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Myanmar's democracy and health on life support

2021; Elsevier BV; Volume: 397; Issue: 10279 Linguagem: Inglês

10.1016/s0140-6736(21)00656-5

1474-547X

The Lancet,

Migration, Health and Trauma

A violent political crisis in Myanmar is escalating, which begs for more international attention and action before further lives are lost, democratic and health systems collapse, and the health of the people is further imperilled. In a coup on Feb 1, 2021, the military seized control from the newly re-elected National League for Democracy (NLD) government. NLD leader Aung San Suu Kyi and President Win Myint were placed in military detention. A day later, pro-democracy protests against the military's seizure of power began. Health professionals have led the emergent civil disobedience movement (CDM), which continues throughout the country now under siege. In response to the protests, security forces of the Myanmar military, or Tatmadaw, have brutally cracked down, opening fire on civilians and making mass arrests. Video and testimony are startling. Social media posts show civilian demonstrators attacked with tear gas, grenades, rubber bullets, and live rounds. As of March 15, 112 people have been murdered by the military junta, according to the Assistance Association for Political Prisoners, which tallies 2156 people arrested, charged, or sentenced in relation to the military coup so far. The UN Special Rapporteur on human rights in Myanmar has stated that the crackdown probably involves crimes against humanity. The UN's March 11 statement, in which Security Council nations including Russia and China asked for restraint by the military but fell short of condemning the violence or promising action, is wholly lacking. The Tatmadaw tactics appear to involve strategically and systematically targeting health-care sites and personnel. In Yangon, soldiers have occupied the city's largest hospital, Yangon General Hospital, as well as many others. Occupying hospitals and ambulances lets police easily arrest wounded people, whom they then presume to be protesters, the Associated Press said. Physicians for Human Rights condemned the occupation of hospitals, saying that it was “appalled by this latest wave of violence by the Myanmar military, including the invasion and occupation of public hospitals and wanton excessive force against civilians”. The widespread siege of hospitals followed days of civilian injuries and casualties, they said, and can be interpreted as a direct attempt to impede access to care for civilians, which is a breach of international human rights law. The broader consequences are dire. The coup reverses years of incremental progress towards democracy. Before the 2015 election of Suu Kyi's party and civilian government, Myanmar had suffered under military rule that led to international sanctions and isolation. Despite this, health gains were made. Since 2010, for example, steady improvements in health indicators including infant, child, and maternal mortality and malaria incidence have been observed, despite extremely low government health expenditure and Myanmar being among the world's 30 least developed countries. Life expectancy increased by more than 12 years between 1990 and 2017. Universal health coverage is a key aspiration in Myanmar's national health plan to 2030, fuelled by the promise of economic and social development. Now those health gains and aspirations seem very much under threat. Health-care workers in the country say Myanmar risks profound health-system collapse, but the CDM medics are defiant. Just weeks ago, the health-care workforce was immunised with COVID-19 vaccine produced by the Serum Institute of India, but the roll-out of the second dose has been interrupted by the coup. Reports suggest the military storming of hospitals is an attempt to stop the CDM medics from caring for those injured in the protests and make them renounce the CDM and return to work. Offers of COVID-19 vaccine have been rebuffed, with CDM medics stating that they will not be bribed with vaccines to give up on democracy, and some are publicly refusing vaccines. The civilian protesters and medics cannot be left alone to mount resistance to this appalling injustice in Myanmar. The international community must act forcefully to cut off the junta, prevent further violence, and hold the military rulers accountable for breaches in law and human rights. Targeted economic sanctions are necessary to deny the legitimacy of the military government and to freeze the military's access to foreign assets and arms. More pressure needs to come from powerful geopolitical neighbours in the region. International health agencies and donors must strongly call for the protection and support of health workers and services, including the COVID-19 response. Collective action is urgently needed to return Myanmar to its path towards democracy and health.