Myanmar: Access to health a worry in Rakhine State

Aid workers are concerned about access to healthcare in Myanmar's northern Rakhine State, more than a month after communal violence left over 50,000 people displaced.

"Even before the recent unrest, there was limited access to healthcare for many in Rakhine State," said Victoria Hawkins, deputy head of mission of the medical charity, Médecins sans Frontières (MSF-Holland), which has been working in the region for 18 years. "Now the situation is becoming desperate."

A 2012 report by the Arakan Project, an advocacy group that works with Rohingya, an ethnic, religious and linguistic minority numbering about 800,000 in Rakhine, noted that the health indicators were appalling.

In the administrative district of Maungdaw Township, just 30 percent of the population have access to public health services and there are only three medical doctors for a population of 430,000, while Buthidaung Township has just two doctors per 280,000 people. Almost half the population in the area have no access to clean water.

On 8 June, a wave of violence erupted in Rakhine State following the rape and murder of a young Buddhist woman in late May, allegedly by three Muslim Rohingya men. On 3 June an attack on a bus left 10 Muslims dead, and the ensuing revenge attacks left thousands of homes burned and dozens killed. A state of emergency was declared on 10 June and is still in place.

The rainy season, which lasts from mid-May to the end of October, brings seasonal illnesses, especially to the more vulnerable of the displaced people. One voluntary health worker said they had treated nearly 100 patients at the makeshift clinic in the Mingan Quarter of Sittwe, the capital of Rakhine State.

"As we are now in the rainy season, we would normally see a rise in the number of diarrhoea, respiratory infections and malaria cases. This will only be exacerbated by the conditions that are reported in some of the IDP locations," said MSF's Hawkins.

"The biggest challenge we face at present is access. The tension and insecurity [in Rakhine] means we are unable to reach many people in need of urgent healthcare," she said. "It is critical that all efforts are made to ensure that medical organizations are able to resume their activities to reach all those in need."

According to the latest information from the UN Office for the Coordination of Humanitarian Affairs (OCHA), mobile medical teams from the military, the ministry of health, the Myanmar Medical Association and the UN Population Fund (UNFPA) are providing basic healthcare services to the displaced.

Government estimates put the number of internally displaced persons (IDPs) at some 52,000, living in more than 60 locations, but international agencies estimate the actual number of people affected at 100,000. Most of the displaced are Rohingya, who have long faced persecution in Myanmar. Under Burmese law, the Rohingya are stateless and viewed as illegal Bengali immigrants.

The prevalent causes of mortality in Rakhine listed in a 2010 report by the UN Human Rights Council included malaria, diarrhoea, respiratory and skin infections, intestinal parasites and cholera, while the maternal mortality rate of 380 per 100,000 live births in the state was significantly higher than the 240 recorded in the rest of the country.

Of particular concern are people living with HIV and TB. "Disruption of access to the drugs could result in drug-resistant cases," said Thiha Kyaing, head of the Phoenix Association, a local NGO assisting HIV patients in collaboration with MSF. Any disruption in their medication could endanger their lives and the general level of health in the area.

MSF, the largest provider of life-prolonging antiretroviral (ARV) treatment in Myanmar, said it was worried that many of those in need were not able to access the drugs they needed. "The limited contact we have been able to have with our HIV patients has confirmed to us how concerned they are about disruption to their treatment," said Hawkins.

According to the Myanmar Positive Group (MPG), an HIV support network, 669 patients (320 in Sittwe and 349 in the Buthidaung and Maungdaw areas) are on a list of people needing ARV drugs from the clinics run by MSF.

The clinics were forced to shut down due to security concerns, disrupting the drug delivery system. The Phoenix Association in Sittwe and MPG have been trying to establish contact with the people on the list.

"[We have been] unable to contact 30 patients," said Min San Tun, a programme officer at MPG. "We are very worried about the health of these people."