In Myanmar, Health Care Has Become a Battleground

In Myanmar, Health Care Has Become a Battleground

Three years after a military coup, attacks against health care in Myanmar have reached a tipping point

Medical workers wearing red ribbons pose during a protest against the coup that ousted elected leader Aung San Suu Kyi.
Medical workers wearing red ribbons pose during a protest against the coup that ousted elected leader Aung San Suu Kyi, at Yangon General Hospital, in Yangon, Myanmar, on February 3, 2021. REUTERS/Stringer

This February marked three years of military-led terror for people in Myanmar. 

On the morning of February 1, 2021—in the wake of an election that would have kept the civilian National League for Democracy and its allies in charge—the country's military staged a coup, the latest grab for power in a decades-long struggle for governance. The coup ushered in a turbulent new chapter for Myanmar's people, marked by the military junta's brutal and unlawful crimes against civilians with "the highest levels of cruelty and harm to the victims," according to the United Nations.  

Following a slew of military attacks on health-care facilities and blockades on medicines, bandages, and surgical equipment, the country's health-care system faces near-complete destruction. Health-care workers and patients are in dire need of support, and the UN Security Council issued a recent statement expressing concern for "the denial of access to medicine and medical care" and "lack of progress" in resolving the conflict.  

"There's a stunning record of lack of action on this," Human Rights Watch's Asia Advocacy Director John Sifton told Think Global Health. "We're frankly appalled. Denying a population health care is a massive violation of their human rights." 

Now Myanmar's military is losing ground in the battle for control of the country.  

Scorched Earth Tactics

Satellite images from 2021 and 2023 show destruction of Thantlang Township Hospital in Myanmar. Map data: Google, Maxar Technologies, Airbus

Increasingly successful offensives—organized by loosely allied ethnic minority militias as well as newer armed groups made up mostly of the ethnic Burman majority—have grabbed territory, which has forced surrenders, driven low morale in the junta, and left the regime desperate to maintain its grip on power, according to Joshua Kurlantzick, senior fellow for Southeast Asia at the Council on Foreign Relations. Lacking enough troops to fight on many fronts and using its typical scorched earth tactics, the junta has resorted to indiscriminately bombing citizens and most recently reinstated a countrywide draft to boost its infantry. The sweeping attacks have further damaged Myanmar's health-care infrastructure, and the recent conscription order has given rise to a new wave of fear and uncertainty among its people. 

With Myanmar's future at a tipping point, the health and well-being of Myanmar's people remains in limbo. 

Three Years of Violence

Attacks on health care spiked with the military coup and remained consistent in the years that followed

Health Care Under Attack 

According to Insecurity Insight, a nonprofit group collecting data on conflicts worldwide, nearly 1,200 attacks on health-care workers and facilities have taken place in the three years since the coup. Doctors, aid workers, and other medical personnel have been detained and arrested, targeted for allegedly taking care of protestors or participating in the civil disobedience movement (CDM).  

A nonviolent protest against the junta that began after the coup, the CDM predated the armed conflict and has continued to some extent as the armed conflict has ramped up. Hospitals have been invaded, bombed by homemade explosives, and occupied by troops as part of a clampdown against earlier large, nonviolent nationwide protests. Ethnic minority militias, during efforts to target soldiers occupying hospitals, have committed abuses as well. 

An attack on health care [in an ethnic minority area] is an attack on an ethnic group's claim to power, legitimacy, and government

Although more than 70% of health-care workers are believed to have left the country, those who have stayed treat patients under the most difficult of circumstances. They operate out of makeshift hospitals, turning the lights out when jets fly overhead and eating and sleeping when they can. They have no regular salaries and no certain future. They fear arrest and death daily. 

"Because health-care workers are key members of the community, they become targets," said Christina Wille, director of Insecurity Insight. "An attack on health care [in an ethnic minority area] is an attack on an ethnic group's claim to power, legitimacy, and government." 

Violence has occurred countrywide, not only in the regions with large ethnic minority populations but also in large cities such as Mandalay and Yangon, which are primarily populated by the ethnic majority Burmans. Because the country is home to more than 100 recognized ethnic groups, "it's a different story in every part of Myanmar," Wille explained. 

Attacks on Health Care in Myanmar, 2021 – 2023

Myanmar's health system is under attack countrywide, with the greatest number of attacks taking place in the Sagaing, Mandalay, and Yangon regions

Myanmar's health-care system has been hollowed in the process, allowing infectious diseases such as malaria, HIV, and tuberculosis to soar. People living with HIV are struggling to access the antiretroviral medication they need, and vaccines have been distributed largely only to military-controlled areas. In eastern border regions, drug-resistant malaria cases have skyrocketed

Deaths from Infectious Diseases Spike in Myanmar


A Possible Turning Point 

With no immediate end to Myanmar's conflict in sight, despite the army's losses, Myanmar's already battered health system remains under threat.  

Countries have provided billions in aid to Myanmar, but too little of it has reached its people in need. The United Nations and many countries, including the United States, also have imposed sanctions against Myanmar's natural gas exports, which are a major source of income for the military, but more can be done.  

"It's about strangling this brutal military dictatorship with sanctions," Sifton of Human Rights Watch said. 

Meanwhile, the crisis continues to spill over borders to neighboring countries, including China, India, and Thailand. As of January 2024, nearly 2.6 million people in Myanmar have been displaced from their homes

"Crises abroad impact all of us in one way or another," Sifton said. "Given the severity of the situation, this is a threat to international peace and security."  

Despite challenges to delivering aid, groups are taking action to support health-care efforts in Myanmar. The Tropical Health & Education Trust (THET) in the UK convened Health Partnerships for Myanmar, which provides medical education, guidance, and support for health workers in the country. The group's virtual programs include workshops on delivering emergency treatment and trauma training.  

The initiative also advocates for the safety and protection of Myanmar's health workers and patients amid this crisis, urging the international community to speak up against human rights violations in the country. 

"One of my friends died after being imprisoned with his wife, also a doctor. The National Immunization director and his child were arrested, too," said Dr. Thinn Hlaing, Myanmar country director at THET. "This conflict has put all health-care workers on the spot. They are risking their lives. Through your pen and voices, please speak up against these crimes against humanity." 

People walk on a street as barricades burn behind them during a protest against the military coup
People walk on a street as barricades burn behind them during a protest against the military coup, in Mandalay, Myanmar, on March 27, 2021. REUTERS/Stringer

Allison (Allie) Krugman is the data visuals staff editor for Think Global Health at the Council on Foreign Relations.

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