Following the closure of hospitals in refugee camps along the Thai-Myanmar border, which had received funds from the US government, due to the suspension of US foreign aid, hospitals along the border have committed to continuing humanitarian aid and preparing for an influx of patients from the camps.

Tak province is home to tens of thousands of Karen refugees, many of whom fled the ongoing conflict in Karen State, which has escalated after the 2021 coup triggered a widespread armed uprising.

Hospitals in the three refugee camps in Tak province, Nupo, Umpiem, and Mae La, were funded by the International Rescue Committee (IRC) and  were forced to close, with patients being asked to leave.

After meeting with several stakeholders in the Province, Dr Worawit Tantiwattanasap, Director of Umphang Hospital in Tak, told Prachatai that the meeting focused on approaches for hospitals responsible for patients from each refugee camp. These include mental health care, antenatal and obstetric care, emergencies, HIV and tuberculosis cases, vaccines for children, long term care, and outpatient and inpatient treatment.

The hospital director said once these are properly managed, dental care will be added.

Previous regulations did not allow everyone to enter the camps, but the Tak Provincial Governor and district authorities have now approved a plan to allow the public health officials to enter the camps without permission from administrative officials. In addition, patients in the camps are allowed to seek medical treatment outside.

He added that the transportation will be facilitated by the Volunteer Defence Corps under the Interior Ministry who will assist in driving patients in hospital vehicles while the hospitals will still be responsible for covering fuel costs.

Dr Worawit said the hospitals will record actual expenses, such as medication and fuel costs. Donations may be sought based on the actual costs. In case of any shortages, the hospital may temporarily use its existing resources to ensure proper care.

He emphasised that the cost of treating illness or handling outbreaks is enormous. Investing in primary care to prevent such serious issues is far more cost-effective.

Infrastructure improvement needed

Dr Worawit said some infrastructure, such as electricity and internet connections, must be prepared for telemedicine.

In addition, facility improvements are necessary so that personnel from IRC can continue their work without any restrictions. He also remarked that IRC personnel will still receive wages from IRC, but they will no longer be able to operate under IRC’s name.

He added that Mae La camp could be challenging to handle as it is the largest and most crowded camp, with over 30,000 people. Responsibility for healthcare there is shared between Tha Song Yang Hospital and Mae Ramat Hospital. However, for Umpiem and Nupo camps, which have similar population sizes, a single hospital should be sufficient to handle the situation.

Emergency cases from the refugee camps have always been transferred to the hospitals as surgical specialists are not available within the camps.

After inspecting Nupo camp, the director believed that healthcare services could be improved by better technology while also saving costs. For example, antenatal care can now include ultrasound scans, allowing medical officials to assess foetal conditions early. If a case requires a Caesarean section, the patient can be referred to the hospital in advance.

Humanitarian crisies are unacceptable

Dr Worawit said the situation is volatile, and IRC has never faced this issue before. It is possible that IRC may not resume its operations. Alternatively, the Thai authorities may have to take full responsibility for this situation in the long term.

Most refugee camps are under the UNHCR’s responsibility. He believed that UNHCR would find other NGOs to take care of the issue, but during this time, Thailand must take the lead before UNHCR can hand over to other organisations.

He stated that UNHCR, which is responsible for refugee affairs globally, should play a role in bringing in other NGOs, such as those from Europe.

However, the director also acknowledged that the situation facing European NGOs is not much different due to the ongoing war between Russia and Ukraine and the economic challenges in Europe.

He observed that opinions may be divided on this matter, but he asserted that a humanitarian crisis is unacceptable.

“We cannot let people die or let disease spread uncontrollably like wildfire. I cannot accept that. We must try to control things so that this does not happen,” remarked Dr Worawit.