LONDON — Rights groups and aid workers are voicing concerns about Myanmar’s capacity for dealing with the impending public health crisis of COVID-19, after the country’s first death was reported last week, amid a mounting caseload.
Among those most vulnerable are the estimated 350,000 displaced nationwide by conflict and violence, in Rakhine, Chin, Shan, Kachin, and Karen states.
“The internet shutdown, designed to cover up human rights violations, will now mean more people die as they will not be able to access life-saving information.”— Mark Farmaner, director, Burma Campaign UK
“Years of conflict, neglect, and abusive policies by Myanmar’s government and military have left hundreds of thousands of displaced people sitting in the path of a public health catastrophe,” warned Human Rights Watch Asia director, Brad Adams. “The authorities need to ensure these groups have access to information, humanitarian aid, and health services, including prompt testing and isolation for those who show symptoms.”
‘A ticking time bomb’ in Rakhine
In Rakhine State, the situation is particularly grave, Amnesty International’s Myanmar researcher Laura Haigh told Devex.
With social distancing and regular hand-washing almost impossible to do in refugee camps, Devex explores how organizations are working to protect the communities from COVID-19.
“Tens of thousands of people are displaced as a result of conflict in Rakhine State, while hundreds of thousands of Rohingya are confined in camps and villages which are essentially open-air prisons,” Haigh said. “The risk of large-scale community spread of the COVID-19 virus is extremely high. The situation is a ticking time bomb.”
Added to this, the Myanmar government has imposed an internet blackout in nine townships of Rakhine, which is now the world’s longest-running shutdown. Amid a crackdown on journalists reporting on the conflict and the blackout, news of civilian casualties, deaths and property destruction is making far fewer international headlines than the peak of the Rohingya exodus.
Mark Farmaner, director of London-based lobby group Burma Campaign UK reiterated international calls for the blackout to be lifted.
“The internet shutdown, designed to cover up human rights violations, will now mean more people die as they will not be able to access life-saving information about how to avoid catching and spreading the virus,” he said.
According to figures from Malaysia-based monitoring group Arakan Information Center, March saw a stark increase in civilian casualties from crossfire, landmines, shelling, and airstrikes. In March, the group documented 42 deaths, 126 injuries, 36 arrests, and 32 disappearances. By contrast, in February it estimated 18 civilians were killed and 71 injured.
A statement issued on April 1 by an umbrella group including the Arakan Army announced the continuation of a unilateral ceasefire, however violence continues to escalate, and clashes are ongoing.
The Rakhine Ethnics Congress issued a statement noting the mass return of now-unemployed Rakhine workers, and encouraging those returnees to self-isolate and monitor possible symptoms.
One aid worker expressed horror at footage from the Thai-Myanmar border, as tens of thousands of workers flooded back into the country. While workers are being advised to isolate, extreme financial precarity likely renders such measures fanciful.
“It’s such an obvious impending disaster,” said one senior aid official, on the condition of anonymity as government officials aren’t authorized to speak on the matter. “I don’t think [the Union government] has a plan.”
Haigh said that humanitarian access remains a pressing concern.
“The Myanmar authorities have restricted humanitarian access in Rakhine State for years, imposing cumbersome and bureaucratic authorisation processes which prevent aid workers from being able to access communities in need. With armed conflict continuing to displace civilians, such restrictions were already unacceptable. In the context of a global pandemic they are unconscionable,” Haigh said.
An internal United Nations memo viewed by Devex highlighted the logistical challenges facing aid organizations, citing abductions on one key transit route and reports of vessels being shot at on the waterways in the state’s center. It also highlighted that agencies still face “a great deal of paperwork,” and difficulty in obtaining “more predictable and regular/longer-term access.”
At present, the government is still forging ahead with its IDP camp closure strategy, which has created a dilemma for aid organizations keen to retain what operational leeway they do have.
INGO sources say the same factors that have beleaguered humanitarians since 2012 continue to play out. Aid workers have to think through short-term and long-term considerations of lifesaving humanitarian principles versus supporting the government in its policies of discrimination for ensured access to continue humanitarian work, experts said.
Situation in camps
Rohingya translator Brights Islam told Devex he was concerned about what the near-future holds.
“Here in the camps, people are aware about the coronavirus because it’s spread all over the world, and there are now more than 40 cases in Myanmar. People are scared, but the bad situation is there is no preparation in the camps.”
Chief among his concerns is unaltered food distribution practices in a time where there is a high probability of community spread.
“The MOHS suggests people not to gather, but the distribution in the camps is basically gathering people,” Islam said. “To me, this is the most important thing. [COVID-19] is very easy to transmit.”
INGO sources say there are adjustments being made to standard operating procedures, in a bid to ameliorate the possibility of spread from such gatherings.
“The only information about the coronavirus is like, a few INGOs are providing pamphlets, but there are no quarantine preparations [that I’m aware of],” Islam added.
INGO sources indicated there had been plans submitted to the Rakhine State Government, which would involve commandeering community shelters for quarantine purposes — however this had yet to be formalized or actioned at the time of publication. Local media reported 50-person quarantine facilities would be established in each of the state’s 17 townships.
WASH programs in IDP camps and villages where INGOs have access are continuing as normal, with awareness campaigns stepped up. But there is a limit to what can be done given access restrictions.
“In [parts of] Kyauktaw [Township], water is being brought in in jerry cans. They’re not going to have much for handwashing, even if they had soap,” one aid worker remarked, who requested anonymity due to fear of government backlash.
Civil society groups have mobilized thousands of volunteers, reaching parts of the state that elude international groups reliant on travel authorizations. However, the conflict means civilians are at greater risk than ever before of being suspected of having ties to the Arakan Army.
Preparedness slow, no plan for eventuality
Overcrowded shelters and poor sanitation conditions mean disease spreads quickly in the camps of Rakhine. In one study, it was found that the incidence of tuberculosis in the Rohingya IDP camps was some nine times higher than in villages nearby.
The state has, in some townships, just one doctor per 83,000 people, or 0.12 per 10,000. More broadly, there are questions about how the country’s ramshackle health care system will fare as the pandemic hits in earnest.
A 2018 study found just 95 ‘level 3’ intensive care beds across 17 hospitals in Yangon, Mandalay, and Nay Pyi Taw. Level 3 intensive care refers to facilities and staffing levels that provide for patients requiring multiple organ support or mechanical ventilation.
Yangon-based Frontier magazine reported that medical and travel security advisory International SOS estimated the country had fewer than 200 ventilators.
The biggest public hospital in Rakhine is the decrepit Sittwe General Hospital, which despite some recent overhaul operates well below its goal capacity of 500 beds and suffers from staffing shortages.
In 2018, state officials said that four in every 100 patients admitted to Sittwe hospital died. For Rohingya, referral to the state hospital is preceded by often-insurmountable bureaucratic hurdles.
The U.N. is in the process of sourcing and purchasing 50,000 tests for the National Health Laboratory. One laboratory in the country has the ability to process active COVID-19 tests. Cases are being tracked on a dashboard run by the Ministry of Health and Sport.
As one aid worker pointed out, preparedness is one thing, lamenting that: “There’s no plan, nothing for when it actually hits.”
Update, April 8, 2020: This piece has been updated to clarify that 100,000 people have been displaced in Rakhine State this year.
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