Short Situational Report of Healthcare in Myanmar: the most dangerous place in the world for healthcare professionals (9-month Review)

28 October 2021

Briefing

1. Introduction
   • Status of the healthcare system before February 2021  
   • Status of the healthcare system since February 2021
2. Targeting of healthcare workers
3. Covid-19 growth pattern in Myanmar
4. Root causes leading to catastrophic health system breakdown (in the aftermath of military coup) in Myanmar
5. Conclusion
6. Recommendation

Authors

• Myanmar Doctors for Human Rights Network
• Yangon Medical Network

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      I.          Introduction

Myanmar is in the midst of a humanitarian and health crisis. Since the attempted military coup d’état of February 2021, Myanmar’s healthcare system has all but collapsed. Denial of access to medical care, treatment and medicines has been used by the military as a weapon of war, compounded by direct attacks on medical personnel. According to the World Health Organization’s (WHO) Surveillance System For Attacks On Health Care (SSA), Myanmar is now one of the deadliest places on earth for healthcare workers, with 260 documented attacks this year alone, accounting for nearly 40% of the global total.[1] Added to this, a catastrophic third wave of COVID-19 that peaked in July 2021, claimed an unknown number of lives and otherwise preventable deaths.

This report provides a situation update on healthcare in Myanmar over the nine months since February 2021.

A.    Status of the healthcare system before February 2021

Even before the attempted coup, the healthcare system in Myanmar consistently ranked amongst the lowest in the world, despite the efforts to modernise it and to increase coverage over the recent decades. Expenditure on healthcare had been historically low, ranging between 0.5% to 3% by the successive military governments from 1962 to 2011, while as much as 40% of annual spending was on defence. Not more than 40 cents per citizen per year was spent on healthcare in Myanmar, in contrast to the government of neighbouring Thailand, which spent $61 per citizen a year, according to the report. [2]

However, after the election of the newly democratic government in 2015 [3], a series of healthcare reforms were enacted, and healthcare spending rose significantly to 5.2% of GDP under the National League for Democracy (NLD) led Government. This included the acquisition of modernized medical equipment and expanded facilities to keep pace with the growing population [4].

Despite these considerable state improvements, other sources of healthcare provision, including the private sector, non-government organizations and charity organizations, remained central to meeting the country’s healthcare needs. In 2018, Myanmar’s doctor-patient ratio was around 6.7 doctors per 10,000 population, considerably lower than the then global average of 15.6 doctors per 10,000 population [5].

COVID-19, which spread through Myanmar in two initial waves during 2020, overwhelmed the public healthcare system. In response, the Government sought international support and implemented advice from experts on containment and combating of the virus [6]. These early efforts proved moderately successful, due in part to strong coordination between various sectors of healthcare. Government hospitals were bolstered by the support of general practitioners, medical officers and junior doctors who volunteered to operate several clinics as primary care services. Additionally, the Government opened a number of quarantine centres funded by both state funds and public donations.

Many of the “pop-up” quarantine and treatment centres in every state and region, including conflict areas such as Karen, Kachin and etc, were quickly equipped with the required medical facilities, allowing better treatment of the patients and quality of care. An effective contact tracing system, run by volunteers, also helped to contain the spread of the virus.

B.    Status of the healthcare system since February 2021

On 1 February 2021, the Myanmar military (also known as the Tatmadaw) launched an attempted coup, arresting and detaining senior members of the democratically elected NLD-led Government and declaring a state of emergency. In November 2020, the NLD overwhelmingly won a national election and was returned to Government with an enlarged majority. The military claimed to have acted in response to electoral fraud; a claim refuted by Myanmar’s Election Commission and independent international observers, including the United Nations (UN) [7].

In response to the attempted military coup, millions of people [8] took to the streets across the country and engaged in peaceful protest, demanding the reinstallation of the democratically elected civilian government. These were the largest nationwide protests since the Saffron Revolution in 2007, when thousands of monks rose up against the then military regime.

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[1] https://extranet.who.int/ssa/Index.aspx

[2] https://www.berkeley.edu/news/media/releases/2007/06/28_Burma.shtml

[3] https://en.wikipedia.org/wiki/Politics_of_Myanmar

[4] https://www.statista.com/statistics/780526/health-expenditure-share-of-gdp-myanmar/

[5] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?end=2018&start=1960

[6] https://www.eastasiaforum.org/2021/09/14/the-myanmar-militarys-politicisation-of-covid-19/

[7]https://www.independent.co.uk/news/election-watchdog-says-no-credible-proof-of-myanmar-fraud-myanmar-bangkok-asian-network-aung-san-suu-kyi-muslim-b1848885.html

[8] https://www.nytimes.com/2021/02/22/world/asia/myanmar-general-strike.html