Hla Min, a rice farmer in central Myanmar, was getting regular radiation therapy for cancer when the military seized power on February 1st. Initially expected to survive, he lasted less than three months.
His treatment ended when doctors at Mandalay General Hospital walked off the job to protest against the coup. Soldiers soon occupied the hospital and others across Myanmar, using them as bases for their bloody crackdown on resistance to their rule. Many medical workers and would-be patients, fearing arrest or worse, stayed away.
Even as his health deteriorated, Hla Min supported the doctors’ decision to stop working at state-run facilities, which helped start a general strike that has brought the economy to a near-halt. “I know I’m dying,” he said in an interview in late April. “But I will never blame the doctors, because young people are dying in the street after being shot by the police and soldiers. Compared to them, my death will be nothing.” He died a week later, at 46.
Since the coup, more than 860 people are believed to have been killed by the security forces, who have gunned down protesters, bystanders and even young children. But health experts say the breakdown of Myanmar’s public health care system is taking a greater toll.
Hundreds of lives are lost each week because emergency surgeries are not being performed, doctors say. Disease prevention programmes have halted, including a child vaccination campaign. Many physicians who refuse to work for the regime are treating patients at private hospitals or underground clinics, but those facilities cannot provide the specialised care that major public hospitals like Mandalay General can.
"I know there are hundreds of people dying per week," says Dr Kyaw Moe, one of the striking Mandalay General surgeons, who now sees patients at a private clinic. "Of course, I feel sorry and very sad for that, but the most important thing for our country is to bring down the military. If not, our future generations and our country will die."
The crisis, which a United Nations official has called a "health emergency", comes at a potentially critical moment in the Covid-19 pandemic for Myanmar. There are reports of significant outbreaks in towns near the border with India, where a new variant has raged, but testing and vaccinations in Myanmar have nearly stopped. Experts fear the virus could spread undetected and overwhelm understaffed hospitals and clinics in the coming months.
Going backwards
In the 10 years before the coup, during which the military shared power with elected civilian leaders, Myanmar made significant improvements to its healthcare system, especially in preventive care. But many of these gains have been lost, health experts say.
Successful programmes aimed at stopping the spread of HIV, tuberculosis and malaria, run by the now-ousted civilian government, have stalled. More urgently, so has a campaign to vaccinate nearly a million children this year against measles and other diseases. Unicef, which provides vaccines for the programme, fears that could mean deadly outbreaks in the coming months, after the monsoon season ends.
"The continuing use of force against healthcare workers, including the reported occupation by security forces in hospitals, is taking a devastating toll on Myanmar's healthcare system, slipping from the achievements of the last decade to a health emergency since the crisis began," says Andrew Kirkwood, the acting United Nations resident co-ordinator for Myanmar.
Doctors, who are highly respected in Myanmar, were among the early leaders of the civil disobedience movement, which has virtually shut down the economy in an effort to force the regime from power. The first protest against the generals, three days after the coup, was led by a doctor, Tayzar San, in the city of Mandalay. The junta has issued a warrant for his arrest.
In February, as the security forces began shooting protesters in large numbers, volunteer doctors, nurses and students organised to treat the wounded. A 20-year-old nursing student, Ma Thinzar Hein, was shot and killed in March while helping protesters in Monywa, a city west of Mandalay.
The World Health Organisation has reported a dramatic surge in attacks on healthcare personnel and facilities in Myanmar this year, resulting in 14 deaths, though its published statistics provide few details. Some doctors and medical students have joined a fledgling armed resistance to the military.
Soldiers have been stationed at more than 50 hospitals and other healthcare centres at various times since the coup, according to the United Nations. Their presence has deterred many people from seeking care. Some said they feared being shot if they approached a hospital. Others said they would rather die than get treatment or a Covid vaccine at a hospital under army control.
Embedding soldiers
The hospitals were among many institutions occupied by the military – including schools, universities, monasteries and temples – across the country. The occupations – some of which lasted for days, others for months – enabled it to embed soldiers in communities rife with protest.
Mandalay General, a 1,500-bed university teaching hospital with dozens of specialised departments, had more than 200 doctors before the coup. In April there were just 20, according to a surgeon who returned to work there after walking out in February.
Hla Min, the farmer, was diagnosed with bladder cancer at Mandalay General in January. He underwent surgery and began radiation therapy, said his widow, Daw Khin Myat (42). She said his prognosis was good. But in February, after the doctors walked out, the hospital closed, and his treatment stopped.
The couple returned in March to see if he could resume radiation therapy, only to find soldiers with rifles posted at the entrances, where they were checking the identification papers of those who entered. Most departments and clinics were closed, including the cancer ward.
One doctor suggested that the couple go to Yangon, Myanmar's largest city, for treatment at a military hospital. But the couple wanted nothing to do with the junta or its leader, Senior Gen Min Aung Hlaing. "Even if we could afford it, we wouldn't go to a military hospital," says Khin Myat. "We all expected that he would survive and the regime would surrender before he died. But he died before Min Aung Hlaing, who is dragging the country into hell."
A spokeswoman for the health ministry, Dr Khin Khin Gyi, says soldiers maintain a minimal presence at medical facilities and are there to provide security. She also says that more than half the healthcare workers who walked out are back on the job. (Striking doctors dispute that, saying that less than a quarter have returned.)
Stray bullet
Khin Khin Gyi says only patients who have done something wrong should fear going to a military-occupied hospital. “If they do not make mistakes, they do not need to be afraid of the soldiers,” she says.
The family of Ma Ni Ni Win would disagree. Ni Ni Win (30), an importer of Chinese goods, signed up to get a coronavirus vaccine last month at Mandalay Workers’ Hospital, another facility occupied by soldiers. As she waited outside in her car for her appointment, a stray bullet struck her in the eye, killing her. Witnesses said she had been shot by a soldier who was aiming at a man on a motorcycle.
Health experts worry that the regime has engendered such opposition and distrust that many people will reject any efforts it makes to revive health programmes, including measures to contain the coronavirus.
Alessandra Dentice, head of Unicef's Myanmar office, who has worked for two decades in hot spots around the world, says that until now, she has never seen people so hostile to authorities that they would refuse healthcare that they need.
Even some doctors have done so. Dr Kyaw Lwin, a surgeon on strike from Mandalay General, says he has skipped a scheduled Covid vaccination. "I don't want anything related to the junta," he says. "Even if we were fully vaccinated, we would have a 100 per cent chance of dying any time because the police and soldiers are everywhere and will shoot us for no reason. So the Covid vaccine doesn't matter in Myanmar." – New York Times
