Recent heavy rain, coupled with the after-effects of a recent aid worker pull-out, is prompting health concerns in Myanmar’s western Rakhine State for the more than 140,000 internally displaced persons (IDPs) mostly from the persecuted Muslim Rohingya minority.
Riots in March amid tensions over perceived bias towards Rohingya Muslims in the area forced international humanitarian workers to pull out. Aid has trickled back but IDPs displaced by communal violence in 2012 remain in squalid camps. According to the UN, there are also 700,000 vulnerable people outside the camps who were receiving aid from multiple agencies.
“When it rains heavily, some camps are flooded, which make elderly people and children very vulnerable to get sick,” said a local health worker who asked not to be named. “The displaced people are also vulnerable to water-borne diseases such as diarrhoea and skin diseases because toilets, where they exist, get flooded and overflow due to the rain,” he told IRIN.
According to government figures, Rakhine has received around 46 inches of rain so far in 2014. Historical data indicate that July is traditionally the heaviest rain month there, and it could mean nearly 46 more inches in this month alone.
According to Médecins Sans Frontières (MSF), Rakhine, Myanmar’s second poorest state, has historically received less investment in health care than other areas of the country. Before the March withdrawal of aid organizations, there were 47 organizations active in Rakhine, with 16 working in health - the most of any sector. After the departure of internationals the Ministry of Health took over the healthcare response.
Under Burmese law, the Rohingya are de jure stateless. There are an estimated 800,000 Rohingya in Myanmar and human rights groups say they have long faced persecution and discrimination.
A 2014 report by Fortify Rights, a Bangkok-based human rights organization, entitled Policies of Persecution: Ending Abusive State Policies Against Rohingya Muslims in Myanmar, noted that “Rohingya are prevented from travelling freely to neighboring village tracts or townships for medical treatment,” and that such policies, coupled with the deteriorating humanitarian situation in the state were leading to “avoidable deaths”.
Aid agencies are scrambling to get operations in Rakhine back to scale. Some services have improved in the past months, but a humanitarian shortfall and associated risks remain, officials say.
“Displaced people can easily get treatment without delay as there are mobile clinics in a few minute walk from the camps,” said a government official speaking on the condition of anonymity due to a gag order on media interviews. He added that there had been diarrhoea outbreaks in some camps but they were controlled.
According to UN Office for the Coordination of Humanitarian Affairs (OCHA), there were 15 teams operating mobile clinics for IDPs in Rakhine at the end of May, up from 11 during the previous month.
“As [IDP] camps are packed with people, any communicable diseases can spread easily among the people,” the government official admitted, adding that people in camps getting the flu or a cold is a common occurrence.
Humanitarian officials say services remain limited.
“Some critical activities are still taking place at reduced levels,” said Pierre Péron, OCHA’s public information and advocacy officer in Myanmar. “There are still difficulties with the referral of severely malnourished children who have medical complications from IDP camps to Sittwe Hospital, due to continued limitations on medical referral services,” he said, citing reports OCHA had received from organizations operating in Rakhine.
In April the UN Children’s Fund (UNICEF) estimated that services for 2,700 malnourished children in Rakhine were suspended by the aid agency pull-out.
“Humanitarian organizations continued to support Ministry of Health medical teams and national health institutions in restoring access to health care for displaced people and vulnerable communities,” said Péron, pointing to an increase in the number of staff taking part in the government-led joint Rapid Response Teams from 83 people to 100. However, he explained, “MSF-Holland, [which] prior to March [was] the biggest healthcare provider in the state, remains suspended, leaving a critical gap in services, in particular in Maungdaw and Buthidaung,” two towns near the border with Bangladesh.
Slow return of aid workers
“Many organizations are still operating at reduced capacity, with 70 percent of UN and international NGO staff having been able to return to Sittwe [Rakhine’s capital city] by the end of June,” explained Péron. The limiting factor in many cases, he said, is available facilities.
During the March riots, offices of at least two UN agencies and a number of NGOs, as well as guest houses accommodating aid workers, were vandalized, damaged, or looted.
In April the government pledged to provide security to aid organizations and “cooperate with them on all levels”, and agencies slowly began to return.
“The main constraint is the limited offices and premises available for the UN and INGOs in… a designated area where humanitarian organizations have been told they have to have their premises and where the government is providing additional security,” said Péron.
MSF-Holland has still not yet been allowed to resume their normal operations in Rakhine, pending government permission.