Q&A with MSF’s project coordinator for northern Rakhine, Nimrat Kaur

Myanmar is facing an acute humanitarian crisis since fighting escalated at the end of October 2023. The intensification of conflict has led to a lack of humanitarian access to areas where people need urgent assistance, a decimation of the healthcare system, and due to a law passed in February, increasing fear among people of military conscription, or forced recruitment into other armed groups.

In Rakhine state, MSF is witnessing a near total absence of humanitarian assistance for communities who rely on it. Our ability to run regular programming is severely constrained with monthly consultation numbers dropping from 6,484 in October 2023 to just 81 teleconsultations in March 2024. Our ability to facilitate emergency referrals for critical patients dropped from 264 in October 2023 to 28 in March 2024.

Indiscriminate violence, including explosions, airstrikes, and mines are threatening civilian lives and leading to displacement. MSF teams are witnessing attacks in highly populated civilian areas like markets and villages and have seen attacks on healthcare facilities, threatening the lives of patients and healthcare workers.

Lack of humanitarian access is becoming normalised in Myanmar: since November 2023, the authorisation to deliver healthcare activities has been removed for all organisations in Rakhine state and MSF teams have not been able to run mobile clinics. Outside of Rakhine state, movement across the whole country is heavily restricted and dangerous.

The number of functioning hospitals is dwindling fast and those that are still running are often lacking in specialist medical professionals and supplies. Without the safe and authorised movement of humanitarian workers and medical supplies, communities will be left with no options for medical care.
 

Nimrat Kaur has been the project coordinator in Maungdaw since mid-April 2023. She arrived in the project just before Cyclone Mocha hit last year on May 14 2023 and has seen first-hand the challenges faced by people living there. Now leaving Myanmar, Nimrat wants to share her experience and that of her colleagues, reflecting on the events she witnessed and the impact this is having people’s lives.

What did you witness in northern Rakhine state?

Since 13th November 2023 we have seen an escalation of conflict in Rakhine state and the townships of Maungdaw, Buthidaung and Rathedaung became cut off from the rest of the state. People were locked out and blocked in. Communities were not able to move across the state, and supplies could not come across. I don’t just mean healthcare supplies, but basic life-supporting supplies like food, petrol, water. These kinds of things were restricted, which led to whatever supplies available becoming inflated in price. There were some days of fear when you hear sounds, and you don’t know where the next sound is going to land, or if it is going to be too close to you. We had some experiences of when the fighting was very close, and we had to hibernate. We had to move the team to the safe room almost three or four times one day.

How has MSF been supporting communities in this area since November?

Usually, in northern Rakhine, we provide mobile clinics. This is where a mobile team of doctors, nurses and other staff go to rural areas far off from the main town. Since the conflict started, we haven’t been able to run these clinics. This is because of the increased insecurity and because we did not receive authorisation.* People in the areas we usually travel to already have very limited access to healthcare. We’re extremely concerned about the impact of having no access to essential healthcare for people who usually rely on our mobile clinics for medical services.

*To run medical humanitarian activities in Rakhine state, MSF requires an official authorisation from the authorities. Since conflict erupted again in November 2023, MSF has not received this authorisation.

How has the conscription law affected people in northern Rakhine?

Three months into the latest eruption of conflict, the conscription law was announced in the country. The law states citizens are expected to serve in the armed forces for anything from two to five years. I’ve seen how this has affected everyone. Rakhine communities have been trying to leave the state and go to Sittwe or Yangon and find refuge somewhere. Unfortunately, my Rohingya colleagues and the wider Rohingya community do not have paperwork to move outside of their own village, so I really wonder what is going to happen to them and I am really worried about their safety.

I could see the change in the understanding of the staff about what is happening in the country - that the conflict is now at another level.

*Rohingya people were stripped of their citizenship at home in Myanmar in 1982, rendering them stateless, and face severe restrictions imposed on all aspects of their lives, including their freedom of movement. Rohingya people cannot move from the fenced camps or villages they are contained to without receiving authorisation.

Why are the Rohingya community particularly vulnerable?

In Rakhine state, it’s a mix of ethnicities. There are Rakhine, Rohingya, and Hindis. Arakanese are citizens of Rakhine, but Rohingya were stripped of their citizenship in 1982.

Generations of Rohingya people have really struggled for what they have now. You cannot understand how challenging and limited life is for them.

In our team, we have Rohingya staff. Some of these staff have been able to get a citizenship card, but this is an exception and not the story of most. Other Rohingya staff, same team, same age group, same village, do not even have a national identification card or a basic yellow card, which is needed to move even just within their own village.

For a Rohingya staff working in Maungdaw, it takes months for them to be authorised to travel from Maungdaw to Sittwe (Sittwe is where the other MSF project is based and under 100km drive from Maungdaw). It is even longer for the authorisation to travel to Yangon because of the paperwork required. For Rohingya staff to travel they need to receive a village administration verification, ward administration verification, police administration verification, and then often other authorisations from other authorities’ and then of course, on top of this, you must pay fees and these fees are not the standard fees people with citizenship cards pay.

Many Rohingya staff in Maungdaw have not seen the other township that they’re working for. The whole time they have been in Maungdaw because they are not permitted to travel. This gave me a sense of yes, these circumstances are very different compared to the circumstances in other states we work in.

What are the current healthcare options for communities in northern Rakhine?

We’ve haven’t able to run mobile clinics since the time the conflict started, and already these communities we were assisting were vulnerable because of the lack of access to safe healthcare. We tried to provide a few months' worth of medications to our own patients who are taking diabetes or hypertension drugs. We have also supported with teleconsultations, which we have tried to maintain to support people who needed mental health care. But this also unfortunately could not last for more than a few weeks because since 10th January, Buthidaung and Maungdaw have not had any electricity and with no electricity there was also no cell coverage.

The latest blow for people has been the closing of Maungdaw and Buthidaung township hospitals. We’re unsure why Maungdaw, but admitted patients had to leave with no alternative option to go to. Buthidaung closed because it ran out of human resources and supplies. These two township hospitals were our only healthcare stakeholder left with whom we could work with and refer emergency patients to. This has a huge impact on communities here. If the township hospitals are closed, where do people go?

With hospitals shut, people reach out to MSF and healthcare organisations on the ground to support them, but we have had limited capacity in terms of resources. We do usually stock up for a minimum of four to five months, but those stocks have not lasted very long. We still don’t have any way to bring in our supplies. Staff have also not been feeling safe working in Maungdaw, Buthidaung and Rathedaung.

Day to day activities are becoming more difficult. You need fuel to run an office so we can run internet and be connected to the rest of our team. It has really affected us that we are not able to serve the community we are there for.

I am fortunate I had the opportunity to leave the violence, but there are many who don’t have the opportunity to even move. I really feel for that. That thought really consumes me.