Asia Briefing N°161: Conflict, Health Cooperation and COVID-19 in Myanmar

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Conflicts have paused in much of Myanmar, opening a window for the government, military and ethnic armed groups to pursue a holistic response to the coronavirus. The parties should also work together in Rakhine State, where fighting persists, to limit the disease’s spread.

What’s new? Amid a lull in fighting in much of the country, the Myanmar government and ethnic armed groups appear willing to put aside politics and work together to prevent the spread of COVID-19. The exception is Rakhine State, where conflict is escalating, putting medical workers at risk and exacerbating a potential health disaster.

Why does it matter?  Conflict-affected areas of the country are highly vulnerable to COVID-19 but often outside state control. A successful response to the pandemic will require close coordination among the government, the military and ethnic armed groups, many of which have long run their own health systems.

What should be done? The government, military and ethnic armed groups should work together to combat the virus through prevention, surveillance, testing and referrals. In Rakhine, they should ensure the safety of health workers, enable access to displaced populations and strengthen COVID-19 prevention messaging.

l. Overview

A major COVID-19 outbreak could have devastating consequences in a country as conflict-affected as Myanmar, where health spending is limited, governance is weak, hundreds of thousands of people are displaced by fighting, and the government cannot reach many areas held by ethnic armed groups. Reducing transmission as much as possible so that the health system can better cope will require cooperation with these groups, many of which run their own health systems. Promising discussions that have already begun between the government and various ethnic armed groups should continue in earnest to enable a holistic response in areas of the country where conflict is presently limited. The exception is Rakhine State, where fighting continues to escalate between the Myanmar military and Arakan Army, undermining prevention efforts and putting the lives of health workers at risk. Here, all sides should ensure the safety of medical personnel, allow humanitarian access to displaced and other vulnerable populations, and work to improve public adherence to mitigation measures.   

Myanmar was one of the last countries in the world to confirm a case of COVID-19, announcing its first two positive tests on 23 March. So far, the spread of the virus appears to be limited, with fewer than 200 cases and just six deaths recorded, but low testing capacity and the geographic distribution of cases mean that the disease is likely to be far more prevalent than reported. Even a modest outbreak would put considerable strain on resources, particularly hospital beds for severe and critical cases. A holistic response that includes cooperation with ethnic armed groups will be essential for containing the pandemic and avoiding a potentially catastrophic human toll.

Although Myanmar’s military eventually announced a national ceasefire to support the response to COVID-19 in early May, it has excluded areas of Rakhine and southern Chin States where it remains engaged in fierce fighting with the Arakan Army. The Arakan Army, through its alliance with two other ethnic armed groups, has also announced a unilateral ceasefire, but the war shows no sign of abating. Hundreds of combatants and civilians have been killed since the start of the year, and the government’s recent designation of the Arakan Army as a terrorist group has further diminished any prospect of de-escalation. The death of a World Health Organization (WHO) driver, whose vehicle was attacked on 20 April as it took novel coronavirus swabs to Yangon for testing, underscores the risks this conflict poses to health workers and to efforts to combat the virus. With no chance of a ceasefire in the near term, the government, the military and the Arakan Army should instead aim to reach an agreement that guarantees safe access for medical personnel and humanitarian workers.  

Elsewhere, cooperation between the government and ethnic armed groups remains very much possible. The pandemic has surfaced in Myanmar at a time when the rest of the country is experiencing a lull in armed conflict. Although the peace process is largely stalled and the most powerful armed groups continue to resist signing the Nationwide Ceasefire Agreement (NCA), there have been few clashes reported in recent months in Kachin, Kayin and Shan States. Combined with this relative calm, the urgent need to respond to COVID-19 has created an opening for discussions. The government has already taken a number of positive steps, including forming a committee to coordinate with ethnic armed groups and developing a response plan that formally recognises the role of ethnic health providers. Tentative talks are now under way on how to take coronavirus cooperation forward.  

Keeping discussions focused on technical aspects of health coordination, and avoiding linking the response to the peace process, will ensure the best opportunities for progress. It is of course possible that cooperation on COVID-19 could have benefits beyond the immediate response, including for the peace process. If the government, ethnic armed groups and ethnic health providers are able to work together to respond to the pandemic, this effort should, at a minimum, help build some trust. The most likely positive consequence is that it will prompt future coordination on health-related matters, something for which the NCA already provides but has not yet been pursued by either side. Generating dividends for the peace process should not be the primary objective, however, because it will politicise and thus complicate – even likely derail – collective efforts to respond to the virus. It is important that the focus remains on the pressing need to protect people across the country from contagion, whether they live in government-controlled areas or under an ethnic armed group’s administration.  

The government and ethnic armed groups need to find a way to work together, putting aside to the extent possible the political issues surrounding the peace process. The support of the Tatmadaw, as the Myanmar military is known, will be vital. Donors also have an important role to play in providing financing and technical support to facilitate this cooperation.