Challenges faced by migrant populations in complying with public health measures during the COVID-19 pandemic in Malaysia: A qualitative study.

Introduction: The COVID-19 pandemic adversely impacted migrants in Malaysia, raising concerns about the effectiveness of public health measures. This study aims to investigate challenges faced by migrant populations in complying with public health measures during the pandemic. Methods: We conducted 29 in-depth interviews with stakeholders between April 2022 and February 2023. Thematic analysis was conducted, and results were organised by major COVID-19 public health measures: (1) movement restrictions, (2) non-pharmaceutical interventions, (3) COVID-19 screening and testing and (4) quarantine, isolation and hospitalisations. Results: Migrants encountered difficulties complying with the movement control orders due to livelihood crises and a lack of understanding of regulations. Financial constraints hindered migrants' ability to purchase quality face masks, and they lacked the comprehension of the importance of non-pharmaceutical interventions for disease prevention. In the absence of government intervention, non-governmental organisations and international organisations played an important role in providing essential food aid, health information, face masks and hygiene products, and other services to migrants. Despite encouragement to seek testing and treatment, migrants were deterred by fear of immigration enforcement and unaffordable fees. Overcrowded living conditions made physical distancing, isolation and quarantine challenging. Many avoided government-designated quarantine centres due to financial constraints and fear of arrest. Delayed medical treatment may have resulted in high COVID-19 mortality among migrants. Conclusions: The COVID-19 pandemic highlighted significant health disparities experienced by migrants in Malaysia, including the double health and livelihood crises, and limited access to essential health information, resources, healthcare and social protection. Urgent reforms are needed to ensure migrant-inclusive health policies, enhance outbreak preparedness and prevent unnecessary suffering and deaths among migrants during both pandemic and non-pandemic periods.