Since last’s year’s military coup, Myanmar’s campaign against COVID-19 has been in disarray.
The health system has all but collapsed with thousands of medical staff in hiding and others languishing behind bars for their involvement in the civil disobedience movement.
Thai epidemiologist Dr Vit Suwanvanichkij, who has long experience of regional health problems, is deeply worried by the chronic lack of information coming out of Myanmar. “There is little or no reporting of the COVID-19 virus and its variants. Given the collapse of Burma’s health system and its very limited capacity to test or do genomic surveillance, we have no idea and neither does anyone else know what is going on.”
What we do know is that the uncontrolled spread of COVID-19 inside the country has even worse implications for thousands huddled in displacement camps.
Half of Kayah State has been displaced since the coup with little or no access to official health services. Around 800,000 have been displaced nationwide.
The conditions for the displaced create a “serious danger of viral replication on a massive scale and that means evolution and virus mutation”, according to Dr Vit, who says there is an ongoing danger of Myanmar becoming a super-spreader.
The case for cross-border intervention
As long as the military regime remains in power, the enfeebled state-controlled health sector, now increasingly staffed by military personnel, will always lack the capacity and neutrality to carry out an effective vaccination and COVID-19 surveillance.
However, most western aid and vaccines are still dispatched to Yangon where distribution is at the mercy of military authorization and distribution permits.
The need for the international aid community to make a serious effort to diversify humanitarian aid corridors with alternative routes from Thailand and India is surely beyond dispute, whatever the practical and political constraints.
The predominant response from Thai military authorities to the war in Myanmar has been to tighten border controls and deny all NGOs and the UNHCR access to refugees. Officially there is no Thai approval of cross-border aid and thousands fleeing have been pushed back across the river.
The Thai government is so immersed in orthodox measures in tackling border security that it has failed to grasp that no amount of conventional security can stop a virus spreading across an international frontier.
UN rapporteur Tom Andrews said: “Covid does not respect nationalities or borders or ideologies or political parties. Covid is an equal opportunities killer.”
Beyond Myanmar’s borders, Thailand, China, India and Bangladesh could all be exposed to a super-spreader state unless there is decisive UN-endorsed cross-border humanitarian intervention.
So far Thailand has not made any specific preparation for a spillover from Myanmar. According to Dr Thira Wora Woratanarat, an epidemiologist at Chulalongkorn University’s Faculty of Medicine: “I do not think there is any focus from the Thai authorities to care about the lack of vaccination inside Myanmar.
“If it is obvious the disease is going to be uncontrollable in the area, cross-border medical aid is essential. This may be a good opportunity for the Thai government if it decides to use this channel to provide benefits for both countries in respect of pandemic control. Education, as well as medical services and supplies, could be a good intervention.”
China, which has a 2,000km border with Myanmar, has been proactive, dispatching Chinese Red Cross teams to administer free vaccinations in Kachin and Shan states.
The Kachin Independence Organisation said 10,000 people were vaccinated at its Laiza headquarters last year. China has also promised to supply half a million doses to the Ta’ang National Liberation Army during 2022.
Would Thailand back cross-border vaccine distribution routes?
Thailand’s refusal to allow cross-border aid and restrictions on humanitarian aid distribution by NGOs is partly based on sovereignty and national security concerns.
However, Relief International, a US-based NGO, says international humanitarian law, which normally requires a country’s consent for cross-border assistance, does not apply in cases of humanitarian emergency.
The NGO said countries cannot “arbitrarily withhold consent for aid where it is clearly necessary and where efforts are clearly humanitarian in nature”.
The UN General Assembly has refused to recognize the junta as Myanmar’s legitimate government. Hence the Thai authorities have no legal obligation to seek consent from the military regime.
This indicates that the real obstacles and objections coming from the Thai side are not based on law but rather belong to the domain of diplomacy and politics.
Asean’s abysmal failure to engage with the National Unity Government (NUG) and Thailand’s fears of further waves of refugees are the main factors governing current border governance.
International NGOs have stressed many times since the coup the need to upscale cross-border aid using mechanisms already in place which date back to previous refugee influxes in the 1990s.
There is already a credible aid partner inside Karen State. The Karen National Union (KNU) and NUG’s task force is a joint effort between the civilian health ministry and the ethnic armed organization’s health agency, formed in July 2021.
Padoh Mahn Mahn, a KNU spokesman, said: “We have asked the Thai authorities for cross-border permission [for vaccinations]. But we still have to overcome many challenges.”
The NUG’s shadow health minister, Dr Zaw Wai Soe, led the ousted democratic government’s coronavirus efforts and is doing the same job underground.
What needs to be done?
In the middle of a pandemic, advocates of cross-border aid argue health security should take priority over normal border-control regulations and sovereignty concerns for the sake of common good and mutual medical benefit.
Humanitarian aid worker Johny Adhikari of the charity Metta asked: “If China can so easily deliver enough vaccines to Shan State, what is stopping Thailand facilitating a similar cross-border vaccination drive into vaccine-starved Karen State?” His charity is a major aid distribution agency for migrant workers and refugees.
The KNU’s Padah Mahn Mahn told The Irrawaddy: “We carried out 1,500 vaccinations in March this year [of] over 100,000 people in Hpapun district of Karen State. We need many more vaccine donations. But many donors like the Gavi vaccine alliance have declined the NUG’s request for help.”
Covax and Gavi are linked to World Health Organization initiatives designed to support access to vaccines for the poorer countries and have miserably failed to provide equal access to COVID-19 vaccines. Western governments hoarded most of the vaccines produced in the US and Europe during 2021.
Phil Robertson from Human Rights Watch Asia is not surprised about donor reticence.
”Without some willingness by Thailand to change its policy on cross-border assistance, it’s not surprising that both donor governments and INGOs are pessimistic about providing such assistance,” he said.
There have been private talks between the Thai foreign minister and the UNHCR about preparing for a deepening crisis in Myanmar and a major influx of refugees in 2022 but there has been no information shared with NGOs on the border.
The clear pathway for a breakthrough with the Thai authorities is for Thai NGOs, medics and UN agencies to convince Thailand that a major shift in border policy is hugely in the interests of Thai society and an essential step in relieving the humanitarian disaster in Myanmar.
Adhikari said: “The Thai government could help contain the COVID-19 threat and migrant problems by setting up one-stop offices at the border crossings. These multifunction offices could provide health checks and vaccinations and process visa renewals for migrant workers, helping to eliminate brokers and traffickers. This would benefit all sides and help the Thai economy.”
The proposal offers the potential of a win-win humanitarian solution for Thailand and Myanmar. But it will require a huge amount of lobbying to make any kind of breakthrough and transform the frontier into a zone of international COVID-19 prevention and cooperation.
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