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Published on December 19, 2007

The Thai government has recognised the barriers to healthcare for migrants and adopted a comprehensive policy on migrant health, but policy implementation is slow in some provinces and the Ministry of Health should ensure it is implemented in all public health facilities.

In Phang Nga, where MSF has been working with this marginalised population for nearly three years, few have access to basic healthcare. The main barrier these people face is the complex and long registration process, which then allows them to get a health card. Without the card, they have to pay the full cost of their medical care, but most can't afford it as they have very low-paid jobs.

In order to improve migrants' access to health in all provinces, MSF strongly recommends the registration process is made simpler and cheaper, and that all migrants are eligible to a health card independently of their registration status. 

Nearly three years after the tsunami, Phang Nga province is undergoing an impressive economic recovery in tourism, agriculture and the fishery industries, towards which migrant workers have been widely contributing. Yet few can reap the benefit of their work, even in terms of basic human rights like access to health. Besides the language barrier and a general lack of knowledge regarding health issues, the constant fear of being arrested and deported also prevents migrants from seeking adequate care.

In Phang Nga, this situation has even worsened. A provincial decree introduced in June 2007 has restricted the movement of documented migrants and strengthened the implementation of the arrest and deportation policy for undocumented migrants. Migrants have to respect a curfew and the decree forbids them to own a mobile phone or gather in groups of more than five people outside their living compounds.

These measures have compounded the atmosphere of fear and mistrust between the migrants and the local Thai community. Some of our patients in need of urgent medical treatment have even refused to come to the hospital for fear of being arrested or harassed by the police or the local Thai population. As a result, migrant workers often seek medical assistance when their health problem has reached an advanced stage. TB and HIV prevalence are estimated to be higher among migrants than among Thai nationals. Vaccination coverage among migrants' children is low and the knowledge of reproductive health is limited.

Veronique Terrasse

MSF Regional Communication Officer

Bangkok

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Investors deceived by Thai government

When someone gives you something, then later takes back the gift, we call them an "Indian giver". But in business, it is fraud.

Nowhere was it disclosed when the government of Thailand sold MCOT shares to the public that state assets were involved, unlike PTT. Nor did Thailand's publicly licensed accountants disclose any state assets in any of MCOT's financial statements.

Day traders have already dumped MCOT's shares. Only long-term investors are left holding the bag.

Steven Stoffers

Bangkok

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Let's stick to the facts on the Nam Theun 2 Dam

It is a shame that Probe International has chosen to attack the Nam Theun 2 hydro project in the Laos and forget what it is all about - the Lao people. Working with the government to generate revenues, foster economic growth and put in place transparent mechanisms to manage finances is by no means simple. But Laos deserves an opportunity to improve the living standards of its people.

The Nam Theun 2 project, which will generate US$2 billion over 25 years for the Lao government to invest in poverty reduction projects, offers that opportunity. That is why the World Bank is supporting this project.

NT2 was designed to not only benefit the country but also improve the living standards of the people affected by the project. Years of consultations with affected communities helped to develop a project that is responsive to their wishes and that works to mitigate the impacts they will inevitably suffer. In this way, 6,200 villagers in the Nakai Plateau are benefiting from new and better houses, access to roads, schools in each village, water pumps, toilets, electricity - things they had never enjoyed before.  The World Bank, as well as numerous other entities, is working hard to ensure all social and environmental programmes are well implemented.

When Probe refers to the quality of agricultural land in the resettlement area, they choose to leave out the most important aspect: the Lao villagers who are being relocated chose this location above others with better soils due to cultural beliefs. While this poses additional implementation challenges, the project respected the people's preference and is working with them to develop the most efficient forms of agriculture.

Probe's misrepresentation of the Panel of Expert's report and its claims on the management of the protected area by the Watershed Management Protection Authority, are also wrong. In fact, the Nakai-Nam Theun Protected Area is one of the best-managed in the country. .

Nam Theun 2 implementation is not over. The project is progressively overcoming challenges and our work continues. Stakeholders need to recommend actions, share knowledge and provide input so NT2 can continue to be better implemented as, ultimately, it is people's lives we are seeking to improve.

Peter StephensWorld Bank Communications Adviser

Bangkok

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Benefits of Lao dams not proven and yet to be seen

Re: "Locals reap the benefits of Laos dam's construction", Letters, December 17.

The letter by Mr Bernard Tribollet, former CEO of the Nam Theun Power Company, should be regarded as a historic document. The project itself was controversial from the day it showed up on the drawing board, and will remain so in future. It was this CEO who had the chance to bring it out of controversy through determined implementation of the social and environmental programmes. To resettle people just in time before they would be drowned is hardly an achievement. Now their houses are better and access to drinking water, electricity, health services and education is better - but aren't these the normal obligation of any government?

The future livelihood of the resettled people is still not more than a promise, and for years they will depend on hand-outs. Downstream, the people affected by the construction are not so fortunate. Their income and livelihood will not be restored before the dam starts operating by the end of 2009. The slow and insufficient implementation of the compensation process is the responsibility of the Nam Theun Power Company and its CEO. He personally rejected the recommendations of experts for the modification of the downstream channel to reduce the impact on the Xe Bang Fai River ecosystem.

Whatever development programme is in place, it will not be sufficient to compensate for the future damage. The start of the dam's operation is not very far away. Let us watch the coming events very closely and then decide what legacy someone deserves.

Erhard Floether

Former PL/Downstream Manager

Nam Theun Power Company

Bangkok

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