Health care in protracted crises – reflections from Myanmar

“Is it better?”

“It’s different”

While setting off on a 3-day trip of getting eaten by leeches and being run down by cattle, I am curious to gain an insight into the life of my hiking guide who originates from one of the mountain villages of the Shan state in Myanmar. Everyone I have met here, whether local or not, describes the changing face of the country with the development of city nightlife, being able to own phones and use social media, and increased access to the rest of the world they live in. Experiencing life here during such a dynamic time makes it hard to obtain an accurate perspective of life in Myanmar, specifically healthcare.

As with many low-income countries, Myanmar’s healthcare provisions are limited by infrastructure, money, and accessibility. It has the lowest life expectancy figures in South East Asia at 65 for males and 68 for females. Contributing to this is the fact that Myanmar had been caught in the grips the world’s longest running civil war. Predominantly fuelled by the agendas of the differing cultural groups that reside within Myanmar, it officially ended in 2011 when a civilian government took over from military rule. Although a nationwide ceasefire agreement was drawn up to unite the country with 15 insurgent groups in 2015, only 8 of these signed and the burgeoning tensions continue to erupt into violence and displacement.

There are wide disparities in health between the seven states of Myanmar. From my guide’s village, it would be a 2-hour motorbike journey to get to any sort of preliminary medical assessment and barriers to healthcare in rural areas continue to be remote location, low socioeconomic development and conflicts. This inequality is reflected in life expectancy which is a difference of up to 11 years between regions and in the Eastern mountainous communities where tuberculosis and malaria are prevalent, infant mortality is reported to be 94.2 per 1000 births.

There are no recent published figures but the WHO state that only 2.3% of government expenditure is allocated to healthcare with unequal distribution favouring areas with better health statistics while states with high health demands are not getting attention. The health providers are a mixed bag- free clinics provided by numerous NGOs are scattered amongst government lead, fee paying hospitals and there has been a recent introduction of health insurance policies but the uptake of these is not known.

Developments have been made in that over the last few years the under 5 mortality risk has reduced, there is improved coverage of measles vaccination programmes and improved survival of malaria. It is likely that this is not a true representation of the country, but it shows that there are positive processes in place that can potentially be rolled out to all regions.

Most recently fresh violence broke out following a coordinated attack by Rohingya militants on police posts on 25th August 2017. There have been horrific reports of systematic killing of civilians, use and threats of mass rape to intimidate and evict, and aerial images of burning villages. The UN refugee agency reports that 313,000 Rohingya have fled across the borders into Bangladesh since fresh violence erupted on 25th August 2017 and that 11,000 Myanmar people belonging to other tribes have also been evacuated from the area. This population have been stripped off their most basic needs- including protection, shelter, food and clean water. The follow-on impact on mental health, physical health and social structures are almost overwhelmingly inconceivable. Sexually transmitted diseases, waterborne diseases, unwanted pregnancies and complications from childbirth are issues common in all situations of displaced communities. And the immense psychological trauma that has the immediate effect of reducing natural resilience against disease, will also have a butterfly effect on the community for generations to come.

The current climate within the country is one of dissociation. Watching a trail of monks at dawn making their way through the quiet streets of Yangon, it is hard to imagine that a few hundred miles away their fellow countrymen are witnessing their children being killed and their homes destroyed. The United Nations Development Programme states that the average length of displacement is 17 years, with people being unable to return home, while having no visible prospects looking forward. With foreign aid being blocked from entering Myanmar and limited reporting in the local media, the biopsychosocial health burdens being created are immeasurable and Myanmar is a long way from acknowledging this or tackling them. And this is why we must advocate, through petitions, through charities and through the United Nations, for change to happen early and to establish sustainable solutions. Because how else will these people and people like them, be able to simply continue living their lives?

This article is part of a blog series drawing attention to overlooked conflict zones. The series examines man-made disasters, which despite causing years of human suffering and environmental degradation rarely receive any media or policy attention. Send us your suggestions or get in touch if you would like to write about conflict areas you believe are overlooked by the world.