THE LANDSCAPE OF SEA NOMADS IN SABAH: A NARRATIVE REVIEW ON HEALTHCARE
DOI:
https://doi.org/10.55197/qjssh.v6i5.758Keywords:
sea nomads, statelessness, healthcare access, health equality, mobile populations, narrative reviewAbstract
The sea nomads of Sabah, are stateless maritime communities whose lives remain deeply intertwined with the ocean. Despite their rich cultural heritage, they face enduring socio-legal and health inequities, mainly stemming from historical displacement, marginalisation, and the absence of official citizenship. This narrative review synthesises literature on the historical development, legal frameworks, and healthcare access challenges affecting these communities in Sabah, Malaysia. Drawing upon academic publications, government reports, and grey literature, the study employs Levesque et al.’s (2013) healthcare access framework to analyse the barriers sea nomads encounter in perceiving, seeking, reaching, affording, and engaging with healthcare services. The findings highlight that entrenched cultural beliefs, lack of legal documentation, geographical isolation, economic precarity, and language barriers collectively inhibit effective healthcare utilisation. The Malaysian legal system's rigid citizenship criteria and lack of differentiation between stateless persons and undocumented migrants further restrict access to subsidised healthcare. The consequences include low immunisation coverage, delayed treatment, and poor health outcomes, which pose broader public health risks. This review highlights the necessity for targeted policy reforms and culturally sensitive health interventions, including mobile clinics, community health worker training, and legislative updates that recognise the unique needs of stateless maritime groups. Enhancing healthcare access for sea nomads is crucial to ensuring health equity and safeguarding public health in the coastal and borderland regions of Sabah.
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