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Efforts by the Myanmar Health Cluster partners to discuss restored humanitarian access across Arakan State have been subject to political pressures, sources close to the negotiations tell DVB, although cooperation between the Ministry of Health and NGOs over the past few days indicates that limited progress is occurring.
More than 170 staff members from international NGOs and UN agencies were evacuated from Sittwe following attacks on their offices and residences last week. Their departure follows the expulsion from Arakan State in late February of Médecins Sans Frontières Holland (MSF-H) whose programs provided frontline healthcare for an estimated 700,000 people, including some 200,000 residents of displaced persons camps and remote areas, mostly Rohingya Muslims.
Although the government pledged to fill in the gaps left by the “temporary suspension” of MSF’s activities, there is evidence to suggest elements within it are actively undermining efforts to re-establish humanitarian access.
“It’s a bit of a contradiction: on one hand they [Burmese authorities] are saying they want the UN and the INGOs back in, but at the same time they can’t get back in,” a foreign NGO official, who did not want to be named, told DVB.
Burma’s Ministry of Health (MoH) dispatched teams to Arakan to pick up where MSF and other aid agencies were forced to leave off, but their capacity to provide services is limited.
“What they’re doing is miniscule. They’re not even doing that effectively,” the international aid worker said. “There is basically no health cover in Rakhine [Arakan], and in the north – especially in Maungdaw – there’s a lot of intimidation, attacks on villages, people being beaten.
“It’s a humanitarian disaster, and there’s also a risk of a massacre.”
The official claims that offers of assistance by the WHO Health Cluster for Myanmar – which coordinates policy among humanitarian organisations and UN agencies – have largely been ignored or refused outright.
The official claims a proposal to establish a “rapid response team” for when crises arise – comprised of humanitarian workers from abroad or working in other parts of the country – was not immediately embraced by the MoH, even though the proposed composition of the team was intended to allay fears of bias.
Offers from MSF Holland and other NGOs to allow MoH relief teams to use their vehicles, as well as offers of financial support, were also allegedly rejected, although limited cooperation has begun over the past week. The Ministry has sent five relief teams, comprised of 18 healthcare professionals, which have joined forces with a contingent of 17 workers from the Myanmar Health Assistants’ Association already in Sittwe. However, the INGO official told DVB that the relief workers have just two ambulances at their disposal. This means their activities have been largely limited to camps around Sittwe, as they have no other means of accessing needy areas further north.
The Ministry’s relief efforts have been largely unable to service Rohingya populations, as relief staff are afraid to enter Rohingya camps for fear of reprisal. “They’re only going to Rakhine places anyways, not to the camps, because they feel unsafe there,” the official said.
Sources familiar with the negotiations between the WHO Health Cluster and the Ministry of Health claim that the health teams dispatched by Naypyidaw mean well, but have to contend with pressure from other branches of the government.
“The non-acceptance of offers does not constitute immediately the rejection of offers,” Dr. Liviu Vedrasco, the WHO Health Cluster coordinator for Myanmar, told DVB on Friday. “Offers of assistance have been accepted at the Sittwe level, and things are moving in that regard … if you want to look at all the ministries in the Myanmar government, I think the Ministry of Health has been the most responsive in this situation,” he said.
Another proposal – which would have MoH teams partner with international NGOs to operate mobile clinics – has been more successful. A joint effort by the MoH and Mercy Malaysia to deliver aid to a Rohingya camp near Sittwe was blocked by protests last week, but the blended team has been able to deliver some aid over the past few days using Mercy Malaysia’s vehicles, with more to come on the horizon.
The Arakan State Health Department will apparently allow joint MoH-INGO teams to expand their operations to Mrauk-U and Pauktaw townships next week.
“I am hoping this will only increase … and we will come back to the state of affairs that we had a few weeks ago in a short time,” Vedrasco said.
Despite these signs of progress, Vedrasco estimates that Arakan State has just 10 or 15 percent of the front-line medical relief workers that it did before the pullout.
The UN Office for the Coordination of Humanitarian Affairs (UNOCHA) claims the humanitarian situation in Arakan is at a tipping point. “The immediate effects of the disruption of humanitarian services [are] already being felt in IDP camps and isolated villages in Rakhine State,” the agency said in a statement released on Wednesday.
More than 300 children with severe malnutrition in Sittwe are no longer receiving therapeutic treatment, while 1,300 metric tonnes of food needs to be distributed in Arakan to replenish dwindling stores, the statement said, a feat that will be difficult for the government to accomplish without the participation of NGOs.
A Reuters report on Wednesday quoted humanitarian workers stating that camps around Sittwe will run out of drinking water within ten days. “Water is a critical issue at this time of year. The camps we’re particularly concerned about are ones that depend on ‘waterboating’ – bringing water to them by boat,” said UNOCHA spokesman Pierre Peron. “That’s a particular problem in Pauktaw … there are a couple of camps there where … it’s a real concern, and they need water ASAP.”
The US State Department issued a statement on Wednesday condemning the Burmese government for its failure to provide “the travel authorisations necessary for the humanitarian aid workers to resume their life-saving services.”
NGOs and UN agencies apply for travel documents with the ministries closest to their mandate – medical NGOs would apply with the Ministry of Health, for example – but these are then processed by a higher office.
The NGO official claims that new travel authorisations will not be issued until after the Burmese New Year holidays, which end on 21 April. This was seemingly corroborated by Arakan State government spokesman Win Myaing on Thursday, who told the media that relief efforts in the state would resume “in the third week of April”.
In the meantime, he said, state-level departments have aid distribution covered, and currently have enough food and medicine to supply those in need until 16 April.
“We have already distributed them [vulnerable communities and internally displaced persons] both food and medicine through state-level government departments to last until 16 April,” he said. “We also have a store of rice – more than 3,000 sacks at a Sittwe warehouse and another 1,000 more at the Myanmar Port Authority warehouse.
“In fact, that is enough; we can do the math,” he told DVB on Thursday. “In the past, aid from donor countries was distributed through organisations set up by state-level government departments – it did not always go through the UN and INGOs.”“What they [Burmese authorities] are doing is miniscule. They’re not even doing that effectively. There is basically no health cover in Rakhine [Arakan], and in the north – especially in Maungdaw – there’s a lot of intimidation, attacks on villages, people being beaten.”
Some INGOs hold previously approved travel authorisations that are still valid, but logistical challenges have prevented them from resuming operations.
The destruction wrought by the attacks has left humanitarian agencies without the living quarters, offices and warehouses they need to conduct their operations, posing a significant challenge to re-establishing operations in a timely manner.
“To provide this kind of assistance, you don’t just need doctors and nurses. You need the logistical backup … even if 50 doctors were to show up tomorrow, you can’t do much,” said Vedrasco.
An Emergency Coordination Centre (ECC), run cooperatively by the Union and Arakan State governments, has existed in a limited capacity for a while. It should – at least in theory – serve as a much-needed coordination mechanism for the government to prevent overlap and redundancies in aid distribution.
“They are trying to strengthen their activities and their presence, and all people within the government, INGOs, and the UN, are calling for a stronger ECC,” Vedrasco said.
On Wednesday, Win Myaing claimed the activities of humanitarian agencies that intend to return to Arakan would be subject to the approval of the ECC, raising fears that a strengthened ECC will function as a mechanism to further politicise and restrict aid delivery to Arakan’s hardest-hit populations.
Vedrasco dismissed the notion that the ECC will have veto power over the activities of humanitarian organisations, as existing memoranda of understanding between INGOs, UN agencies and various ministries determine what humanitarian organisations are allowed to do.
But a number of organisations operate in Burma with expired or lapsed memoranda of understanding, raising fears that re-negotiated terms will make them beholden to government-mandated missives to politicise their aid delivery. In February, the government cited MSF’s lapsed memorandum of understanding as partial justification for its order to suspend the organisation’s medical and healthcare activities in Arakan.
The attacks against UN agencies and INGOs in Sittwe last week were prompted by the removal of a Buddhist flag from the offices of Malteser International by a foreign female staff member, which Arakanese nationalists have adopted as a symbol of protest against the controversial, UN-backed census currently underway around the country.
The effects of this protest are immediately significant; however it is the essentially the impoverished people of Arakan – Buddhist and Muslim alike – who will pay the highest price.