees to access Indonesia’s public health care system were minimal.
Healthcare in Indonesia was once highly fragmented by class status, with those who could afford accessing private health insurance, and those who could not. In 2014, Indonesia launched its national health insurance scheme (Jaminan Kesehatan Nasional, JKN). Eligibility to this scheme depends on citizenship and indirectly on employment rights, both of which refugees are excluded from. While access to education was deemed plausible amongst Indonesian policy-makers, access to labour market and healthcare rights is highly protected due to the high implied costs.
Ever since refugees started transiting through Indonesia in the late 1990s, the provisions for their healthcare had been outsourced. Those refugees under the care of the IOM had access to Indonesian clinics, with the IOM usually covering the expenses for their treatment. In some cases, they had to advance payments and wait for reimbursements. Some international non-governmental organisations (NGOs) in charge of refugees in Indonesia had funds for emergency treatments. Since 2018, however, the proportion of refugees under the care of the IOM has shrunk due to funding shortages. Refugees who arrived in Indonesia after that point are excluded from living in IOM-sponsored community shelters; they also do not receive the monthly subsistence payments and healthcare coverage that many refugees before them could count on.
When the COVID-19 pandemic hit Indonesia in early March 2020, the shortages in the national health system became visible immediately. Affluent citizens received better treatment and care than the poor, racialised, and religious minorities. Refugees were even more marginalised and received limited care and guidance. In light of the enormous costs of masks, ventilators, and other equipment, the IOM in its health campaigns targeted at refugees concentrated mainly on prevention by communicating risks, raising awareness, encouraging social distancing and isolation as well as improving hygiene measures. This could only slow down but not prevent the spread of the virus amongst refugees.
As the pandemic progressed, refugees experienced deeper health precarity due to the processes surrounding vaccination access. By the end of March 2020, the Indonesian government introduced a digital COVID-19 contact-tracing app “Peduli Lindungi”. Through this app users could register for vaccinations and vaccinated users had access to public facilities and mass transport. To schedule an appointment for vaccination, people had to upload a 16-digit government-issued civil registry number, which only citizens, permanent residents, and foreigners with work visas possess. Refugees did not have access to this government issued number and hence could not register for vaccinations.
Despite this, the Indonesian Ministry of Health opted for a comprehensive commitment to addressing the pandemic throughout Indonesia which required the COVID-19 services to be made accessible and available to all foreign nationals, independent of their social and legal migration status. A Circular Note, issued by the Government of Indonesia on 10 June 2020, ensured access for registered refugees (UNHCR ID card holders) to COVID-19 related services. Even though the service delivery was not as efficient as hoped, from September 2021 onwards, refugees too could get vaccinated by private providers without paying from their own pockets.
However, those who received their vaccinations at local health clinics under the public vaccination plan did not receive an electronic vaccine certificate but only a handwritten slip that they could upload to the Peduli Lindungi app. Access to public space was therefore out of question. Eventually the UNHCR, with the support of an Indonesian state-owned pharmaceutical company Bio Farma, developed a system to generate a different registration number to allow refugees to register in the app and thereby reclaim some basic mobility rights.
What might appear somehow banal gave hope to subsequent forms of inclusion of refugees in Indonesia. The UNHCR kept demanding that refugees be entitled to universal health coverage in Indonesia. Unfortunately, nothing much has happened in this regard. To date, all registered refugees have access to only low-cost primary healthcare at local Community Health Center (PUSKESMAS) and for which they have to pay themselves. More expensive treatments need to be requested from UNHCR, but only every second request is granted. Realistically, in order to be able to pay the monthly premiums, refugees in Indonesia require the right to work and make an income.
In light of the upcoming new presidency of Prabowo Subianto, a former military general who during his election campaign played the nationalist card by speaking out against helping refugees coming to Indonesia, better health and work rights for refugees in Indonesia may remain wishful thinking. The tiny window of opportunity for better health care inclusion, which opened up during the COVID-19 pandemic, might have been missed.
Antje Missbach
Antje is Professor of Sociology at Bielefeld University. She is interested in border and migration studies in the Asia Pacific, mainly Southeast Asia. Her latest book was on The Criminalisation of People Smuggling in Indonesia-Australia (2022).
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