COVID-19 compounded followed by the February 2021 coup d’etat in Myanmar has resulted in increased conflict and violence and ongoing deterioration of the health and education landscape for the people of Myanmar. In nearly 70 years of struggle the situation has never looked so unstable and defragmented. Inside Myanmar there has been a rapid rise in internal displacement from less than 100,000 before 2021 to approximately 2.9 million people at the end of 2023, up from the 1.5 million at the end of 2022 (https://www.internal-displacement.org/countries/myanmar/). Populations fleeing to neighbouring countries including Thailand in the west is largely unregulated and estimated in the hundreds of thousands, some go to refugee camps under UNHCR protection but many see their flight as temporary and just need work for day to day survival. Tak province, western Thailand has a border length of 535 kilometers covered by 5 districts in; Um Phang, Tha Song Yang, Phob Pra, Mae Ramard and Mae Sot is also the main area of migration.
This marginalized population live in poverty, with dwellings of borderline sanitation and unscrutinised working conditions. The Borderland Health Foundation provides basic healthcare to this migrant population in rural agricultural areas of Thailand who are predominantly of reproductive age in family units, or young adults. BHF supports efforts to reduce maternal mortality and reduce transmission of infectious diseases, including in pregnancy. Conflict is a significant driver of malaria and unsurprisingly there has been a 5 fold increase in the incidence of cases of malaria in pregnancy from 2020 to 2023 (and also in non-pregnant) in the clinics of BHF-SMRU in Tak Province and inside eastern Myanmar. One such mum was Mu Mu (not real name) who had 2 episodes of malaria in pregnancy and delivered a 2.6 kg girl at term that was considered ‘too small’, a common adverse effect of malaria. This puts the baby at an increased risk of death especially in the first few months of life. Fortunately, with the help of trained BHF-SMRU providers including midwives, nurses, medics and obstetricians Mu Mu successfully breast fed her baby and is doing well. Mu Mu is a teenage and choose a long-term reversible contraceptive after birth. Looking forward to the future, many health specialists are concerned about the loss of functional health care inside the country. BHF-SMRU hopes that one day they are not needed but in the meantime access to healthcare is a human right and they continue to fill a gap in collaboration with Thai Public Health.
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