US aid halt can be deadly for some

Thailand's Intervention Saved Lives, But Long-term Solutions Needed

Published in: Bangkok Post

Nadia Hardman
Researcher, Refugee and Migrant Rights Division
Nadia_Hardman

Wah K'Ler Paw was just 30 when she died from renal failure in a remote Thai refugee camp near the Myanmar border. Her death was preventable, but the Trump administration's freeze on foreign aid abruptly cut her lifeline: dialysis that had kept her disease at bay.

Wah K'Ler Paw is survived by her husband, Thaw Tu, whom I interviewed in February, and their 2-year-old daughter. They had been living in refugee camps for nearly two decades after fleeing the armed conflict in their hometown in Karen State in neighboring Myanmar.

Refugees who live in the nine camps dotting the border cannot move freely, with the Thai authorities tightly controlling permission to enter and exit the camps. As a result, the approximately 90,000 Myanmar refugees are completely dependent on humanitarian aid -- from food rations to health care.

Thaw Tu told me that no one is allowed to leave the camp to work. Since his arrival, he hasn't set foot outside the camps except to accompany his wife for her bi-weekly dialysis treatments at the Mae Sot hospital over an hour away. He said he has no income to live independently or to pay for medical care, and that the International Rescue Committee, a US-headquartered humanitarian organisation, paid for Wah K'Ler Paw's medical fees and their transportation. Without this support, his wife would never have been able to afford the treatment necessary for her survival.

In late January, Wah K'Ler Paw's dialysis treatment suddenly halted. The International Rescue Committee had received a "stop work order" from the US Agency for International Development (USAID), which provided the funds to assist the organisation in providing health services to its many patients. Thaw Tu and his wife desperately tried alternatives but could not afford the roughly 2,000 Thai baht (US$60) for dialysis, nor the costs for transport and leaving their camp, which refugees must pay. On Feb 16, Wah K'Ler Paw died.

Another Karen refugee in the camps, Koe Noe, told me that his neck swelled, and he struggled to breathe when he could no longer access kidney dialysis. He managed to survive when the Thai Health Ministry stepped in to provide health care to the camp residents amid chaos caused by the sudden withdrawal of US support.

On Feb 9, Health Minister Somsak Thepsuthin announced urgent measures, including establishing a command centre to coordinate with border hospitals for patient care. But for Wah K'Ler Paw, it was already too late.

Koe Noe was able to restart his dialysis and feels well again. While he told me that he deeply appreciates the Thai government's intervention, he said he does not know if it is permanent and expressed anxiety about the future.

Wah K'Ler Paw's tragic and unnecessary death and Koe Noe's last-minute recovery serve as a stark reminder of the camps' decades-long dependence on foreign aid -- which, as the Trump administration's abrupt severance has shown, can be switched off at will, causing immense and irreversible harm. For refugees like Wah K'Ler Paw, decisions made far away in Washington, DC can be a matter of life or death. Now more than ever, a durable solution for Thailand's refugee camps is urgently needed.

The Thai Health Ministry's actions are laudable but do not provide a sustainable pathway for refugees to live independently and work to support themselves and their families. Several million Myanmar nationals already live and work in Thailand, and the 90,000 refugees living in the camps are a comparatively small number that depend on aid to survive.

But it is not just health care in the camps that has been affected. While the International Rescue Committee has reportedly received a partial waiver to continue providing certain health services, funding for the Thai Border Consortium, which provides food aid to all nine refugee camps on the border and also received financial support from USAID, remains suspended. Without support, food rations will run out by the end of March, according to a consortium official.

For the refugees in the Thai camps that have existed since the 1980s, resettlement to third countries has been the only realistic pathway to a better life. But another executive order from Washington has indefinitely suspended all refugee resettlement, effectively closing that door to the United States.

Without US resettlement and safe refugee return to Myanmar not an option, and other countries unlikely to pick up the slack, the Thai government should consider integrating the refugee population. As a start, this would mean allowing refugees freedom of movement and work authorization so they can become self-sufficient and contribute to Thailand's economy. As Thaw Tu told me, "I just want a chance to stand on my own two feet."