The impact of the conflict on medical facilities across Myanmar

Key Event Details

• Case Study locations: Incidents in 16 locations and four in-depth case studies in the following locations:

  • Ma Le Thar village (မလဲသာရွာ), Ayadaw township (အရာတော်မြို့နယ်), Sagaing region (စစ်ကိုင်းတိုင်းဒေသကြီး) [22.115030, 95.455742]

  • Pa Dat Taing village (ပဒတ္တိုင်းရွာ), Myinmu township (မြင်းမူမြို့နယ်), Sagaing region (စစ်ကိုင်းတိုင်းဒေသကြီး) [22.074769, 95.448303]

  • Ma Gyi Kan village (မကြီးကန်ရွာ) in Myaing township (မြိုင် မြို့နယ်), Magway region (မကွေးတိုင်းဒေသကြီး) [21.724870, 94.813232]

  • Pekon township, (ဖယ်ခုံမြို့နယ်), Shan state (ရှမ်းပြည်နယ်) [19.669828, 96.889449]

• Date/Time of Incident:

  • 16 events between 1 February 2023 and 30 April 2023

• Alleged Perpetrator(s) and/or Involvement:

  • Myanmar Air Force (MAF)

  • Myanmar Military

  • Myanmar Police

  • People’s Defence Force (PDF)

• Summary of Investigation:

  • The healthcare sector has been impacted by the ongoing conflict. Medical facilities and medical personnel have been the subject of airstrikes, raids, arson, looting, arrests, harassment, and an array of other violation types.

  • 16 incidents impacting medical facilities across Myanmar in the three-month time frame between February and April 2023 were identified and analysed by Myanmar Witness.

  • Most of the incidents happened in official medical facilities, half of them involved the use of fire, and airstrikes were reported in seven cases.

  • The majority of the incidents were located within the dry zone — the epicentre of the conflict, which has been consistently reported on and monitored by Myanmar Witness. Of the 16 incidents, half were in Sagaing, a state located in the dry zone. This aligns with previous investigations which show increased violence in these areas.

  • Of the 16 incidents, four case studies were investigated in more depth. User-generated content (UGC) showing the damage to medical facilities in Ayadaw, Myinmu, Myaing, and Pekon townships was geolocated and verified.

  • This report demonstrates that hospitals and clinics have previously been targeted by the MAF and Myanmar military, thus minimising access to medical services in hard-to-reach places and impacting medical provision for civilians.

  • Of the 16 incidents, the PDF were reported as an involved actor but no mentions of the PDF being the perpetrators were recorded.

Executive Summary

Since the occurrence of the February 2021 coup, access to essential services has continued to increase across Myanmar, largely being driven by the instability of ongoing conflict. Medical facilities throughout the country, from small rural clinics to large city hospitals, have been widely affected both by violence and the harassment of medical staff.

Through the collection and analysis of user generated content (UGC), alongside data from Armed Conflict Location & Event Data (ACLED), Myanmar Witness has investigated, verified, and reported on human rights interferences associated with conflict impacts on medical facilities across Myanmar. In 2019, the incumbent Burmese government released a map of public hospitals and clinics within Myanmar; as this was the most contemporary data set available, it was used to visualise known and documented facilities. The map itself is still available on the Myanmar government’s official website, of which is now under the control of the SAC, giving reason to believe that the SAC is aware of the locations of most public medical facilities. 

Between February and April 2023, 16 incidents of conflict impacts on medical facilities were identified and analysed by Myanmar Witness. A majority of these cases appear in isolated, rural and regional areas of Myanmar, particularly across the Dry Zone (The Dry Zone covers more than 54,000km, encompassing 58 townships which span from lower Sagaing region, to the western and central parts of Mandalay region and most of Magway region. It is estimated that approximately one-quarter of the country’s population live in this area. Source: Mimu). Given the relative isolation of some of the facilities, and the ongoing conflict that surrounds them, the need for unobstructed medical care is all the more dire.

In half of the analysed incidents, there were reports of the seemingly intentional use of fire, leading to widespread destruction across the facilities, and in extreme cases, to whole villages. Airstrikes, which the Myanmar Air Force (MAF) are the only actor capable of conducting, were reported in seven of the analysed incidents. Previous reporting by Myanmar Witness has clearly shown the interconnected and strategic use of fire and airstrikes in the Myanmar military modus operandi. Since well before the February 2021 coup, the intentional use of fire has been a mainstay of conflict in Myanmar.

From these 16 incidents, four case studies in Ayadaw, Myinmu, Myaing, and Pekon townships were investigated in more detail. Through the use of airstrikes, fire and raids, these examples clearly show how the conflict across Myanmar is impacting medical facilities – sites that come with special protections under international law. 

While there is information to suggest that all sides to the conflict bear some responsibility for attacks which have impacted medical facilities, and the disruption of the services they provide, the involvement  of the Myanmar military has been widely apparent throughout this investigation, more so when compared to other parties to the conflict. Pro-Myanmar military media channels and outlets have also explicitly stated that the violence documented in some of these case studies was targeted towards the People’s Defense Force (PDF) and ethnic armed organisations (EAOs). The targeting of parties to the conflict should not detract from the impact such violence has on places where civilians seek medical attention and assistance. 

The provision of medical treatment is clearly impacted following such attacks. Additionally, violence specifically towards medical personnel has been referenced in this report. Three examples, one from May 2021 and two more recently in 2023, emphasise the direct targeting of healthcare services that were associated with the Civil Disobedience Movement (CDM) or connected to the National League for Democracy (NLD) party — which was ousted during the February 2021 coup. 

These sites hold special protections under international humanitarian law, yet the provision of public health services continues to be impacted by the ongoing conflict.

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