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Myanmar’s post-coup healthcare breakdown

‘The public health system has practically collapsed.’

Health workers carry the body of a protester killed by security forces during anti-coup demonstrations in Yangon on 15 March, 2021. (Aung Kyaw Htet/SOPA Images/Sipa via Reuters)

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Myanmar’s public health system teeters on the brink of collapse weeks into a violent military coup, aid groups say, sparking warnings that healthcare disruptions could cascade into an even wider emergency.

The public health system has come to a near standstill following the military’s 1 February coup, which ousted Myanmar’s elected government. Security forces have responded to widespread protests with increasingly deadly force. Rights monitors say at least 286 people have been killed as of 24 March – including a seven-year-old girl reportedly shot dead in her home this week. UN rights experts say the military crackdown could amount to crimes against humanity under international law.

Many doctors and nurses at major public hospitals have joined a nationwide civil disobedience movement, which has severely constricted healthcare delivery. Soldiers have also occupied major public hospitals and attacked healthcare workers, including emergency responders trying to help injured protesters. Movement restrictions and fear of violence also prevent many civilians from reaching emergency clinics or hospitals that are still running.

Nearly all COVID-19 testing and treatment has stopped, the UN says, and it’s unclear how coronavirus vaccine rollouts, started just before the February coup, will continue. 

“We’re really very worried about an impending humanitarian crisis. The public health system has practically collapsed,” Andrew Kirkwood, the senior UN official in Myanmar, said during a 19 March briefing. “The security forces have occupied 36 hospitals around the country and, in some cases, patients have been evicted from these hospitals.”

The impacts cut across the entire public system, from lifesaving emergency care and reproductive health, to medicine imports and treatment for what should otherwise be manageable diseases.  

“It means there’s a lot of people whose lives are at risk.”

Some health services are still working: Doctors are volunteering emergency services, some clinics or hospitals are open, and community groups have stepped in to fill gaps in HIV treatment, for example. But any public health system relies on a complex network of patient referrals and supply pipelines, and these have largely broken down as services get disrupted or blocked, aid groups say.

Myanmar’s national programmes for HIV/AIDS and tuberculosis have “shut down”, according to Médecins Sans Frontières, which previously worked with the Ministry of Health and Sports on HIV and TB.

“That’s raising really big flags for us about the hundreds of thousands of patients on anti-retrovirals for HIV,” Pavlo Kolovos, MSF’s outgoing head of mission in Myanmar, told The New Humanitarian. “It means there’s a lot of people whose lives are at risk.”

In recent weeks, the impacts on the public health system have spread to conflict-hit states like Rakhine, Shan, and Kachin – home to hundreds of thousands of people frequently displaced by the country’s myriad conflicts and largely dependent on humanitarian aid from local or international groups. 

Doctors at several hospitals in central and northern Rakhine State have left, local media outlet Development Media Group reported. Surgeries in the state capital’s Sittwe Hospital have also been cancelled, patients said.

While many humanitarian groups working in these areas provide basic healthcare through mobile clinics, serious cases such as pregnancy complications or major surgery are often referred to the health system; those referral routes are shrinking rapidly.

“It means that the limited hospitals that were there – that we did rely on for referrals and surgical capacity that we weren’t able to provide – that’s disappearing,” Kolovos said.

Another aid agency, the International Rescue Committee, said it is referring serious cases from its mobile clinics to the private health system, bypassing public shutdowns. 

“We have continued or established new relations to the private health system,” said Sanna Johnson, the IRC’s regional director in Asia, adding that the majority of the group’s referrals already went through private health providers rather than the national system.

Health shutdowns: An ‘ethical challenge’

The health system’s collapse mirrors broader shutdowns across Myanmar’s economy. The banking sector is virtually frozen, making it difficult or impossible to transfer money, pay wages, or send humanitarian cash aid. Food and fuel prices are soaring and the transportation sector has also slowed, sparking warnings of shortages and “panic buying” as cash dwindles in the coming weeks. 

Doctors and nurses were some of the first public workers to join the country’s civil disobedience movement in the coup’s early days. In a letter published in The Lancet on 19 February, prominent physicians acknowledged walkouts would close public hospitals and trigger a “crisis” for the health system.

“Limiting access to lifesaving interventions” is a “complex ethical challenge”, they wrote: “Our duty as doctors is to prioritise care for our patients – but how can we do this under an unlawful, undemocratic, and oppressive military system?” 

Some medical officers at the state and township levels, as well as government staff in key departments – including the health ministry and the Ministry of Social Welfare, Relief, and Resettlement, which oversees relations with many international humanitarian agencies – have also left their posts, several aid officials told TNH.

READ MORE: Coup dilemmas in the aid world

Aid groups also face their own dilemmas about how to operate – and how much to speak out – as the coup’s fallout evolves.

Aid workers at several international NGOs have told TNH there have been internal discussions about how to deal with government counterparts, and debates over how continuing operations would be perceived by the broader public and people in the civil disobedience movement, which has demanded that the international community cut ties with Myanmar’s military.

Generally, humanitarian agencies in particular have tried to maintain existing programmes while keeping contact with authorities minimal – submitting travel authorisation requests to lower-level officials, for example.

“We’ve had very little contact with them,” said Kirkwood. “It’s been kept to the absolute minimum in order to continue our humanitarian assistance.” 

But local civil society groups face pressure from authorities, and these groups often deliver aid and work closely with international humanitarian agencies. Aid workers not quoted in this story told TNH there have been heated internal discussions in some agencies about how to support their local counterparts, and not risk being seen as tacitly supporting the military.

Several Western governments have imposed sanctions and reviewed their aid programmes. This generally hasn’t hit humanitarian aid so far, aid workers said. But many development projects that were paired with government ministries have been suspended – including some health programmes.

For example, Johnson said some of the IRC’s work on strengthening the national health system has now stopped.

“The work we have done with the national health system has been put on hold because of donor expectations,” she said.

The repercussions are emerging throughout an already fragile health system.

Daw Khin Mar Win, chairperson of the Myanmar Positive Group, a national network for people living with HIV, said it has become harder to obtain anti-retroviral drugs.

“Due to the current political situation and its consequences, the regular flow of HIV services across the country is affected, starting with the importation of health products and the supply chain to some outreach services,” she said in an email to TNH.

For the moment, treatment, healthcare, and prevention services are still available through civil society organisations, community networks, and the private health sector, she said, but the group worries about further disruptions.

“Our duty as doctors is to prioritise care for our patients – but how can we do this under an unlawful, undemocratic, and oppressive military system?”

“The longer and more serious the conflict becomes, the more there will be more consequences on the lives of people,” she said.

MSF provides HIV treatment as part of its work. But Kolovos said new patients previously transferred to the government’s shuttered National AIDS Programme are now returning. There are enough supplies of anti-retroviral drugs at the moment, he said. But he worries the impacts will build if stocks are exhausted and drug imports can’t get in the country, if treatment referrals and care continue to be interrupted, and if the national system is incapable of organising it all.

“The spread of drug-resistant tuberculosis is a big concern. If people aren’t able to manage their viral load with HIV by taking those drugs, the risk of an increase in the number of new positive cases is very real,” he said. “So it’s just a cascade of failures that could result in a pretty big disaster for the progress that’s been made.”

The public healthcare system, Kolovos said, must be “de-politicised”.

“Doctors need to be able to come to work and be safe there and not be intimidated,” he said. “Patients need to be able to get to facilities safely and unimpeded. Drugs need to be able to come into the country. Humanitarian aid workers and medical aid workers need to be able to move freely.”

Before the coup, nearly one million people across Myanmar depended on humanitarian aid, including more than 330,000 displaced by conflict.

Aid groups fear the coup could add to this. Already, 100,000 migrant workers returned home this month fleeing escalating military crackdowns in Yangon, the country’s commercial heart, according to the UN; many don’t have food or water.

“We’re worried about a big increase in the people who need humanitarian assistance, particularly because of the complete breakdown of the public health system,” said Kirkwood, the UN official in Myanmar.

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