Introduction

From the start of the COVID-19 pandemic, there were concerns about what would happen in Myanmar, given its extremely weak health infrastructure, its long history of conflict and political instability, and its large impoverished and at-risk population. The low spread of the virus in Myanmar through the first half of 2020 however led some to believe that the Myanmar government was getting it right. The World Health Organisation’s country representative in Myanmar boasted in July 2020 that “Myanmar has done extraordinarily well so far”. He cited Myanmar’s “whole-of-government” approach, adding: “So the country has really gone all out to strengthen the public health side and preparedness and response, which has been critically important to try and make sure we have as few cases as possible in Myanmar.”[1] 

Although the Myanmar government’s COVID-19 Economic Relief Plan (entitled “Overcoming as One”)[2] made claims about being a coordinated action “leaving no-one behind”, many of the positive actions of the government have not reached the entire population. Aid and support have remained insufficient in most rural areas, like that of Southeast Myanmar, which is largely populated by ethnic minorities who are already vulnerable due to protracted and on-going conflict, displacement, and ethnic oppression by the central government. Thus Myanmar’s “success” should and can only be gauged through a closer look at COVID-19 response and impact in rural ethnic areas.

Very early on in the pandemic, despite the relatively slow spread of the virus, political fractures and infrastructure weaknesses due to Myanmar’s long and on-going history of conflict could be seen not simply in the government’s response, but that of other stakeholders, like Ethnic Armed Organisations (EAOs), locally based civil society organisations, and NGO/INGOs. In a brief report on the situation in Southeast Myanmar during the first wave of the pandemic, KHRG noted the poor coordination and collaboration between stakeholders and the delayed and uneven response to the crisis. KHRG argued that “the lack of coordination between political stakeholders has meant that villagers and local leaders have struggled to obtain information and consistent training and regulations, and has left too much of the responsibility of figuring out what to do in the hands of those who lack information and resources to effectively organise awareness and prevention”.[3] Not only did this poor coordination result in the forced removal of screening checkpoints by the Tatmadaw,[4] KHRG also found the rise of conflict and tension between villages, increasingly critical challenges to livelihood, as well as the breakdown of local systems of mutual aid. 

Given the early indications that COVID-19 response and support were failing in some of the most vulnerable areas in Southeast Myanmar, KHRG continued to monitor the situation to more fully assess the structural weaknesses and barriers that might lead to crisis as the pandemic entered a second wave of outbreaks beginning in August 2020. Increased threats of infection in rural areas did in some cases lead to new efforts at awareness and prevention, but in general sparked heightened restrictions by both the Myanmar government and the Karen National Union (KNU).[5] Thus rather than working to increase individual knowledge and responsibility on the part of villagers, most measures ended up being in the form of broad restrictions like travel bans and school closures that have had significant negative impact on villagers’ lives. These restrictions also seemed to be matched by a reduction in the range of stakeholders providing services and aid. Although the government has provided small amounts of financial and material assistance to households in need, villagers living in KNU-controlled and some mixed control areas have been excluded, leaving local authorities and CSO/CBOs to figure out solutions to support these communities.

Most rural areas in Southeast Myanmar have not (yet) experienced widespread local transmission of the virus, and thus impacts have been more clearly tied to restrictions and prevention measures as opposed to the full-on health crisis seen elsewhere. But because of the already extremely vulnerable situation of many rural communities, the livelihood impacts are themselves at risk of creating a humanitarian crisis. The poor handling thus far of information and prevention, as well as of testing and treatment, may also have wider implications if outbreaks start occurring in the more remote areas. 

On February 1st 2021, the Myanmar military seized power by staging a coup against the newly elected government. Although this report focuses on the situation prior to the coup, the infrastructure and services (albeit insufficient) that the central government, EAOs and other stakeholders have put in place over the past year are in the process of being dismantled. Public healthcare services in some areas have come to a halt, and there have been major disruptions to communication, transportation, supply chains, and banking services. COVID-19 testing has been largely reduced, with little reporting now taking place. Any plans for widespread vaccination seem to have been entirely interrupted.

If rural areas of Southeast Myanmar have not yet faced widespread problems of infection, all of this is likely to change. As local doctors have pointed out: “Since the military takeover, the COVID-19 response has stalled. Mass public rallies and protests are both serving a critical function for resistance and unity, but also as likely superspreader events for virus transmission. Without adequate testing, public compliance and goodwill for isolation, access to acute clinical care, and continued immunisations, the implications for COVID-19 spread, morbidity, and mortality are substantial.”[6] Thus, there is need more than ever to find solutions to bring support and aid to rural villagers, whose situation has already deteriorated and become more precarious over the past year. With the military now in control, there is even less likelihood that support and services will reach rural ethnic communities.

Although this report covers the period prior to the coup, and describes an infrastructure that may now barely exist, the problems created by COVID-19 and the government’s response have not disappeared, and will need to be addressed. Furthermore, the underlying political dynamics that impede the development of a support infrastructure capable of addressing the needs of rural ethnic minorities continue to play out. The report thus begins by providing a brief overview of the political dynamics that have shaped access to services and COVID-19 response. Followed by that is a discussion of COVID-19 reporting and testing, and the prevention measures that have been put in place to address the rise in COVID-19 cases. The discussion then turns to impacts on livelihood, access to different forms of support, and the situation of healthcare and education.

Key Findings

Complex political dynamics and on-going conflict make coordinated administration and nationwide programmes and initiatives difficult, even unrealistic. Schemes that rely on local collaboration and cooperation between different political stakeholders can be successful in some cases, but cannot be the only means for service delivery and rights protection. Different areas face different challenges administratively, thus solutions need to consider the specific constraints of local areas.

Despite government claims of reaching the entire population, government support (material and cash hand-outs) have only been provided in areas under government control. This means that areas under KNU administration have been left to figure out their own solutions to the livelihood problems villagers are now facing as a result of the pandemic.

International aid has also been limited in rural areas, less due to travel restrictions themselves than the Myanmar government’s power over which areas NGOs and INGOs can assist. The government also has significant control over all of the international funding that has been provided by large organisations like the World Bank, International Monetary Fund (IMF) and foreign governments. Health and education departments of EAOs, like the KNU, that serve as primary service providers to local communities are not benefitting from this aid, nor are the populations they serve. 

COVID-19 information and reporting of cases is not only partial and misleading but insufficient at protecting populations in ethnic administrative areas. 

Even in the absence of COVID-19 cases, rural villagers are facing a wide variety of impacts to their livelihood, and access to education and healthcare that will certainly have lasting effects. 

●    Although the adoption of widespread travel restrictions may have helped contain the spread of the virus, such measures have made rural livelihood strategies even more fragile and unstable, resulting in increased food insecurity and decreased possibilities for mutual aid within the community. 
●    Access to education has severely diminished, with government services stopping completely, leaving only ethnic education providers operating in rural areas; government-created options for remote learning remain inaccessible to rural villagers.
●    Healthcare has primarily been disrupted regarding non-emergency (even non-emergency essential) services, creating increased health problems and vulnerability for rural communities that already have insufficient access to care.
 
Support in the form of food distribution and cash hand-outs has been critical as emergency relief, but the system of distribution has been neither fair nor transparent, and needs to be supplemented by the development of long-term solutions to combat livelihood insecurity.

Recommendations

The current political situation in Myanmar presents challenges for developing recommendations to address the problems presented in this report. The fact that no legitimate governing body currently exists to which KHRG, nor the people of Myanmar, can appeal, and that the military junta is displaying a complete disregard for sanitary protocols and human rights standards highlights the urgency for a return to civilian rule and the resumption of peace negotiations. The problems in COVID-19 response, including access to support, services, and information in ethnic rural areas, and the immediate livelihood and health needs of villagers will certainly require action through non-state channels. The following recommendations are thus primarily directed toward the international community. Some recommendations for the Myanmar government have been included, the idea being that international bodies should also be putting pressure on the interim government (i.e., the military junta) or an eventual (hopefully democratically) elected government to develop more inclusive support schemes that ensure the protection and well-being of rural villagers, including IDPs and villagers in conflict-affected areas.

State Administration Council (SAC)[7]/Tatmadaw

Immediately step down and restore power to the democratically elected and internationally recognised government.

End the crackdown and targeted attacks on healthcare staff, withdraw soldiers from hospitals, and resume COVID-19 testing and monitoring.

Immediately resume all communication services and end the suppression of media freedom since this is a violation of the right to access information and impedes the ability to ensure health services.

Allow EAOs and their partner non-state service providers to freely engage in COVID-19 prevention and screening in their respective administrative areas; this includes the establishment and running of screening checkpoints and other information-related activities. 

KNU/KDHW

Adopt a comprehensive relief policy to help vulnerable communities living in KNU-controlled areas cope with the negative impacts of the COVID-19 pandemic.

Re-establish COVID-19 prevention measures and continue raising awareness at the community level; and expand work with health partners to provide more testing and treatment.

International organisations (especially IMF, World Bank, Asian Development Bank, Japan International Cooperation Agency), NGOs, funding agencies, and foreign governments

Develop effective monitoring mechanisms, including ones that do not rely solely on reporting by the central government, to ensure that promised support is reaching ethnic minority populations.

Diversify international funding distribution so that more funding is made (directly) available to non-state actors. In particular, increase direct funding for ethnic service providers and civil society organisations, especially those that are working in health, education, and protection sectors.

Prioritise methods of service delivery and communication that rely on local civil society organisations and ethnic service providers that have the ability and networks (due to consistent access and trust from the community) for local implementation of support programmes.  

Strengthen livelihood sustainability in rural areas through initiatives that support and reduce the vulnerability of small farmers and day labourers. For instance, by improving global and regional food-supply chains to make them more inclusive of small farmers; and by further studying local initiatives as models for developing locally appropriate and tailored solutions.

Support EHOs and other non-state health actors, both regarding COVID-19 prevention and treatment (including screening/testing and the running of quarantine facilities), and the provision of other essential health services in rural areas. 

Ensure that COVID-19 information and prevention awareness reaches all communities, including conflict regions, and that critical information is delivered in all ethnic languages in a culturally appropriate and time-sensitive manner.

Increase support for EAO-based education providers and develop new strategies for the delivery of educational support in rural areas, including conflict-affected areas.

Work with Southeast Myanmar border countries to provide assistance to border communities and IDPs in need of health and livelihood services; and facilitate the return of migrant workers to their jobs abroad.

(Future) national government and state actors

Develop national monitoring mechanisms that include representatives from ethnic minority groups to ensure that the health, economic and social rights and well-being of ethnic minorities are protected. And include ethnic minority representatives in the drafting process of future emergency economic and social relief plans.

Reduce livelihood risk in rural areas by including informal workers and small farmers in national social protection strategies, for instance by providing unemployment and social security benefits to them.

Ensure the autonomy of ethnic service providers; and improve government cooperation with ethnic and non-state service providers, in particular EHOs and other health actors, so that they can continue providing and expanding services in ethnic administrative areas.