From ... in Health — Dec 13, 2021

Myanmar: Junta Blocks Lifesaving Aid

(New York) –Myanmar’s military junta is blocking desperately needed humanitarian aid from reaching millions of displaced people and others at risk, Human Rights Watch said today.

The United Nations, the Association for Southeast Asian Nations (ASEAN), and concerned governments should press the State Administration Council (SAC) junta to urgently allow aid to reach all those in need. In recent months, the junta and its security forces have imposed new travel restrictions on humanitarian workers, blocked access roads and aid convoys, destroyed non-military supplies, attacked aid workers, and shut down telecommunications services.

The February 1, 2021 military coup also triggered widespread infrastructure collapse and a severe devaluation of the Myanmar currency, leading to increasingly dire banking and supply chain crises and shortages of food, medicine, and other essentials. “Myanmar’s junta has worsened a self-created humanitarian catastrophe by displacing hundreds of thousands of people and then blocking the critical support they need to survive,” said Shayna Bauchner, Asia researcher. “The generals are callously denying lifesaving assistance to people affected by conflict since the military takeover, seemingly as a form of punishment.” 6 Months After Takeover, Urgent Need for Targeted Sanctions, Arms Ban Since the coup, the junta has carried out a nationwide crackdown on anti-junta protesters and the political opposition that amounts to crimes against humanity and other abuses. Fighting in some ethnic minority areas has expanded, resulting in war crimes.

The crisis has displaced over 284,000 people, with an estimated 22,000 refugees fleeing to India and Thailand. While Myanmar authorities have long impeded access to aid for vulnerable groups, the military junta has established new restrictions, creating a nationwide humanitarian catastrophe.

The UN estimates that the number of people needing assistance will grow from 1 million before the coup to 14.4 million by 2022, including more than 5 million children. About 25 million people, or half the population, could be living below the national poverty line. A man displaced in 2011 and now living in a camp outside Laiza, Kachin State, told Human Rights Watch: “Since the coup, NGOs [nongovernmental organizations] that provide food couldn’t travel easily to the camp and they cannot transfer funding easily. Many people used to go outside of the camp for day jobs and to support families, but because of the coup and Covid-19, there aren’t many job opportunities left they could do.” The junta’s interference in relief operations has disregarded calls for unhindered aid delivery by the UN General Assembly, Human Rights Council, and Security Council, the European Parliament, and donor governments.

The UN relief chief, Martin Griffiths, said on November 8 that “access to many people in desperate need across the country remains extremely limited due to bureaucratic impediments put in place by the armed forces.” He called on the junta to “facilitate safe, rapid, and unimpeded humanitarian access.” On November 10, the UN Security Council issued a statement on Myanmar calling for “full, safe and unhindered humanitarian access to all people in need, and for the full protection, safety and security of humanitarian and medical personnel.” The UN, regional bodies, and donors should pressure the junta to ensure the health and well-being of the population in accordance with Myanmar’s obligations under international human rights and humanitarian law, Human Rights Watch said. At the same time, the international response to the humanitarian situation in Myanmar has been inadequate.

The UN and other aid agencies have only received 18 percent of the US$109 million requested to respond to the post-coup humanitarian emergency. Funding requirements for 2022 have more than doubled due to the crisis, to $826 million. Donors including the United States, European Union, and United Kingdom should increase funding while channeling aid through local civil society groups, rather than through junta authorities, given the military’s track record of corruption and misuse of assistance funding and material. Effective aid delivery hinges on engaging independent and impartial local partners that have the networks and experience to navigate a difficult environment. In areas of armed conflict in Myanmar, the junta’s obstruction of humanitarian assistance violates international humanitarian law. All parties to an armed conflict are obligated to allow and facilitate rapid and unimpeded impartial humanitarian assistance to all civilians in need, and are forbidden from withholding consent for relief operations on arbitrary grounds. Unnecessary delays or obstruction of aid may also violate the rights to life, to health, and to an adequate standard of living, including food and water.

The military has also attacked health facilities and medical workers, in violation of international law. Neighboring countries, including India, Thailand, and China, should facilitate emergency cross-border aid to internally displaced people in Myanmar and provide protection, support, and humanitarian aid to all refugees, including allowing the UN refugee agency (UNHCR) access to screen asylum seekers. The UN Security Council should go beyond issuing statements, and should urgently pass a resolution that institutes a global arms embargo on Myanmar, refers the military’s grave crimes before and since the coup to the International Criminal Court, and imposes targeted sanctions on the junta leadership and military-owned conglomerates. “Governments should press Myanmar’s junta to facilitate, not block, the delivery of assistance that millions of people depend on to survive,” Bauchner said. “Regional bodies and donors should work closely with local groups and cross-border efforts to make sure aid is reaching those in need and not being diverted by generals neck-deep in atrocities.” As opposition to the February 1 coup grew, the Myanmar security forces, including the military and police, violently cracked down on peaceful protests throughout the country.

The military launched new offensives in ethnic minority areas, resulting in abuses against civilians. In some areas, newly formed anti-junta armed groups fought alongside long-established ethnic armies against military forces. In November, clashes were reported in every state and region in Myanmar. The UN has reported that the military has carried out targeted and indiscriminate attacks on civilians, including airstrikes and heavy artillery barrages. Accounts from displaced people and aid workers suggest that the junta has continued to use the military’s longstanding “four cuts” strategy, in which the armed forces maintain control of an area by isolating and terrorizing the civilian population. An estimated 638,000 people are displaced in Myanmar, including many who were forced to leave their homes years prior to the coup. Civilians displaced by fighting, particularly in Myanmar’s northwest and southeast, have faced dire restrictions on access to food, clean water, sanitation, shelter, and health care, leaving them at severe risk of disease and malnutrition. Military forces have seized food deliveries en route to displacement sites and arrested people on suspicion of supporting aid efforts. As the UN special rapporteur on Myanmar reported in September, “The junta is directly to blame for the lack of humanitarian access to internally displaced persons, where its forces have deliberately blocked access roads and turned back aid convoys.” The requisite travel authorization process for humanitarian workers, already highly bureaucratic and arbitrary, has grown even more constrained under the junta’s control, severely impeding aid delivery, in particular during monsoon season floods. Many international aid organizations’ memorandums of understanding with the government were signed prior to the coup and have since expired, raising concerns about travel authorizations for aid delivery. Visas for aid workers have also been delayed or denied. The UN Children’s Fund (UNICEF) reported in October that “the need to procure travel authorization remains a major access impediment and a high constraint factor for the humanitarian partners’ capacity to reach people in need.” Where previously a negative Covid-19 test was sufficient for the application, for example, junta authorities began requiring all staff to submit a vaccination card and recommendation letter from the township medical officer for their travel authorization application, at a time when only 3 percent of the country was vaccinated. Since February, the junta has cut off mobile internet data and blocked public Wi-Fi and most broadband internet service. It has continued to impose communication blockades, particularly in areas of increased hostilities. In August and September, the junta cut phone and internet services in dozens of townships in Chin and Kachin States and Mandalay, Magway, and Sagaing Regions. “We have no internet and sometimes mobile reception is not available,” an aid worker in Chin State said. Disrupted supply chains, increasing prices and scarcity of goods, and loss of access to agricultural livelihoods have compounded food shortages around the country.

The Myanmar currency, the kyat, has lost over 60 percent of its value since the coup, contributing to food crises in urban and peri-urban areas, including Yangon and Mandalay. According to the UN Development Programme, urban poverty rates are set to triple by 2022. Humanitarian agencies and UN human rights experts recently raised grave concerns about the food, shelter, and cash needs of thousands of families who have been forcibly evicted from settlements in Mandalay and Yangon, including Hlaing Tharyar and Dagon Seikkan townships, since late October. Since May, an estimated 93,000 people have been displaced by fighting in Chin State and Magway and Sagaing Regions in Myanmar’s northwest. In Chin State, fighting has increased between the armed forces and the Chinland Defense Force (CDF), an anti-junta militia.

The UN special rapporteur on Myanmar reported that the military, after declaring martial law in the town of Mindat in May, carried out air and ground attacks, committing indiscriminate attacks and sexual violence and using civilians as human shields. An estimated 30,000 people fled the fighting. After capturing Mindat, the security forces imposed drastic measures on the civilian population, effectively cutting the area off from all aid and supplies by closing all roads to the town; blocking nearby supply routes; turning back aid convoys; looting and destroying supplies; interrogating and arresting civilians entering the town for goods; and cutting internet services. In May, military forces fired at makeshift displacement sites marked with white flags. At least six displaced people reportedly died in the jungle from lack of access to health care. Local aid groups and host communities who have tried to support displaced people with food and other supplies have suffered harassment, arbitrary detention, violence, and constant surveillance by the security forces. Some humanitarian workers have been arrested and charged with incitement under section 505A of the penal code. An aid worker in Mindat said that when a team member and an international staff member planning a humanitarian project were arrested, “our operations on the ground got a lot more difficult.” The worker noted that in October, security forces had even arrested people going shopping for household products in Mindat. In July, the UN refugee agency received travel authorization to deliver emergency aid to displacement sites in Mindat, but displaced people in the area reported the aid never reached them after the junta denied aid workers access to any areas outside security force control. In late October, the military deployed tens of thousands of troops to the country’s north and northwest, in seeming preparation for wide-scale operations against anti-junta forces. Satellite imagery revealed that over the next month, hundreds of buildings were burned in Thantlang, Chin State, corroborating video and witness accounts. The aid worker in Chin State said that junta authorities were confiscating aid packages that local humanitarians had tried to bring to displacement camps. Since imposing martial law in Mindat, security forces have taken over the sale of products in town, reselling them at high prices, he said. Anyone attempting to buy more than the allotted amount of food or medicine is accused of supporting the Chinland Defense Force or anti-junta People’s Defense Forces (PDF) and risks arrest. About 3,000 children have been displaced from the town of Mindat, but local aid workers said they have been unable to acquire any educational supplies because of security force checkpoints and the risk of arrest. The UN Office for the Coordination of Humanitarian Affairs (OCHA) reported in December that with food running low in Mindat township, “people are becoming desperate.” Groups continue to advocate urgently for access: “The humanitarian community has developed a plan outlining the assistance it would immediately be able to provide to up to 26,000 people in Mindat Township if access was permitted, and is advocating at all levels for the necessary travel authorisations to be urgently granted.” Since the coup, there has been major insecurity and fighting in southeast Myanmar, notably Bago Region and Karen (Kayin) and Karenni (Kayah) States. Over 173,000 people have been displaced since February.

The junta has imposed severe movement restrictions in the area, requiring permission letters from local State Administration Council administrators to travel, as well as widespread security force checkpoints and patrols. Meeting minutes of UN agencies from May show that the State Administration Council denied the World Food Programme’s request to provide one month of food support to about 4,500 recently displaced people in Myaing Gyi Nyu village in Karen State. Junta officials also suggested they take over the food distribution to the camp. In June, media reported that military forces burned 80 bags of rice, barrels of cooking oil, other food, and medicine in Pekon, southern Shan State, that local residents had gathered for 3,000 people recently displaced by fighting. An aid worker in Karen State said that both the Myanmar military and the ethnic armed group Karen National Liberation Army (KNLA) had imposed obstacles to travel. In KNLA-controlled territory, the local aid workers had to get permission to deliver supplies or hand them off to the KNLA to distribute. Local aid groups have identified Myanmar military checkpoints in the area, which they avoid when transporting food or medical supplies due to the risk of detention, harassment, or confiscation. At a national humanitarian meeting in August, UNICEF discussed the contingency plan for people displaced by airstrikes and ground fighting in Hlaingbwe, Karen State, including identifying supplies “so that we can manage very quickly before the road blockages occur,” according to meeting notes reviewed by Human Rights Watch. About 370,000 people were already displaced in Myanmar prior to the coup, most living for years in protracted displacement in Rakhine, Kachin, and northern Shan States. Humanitarian organizations reported in October that they faced “significantly decreased access” to the preexisting displacement camps and “increased scrutiny of implementing partners [and] activities.” OCHA reported in August that constraints since the coup, including “new bureaucratic restrictions and access limitations linked to the TA [travel authorization] process,” had impeded more than half of all activities in Rakhine State, “negatively impacting the delivery of services and humanitarian assistance to around 440,000 people in need.” UN and international agencies meeting minutes noted the junta’s erratic approval process: “TA granted by RSG [Rakhine State government] is changing every month.” Myanmar’s Mass Detention of Rohingya in Rakhine State Download the full report in English Appendix: Letter to the Myanmar Government About 600,000 ethnic Rohingya are confined to camps and villages in Rakhine State, denied freedom of movement under a system of apartheid, without adequate access to food, health care, and education. An estimated 130,000 Rohingya have been arbitrarily held in open-air detention camps in central Rakhine State since 2012. Humanitarian agency documents detail the serious water scarcity in Rakhine State, noting that water availability there is affected by constraints on access, banking issues, limited funding for water transport and distribution, and increased fuel prices and scarcity. Only 12 percent of people in northern Rakhine State identified as needing humanitarian aid had access to safe drinking water as of September, and only 14 percent had access to functional latrines. Food shortages in the camps and villages grew after June, when the World Food Programme had to halt its monthly cash allowance and food ration distributions. In northern Rakhine State, the junta even obstructs efforts to assess the extent of the gaps and needs. “The full extent of WASH [water, sanitation, and hygiene] needs in northern Rakhine continue to be largely unknown due to access restrictions,” humanitarian agencies wrote in their input to the 2022 Humanitarian Needs Overview. In early November, as tensions between the Myanmar military and the Arakan Army ethnic armed group grew, the junta closed down the Ponnagyun-Rathedaung road, forcing people from 60 villages in the area to travel by waterway. Displaced people’s severe lack of access to water, sanitation, and hygiene in Myanmar – underscored by recent humanitarian data – is life-threatening. UN agency documents stated that “AWD [acute watery diarrhea] cases were reported in 2021 due to the reduction of WASH in many camps in Rakhine and Kachin states.” In late May, at least nine Muslim children reportedly died in central Rakhine State following a month-long outbreak of acute diarrhea. “They have difficulties accessing drinking water, toilets, and sanitation products,” the Chin State aid worker said. “Kids in the camp had skin disease ... because of dirty water.

They don’t even have tanks to store water, they use plastic sheets to make water tanks.” He said that the Kyaukhtu camps in Magway Region have faced severe health crises: Some kids died from malnutrition, had skin disease. People died from not getting medical attention on time.

There’s not enough medicine or medical supplies at camps.

There are doctors who came to the CDF territory to provide health care to IDPs [internally displaced people] but they can’t do much when there’s not enough medical supplies. “IDPs have difficulty accessing food, clean water, and shelters,” an aid worker in Karen State said. “They’re now relying on rainwater...

There is seasonal flu, diarrhea because of no clean water, and Covid cases in the villages.” The Myanmar healthcare system effectively collapsed after the coup. With the junta cracking down on medical professionals for their role in the Civil Disobedience Movement, Myanmar has become one of the deadliest countries in the world to work in health care, according to data from the World Health Organization and Safeguarding Health in Conflict Coalition. From February 1 to September 30, state security forces allegedly killed at least 29 healthcare workers and arrested 210, with another 580 warrants issued for doctors and nurses.

There have been 297 reported attacks on health care – nearly all by the security forces – including 87 raids and 56 military occupations of healthcare facilities. Security forces have beaten and shot medical staff providing care to injured protesters and forced clinics operated by nongovernmental groups to close, driving medics and volunteers to work underground in poorly resourced makeshift mobile clinics. Despite moving frequently, hidden facilities have faced deadly attacks by junta forces. Police and military officials shot at or confiscated ambulances. At least 31 medical vehicles have been attacked since the coup. Médecins Sans Frontières (Doctors Without Borders, or MSF) described the impact of the junta’s nationwide military deployment on access to health care: Patients in Myanmar are forced to travel farther to get care at a time when risks are much greater. Security forces at checkpoints scrutinise those moving around, search their belongings, intimidate them and contribute to a climate of fear. For patients with conditions requiring regular and long-term care, such as HIV, tuberculosis and hepatitis C, the ongoing insecurity and delays in accessing medicines could be life-threatening. Amid the healthcare system’s collapse, Myanmar faced its third and most severe wave of Covid-19 in mid-2021.

The security forces blocked people’s access to hospitals for urgent treatment and hoarded oxygen supplies.

They arrested aid volunteers for attempting to deliver oxygen to affected communities.

The junta’s Health Ministry reportedly rejected a request from a top OCHA official visiting the country in September for greater humanitarian access to address the Covid-19 crisis, which had hit a 38 percent positive test rate at its peak in late July. Myanmar’s UN Country Team reported in May that attacks on medical workers jeopardized the Covid-19 response and essential health services, “with potential devastating consequences.” The pandemic has also been used as a pretext for enforcing increasingly stringent restrictions on aid and movement. Days before the coup, the International Monetary Fund (IMF) had transferred US$372 million to the Central Bank of Myanmar for emergency Covid-19 support. How the junta has used the funds remains unknown. At a September briefing, the IMF stated, “It’s not possible for the Fund to ascertain whether the regime currently in effective control is using the IMF funds as they were intended. Namely, to tackle to COVID and support the most vulnerable people.” Covax, the global vaccine distribution facility, also delayed a shipment of vaccines, citing the junta’s opacity around distribution and refusal to prioritize vulnerable populations. UN Security Council resolution 2286 condemns attacks on medical facilities and health workers in conflicts and calls on all parties to armed conflicts to respect international law, prevent attacks, and hold those responsible to account. It also asks the UN secretary-general to “bring to the attention of the Security Council situations in which the delivery of medical assistance to populations in need is being obstructed by parties to the armed conflict.”.

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Myanmar: Junta Blocks Lifesaving Aid

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