Health workers struggle to respond amid severe restrictions in Rakhine state

A new wave of fighting has gripped Myanmar over the past two months. Médecins Sans Frontières (MSF) is providing medical humanitarian assistance in Shan, Kachin and Rakhine states, where we have witnessed healthcare facilities damaged or abandoned, and hundreds of thousands of newly displaced people attempting to flee for safety.

On 13 November the conflict reignited in Rakhine state, breaking a year-long informal ceasefire. Since then, severe movement restrictions are preventing MSF from running any of the 25 mobile clinics that deliver around 1,500 patient consultations a week.

Community health workers provide vital care

For the past nine weeks, despite our attempts to find solutions to these blockages, such as providing tele-consultations between patients and doctors, our community health workers are some of the only people with direct access to our patients.

Ann Thar Clinic in Min Bya supports over 4,000 displaced people from both Rakhine and Rohingya communities. MSF teams have been unable to run the clinic since 13 November. On 17 November, Min Bya General Hospital, a hospital that MSF uses for emergency referrals came under fire.

“My name is Aung Aung*. I am a community health worker from Ann Thar clinic. The difference here before and after the current conflict is very clear. I was able to do my work regularly and peacefully before, but after the current fighting, I can’t.

“Instead, I am constantly worrying that something might happen, feeling insecure while on the street, and so I take detours using the fields. It’s not safe anymore,” says Aung Aung.

“I’m a community health worker, so my medical skill set is limited. In situations like these, what I can do is to call the doctors and look after the patients according to their instructions. But sometimes, mobile connections are not working, so I have difficulty reaching them.

“There are patients with non-communicable diseases, such as diabetes and hypertension, too, but we don’t have medicines for them now. I’m still unsure how our team is going to arrange it. Currently, we have medicines for antenatal care and epilepsy patients,” says Aung Aung.

“Rising petrol prices are one of the major challenges we face as well. If people wanted to go to the town to pay a visit to a clinic it would cost them around 60,000Ks (around US$29) for a round trip. The town is only five miles from our village. So, the travel cost would be more expensive than their actual healthcare expenses.

This rise in cost has happened since the fighting broke out. It was only 2,000 Ks – 2,500Ks (around US$1) before. I am worried and concerned for our patients here in the village. In the future, for emergency patients, and for those who need a monthly prescription, they will face a lot of difficulties. As long as the roads are blocked and fighting continues, clinics and pharmacies in Min Bya town will remain closed.”

Violent attacks and mass displacement

Min Thu* is a community health worker in Kyein Ni Pyin camp for displaced people in the Pauktaw area of Rakhine state. Kyein Ni Pyin camp is home to over 7,500 people, most of whom are Rohingya who have been displaced since 2012.

Pauktaw has been one of the most severely impacted townships of Rakhine state, confronted by heavy attacks and mass displacement. The Pauktaw hospital was forced to close and movements in and out of Pauktaw, including to the camps, are practically impossible.

MSF and other organisations are facing serious obstacles to provide any form of assistance, and transport of patients in need of lifesaving emergency care is increasingly challenging.

“My name is Min Thu*, I am a community health worker with MSF and I provide health education for people in the camp. I help with almost everything, including translation for patients during clinic opening days. When there are emergency patients, I refer them to the clinic as well.

“We face challenges in transportation and food because of the current conflict. We do not receive rations regularly and the prices are high. We were able to move around before the fighting if we informed the authorities of our movement, but now it’s completely prohibited,” says Min Thu

“We are not able to open our clinics like we used to before, which is affecting our patients in many ways. For emergency patients, we try to contact MSF doctors on the phone to ask for advice and try following any instructions given by them. However, it is very hard when they cannot see the patients in person. The doctors just have to prescribe or advise what to do according to what they hear from the patients, and we follow the instructions over the phone from the doctors and help treat the patients.

“We fear for the future. If we are not able to open our clinics due to the travel restrictions and conflict, our patients will be severely impacted.”

The constant threat of conflict

In Rathedaung, there are many camps for displaced people close to the town, where mostly ethnic Rakhine people who have been displaced since 2019 due to past conflict are living. When recent fighting broke out in the area, the people in these camps fled into more rural areas for safety, including MSF’s community health workers.

“Currently, there is fighting near our camps. People from the camps in the city area had to evacuate to other places. There was heavy firing near our camps, so everyone had to escape and seek shelter elsewhere, including myself,” says Yan Naing*, MSF community health worker.

“It’s inconvenient and challenging for us to settle in different places because we’re constantly on the move, and scarcity of basic commodities has a negative impact on us as well. [When we are displaced] there is also no electricity, so we have to conserve our phone batteries.

“I don’t think we can go back to the city yet due to the intense clashes. People are afraid to move around because we hear rumours from other areas about civilians getting arrested or being used as human shields,” says Naing.

“Shortages in food supplies are also impacting people. My only concern right now is about health and food for the people.” – YAN NAING, MSF COMMUNITY HEALTH WORKER IN RATHEDAUNG

“We have patients with non-communicable diseases in our camps, and they are some of our regular patients. They have been coming to our clinic for a long time.

“Since there are transportation blockages, patients who need to go the clinic might not be able to do so. Shortages in food supplies are also impacting people. My only concern right now is about health and food for the people,” says Naing.

Unprecedented violence across Myanmar

The level of violence across Myanmar in the past few months is unprecedented and is severely impacting people living in and around the fighting areas where lifesaving services are either non-functional or limited and dangerous to reach.

In Rakhine state, communities are already heavily reliant on humanitarian assistance and live with imposed restrictions that limit their freedom of movement. Assistance that was permitted in the state before the conflict was lifesaving, especially for communities in many of the rural areas, which our mobile clinics were serving, and who otherwise have no other affordable options for medical care.

Access for humanitarian organisations into Rakhine state has always been meticulously controlled, but the continuation of these current blockages will have a catastrophic impact on people’s health.

Our community health workers are seeing patients lacking their regular medication, with difficulties speaking to doctors, as well as patients being blocked from accessing specialised healthcare.

According to the latest data from the Global Camp Coordination and Camp Management cluster, there have been over 120,000 newly displaced people in Rakhine since 13 November, and this number shows no sign of slowing down.

Hospitals in central Rakhine have been hit during heavy firing or abandoned by staff forced to flee the area. Two hospitals in Central Rakhine where our teams usually take emergency patients are no longer functioning, while another, Min Bya General Hospital, was damaged on 17 November.

In northern Rakhine, some emergency referrals have been possible through the support of our community health workers. Health facilities are operating, but some are functioning with only a skeleton team and limited medical supplies, or else they are shifting their resources into more remote areas to support displaced people looking for safety.

With access routes blocked and without authorisations to provide assistance, we cannot run our 25 mobile clinics. These restrictions are impacting other humanitarian organisations, too, with many reporting that they cannot deliver regular interventions.

All parties to the conflict should ensure that healthcare facilities and humanitarian workers can continue to operate and must guarantee safe access to healthcare for people in Rakhine.

*Names changed to protect identity.