November 17, 2022
Environmental Health Risks in the Philippines
Doctors of the World has been working in Myanmar with at risk communities such as drug users and sex workers since 1991
14 million
people in need of humanitarian aid
220,000
people are HIV positive
70%
of new HIV infections concern populations most at risk
COUP D’ÉTAT IN MYANMAR
On February 1, 2021, the democratically elected members of the National League for Democracy (NLD) were removed from power by the Tatmadaw, the Burmese army. A state of emergency was declared and power transferred to military rule. The results of the November 2020 elections were invalidated and the leaders of the NLD were arrested.
Quickly, a movement emerged, organizing protest activities and boycott campaigns across the country. Healthcare workers mobilized extensively in this civil disobedience movement and were heavily repressed in return. Nearly half of the abuses recorded globally against healthcare workers and health facilities took place in Myanmar in 2021.
Travel restrictions and insecurity have had a significant impact on humanitarian work. At the same time, already vulnerable populations, such as sex workers or people who use drugs, have had to adapt and become highly mobile to protect themselves, complicating the maintenance of humanitarian activities and contacts between these populations and NGOs. The populations are thus confronted with a multidimensional crisis, political, economic, social, health and humanitarian. The United Nations estimates that nearly 14 million people require humanitarian assistance, including 3 million people immediately.
The country has also not been spared by the Covid-19 pandemic. The largest epidemic wave hit Myanmar in July 2021 and in the months that followed.
Around a quarter of a million people are infected with HIV in Myanmar
Despite the current events in Myanmar, it must be remembered that the country is experiencing one of the largest HIV/AIDS epidemics in Southeast Asia, and that the difficulty of access to antiretrovirals and treatments is only part of the problem. A medical aid plan must be deployed along two axes: access to treatment and public awareness. Furthermore, the humanitarian response must focus on helping the most at risk populations: drug users, sex workers and homosexual men. These populations are isolated from the healthcare system and have higher rates of exposure to HIV. Addressing their health needs is Doctors of the World priority in Myanmar.
Drug Users
In Kachin State, Doctors of the World works with people who use drugs, particularly affected by infectious diseases. In certain areas of intervention, more than half of people who inject drugs are HIV positive, and among them 70% are also affected by the hepatitis C virus.
With the coup d’état and the Covid-19 pandemic, Doctors of the World had to adjust its medical and prevention activities in order to ensure the safety of teams, peer workers and also people using its services. The association operates in 90 sites spread across three Townships, as well as through “go-to” activities, supported by a network of 116 peer workers.
In 2021, this community and mobile model enabled more than 7,500 injection drug users to continue to benefit from access to prevention and harm reduction services. Thus, the main objective of the Doctors of the World teams was to ensure the continuity of essential medical services for these key populations, by maintaining an offer of screening, counseling and treatment for HIV, vaccination against hepatitis B, screening for hepatitis C, or by offering access to methadone substitution treatment. Prevention and risk reduction materials were also distributed (condoms, sterile syringes, water, alcohol swabs).
In the second half of 2021, Doctors of the World also began developing a pilot project in Kachin on amphetamine-type stimulants, the second most used drug in the world after cannabis. The objective is to strengthen the capacities of people who use stimulants in order to create and promote access to appropriate risk reduction services. In July 2021, the association led an exploratory mission in Kachin to analyze needs, meet users, discuss with potential future local partner associations and work together to develop a roadmap. It is important to co-construct this project with people who use stimulants and local associations in order to guarantee lasting ownership of the activities and an adapted service offering.
Isolated and Oppressed Populations
Doctors of the World France has been working since 2000 with the community of sex-workers and men who have sex with other men in Yangon, in the south of Myanmar.
It is through a network of “peer educators” that HIV prevention activities are carried out by Doctors of the World. Collaborative humanitarian actions which have made it possible to support thousands of individuals potentially at risk of infection.
In 2021, due to the Covid-19 pandemic and political turbulence, peer workers had to adapt and offer a more flexible, mobile intervention to go directly to meet these key populations. Thus, the prevention teams targeting men who have sex with men and sex-workers have organized “go-to” sessions, the distribution of risk reduction materials and ensuring the referral of people towards health services and HIV testing.
In 2021, Doctors of the World has…
- Offered HIV prevention services to 2,620 sex-workers and men who have sex with men,
- Allowed 2,600 sex-workers and men who have sex with men to be tested for HIV,
- Distributed more than 104,550 condoms to the most at-risk populations in Yangon.
Rohingya Refugee Crisis
In August 2017, Myanmar’s military launched widespread and deadly attacks on the Rohingya ethnic minority living in Rahkine state
AN ESTIMATED 288 VILLAGES WERE BURNED TO THE GROUND WHILE THE MILITARY COMMITTED MASS ATROCITIES, INCLUDING THE SYSTEMATIC MURDER AND RAPE OF ENTIRE ROHINGYA COMMUNITIES
The ongoing violence has forced more than 800,000 Rohingya to flee across the border into Bangladesh, where many are now residing in squalid refugee camps with little access to food, water or medical care.
In Bangladesh, Doctors of the World has partnered with Bangladeshi NGO Gonoshasthaya Kendra (GK) to assess and respond to the needs of the Rohingyas living in Bangladesh’s border refugee camps. We are also supporting the Bangladeshi government’s efforts to provide medical care to the refugees, including primary and mental healthcare for those who have witnessed or experienced extreme violence. Along with our national partners, Doctors of the World has set up medical clinics in the camps and is currently serving around 700 patients a day. Read more about our work with the Rohingya here.