Doctors Without Borders (MSF) recently received a written order from the Burmese government to cease all operations in the country, which led to a full closure of all Dutch MSF clinics. This act left patients confused and desperately concerned across the whole country and has human rights organizations concerned about the escalating humanitarian health crisis in Rakhine state. Ongoing conflict, forced displacement and poverty have all had an impact on the general health of people living in certain parts of Burma.
MSF has a long history of working in Burma and has focused on serving populations within the country that otherwise would not be able to access health care. This includes approximately 30,000 people living with HIV/AIDS, several thousand living with TB and members of marginalized groups such as the Rohingya.
On February 27th, the Dutch order of Doctors Without Borders (MSF) received a written order from the Burmese government the shut down all operations in the country; this led to a full closure of all Dutch MSF clinics on February 28th. After dialogue with the government in Naypyitaw on February 28th, MSF was informed by the Minister of Health and the Minister of Home Affairs that the organization could resume part of the activities including HIV/AIDS treatment and other activities in Kachin and Shan states, as well as Yangon region.
MSF says that while they ‘’are encouraged by this and will resume these activities for now’’ they remain ‘’extremely concerned about the fate of tens of thousands of vulnerable people in Rakhine state who currently face a humanitarian medical crisis.’’
MSF clinics in Rakhine remain closed since February 27th. Prior to the suspension, MSF carried out a variety of activities in nine townships across in Rakhine, treating anyone who was unable to access the medical care they required.
In June 2012, deadly communal clashes in Rakhine State triggered an official state of emergency. An estimated 75,000 people were displaced; many had their homes burned down. Further outbreaks of violence last October exacerbated the humanitarian crisis, forcing an estimated 40,000 people to flee. Many ended up living in makeshift camps lacking sufficient shelter, water, sanitation, food and health care. According to official estimates, the vast majority of those displaced are Muslim. In addition, hundreds of thousands of people who are still living in their homes have had very limited access to health care because medical services were cut off. In many areas, medical services have still not resumed.
Widney Brown, Director of Programs for Physicians for Human Rights said that ‘’The government of Burma should re-think its decision regarding MSF operations in the country, and must heed the calls for an independent investigation of the massacre that initiated this incident. The government has an obligation to ensure the right to health for all of its people. If it is unable to do so – whether because it lacks the resources or because of conflict – it must seek international assistance to meet that obligation.’’
In one of MSF’s largest programs in any country, teams have been working across Rakhine for nearly 20 years, providing primary and maternal health care and treating diseases such as malaria, HIV/AIDS and tuberculosis (TB). Since 2005, MSF has treated more than 1.2 million people from all ethnic groups in Rakhine State for malaria. Rakhine is Myanmar’s second-poorest state and has historically received less investment in health care than other areas of the country. Over the years, MSF has treated hundreds of thousands of people across the state.
Violence and displacement have worsened the harsh living conditions that many people in Rakhine were already enduring and further limited their access to health care. The stateless Rohingya lack basic rights and freedoms and are subjected to severe restrictions and abusive treatment. Their health situation has been unacceptably poor for years.
For many years, malnutrition and maternal and primary health care needs have been particularly acute in the community, while gaps in official health care services have been more pronounced in areas where Rohingya live.
During one recent camp clinic, 40 percent of the children under five years of age that MSF saw were suffering from acute diarrhea. “Our children are dying from diarrhea,” said one man in a displacement camp in Pauktaw Township. “We all have diarrhea. We need more health care. Our latrines are full. We can only dig holes up till 40 centimeters [deep] and then we hit the salty water, so what should we do? The nearest source of water where we dare to go is 40 minutes by canoe. We received since we are here [since October] one time a tank with drinking water.”
Physicians for Human Rights says that MSF’s work has been lifesaving. ”The government, in shutting down the clinics where MSF provided much-needed services, is playing roulette with the lives of individuals and with the health of the general population. Not even the former military Juntas shut down operations of international organizations in Rakhine state, despite their clear dislike of the presence of outsiders in the region,” Ms. Brown added.
She also warned that depriving people of essential medicines such as anti-retrovirals and antibiotics for tuberculosis not only places individual patients at risk of illness and death, but may contribute to the emergence of strains of HIV or TB that are resistant to the medicines – placing a much larger group of people at risk.
Critically, the loss of an international presence from humanitarian organizations such as MSF greatly increases their risk of suffering more human rights abuses.
This is not the first time MSF has had to close down one of its operations in Burma. In 2006, the French section of MSF had to close down its medical programs there — mainly focused on malaria treatment — and leave the country. By the end of 2005, the military authorities had imposed so many travel restrictions on MSF and applied such pressure on local health authorities not to cooperate with our teams that it became impossible for them to work in an acceptable manner.
“The Burmese regime wants absolute control over any humanitarian actor present in these politically-sensitive regions,” explained Dr. Hervé Isambert, program manager for the French section of MSF, at the time. “If we accept the restrictions imposed on us today, we would become nothing more than a technical service provider subject to the political priorities of the junta. It appears that the Burmese authorities do not want anyone to witness the abuses they are committing against their own population.”
MSF has been providing health care around the world and in Burma for decades, meeting the medical needs of millions of people hailing from countless ethnic origins. Across Burma, MSF provides more than 26,000 people with lifesaving anti-retroviral treatment for AIDS and was among the very first responders to cyclones Nargis and Giri, providing medical assistance, survival items, and clean water for tens of thousands of people. All MSF services are provided based on medical need only, regardless of ethnicity, religion or any other factor. MSF says that it looks forward to continuing the dialogue with the government to ensure that essential life-saving services continue to reach those that need them.