ResourcesResearch Brief

Violence Against or Obstruction of Health Care in Myanmar

February-September 2021

This research brief was prepared from information complied by Insecurity Insight, Physicians for Human Rights, and the Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health based on open source data. This is an update to the original data published on April 20, 2021, that can be accessed here.


On February 1, 2021, the Myanmar armed forces (known as the Tatmadaw) seized control of the country, following a general election that the National League for Democracy party won by a landslide. The military-run State Administrative Council (SAC) has targeted doctors and other health workers for taking a leading role in the nationwide Civil Disobedience Movement (CDM).

Doctors and nurses have been served with warrants and arrested, health workers have been injured while providing care to protestors, ambulances have been destroyed, and health facilities have been raided. Now, nine months into the coup, the emergency in Myanmar has evolved into a protracted crisis; the violence against health care workers continues as part of the military’s offensive against anti-coup movements, and civilians’ access to health care is becoming increasingly compromised.

This document is the result of collaboration between Insecurity Insight, Physicians for Human Rights, and the Johns Hopkins Center for Public Health and Human Rights as part of the Safeguarding Health in Conflict Coalition (SHCC).

It discusses reported incidents of violence against health workers, facilities, and transport in Myanmar between February 1 and September 30, 2021 to highlight the impact on the health system as a whole. It further includes personal testimonies by nurses on how the conflict is impacting them and analysis on the security situation for aid organizations working there. It does not include information on violence against patients.

The incidents referred to are based on the dataset 01 February – 30 September 2021 Violence Against Health Care in Myanmar Data, which is available on the Humanitarian Data Exchange (HDX).

The incidents here highlight concerns over:

  • Access to health care is being severely impacted as part of the Myanmar military’s blanket offensive against the anti-coup movement.
  • Health workers are targeted: they are intimidated, arrested, and prevented from caring for those injured in the course of political violence and the growing conflict.
  • There are widespread interruptions to health care training.
  • Health supplies are confiscated, critically affecting COVID-19 treatment and oxygen supplies during the third wave (which spiked between June and August 2021).
  • Transport routes are blocked and aid agencies are prevented from reaching people in need.
  • Health workers across Myanmar face a series of restrictions.
  • Patients are blocked from accessing health care.
  • State and non-state actors continue to use explosive weapons at or near health care facilities.
  • Professional health care standards are at risk.
  • Threats and violence from state and non-state actors have made health workers fearful of providing care.
  • Health workers are forced to provide care clandestinely and in conditions inadequate for medical care, such as makeshift clinics in harsh jungle settings, underground facilities that are subject to frequent raids by security forces, and curfews imposed through martial law that prevent critical in-patient care and follow up.
  • Medical shortages, power outages, and intentional destruction and disabling of general infrastructure jeopardize the proper operation of health facilities and put patients’ lives at risk.

Notable Developments Since Last Report

Health facilities are used to arrest civilians suspected of participating in the anti-junta movement

On August 4, an elderly pro-democracy activist was arrested by SAC forces at a COVID-19 vaccination center. He reportedly received a call that he was eligible for the vaccine, and was instructed to travel to the vaccination center. On arrival, he was charged with violation of Penal Code 505(a) (see below) and remains detained in Yangon.

Health care is denied to health workers and people in detention

On August 8, a well-respected surgeon and lecturer from the Mandalay University of Medicine died from COVID-19 after timely medical care was withheld from him for more than two weeks. He was detained by junta forces for his affiliation with the Civil Disobedience Movement and was held in an interrogation center, where he contracted the virus.

Health workers are targeted for providing care

Many health workers and volunteers who provided medical care to those injured during protests have been arrested or have been issued with arrest warrants. As many as 400 doctors and 180 nurses have been issued arrest warrants. Some of those arrested have been coerced into confessing to falsified charges, such as possession of weapons or links to anti-junta terrorism.

  • On August 19, a volunteer providing free oxygen concentrators to COVID-19 patients was arrested at her home in Yangon by 20 armed security forces. She was accused of terrorism and had her phones and laptops confiscated.
  • On September 25, a doctor and nurse in Yangon were dragged from their apartments in the middle of the night by armed SAC forces and were tortured and killed. Both health workers had volunteered to treat COVID-19 patients and were involved in the CDM. The military has portrayed the incident as a firefight between SAC and the People’s Defence Force. However, footage of the incident captured by a bystander is inconsistent with this story.

Widespread interruptions to health care training

The February 2021 coup ended the previous government’s drive to improve the professional skills of nurses. In 2018, the Ministry of Health and Sports started a program to train more nurses and annual intakes into nursing courses doubled. Nurses with basic qualifications were offered additional courses to expand their professional education. Following the coup, nursing courses were shut down. Arrest warrants were issued against many who worked to improve professional standards for nurses.

Similar interruptions have been seen across the medical and public health higher education sector, as the junta seeks to prosecute prominent heads of many health departments across the country. Notable figures include Dr. Zaw Wai Soe, rector of the University of Medicine 1, Yangon; the minister of health for the junta-opposing National Unity Government; Dr. Maw Maw Oo, professor and head of emergency medicine at the University of Medicine 1, Yangon; and Dr. Thet Htay of the University of Medicine, Mandalay, who had been training medical students whose programs had been interrupted due to the coup.

The COVID-19 response was affected

  • On August 26, an NGO volunteer with a COVID-19 relief organization was arrested by SAC forces while retrieving oxygen for COVID-19 patients in Sagaing region. He was beaten during his arrest.
  • On September 8, two NGO ambulances were confiscated and four aid workers arrested by SAC forces during a raid on the organization’s office in Yangon. The organization is involved in distributing face masks and disinfectants and transporting patients with COVID-19.
  • At least 43 in-country pharmaceutical warehouses were closed, per SAC directives. In response, wealthy citizens hoarded the immunosuppressive Tocilizumab and antiviral Remdesivir medications, resulting in egregious price hikes, exacerbating inequities in access, and giving rise to a black market for COVID-19 drugs and vaccines as ordinary citizens struggled to procure them.
  • Unethical conduct was reported in the junta’s COVID-19 vaccine distribution campaigns. Members of the military who were due to receive approved, licensed vaccines were reportedly enrolled in Phase 3 trials of the Covaxin vaccine without their prior consent/knowledge.

Transport routes are blocked and aid agencies are prevented from reaching people in need

  • Relief agencies have reportedly been unable to access camps for people internally displaced (IDPs) by the conflict since the third COVID-19 wave in Myanmar.
  • The UNHCR was blocked in Mindat (Chin State).
  • Similar obstructions were reported in IDP camps and other makeshift shelters across the country, including Kachin, Karen, Kayah, and Rakhine states, and Magway, Sagaing, and Tanintharyi regions.

Health workers across Myanmar face a series of restrictions

  • On August 2, it was reported that the military General Administration Department ordered village leaders in Hpa-An township, Karen state, to record the names of all health personnel within their areas. All physicians were restricted from leaving their township without the permission of the administration.
  • On September 6, the junta discharged 234 staff from its reinstated Ministry of Health who were jointly employed by UN and INGOs on national public health projects. Reasons for dismissal included failure and refusal to report for duty, and working from home.
  • Health workers frequently report that, following heavy clashes along the border areas, police carry out next-day searches for those who care for the wounded.

Patients are blocked from accessing health care

  • On August 14, a military road blockade prevented patients at the Paletwa Township People’s Hospital in Chin from travelling to receive specialist care.
  • Displaced pregnant women at the Pi Pin Yin and Sin Baw Kaing IDP camps in Rakhine state have been unable to receive basic obstetric health care since June. Similar accounts have been reported by civilians and attending medical personnel serving IDPs in Chin, Karen, Kayah, and Shan states.

State and non-state actors continue to use explosive weapons at or near health facilities

  • On August 8, the Myanmar military fired shells near a COVID-19 clinic in Kachin state, disrupting treatment.
  • On September 22, a car bomb exploded outside the Public Hospital in Mandalay region, killing one person and injuring two others. SAC forces have reportedly occupied the hospital for several months.

Analysis

  • Through persistent attacks on health workers, the junta has weakened access to medical care in Myanmar. The health sector is unable to adequately provide care to civilians seeking medical attention, and, conversely, civilians are often restricted to junta-run care facilities which they strongly mistrust.
  • With medical supplies now scarce as a third wave of COVID-19 hits, the junta is denying or obstructing medical care to civilians, diverting it to military personnel instead. This reinforces to the civilian population that the military will focus support on those who are allied with it rather than those who oppose it, and contributes to community fear-mongering that the junta is actively weaponizing COVID-19 to destroy the opposition.
  • The NUG’s September 7 call for a “people’s defensive war” has led to an increase in fighting in the borderlands, so aid organizations and health care providers – seen as siding with the NUG and other opposition groups – are likely to continue being targeted by the military’s ongoing violence to quell the protests, with further arrests and attacks of health care workers highly likely.

Recommendations

Over the past five years, members of the international community have made many commitments to carrying out the requirements of UN Security Council Resolution 2286, which was adopted in May 2016 and strongly condemns attacks on medical personnel in conflict situations. Many states have formally reiterated their commitments, including in the July 2019 Call for Action to strengthen respect for international humanitarian law and principled humanitarian action, which was signed by more than 40 states.

Further, as the conflict evolves into a protracted crisis amidst the ongoing COVID-19 pandemic, government leaders and humanitarian responders have called for a “COVID ceasefire” in the name of regional and global health security. We join the UN Special Rapporteur on the situation of human rights in Myanmar in calling on the UN Security Council and all member states to invoke Resolution 2565, which demands that “all parties to armed conflicts engage immediately in a durable, extensive, and sustained humanitarian pause to facilitate the equitable, safe and unhindered delivery and distribution of COVID-19 vaccinations in areas of armed conflict.”

All UN member states should:

  • adhere to the provisions of international humanitarian and human rights law regarding respect for and the protection of health services and the wounded and sick, and regarding the ability of health workers to adhere to their ethical responsibilities of providing impartial care to all in need;
  • ensure the full implementation of Security Council Resolution 2286 and adopt measures to enhance the protection of and access to health care in situations of armed conflict, as set out in the Secretary-General’s recommendations to the Security Council in 2016;
  • strengthen national mechanisms for thorough, impartial, and independent investigations into alleged violations of obligations to respect and protect health care in situations of armed conflict and for the prosecution of the alleged perpetrators of such violations; and
  • facilitate the unhindered delivery and distribution of COVID-19 vaccinations, medication, and supplies in areas of armed conflict, as called for in UN Security Council Resolution 2565.

Non-state actors should:

  • adhere to the provisions of international humanitarian and human rights law regarding respect for and the protection of health services and the wounded and sick, and regarding the ability of health workers to adhere to their ethical responsibilities of providing impartial care to all in need; and
  • sign the Deed of Commitment on protecting health care in armed conflict and ensure compliance with its principles.