The situation for refugees on the Thai-Myanmar border when Myanmar’s transition stalls

The political situation in Myanmar has changed from a military government, which ruled since 1962 until a civilian government led by the National League for Democracy (NLD) won the elections in 2015.  Even though this has still not brought the country to a fully democratic system of government, since the 2008 Constitution still reserves political power to the Myanmar military, it has been enough for western countries to adjust relations with Myanmar by relaxing sanctions, investing in Myanmar and donating more assistance funding.

There have been peace negotiations between the Myanmar government and the ethnic armed organizations (EAOs) since the end of 2011, leading to the signing of a National Ceasefire Agreement (NCA) on 15 October 2015 with 8 EAOs, led by the Karen National Union (KNU) and the Restoration Council of Shan State/ Shan State Army (RCSS/SSA).  In February 2018, a further 2 groups signed: the Lahu Democratic Union and the New Mon State Party.  But at present, steps in the peace negotiations and political negotiations show no progress.  On the other hand, the Myanmar Army itself has expanded its military forces and reinforced its military facilities in the areas of the EAOs, leading to many military confrontations and clashes which deteriorated further when the Myanmar Army wiped out Rohingya Muslim communities in August 2017.  The latest figures have more than 800,000 refugees across the Bangladesh border.

This changed political situation in Myanmar has an impact on the humanitarian situation on the Thai-Myanmar border area, because after western governments adjusted their relations with the Myanmar government, donors from the western countries, both government and non-government, began to cut their budgets or shift their priorities from the border to assistance inside Myanmar.

This report will survey the humanitarian situation on the Myanmar border which has been affected by changes in foreign assistance and the human rights and security situation in the Thai-Myanmar border area.  It will look at three cases: 1) the Mae Tao Clinic which has long provided important public health services on the Thai-Myanmar border;  2) the Koung Jor refugee camp on the border between Thailand and Shan State, in Wiang Haeng District, Chiang Mai Province;  3) 12 communities of Internally Displaced Persons (IDPs) in Karen State after the Myanmar Army cut a strategic road into an area administered by the KNU.

Dr Cynthia Maung

1. Mae Tao Clinic

The Mae Tao Clinic was set up in 1989 as an important clinic on the Thai-Myanmar border.  Each year it treats on average no fewer than 100,000 patients from the border area or cross-border patients, 50% of whom are from Myanmar.  It also helps delivering 2,300 babies a year, screens for tuberculosis and HIV, and conducts research and prevention of infectious diseases, especially malaria.

Dr Cynthia Maung gave treatments to patients at Mae Tao Clinic in 1990

A mother took her baby for a vaccination at Mae Tao Clinic

For the past 30 years, it has been a training centre for more than 2000 public health officials who have gone back to take important roles in remote areas in the east of Myanmar which are the home of ethnic minorities, including Shan State, Karenni State, Karen State and Mon State, using a Health System Strengthening (HSS) programme which collaborates with 8 ethnic minority public health organizations.

However, according to Suwannimit Foundation, the umbrella organization that administers the Mae Tao Clinic, the budget received by the Mae Tao Clinic from funding agencies at the beginning of 2018 was initially sufficient for only 25% of its actual needs.

The principal funders, such as UK Aid and USAID, explain that they are unable to provide any more assistance budget for the Thai-Myanmar border and have to switch to operations inside Myanmar instead.  The Mae Tao Clinic therefore has to look for replacement budget and funding sources in order to be able to continue its border public health activities.  Otherwise the Mae Tao Clinic will have to cut its budget for many public health and child welfare projects.  This will affect infectious disease prevention along the border.

Data from staff of the Suwannimit Foundation, the umbrella organization of the Mae Tao Clinic, reveals that in the last year, all project sections have been reduced from 400 to 300 staff and stipends have been cut by 20% for a period of 10 months.

Dr Cynthia Maung, the director of the Mae Tao Clinic, revealed that in the past there has been a review of the personnel structure of the Clinic and there are plans to adjust the number of personnel appropriate for providing public health services efficiently.  There is also a search for other allies and funders at the regional level, such as the private sector in Thailand which occasionally helps with medical supplies, for assistance from governments and the private sector, and for Grant Assistance for Grassroots Human Security Projects (GGP) from the Japanese government.

For the costs of treatment, a system of voluntary co-payment by patients was begun in October 2017, but this is not used for all treatment.  The co-payment system is used for cases which are not emergencies, such as vision care and non-emergency surgery and treatment.  Patients may contribute 25% of the medical costs.  If they are unable to pay, this may be reduced to 10% or 15% or whatever the patient is able to pay, such as to 100 baht or 50 baht.  From a basic assessment, staff of the Suwannimit Foundation reveal that after one year of the voluntary co-payment system, the medical fees received cannot yet cover the costs of the Clinic but merely provide a breathing space for operations.  The Mae Tao Clinic also still encourages migrant labour in the area to access health insurance at an appropriate price.

After these new measures, the Mae Tao Clinic secured sufficient operational and project budget for the year of 2018.

Health care staff gave a training session on postnatal care at Mae Tao Clinic (March 2017)

Patients were waiting at registration desk

At the same time, Dr Cynthia commented on the peace negotiations, especially in Karen State, which affect the public health situation and policy on the border, by saying that since the ceasefire it has been much easier for health volunteers working on malaria prevention.  The Shoklo Malaria Research Unit, a collaboration between the universities of Mahidol and Oxford, is able to do more work inside Karen State, and this has an effect on disease prevention and reduces the number of malaria patients in the western border areas of Myanmar.

The lack of progress in the NCA negotiations has had an impact on public health policy along the border to the point where the Myanmar government still does not guarantee health personnel, especially health personnel from the ethnic minorities, and still has no Memorandum of Understanding between the Ministry of Health of the Myanmar government and the public health organizations of the ethnic minorities.

2. Koung Jor refugee camp

Koung Jor refugee camp, Wiang Haeng District, Chiang Mai Province, was established in 2002 as one of six communities of war refugees from Shan State.  At present it has 90 households with 402 people.  The other five camps are in Shan State.  All six camps on the Thai-Myanmar border house 6,185 refugees from Shan State.

Information from the Shan Human Rights Foundation (SHRF) shows that the camps of refugees from Shan State date from more than 19 years ago as a result of the large-scale sweep by the Myanmar army in central Shan State between 1996 and 1998 when the army used the "Four Cuts" operation, cutting supplies, funds, information and personnel, in order to deprive the SSA of support.  Communities in 11 districts of southern Shan State were forced into the cities, turning more than 1,478 villages into abandoned villages.  Around 300,000 villagers from 55,957 households were affected.

SHRF states that from 1996, tens of thousands of civilians crossed into northern Thailand to work in agriculture and construction in Chiang Mai Province.  The Thai authorities did not allow a camp for refugees from Shan State, unlike the camps for refugees from Karen and Karenni states along the Thai-Myanmar border which are registered with the UNHCR. as officials in Thailand believe that Shan refugees are merely ‘seasonal refugees’.

There are also refugees from Shan State as a result of the expansion of the power of the United Wa State Army (UWSA).  The Myanmar army has allowed the USWA to bring Wa people from northern Shan State on the border with China to settle in the area of Tachileik, Mong Hsat and Mong Ton near the Thai-Myanmar border, forcing the original residents to flee elsewhere in Shan State or across the Thai border.

In the case of Koung Jor refugee camp, the fighting between the Myanmar Army and the SSA in 2002 forced the inhabitants of 4 villages near the Thai-Myanmar border, Ban Huai Yao, Ban Pang Hok, Ban Pang Mai Sung and Ban Pang Kam Ko, to decide to flee into Thailand and set up a refugee community in Wiang Haeng District, Chiang Mai Province.  However, assistance, especially in the form of food, stopped in October 2017 when many of the original funders shifted their assistance from the border area.

Uncle Sai Laeng presented a sample of product from women group in the community.

Uncle Sai Laeng, the Koung Jor refugee camp community leader, reports that they used to receive a rice ration of 16 kg per person per month.  This was later reduced to 11 kg.  They used to get 1 litre of vegetable oil per person per month; this was later reduced to half a litre.  And since October 2017, the cuts in assistance have led them to seek emergency from the Philanthropy Connections Foundation (PCF), which provides basic foodstuffs to refugees with a rice ration of 12 kg per person per month and 1 litre of vegetable oil per person per month.  PCF said in its report that it will provide assistance until the assistance situation revives.

Since to reduce costs, refugee assistance provides only basic foodstuffs and other daily essentials, the villagers in Koung Jor refugee camp must seek seasonal employment in the surrounding agricultural area, such as harvesting garlic and chili.  They can work only 90-100 days a year.  Some with construction skills become labourers in small construction sites in the surrounding villages.

Aunt Khin (pseudonym) said that living conditions after the assistance was cut have been rather difficult because in the household there are additional expenses.  Aunt Khin hopes that the assistance, which is important for refugees, may be something to study with respect to youth and basic food assistance.  As regards going home to Shan State, the Norwegian Refugee Council, under the peace support programme of the Norwegian government, came in 2012 to survey the opinions of refugees about whether they would be happy to return to their homes close to Mong Hta in Shan State.  The refugees in Koung Jor refugee camp told the Norwegian representatives that they did not yet want to go back since it was not yet safe from the Myanmar military.  It was also a heavily mined area.  The Shan community issued a statement saying that conditions in the area that had been prepared for the refugees’ return ‘were almost abandoned villages’.  There was also still fighting between the SSA and the Myanmar military in many areas including the area of Mong Hta

Wat Fa Wiang In from Shan state side

Satellite imagery shows the Myanmar military base in the place where were home of reugees in Koung Jor camp.

Regarding the situation in Mong Ton and Mong Hta where the Myanmar government states it will build houses for refugees, Sai Laeng said that apart from the activities of the SSA, it is still a base of the Myanmar military and the UWSA and there are still Lahu volunteer troops.

“When there are many sides, villagers do not have confidence in being able to live there.  Also in Shan State there is still shooting, and no real peace as many understand,” , Sai Laeng said.

3. Internally Displaced Persons in Karen State

A new wave of refugee villagers in northern Karen State shockingly reflects the status of peace negotiations in Myanmar and destroys the trust of Karen communities in the Myanmar army’s ability to make peace.

Karen refugees from He Gho Loh Der village

Mutraw District, or Hpapun as it is called on the Myanmar side, in the north of Karen State is known as a “black zone” by the Myanmar army since most of the area is still under the control of the Karen National Union.  A report, ‘The Nightmare Returns’, published in April 2018 by the Karen Peace Support Network (KPSN) states that the Myanmar army is still conducting operations in the area as if it were a military target.  The 3 major campaigns between 1992 and 2008 resulted the inhabitants of more than 80% of the area becoming refugees, with up to 107,000 in 2003.  Many communities in Mutraw District had to flee for their lives into the forest or into areas far from the Myanmar army, becoming Internally Displaced Persons (IDPs) and a great number became refugees in camps on the Thai-Myanmar border.  14,672 people or 15.72% of the population of the refugee camps come from Mutraw District.

Eventually the Myanmar government and the KNU signed a bilateral ceasefire in 2012 and signed the National Ceasefire Agreement on 15 October 2015.  Since then, the Karen villagers in the northwest of the Lu Thaw area of Mutraw District began to meet to find a way to revive their communities in the Ler Mu Plaw area.  In 2013, the villagers returned to farm again near to the area seized by the Myanmar military. At first they worked in the area in the middle of the day and returned to homes in a place distant and safe from the army base and the Myanmar military’s strategic road.

In 2016, when the National Ceasefire Agreement came into force, the villagers began to reconstruct their old villages and also built primary schools and health stations in the area.  They also initiated the Salween Peace Park covering an area of 5,485 km2.  From May 2016, community representatives from all over Mutraw District began a public consultation process and at the beginning of 2018 collected signatures of support from 300 villages of 26 communities throughout Mutraw District to designate 88 sacred areas according to their beliefs, or ‘Kaw’, with an area of 1.12 million rai [1,790 km2], and declare 23 community forests to conserve trees and wildlife habitat.

However within a few years after rebuilding the communities, their future is uncertain.  Many communities in the Salween Peace Park have become IDPs again since four reinforcement battalions of the Myanmar army from Bago entered the Lu Thaw area in the middle of February 2018, claiming that they wanted to repair the strategic road connecting two army bases between Kay Pu village and Ler Mu Plaw village.  By March, the Myanmar military had brought in more than 1,500 extra troops while 304 Karen households or 2,417 people from 12 villages had to flee into forested areas in the Lu Thaw area, Mutraw District, Karen State, and five schools had to close.  Another four villages with 72 households are at risk of having to flee if the situation becomes more violent.

Trust between the Myanmar army and Karen communities worsened even further when Saw O Moo, 42, a Karen community leader, an important activist for the Salween Peace Park, and one of a team working to provide humanitarian assistance to Karen refugees, was shot and killed by the Myanmar military while returning to Ler Mu Plaw village.  Until now (November 2018), the family of Saw O Moo have still not received his body for a funeral ceremony and have merely retrieved his motorcycle.

(By courtesy of KPSN)

Funeral ceremony of Saw O Moo, photos by courtesy of KESAN

Community organisations and civil society groups in the area set up the Mutraw Emergency Assistance Team (MEAT) on 12 March 2018 to provide medical and food assistance to refugees using Der Poo Nu village in the Lu Thaw area as an administrative centre for Mutraw District of the KNU for administering and coordinating assistance.

Saw Tender, the Mutraw District Governor, stated that the administration centre will be responsible for giving information to those who want to help refugees and coordinate information with refugees in the forests in the area on when donations will be distributed to refugee communities.  The refugees themselves will have village-level committees with the responsibility for receiving assistance and taking it back for distribution and preparing officials to give assistance to refugees who have to hide in the forest.

The Mutraw District Governor estimates that if the refugee situation extends until the end of 2018, and the communities cannot return for planting, the dry food that they have collected will not be enough and in his estimation the families who do not have enough food to last till the end of the year are more numerous than their families who have enough.  For this reason he is trying to get each community to set up a group to go out and look for food in the forest.  The Mutraw Emergency Assistance Team is also proposing assistance in the form of medicines and food, which are greatly needed in the area over the long term.

The KNU is trying to find ways to resolve the tensions with the Myanmar army through mechanisms in the NCA.  However negotiations on 29 March 2018 failed when the Myanmar army broke off negotiations until there were informal consultations on 17 May 2018 between General Min Aung Hlaing, commander of the Myanmar army, and representatives from the KNU led by General Mutu Say Poe, chairperson of the KNU.  The Myanmar army agreed to postpone military manoeuvres and road building in Lu Thaw and agreed to look for a way for civilians to return to their communities.

(By courtesy of KPSN)

However information from the Karen Environmental and Social Action Network (KESAN) reveals that villagers from all 12 villages are still living in the forest because they do not trust the situation and the Myanmar military are reinforcing both their military bases.  Saw Tender, the Mutraw District Governor, also estimates that if in the long term the Burmese military do not completely move out, the villagers may decide to settle down and build new communities in this area where there has been heavy fighting for decades.  The villagers have experience of being refugees in this area and know the water and soil conditions.  As regards providing education for the youth in the community, building a new school may be considered at a site where population is greatest to replace the school that has been closed.

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