Amid political and civil unrest in Myanmar, health services are inaccessible

Myanmar is a democratic country in political crisis, and a suspension of health services is placing millions of patients with chronic illnesses in increasingly difficult situations.^1,2 On Feb 1, 2021, the military initiated a coup and committed aggressive repression. In response, Myanmar’s citizens engaged in massive protests and a civil disobedience movement in an attempt to end the coup and restore democracy.³ Our colleagues and friends in Myanmar, who ask for anonymity to protect themselves and their families from military reprisals, have relayed to us how political turmoil turned violent and continues to escalate. Numerous service sectors, including transportation and health care, have been disrupted. Public spaces have become unsafe due to increased violence, streets have been closed as a result of confrontations, and health services have either been suspended or operate on reduced hours because of a decrease in work-force and military police raids.

We are particularly concerned for those patients with chronic illnesses who have multiple unmet needs. For example, essential HIV services (including HIV testing), delivery of antiretroviral therapy, viral load testing, and adherence counselling have been reduced or suspended because of closed facilities and the disappearance of providers in many towns throughout Myanmar. Within the health-care system, many medical facilities have closed or relocated to avoid military or police targeting. Health-care workers’ security is under threat from state violence, resulting in additional barriers to accessing care. Most public hospitals with inpatient services have stopped providing services, leaving patients no choice but to use expensive private institutions. Moreover, because public transportation is unavailable and personal safety is increasingly threatened by violence on the streets, patients are reluctant to travel to refill life-sustaining medications. Given the far-reaching impacts of political instability on the health-care infrastructure, people with various illnesses in Myanmar are likely to experience serious service interruptions.

Considering these dire conditions, we urgently call for humanitarian interventions from the international health-care community to ensure patients in Myanmar with chronic illnesses have access to necessary medical care for basic health maintenance and survival. Financial aid, human resources, and technical support are needed to create one-stop, wrap-around services for these patients, from screening to treatment.⁴ A continuous flow of medical supplies must be secured. Safe transportation is crucial for access to health care. Finally, research is needed to investigate how patients with chronic illnesses in Myanmar use health services because their physical and psychological health is negatively influenced by traumatic geopolitics. This research would allow the development of evidence-based interventions and serve populations who need support during these unstable political conditions.