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Background: Given the urgent need for help amongst vulnerable populations throughout the coronavirus disease 2019 (COVID-19) pandemic, civil society organizations (CSOs) and members have stepped up to provide support for impacted communities. The process of responding to these urgent needs reflects the agency and resilience of civil society members in accessing or providing resources. There is still a lack of understanding of how human agency is exercised in the context of power imbalances. Such an understanding is important not only for creating an effective and inclusive aid delivery mechanisms but also improving preparedness for future public health and economic crises. Methods: This study utilizes Albert Bandura’s social cognitive theory to comprehensively map the agency landscape of aid providers and marginalized populations during the first few months of the COVID-19 pandemic in Malaysia. Assuming that these populations’ main goals are access to aid while providers’ main goals are to provide aid, this study categorizes the different modes of agency involved and highlights environmental facilitators and constraints for each of these groups in achieving their goals. Data was collected through in-depth interviews with 34 participants. Using a hermeneutic content analysis based on a sample of 824 textual excerpts from the interviews, we explore the relationship between each component of the agency landscape to understand the relationships between them. Results: We find that marginalized populations are often unable to achieve their goals despite clear intentions to survive. Additionally, we find that proxy agency is problematic for marginalized populations and characterize why this is the case. Conclusions: Finally, we present policy recommendations which prioritise marginalized populations and their needs, while removing barriers to accessing aid.

Background: Globally, vulnerable populations have been disproportionately affected by the COVID-19 pandemic and subsequent responses, such as lockdown measures and mass vaccinations. Numerous ethical challenges have arisen at different levels, be it at the policy-making level or on the ground. For example, policymakers have to contain a highly contagious disease with high morbidity using scarce resources, while minimizing the medium- to long-term social and economic impacts induced by containment measures. This study explores the impact of COVID-19 on vulnerable populations in Malaysia by using an intersectional framework that accounts for overlapping forms of marginalization. Methods: This study utilizes in-depth qualitative data obtained from 34 individuals and organizations to understand the impact of the COVID-19 outbreak on vulnerable populations in Malaysia. We utilize four principles of ethics to guide our coding and interpretation of the data – namely beneficence, non-maleficence, justice and autonomy. We utilize a frequency analysis to roughly understand the types of ethical issues that emerged. Using hermeneutic content analysis (HCA), we then explore how the principles interact with each other. Results: Through the frequently analysis, we found that although beneficence was very prevalent in our dataset, so was a significant amount of harm – as perpetuated through injustice, the removal or lack of autonomy and maleficence. We also unearthed a worrying landscape of harm and deep systemic issues associated with a lack of support for vulnerable households – further exacerbated during the pandemic. Conclusions: Policy recommendations for aid organizations and society to mitigate these ethical problems are presented, such as long overdue institutional reforms and stronger ethical practices rooted in human rights principles, which government agencies and aid providers can then use in the provision of aid to vulnerable populations.

Malaysia hosts over 175,000 refugees or asylum seekers who are registered with the United Nations High Commissioner for Refugees, over half of whom are ethnically Rohingya. Economic, social and health challenges are common among refugees residing in countries of asylum such as Malaysia with limited legal rights and uncertainty regarding the future. This study examined emotional distress among a sample of 115 Rohingya refugees living in urban areas within Malaysia. We utilised both quantitative and qualitative methods to assess psychosocial wellbeing. After measuring emotional distress with the Refugee Health Screener-15, we examined socio-demographic and environmental characteristics associated with distress scores. We then examined open-ended responses to qualitative questions regarding perceptions of difficulties refugees experience in Malaysia as well as perspectives on needed assistance. Findings indicated that emotional distress was widespread among this sample. Age was associated with higher rates of distress, while gender, time in Malaysia, employment and other measured factors were not associated with distress. Qualitative themes emphasised challenges with income, documentation and concerns regarding global conflict. Findings point to the need for services that address economic needs as well as reducing distress, in addition to policy challenges that will enable stability and security for Rohingya refugees.

Abstract Migrants and refugees face challenges accessing both healthcare and good social determinants of health in Malaysia. Participants at the “Migrant and Refugee Health in Malaysia workshop, Kuala Lumpur, 9-10 November 2017” scoped these challenges within the regional ASEAN context, identifying gaps in knowledge and practical steps forward to improve the evidence base in the Malaysia.