State of the World's Minorities and Indigenous Peoples 2013 - Case study: Despite the ceasefire, health care woes continue in south-eastern Burma

In a bustling waiting room, Naw sits on a fold-up chair, her hair caught in the breeze of a whirling fan.

Her arms rest over the bump just beginning to show beneath her clothes. This will be the eleventh time she has been pregnant. However, it is the first time she will actually consult with a health professional during the sensitive prenatal months.

For many like her, the Mae Tao Clinic in the western Thai town of Mae Sot along the Burmese border is the only opportunity to access reliable health care.

'When I was in the countryside in Burma, there would be only one midwife for the entire village,' says Naw, who asked that her name not be published. 'If I wanted to get proper health care, I had to go to a big city and spend money.'

It is a vital issue in south-eastern Burma, which has suffered from years of clashes between Burmese troops and armed ethnic militias fighting for autonomy. That includes decades of fighting over the border in Karen state, where many of the patients who cross the border to reach the clinic live.

The instability means the maternal mortality rate in south-eastern Burma – describing the rate of women who die during pregnancy – is more than three times the national rate, at 740 deaths per 100,000 live births.

Mortality rates for infants and children under the age of five are also disproportionately high. Naw, who lost four of her children before they were five years old, says she feels safer having a baby here in this clinic. That's why she pays for transport across the Moei River, which acts as a natural border here between Thailand and Burma, so she can reach the clinic on the Thai side.

Naw says, 'I'm not young any more. I know I'm old to be having a baby. I should be delivering in a proper health centre.'

The year 2012 began with hopeful news in Naw's native Karen state: the announcement of a ceasefire between the Burmese government and the Karen National Union (KNU), who have been engaged in one of the longest-running civil wars in the world.

An October survey from The Border Consortium (TBC), an umbrella organization of international groups delivering aid to Burmese refugees in Thailand, estimated that 10,000 people were displaced in south-eastern Burma during 2012. It is still a worrying figure, but far less than the estimated 75,000 a year that had been recorded prior to this.

Even as hostilities cooled during the year, however, the health situation remains perilous. The TBC survey suggested almost three-quarters of people in the south-east's rural areas do not have access to safe drinking water, while almost half cannot access proper latrines.

While Burma has boosted funding for its health services recently, the national health budget still comprises only 3 per cent of total government expenditure, according to medical journal The Lancet.[7] People like Naw have turned to the international community, through the Mae Tao Clinic, which has a target population of about 150,000 people on both sides of the border.

For others, who cannot reach the clinic, the situation is often dire. Groups like the Backpack Health Workers Team, based in Mae Sot, are trying to take health care to those who need it.

For years, the group has sent mobile teams into remote areas to deliver health care. In just the first six months of 2012, health teams dealt with more than 45,000 individual cases.

Mahn Mahn is the group's director. He says last year's KNU ceasefire has made travelling in the region easier for health workers. But even with a ceasefire, health problems are just as worrying. Preventable illnesses like malaria, diarrhoea and acute respiratory infections are still prevalent in the target area. At the same time, aid workers say the relative calm has sparked a renewed interest in large-scale development projects, particularly in the mining sector. There have been more reports of land confiscation as proponents of these development projects are eager to take advantage of the relative calm.[8]

Mahn Mahn says, 'There are direct health impacts, but also indirect ones from land confiscation, conflicts between locals and workers.'

Mahn Mahn says he hopes a permanent end to the fighting will see the health situation improve. However, the path ahead remains difficult.

'We see only the ceasefire, but we don't see the peace process clearly. We need to see what the peace process will be in order for the political situation to stabilize. Without solving the political situation, the ceasefire is not sustainable.'


7. 'Burma: health and transition', The Lancet, vol. 379, no. 9834, 23 June 2012, p. 2313, retrieved June 2013,….

8. Back Pack Health Worker Team, Provision of Primary Healthcare among the Internally Displaced Persons and Vulnerable Populations of Burma, 2012, retrieved June 2013,….

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