From ... in Health — Mar 30, 2020

Myanmar: Displacement Camps Are COVID-19 Tinderboxes

A city worker disinfects government offices as a preventive measure against the coronavirus, Yangon, Myanmar, March 25, 2020.

(Bangkok) – The Myanmar government should take urgent steps to reduce the risk of COVID-19 transmission among the estimated 350,000 people displaced by conflict and violence across the country, Human Rights Watch said today. Overcrowding, a mobile internet shutdown, blocks on humanitarian aid, and movement restrictions have left displaced communities in Rakhine, Kachin, Shan, Chin, and Karen States especially vulnerable to a virus outbreak. While concerns have been raised about Myanmar’s capacity to manage the coronavirus given its poor healthcare infrastructure, the country’s displaced populations face even greater risks. Most are trapped in dangerously overcrowded camps with severely substandard health care and inadequate access to clean water, sanitation, and other essential services. Many displaced people have underlying medical conditions and chronic diseases, putting them at high risk of suffering serious effects from the virus. State media announced the government was drafting a COVID-19 response plan for internally displaced persons (IDPs), but humanitarian workers told Human Rights Watch they had not been consulted on the draft or given guidance about responding to a potential spread. “Years of conflict, neglect, and abusive policies by Myanmar’s government and military have left hundreds of thousands of displaced people sitting in the path of a public health catastrophe,” said Brad Adams, Asia director. “The authorities need to ensure these groups have access to information, humanitarian aid, and health services, including prompt testing and isolation for those who show symptoms.” The Myanmar government officially confirmed its first cases of coronavirus last week, following growing skepticism about its reported lack of cases. According to the health ministry, there are 10 confirmed cases, 55 lab results pending, and 430 individuals being monitored at hospitals across the country, as of March 30.

The actual number of cases is likely much higher, in part due to limited testing capacity and the country’s weak health system.

The government implemented more stringent restrictions last week, including a mandatory two-week quarantine for all foreigners and Myanmar nationals entering the country. Asia Director Myanmar has 6.1 doctors per 10,000 people, falling short of the World Health Organization’s recommended minimum. In rural and conflict-affected areas the availability of health personnel drops precipitously; one Rakhine State township has only one doctor per 83,000 people, or 0.12 per 10,000. With just one laboratory in the country that can process COVID-19 tests and enough kits to test only 1,700 people at present, Myanmar is ill-equipped to handle the growing caseload that has overwhelmed health systems elsewhere.

The government has yet to designate a hospital in Rakhine State for the handling of coronavirus cases. Overcrowding in the camps is pervasive, making physical distancing nearly impossible and significantly increasing the risk of transmission. In many cases, the government has for years refused to allocate adequate space or suitable land for the camps’ construction and maintenance, while denying those displaced their right to return to their place of origin or of choice. Myanmar has an obligation under international human rights law to ensure equal access to essential health care, regardless of ethnicity, religion, citizenship status, age, or gender. As several United Nations rights experts stated, in addressing the pandemic, “States must take additional social protection measures so that their support reaches those who are at most risk of being disproportionately affected by the crisis.” The government should ensure its response to COVID-19 includes targeted prevention and treatment efforts for displaced populations, including allocating additional space and resources to alleviate overcrowding and improve water, sanitation, and health services, in line with international guidelines on responding to the coronavirus in camp settings.

The health ministry should consult experts and humanitarian agencies and make public its plan to reduce the risk of infection and protect internally displaced people and staff working in the camps. Any quarantine or isolation measures should be strictly necessary, proportionate, and limited in scope and duration. “Health conditions are already disastrous for displaced people in Rakhine, Kachin, and northern Shan camps, and now COVID-19 is threatening to decimate these vulnerable communities,” Adams said. “Donors are ready to help, but nothing can happen unless the Myanmar government ends restrictions on movement and permits aid groups the kind of unfettered access needed for a rapid, substantive response to the virus.” Rohingya walk at Dar Paing camp, Rakhine State, Myanmar, March 17, 2017. In central Rakhine State, about 130,000 Muslims, predominantly ethnic Rohingya, have been confined to open-air detention camps since 2012. Arbitrarily denied freedom of movement, they are effectively imprisoned by the Myanmar government and security forces in squalid conditions. Access to health facilities is extremely restricted.

There are only two government-run health centers with limited opening hours and few beds, both inaccessible to those in remote camps, and part-time basic mobile clinics. None have COVID-19 testing capacity. For those facing serious medical problems, procuring an emergency referral to Sittwe General Hospital in the state capital is bureaucratically and financially prohibitive. Only 16 percent of Rohingya in the camps reported receiving necessary medical care. Rohingya elsewhere in Rakhine State face similarly abusive restrictions on accessing health services.

The government should urgently lift restrictions that prevent Rohingya and other minorities from accessing equitable health care, including eliminating the medical referral system, removing financial requirements for accessing Sittwe General Hospital, and increasing 24/7 ambulance services. Water, sanitation, and hygiene structures in the camps are severely inadequate. One latrine is shared by as many as 40 people; one water access point by as many as 600. Communicable diseases such as COVID-19 can spread easily amid the congested and deteriorating camp shelters. Camp clinics were found to have significantly higher rates of communicable diseases – scabies, dysentery, tuberculosis, and influenza – than nearby village clinics, with the tuberculosis rates nine-times as high. None of the camps have the minimum amount of space per person of 45 square meters recommended by international standards.

The average is 20 square meters per person, less than half the minimum standard. In the most crowded camp, 12,500 Rohingya have an average of just 7 square meters per person. In Rakhine and Chin States, fighting between the Myanmar military and the insurgent Arakan Army since January 2019 has displaced at least 100,000 civilians, according to local groups.

The majority are ethnic Rakhine taking shelter in makeshift displacement sites in villages and monasteries. Local residents have described the challenges accessing clean water in the temporary shelters, as well as the accompanying impacts on health and hygiene, including growing rates of malnutrition. In response to the conflict, authorities restricted humanitarian access in half of Rakhine State’s townships, making it difficult or impossible for life-saving supplies to be delivered. Over 107,000 IDPs live in camps in Kachin and northern Shan States, displaced by ongoing fighting between the Myanmar military and ethnic armed groups. Harsh government restrictions on humanitarian groups have compounded the lack of access to health care, shelter, clean water, sanitation, and food. About 70,000 displaced people in the area are denied adequate aid, particularly those in areas not controlled by the government along the Chinese border.

The government should lift blanket restrictions on aid delivery and grant humanitarian groups and UN agencies immediate, unrestricted, and sustained access to displaced civilians, particularly for providing urgent health services such as COVID-19 screening and testing.

The Myanmar military and ethnic armed groups should safeguard civilians from fighting and ensure health care and other assistance can reach vulnerable populations. Children play in a makeshift bomb-shelter made with sandbags at Woi Chyai IDP camp, Kachin State, Myanmar, March 19, 2018. In response to the Arakan Army conflict, the government since June 2019 has imposed restrictions on mobile internet communications in Rakhine and Chin States, currently encompassing nine conflict-affected townships and approximately one million people. With overlapping blockages on internet and aid, many will be left with no viable access to medical guidance if they develop COVID-19 symptoms.

The blanket shutdown violates international human rights law, which requires internet-based restrictions to be necessary and proportionate. Access to information is a critical part of the right to health. As UN experts noted, during the pandemic “it is essential that governments refrain from blocking internet access.... Especially at a time of emergency, when access to information is of critical importance, broad restrictions on access to the internet cannot be justified on public order or national security grounds.” The Myanmar government should immediately end the internet shutdown and provide accurate and up-to-date information about the virus, access to services, service disruptions, and other aspects of the response to all, including in multiple languages and for those with low or no literacy. “The looming threat of the coronavirus demands Myanmar reverse course in its approach toward those affected by conflict, from negligence and abuse to urgent protection,” Adams said. “It should prioritize its COVID response in camps and immediately remove the barriers to health care it has enforced for years – or it will be condemning people to preventable deaths, both in the camps and na.

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Myanmar: Displacement Camps Are COVID-19 Tinderboxes

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