Penang Malaysia, By Zach Hope South-East Asia correspondent, SMH

Someone is violently dry-heaving in the waiting room outside our meeting space. Khairul, though, doesn’t bat an eyelid, so I pretend not to notice and carry on with another question.

Is it possible, I ask, to go back to the refugee camp and see your parents?

“By the grace of Allah, I survived the boat journey here. It was my luck,” he says. “That cannot be my luck if I am going back.”

We’re speaking in Penang, Malaysia, in what used to be a warehouse or offices. A few years back, Medecins sans frontieres (MSF) turned it into a free health clinic for innumerable Rohingyas, a persecuted Muslim minority from western Myanmar. Some were smuggled directly from their scorched homelands. Others, including Khairul, came from dire conditions at teeming refugee camps in Bangladesh. Close to 900 Rohingya refugees died at sea last year.

Khairul was 14 when he left the camp where he was born, crowding “shoulder to shoulder” on a boat with 250 others. He was fed only one meal and 2½ glasses of water for each of the 19 days he sobbed at sea.

After reaching land, the smugglers took him and the others deep into the jungles of southern Thailand, where he says a man dropped dead in front of him – he presumes from exhaustion, thirst or starvation.

Only when his parents scrounged and borrowed for his “ransom” did the smugglers let Khairul cross the border to Malaysia, he says.

He has not seen his parents since.

Since a military coup in 2021, Myanmar has again been mired in a multifront civil war. Some of the fiercest fighting between the ruling military and ethnic rebels has been in the Rohingyas’ home state of Rakhine, where they have lived for generations.

The military has long wanted to eradicate the Rohingyas, claiming they are interlopers from Bangladesh. Some 750,000 fled to the refugee camps in that country when the killings and village-burning started in earnest in 2017. Other nations don’t want them.

Now 27, Khairul works for MSF helping his people get the essential medical treatment effectively denied to them elsewhere in Malaysia.

As with Indonesia, the other main destination for fleeing Rohingyas, the Malaysian government has not signed up to the United Nations 1951 Refugee Convention. It tolerates their presence while denying them meaningful support, status or rights.

Malaysia alone has about 130,000 Rohingyas registered with the United Nations Refugee Agency (UNHCR). Many, perhaps tens of thousands more, are not registered because of backlogs at the UNHCR and difficulties getting to its only office in Kuala Lumpur.

Even when registered, they are not legally allowed to work. Nor are they charged the same rates as locals for medical care.

Since US foreign aid cuts killed other services, the privately funded MSF clinic in Penang is now so overwhelmed, the small medical team has to turn people away.

Khairul, acting as my interpreter, asks the dozen or so women in one of the waiting rooms if any of them wishes to speak to an Australian journalist. A smattering of hands rise from black Islamic shawls.

One belongs to 23-year-old Minara. She has come to the clinic with her two children, aged five and three.

The children are Malaysian-born, but will never be citizens. Unless the family gets resettled in another country – which will take unknowable years, if it happens at all – the kids will have to work off-the-books like their father. He makes the equivalent of about $1000 a month at construction sites at the best of times, nowhere near enough to afford hospital fees.

Minara came by boat to Thailand from Myanmar in 2020 and then overland to Malaysia. At that time, it was a new route, she says. She and her travelling companion, a sister-in-law, each paid smugglers from the Arakan Army – an armed ethnic group fighting the military and also tormenting the Rohingyas – close to $8000 borrowed and saved by their families.

Her parents remain in Rakhine, moving from village to village to escape the fighting,

Last year, Minara and her husband had a third child, who was born with a heart problem. They went more than $10,000 into debt with the hospital to keep the baby in special care for 1½ months, but couldn’t afford the necessary surgery.

“The doctor said, ‘If you want to bring your baby home, you can, but if he passes away that’s not our responsibility’,” she says. “Because of our financial situation, we had to bring our baby home.”

He died three months later.