The Ongoing Humanitarian Emergency in Myanmar's Rakhine State

Eight months since deadly communal clashes first broke out in Myanmar’s Rakhine State, tens of thousands of people are still unable to access urgently needed medical care. Doctors Without Borders/Médecins Sans Frontières (MSF) calls on government authorities and community leaders to ensure that all people of Rakhine can live without fear of violence, abuse, and harassment, and that humanitarian organizations can assist those most in need.

Rakhine state in western Myanmar is home to numerous ethnic groups, including the Rakhine community and a Muslim minority often referred to by the international community as the Rohingya.

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). 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 regardless of ethnic origin or religious affiliation.

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.

Many of those who fled went to neighboring Bangladesh, where an estimated 300,000 Rohingya refugees already live. The majority of them are undocumented and live in deplorable conditions; many have struggled to survive for years. MSF provides health care outside one of the makeshift camps to unregistered refugees and to local Bangladeshis.

Others went to Thailand and Malaysia. They say their main reason for leaving was to avoid extreme violence toward them and their families. “I can swear in front of my eyes they killed a lot of people in my village . . . and I was the witness,” said one 15-year-old Rohingya refugee in Malaysia.

Violence Worsened Already Harsh Conditions

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.

Since the outbreaks of violence, health care and other forms of humanitarian assistance, including services delivered by MSF, have been very slow to resume or start up in some of the worst affected areas. Delayed permissions, ongoing insecurity, and threats and intimidation by a small but vocal group within the Rakhine community have severely impacted our ability to deliver lifesaving medical care where it is needed most.

Life in the Camps

Following the clashes and amidst deep hostility, communities that were previously living side-by-side, and sometimes intermixed, are now divided and separated. Many thousands of people—mainly from the Rohingya community—remain unable to return home and are instead living in rice fields or other crowded strips of land. MSF staff on the ground are seeing the most acute needs among these people.

Since October, MSF has conducted more than 10,000 medical consultations through mobile teams in some of these areas, but the medical needs are far from covered. While MSF is currently working in 15 of the largest camps, we do not have the capacity to establish a fixed presence in the dozens of smaller camps, where conditions are likely to be equally poor.

A big obstacle for MSF is not having enough staff. Doctors and other essential personnel are too scared to work in Rakhine State. This fear is the result of sustained intimidation and threats against MSF workers by some members of the Rakhine community. MSF is alarmed that this health gap is still not being filled by the government or other organizations. We urge the government to do more to create a safe environment for humanitarian assistance and encourage medical staff from other parts of Myanmar to help provide emergency health care in Rakhine.

Malnutrition, Chronic Coughing, and Diarrhea

Where MSF has been able to run mobile clinics, the most common diseases we see are skin infections, worms, chronic coughing, diarrhea, and respiratory tract infections. Shelters are frequently inadequate, leaving people exposed, and there are rarely enough blankets to go around. Severe malnutrition is also present, particularly among children in many of the camps.

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.”

Limited Access to Water

Lack of access to clean water is the likely cause of the high rates of diarrhea. Although there is plenty of clean water available, many of the displaced are denied access to it. “The only drinking water pond we have is the one [that] we have to share with the cattle of the nearby village,” said the man in the Pauktaw Township camp. “Five minutes from here is a pond with crystal clear water [but] we don’t dare to go.”

The vulnerability of those living in the camps is exacerbated by confinement. People are scared to leave or are at times prevented from leaving out of fear of abuse or attack by hostile groups.

Medical Referrals a Serious Challenge

Patients who are too sick or injured to treat on the spot need to be sent to hospital. The options for referring them are, however, very limited. Patients and those transporting them often face hostility and intimidation. This, compounded by major logistical challenges, means that delays can be life threatening.

“I cannot get my TB treatment anymore so I had to stop,” said a man from Kyauktaw Township. “Before the violence I went to the township hospital. Now I cannot go anymore.”

Threats and Intimidation

The horrific conditions in the camps and the severe impediments to medical referrals underscore the need for the Myanmar authorities to ensure all people living in Rakhine are protected and have access to lifesaving assistance

In pamphlets, letters, and Facebook postings, MSF and others have been repeatedly accused of a pro-Rohingya bias by a small but vocal and influential group within the Rakhine community. One community leader recently described MSF’s medical aid to displaced persons outside their village as watering a plant, a plant he does not want to see watered.

It is this intimidation, and not formal permission for access, that is the primary challenge MSF and others seeking to provide lifesaving humanitarian assistance face. The authorities can do more to make it clear that threatening violence against health workers is unacceptable.

As an impartial medical humanitarian association, MSF provides medical assistance to those in need, irrespective of ethnicity, religion, creed, or political convictions. We base our programs on independent, impartial assessments that seek to provide medical care where it is needed most.

Being impartial means providing care where it is most needed, regardless of where patients come from or what they believe in. This is how we have operated throughout Myanmar and in Rakhine State for the past 20 years, treating hundreds of thousands of people from all ethnic groups for diseases such as malaria, HIV/AIDS, and TB.

Yet despite the track record, the threats continue. The assistance that MSF and others can provide is being dangerously hampered by the hostility we face, leaving tens of thousands of people living in desperate conditions without adequate help.

We urge Myanmar’s authorities to provide greater protection to threatened groups and to help defend our commitment to bringing assistance to those in need.

MSF has been providing health care around the world and in Myanmar for decades, meeting the medical needs of millions of people hailing from countless ethnic origins. Across Myanmar, MSF provides more than 26,000 people with lifesaving antiretroviral 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. MSF has worked for the past 20 years in Rakhine State providing primary and reproductive health care as well as HIV/AIDS and TB treatment. Prior to last June, MSF had been conducting approximately 500,000 medical consultations annually. Since 2005, MSF has treated more than 1.2 million people from all ethnic groups in Rakhine State for malaria.