Myanmar: Encouraging Dialogue on Rakhine, but Clinics Remain Closed

JAKARTA, INDONESIA/NEW YORK—Since Doctors Without Borders/Médecins Sans Frontières (MSF)-Holland was ordered to suspend all activities in Myanmar's Rakhine State on February 26, the organization has engaged in high-level discussions with the Union Government of Myanmar on the need to maintain essential medical services for hundreds of thousands of people in the state who are facing a medical humanitarian crisis.

MSF International President Dr. Joanne Liu arrived in Myanmar on March 16 to participate in the discussions and to visit the towns of Sittwe, Mrauk U, and Minbya in Rakhine State, along with high-level officials from the Union Government, the United Nations, and international aid organizations. Dr. Liu also met with the Minister of Home Affairs, the Minister of Health, and the Deputy Minister of Border Affairs in Naypyidaw.

"I have been encouraged by the open dialogue in the last few weeks on how MSF can work more closely with the Ministry of Health to deliver vital, lifesaving medical assistance to the people of Rakhine," Dr. Liu said. "I also had productive conversations with authorities and community leaders about working with them to improve mutual understanding and acceptance of MSF activities in the state, which remains a serious challenge."

Prior to the suspension, MSF Holland provided medical services to a population of approximately 700,000 people, including almost 200,000 displaced people in camps and isolated villages. More than 500 staff members supported the provision of health services at more than 30 sites in the state, including 24 camps for displaced people, treating anyone in need of medical care. All MSF programs are based on medical need alone and assist the most vulnerable people and hardest-to-reach communities. 

In the three weeks since the closure of MSF Holland's clinics, an estimated 25,000 consultations would have been carried out, including more than 5,300 for children under five. In addition, about 40 malnourished children would likely have been enrolled in feeding programs; MSF Holland could have facilitated 223 emergency referrals; 1,471 pregnant women could have received antenatal care; and 1,500 family planning consultations would have taken place.

During her time in Rakhine, Dr. Liu also visited several medical facilities struggling to cope with the sudden suspension of MSF Holland’s services.

"MSF Holland was the largest and widest-reaching international aid organization working in health in Rakhine, where it has been present for 20 years," Dr. Liu said. "Over 100 of our medical staff, comprising doctors, nurses, and midwives, have now left the state; our activities remain suspended; and all our clinics are closed. While the Ministry of Health has taken positive steps to try and fill the enormous gap created by the suspension, to replace a program of this size and in this context is a considerable challenge. Many medical needs remain untreated."

The ongoing high-level discussions are focused on restarting medical activities, beginning with lifesaving services such as emergency hospital referrals, and ensuring uninterrupted treatment for MSF's HIV and tuberculosis patients in Rakhine.

"Even before the suspension of MSF Holland's activities, medical services in the townships where MSF was operating were not meeting the needs of all communities," Dr. Liu said. "The scale of these needs is such that the contribution of MSF in collaboration with other actors, particularly the Ministry of Health, will be essential for the foreseeable future."

With the rainy season approaching, any reduction in health care in Rakhine is of particular concern. MSF Holland played a key role in previous responses to outbreaks of infectious diseases in the areas in which the organization worked.

"It is imperative that the next stage of discussions focuses on finalizing concrete plans to address all the medical needs of vulnerable people in Rakhine," said Dr. Liu. "We look forward to continuing a constructive dialogue with both Union and State authorities as well as with local communities, towards achieving this shared objective."

Dr. Liu left Myanmar on March 23 for Jakarta to continue her tour of the region, which includes high-level meetings with the Indonesian Government and ASEAN representatives.

MSF has been providing health care in Myanmar since 1992 to millions of people from many ethnic origins. Across Myanmar, MSF provides over 30,000 people living with HIV/AIDS with lifesaving anti-retroviral treatment and provides care to more than 3,000 tuberculosis patients. It was among the first responders to cyclones Nargis and Giri, providing medical assistance, survival items, and clean water sources for hundreds of thousands of people.