Aid agencies are trying to find practical ways of getting humanitarian assistance to hundreds of thousands of people in Myanmar's Rakhine State following a series of attacks on the aid community there, and pending an agreement on the resumption of their operations.
"Various aid agencies and the Myanmar authorities are working together to try to provide critical life-saving assistance immediately, while also negotiating the necessary conditions for a full-scale resumption of humanitarian programmes in Rakhine," said Pierre Péron, public information and advocacy officer for the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Myanmar.
"The current situation has not only affected displaced people in camps around Sittwe [the capital]. Hundreds of thousands of people in isolated villages depend on international NGOs for essential services, particularly in the northern part of Rakhine State," he said.
While negotiations took place in Yangon, humanitarians manoeuvred to continue operations in Rakhine.
According to a UN map, in 2014 there were 47 organizations active in the state, with 16 working in health - the most of any sector.
Said Liviu Vedrasco, technical officer at the World Health Organization (WHO) in Myanmar: "The ongoing situation is quite simply a very acute gap in both primary and secondary healthcare. The absence of these services is leaving hundreds of thousands of people without the only health care they had to begin with."
UNICEF estimates that services for an estimated 2,700 malnourished children in Rakhine are currently suspended.
"[The gap] is definitely resulting in increased health risk, but we don't have the data to say anything quantitative about specific conditions or mortality," Vedrasco said. He explained that the "Health Cluster", which he chairs, on 8 April made a formal offer to bolster the Ministry of Health's ongoing supplemental efforts in Rakhine, which amount to 50 local health workers doing the work that approximately 700 humanitarian health staff used to carry out.
"We gave them a letter offering our staff of about 47 healthcare workers, plus supplies, fuel, cars, boats - whatever we have that they can use," Vedrasco told IRIN. And while such resources on offer fall short of the full operation that existed previously, he explained: "If 100 people are working in these areas and attending to basic health care, it can keep the system afloat temporarily while the major policy discussions take place."
Calling it a "practical solution", Vedrasco explained: "It's our attempt to keep care operational in the interim while the UN and the government debate the issue of humanitarian access more broadly."
However, as negotiations for the resumption of full-scale aid continue, aid workers say the climate of fear means Rakhine is no longer what it once was.
"Landlords who used to rent to NGOs and UN agencies continue to receive threats and simply don't want to take any more risks," explained OCHA's Péron.
"Even with the government's support to create safe spaces for humanitarians in Sittwe and ensure security, we will face a crunch for accommodation and office space."
International aid workers were forced to flee western Myanmar after being targeted by Buddhist mobs, which threw rocks at homes and offices in Sittwe. The riots were sparked on 26 March after a foreign aid worker with Malteser International allegedly handled a Buddhist flag outside the NGO's office with disrespect, though tensions over perceived humanitarian bias towards Rohingya Muslims in the area and the ongoing federal census are believed to have contributed to the violence.
The 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.
According to a 9 April government press release reported in a state-owned newspaper, the authorities were "sluggish" in their response to the violence, and the government has pledged to provide security to aid organizations and "cooperate with them on all levels".
According to the UN, there are 700,000 vulnerable people outside the camps who were receiving aid from multiple agencies. "Inside Rakhine. some logistical operations in more remote areas could possibly grind to a halt as trucks and boats aren't moving supplies as they used to," said Péron.
UN Secretary-General Ban Ki-Moon, in a 31 March telephone conversation with Myanmar's President Thein Sein, urged the government to "help establish a strong presence of United Nations and other international non-government organizations".
The US government demanded Myanmar provide humanitarians currently in Yangon with the necessary permissions and security to travel back to Rakhine and resume their work, and the UK expressed concern about the situation, saying: "The already dire humanitarian situation has deteriorated following the... violence against the offices and residences of humanitarian aid workers in March."