Chaos has ensued over the last 24 hours among civil society organizations working with refugees on the Thai-Myanmar border after the US government under President Donald Trump implemented an executive order immediately halting foreign aid for 90 days, resulting in the closure of hospitals in refugee camps which receive funding from the US government.

At Mae La and Umpiem refugee camps, hospitals funded by the International Rescue Committee (IRC) were closed. Pornsuk Kerdsawang, who works for an NGO in the border area, said that every patient has been asked to leave the hospital, while women in labour have to find their own way to a Thai hospital. Projects on community health, mother and child health, as well as vaccination, sanitation and waste management projects inside the camps, which receive funding from the US, must also stop.

It is currently unclear how many patients have been affected, Pornsuk said, since the data is collected by the IRC.

A doctor working on the Thai-Myanmar border speaking anonymously also said that some of their organization’s programme has been suspended due to the executive order, and that support for food and medication has stopped in some places. The staff are also no longer being paid.

Some camps have “stopped functioning,” said the doctor, who said that some patients have been transferred to Thai hospitals, but that most returned home. Some critically ill patients also remain in the camps. The organization has enough funds to take care of children in the camps it works in, but the doctor said that they are not sure about the future if they don’t receive any more funding.

Meanwhile, funding from the US Agency for International Development (USAID) for NGOs working along the border has stopped, raising concerns among civil society.

Thai hospitals stand ready

Hospitals on the border in Tak province are preparing for an influx of patients from the refugee camps. Dr Worawit Tantiwattanasap, Director of Umphang Hospital in Tak, said that the rising number of patients due to the closure of camp hospitals is unlikely to be a major issue, since patients from these camps only make up around one-third of its total number of patients. Public health NGOS are also still working in coordination with the hospital, which he said improved the situation.

He said that hospital directors from the 5 districts on the Thai-Myanmar border in Tak met yesterday afternoon (28 January), along with Tak’s provincial governor and provincial public health doctors. They agreed that hospitals must follow humanitarian and human rights principles and care for patients whether they are being supported by an NGO worker or not, and that they must treat emergency cases that could result in death or disability, including labour and delivery, accidents, or other serious illness such as strokes, without charging a fee.

Noting that the fees at Umphang Hospital are low to begin with and NGOs could afford to cover them, Dr Worawit said that the hospital will continue to care for patients after many NGOs had their funding cut. He also said that the hospitals would have to work to control diseases that could spread in the camps and care for patients with infectious diseases like tuberculosis. The IRC had a tuberculosis centre, and the hospitals would have to step in and take over the care of patients to prevent the disease from spreading in the camps and outside.

Doctors from Tak’s public health office, hospital directors, and district public health offices will hold another meeting tomorrow (30 January). Each district has been asked to conduct a survey of patients at refugee camps in the area and come up with a plan of what needs to be done to care for them. Umphang Hospital will be responsible for patients from Nupo camp, Phop Phra Hospital will take patients from camps in Umpiem, while Tha Song Yang and Mae Ramat hospitals will take patients from Mae La camp. Mae Sot Hospital will support these four hospitals and may send in doctors or other support.

Dr Worawit also proposed that the Ministry of Public Health set up a national fund for humanitarian aid, because Thailand is being affected by policies implemented by a more powerful nation, which has a worldwide impact and is something out of its control. He said that Thailand has received funding from foreign donors and support from NGOs and companies, and although NGOS can only do so much, their primary healthcare support helps, and only severe cases are referred to hospitals along the borders.

The Ministry of Public Health should also work with UNHCR, the UN refugee agency, which is already working in the refugee camps, Dr Worawit said, noting that humanitarian aid should be extended to people without refugee status as well.

Dr Worawit said he is happy that public health personnel have united to support border hospitals and patients, and that the hospitals are not left to handle things alone. He noted that they are following a policy implemented by Tak’s provincial governor, its public health office, and the Minister of Public Health.

As for preliminary measures, Dr Worawit said he has asked the Volunteer Defence Corps under the Ministry of Interior, which is already overseeing refugee camps, to help transport patients. He also proposed that field medics be hired to work in the camps to provide preliminary care.

Civil society left in limbo

Pornsuk said that the situation in the field and among civil society workers has been chaotic, since the executive order freezes all funding and halts all activities that have expenses. It is unclear whether medical workers will be able to keep doing their work.

“If staff are going to take care of patients, my personal thought is that it should be possible, but now there is fear … so no one really knows what to do. The idea has emerged that everything is prohibited,” Pornsuk said.

“The order is very confused . Civil society have questions about the doctors and nurses in the hospitals. They are Karen people in the camps, right? They are refugees themselves. Can’t they do their job? Is it wrong? Suppose the hospitals close, can they do something else?”

Pornsuk is concerned that humanitarian work along the borders will be significantly affected if the US does not change its policy, since most humanitarian funding for health services, food, and shelter in refugee camps came from USAID.

“It won’t stop immediately, because they have other sources of funding, but a lot of their overall budget will disappear, and it has to have an impact this year,” Pornsuk said.

Pornsuk said that several projects run by Mae Tao Clinic, a clinic for migrant workers in Mae Sot, have been suspended because they were funded by the US. Other organizations funded by USAID, including internally-displaced persons camps in Myanmar and Karenni groups’ education projects could also have their funding cut in the future.

Time to close the camps?

Following the hospital closure, Fair Party MP Kannavee Suebsang proposed that it is time to close the camps and allow the refugees to integrate into Thai society. He said that this is a solution to the humanitarian issues that has been discussed for a long time, because the refugees in these camps cannot return to Myanmar and have almost no chance of going to a third country. Several generations have now been born in the camps.

Pornsuk said that civil society organizations working in the camps know that one day foreign funding will be cut, so they want the Thai government to start seriously considering closing the 9 refugee camps.

“Actually, in the long run the refugees want that. The funding cut this time might play a part in making the Thai government think seriously that [the refugees] don’t want to live like this. They haven’t wanted to rely on others for everything,” Pornsuk said.

Pornsuk said that solving these issues needs a lot of management effort, and that the refugees themselves want to be part of the process. She noted that the refugee committee previously played a larger role in managing the camps, but they have slowly been pushed out. Meetings are now mostly for Thai government officials and foreign NGO workers, while the refugee committee has to ask to sit in on them. She believes that this is because the Thai government feels that it is easier to go through large NGOs.

“[The refugee] are being excluded. It became just NGOs and the Thai state,” Pornsuk said. “In the past, [the refugee committee] had more power than now to take care of themselves, and they were stronger than this. They said that it’s also time that they were given back their role.”