In early February, COVID-19 vaccines had just begun to reach the arms of the general population when military and police forces in Myanmar seized control of the country, including its publicly owned hospitals.
Taking a page from former President Donald Trump’s playbook, Myanmar’s commander-in-chief declared, without evidence, that the loss of the military’s proxy party in the November elections had stemmed from widespread voter fraud and irregularities caused by the pandemic. He detained election officials and members of parliament, then declared a one-year state of emergency until “fair” elections could be guaranteed.
Almost immediately, hundreds of thousands of garment workers, student activists, bankers and civil servants brought basic government operations to a halt by launching a nationwide strike. Frontline medical workers joined soon afterwards, effectively crippling state and federal healthcare infrastructure.
Before joining what has become known as the Civil Disobedience Movement (CDM), physicians in Yangon’s government hospitals had to ensure that their patients would be safe, according to Dr. W., who asked to remain anonymous to protect herself and her family from military reprisals. It took days and a massive organizational effort to discharge all eligible patients to their homes, transfer others to private hospitals, establish mobile clinics, and postpone non-emergency surgeries. In doing so, they also negotiated agreements with private hospitals to deliver care for free or at minimal charge.
An infectious disease specialist from the central city of Mandalay, Dr. Maung explained the rationale behind healthcare workers joining the general strike. “If you don’t have anyone working under you, you can’t call yourself a legitimate government,” he said.
To replace public hospitals, Maung helped to form Mandalay Medical Cover to continue caring for patients with chronic diseases and those who had been injured in the violent military crackdowns. Volunteers in his home town converted neighborhood pop-up COVID-19 treatment centers into general clinics offering free consultations and medications. For necessary tests like CT scans and MRIs, they have also partnered with private hospitals to transfer patients into their care.
“The people are not angry at us for closing the hospitals,” Maung said. “They’re angry at the military for creating this situation.”
Win, a social media influencer who has joined the protests, said, “It was very encouraging to see doctors strike. Doctors are among the most highly regarded professionals in our culture. They’re viewed as intellectuals, and it gave us strength to know they were with us.”
Strikes by physicians are not uncommon and have occurred around the globe, including in the United States. But despite studies that have paradoxically shown either no change or a decrease in patient mortality during times of physician walk-outs, an ethical tension exists between a physician’s desire to improve hospital working conditions and the risks of abandoning patients to join a picket line. But Myanmar’s strike is different both in its widespread support and in the efforts taken not to abandon care but rather to wrest it from military oversight.
Delivering babies in a mobile clinic with limited supplies now comes with added risk, Dr. W. conceded, “but the people and the doctors are one and together. The people support us.”
In mid-February, when the new regime threatened to detain doctors if they refused to staff a city hospital in Shan State, local civilians intervened, banging pots and pans to warn the medical staff of the military’s approach, an echo of the support many urban dwellers expressed toward healthcare workers in the early days of the COVID-19 pandemic in the United States and Europe.
“One of my patients told me that she would rather die than be treated at a military hospital,” Maung said. “We are living in the deadliest moments of our lives, but people are more scared of a future under military rule than they are of COVID-19.”
Slightly smaller than the state of Texas but with nearly twice its population, Myanmar shares borders with India, China, and Thailand. It transitioned from military to semi-democratic rule almost 10 years ago, but in exchange for a series of reforms that included a modern constitution, the junta held onto a crucial block of seats in Parliament that are exempt from elections. It also retained its extensive financial connections to major national industries, such as mining and logging. Some feel that after enacting the new constitution the military expected to be voted back into power through democratic means and staged a coup only when a democratic victory seemed increasingly unlikely.
By now, dozens of unarmed protestors have been fatally wounded by police and military brutality, and graphic images of their deaths have circulated widely on the Internet. And though medical workers have marked their uniforms clearly with white flags or red crosses, they have also become targets.
Dr. Maung recounted a harrowing story of his thwarted attempt to treat multiple bone fractures in a cyclist rammed by a military vehicle in Mandalay. “We were trying to carry the patient into our ambulance when soldiers began firing live rounds. We were the only ones in the street, so we knew they were firing at us. We could hear the bullets hit the metal of our ambulance.”
A separate video capturing a police assault on three volunteer medical workers exposed a brutal beating that led to severe head injuries for two members of an ambulance crew and the death of a third.
When military violence has erupted into mass casualties and overwhelmed mobile clinics, an organized cohort of doctors has managed to temporarily re-open the emergency departments of some government hospitals to treat the wounded. But at these times, Maung says, the military has kept track of which healthcare workers showed up, in some cases issuing arrest warrants. On March 7, police began occupying multiple hospitals in Yangon.
Dr. Maung himself has gone into hiding, living apart from his wife and two children for their protection. He agreed to speak with me on the condition that I use a pseudonym for his name.
“We are in a war zone,” he said. “We went from the threat of COVID to the threat of being shot or detained.” As an infectious disease specialist, he worries that the military may be hoarding more than a million recently donated vaccines for their own purposes, using the promise of COVID-19 immunity to recruit and retain new soldiers. In addition, millions of dollars donated by the International Monetary Fund to support a recovery from the coronavirus crisis is now likely in the hands of the junta. If the regime has reallocated that money to strengthen its own hold on power, the country’s progress against COVID-19 may be reversed by the political crisis, with international implications.
“If we have another outbreak here,” Maung says, “it could spread to the rest of the world. We’re going to win or we’re going to die.”