Building resilient and self-reliant systems for health for migrants and refugees in crisis-prone areas: lessons from the Thai-Myanmar border.

Migrants and other vulnerable populations remain insufficiently integrated into health security preparedness and universal health coverage (UHC) in the Asia-Pacific region. Following the COVID-19 pandemic, which disproportionately affected migrants and displaced populations, the Asian Network for the Inclusion and Integration of Migrants and Other Vulnerable Populations in Health Security Preparedness and Achieving UHC (ANISE) was established to address gaps in pandemic preparedness frameworks. Since then, economic and political instability has driven large-scale and increasingly protracted displacement. At the same time, collapsing humanitarian financing and declining external support have placed severe pressure on migrant health responses, highlighting the need to move beyond short-term humanitarian approaches. This paper synthesizes lessons from the Myanmar border areas in Thailand by mapping insights from a regional pre-conference workshop onto three key elements of resilient and self-reliant systems for health. These elements include community-led and locally anchored capacities, cross-sectoral and cross-border institutional arrangements, and enabling governance with sustainable resource mobilization. The analysis illustrates how community networks, multisectoral collaboration, and integrated surveillance systems have supported communicable disease prevention and service delivery in border settings. The findings also highlight persistent barriers to achieving migrant-inclusive health security and UHC, including legal status constraints among undocumented migrants from Myanmar, limited affordability among migrants with low-socio-economic statuses, weak data coordination across health and local authorities for continuity of care, workforce shortages in border settings, and reliance on external donor funding affecting self-resilience. The recent United States Agency for International Development (USAID) funding cuts have further weakened nutrition, health protection, and disease control functions. Therefore, this crisis creates a stress test for systems for health serving migrants and refugees in crisis-prone border settings. Experiences from the Myanmar border areas in Thailand demonstrate that migrant health can no longer depend on temporary humanitarian responses or external funding alone. Strengthening resilient and self-reliant systems for health requires greater local ownership, domestic resource mobilization, and institutionalized governance that integrates migrant health within broader health security and UHC agendas.