Below is a short explaination of the situation on the border, which outlines why the Mae Tao Clinic is so critical.

The first wave of Burmese refugees arrived in Thailand in 1984 when a major Burmese Army offensive broke through front the front lines of the Karen National Liberation Army (KNLA) forces, opposite the Tak Province of Thailand.  This first group of 10,000 refugees remained in Thailand after the Burmese Army was able to maintain the territory it had gained.[1]  The Karen National Union (KNU) and its armed wing the KNLA, has been in rebellion since the late-1940’s, with aspirations of independence from the Burmese state.  The Burmese Army sought to strengthen its position in Karen State from 1984 to 1994, and followed this with the sacking of Manerplaw, the KNU headquarters in 1995.  After the fall of Manerplaw, the SPDC army forces began a campaign of assimilating the ethnic areas through forced relocations.  With each escalation of conflict, refugees and migrant workers have streamed across the border to Thailand either as a result of conflict, forced relocation, or general economic hardship.  Nearly 3,000 ethnic villages have been destroyed since 1996 affecting over one million people.  It is likely that more than 300,000 have fled to Thailand as refugees (the majority of those being Shan and not recognised by the Thai government).  In 2008 there were estimated to be over 500,000 internally displaced persons (IDPs) in the eastern states and divisions of Burma bordering Thailand.[2]

In a parallel development to the subjugation of the rural ethnic minority areas, the democracy movement crystallised in 1988 when students and monks participated in mass demonstrations against the military.  When the uprising was violently suppressed on September 18th, about 10,000 ‘student’ activists fled to the Thailand-Burma border.  While the students aspired to a democratic state, the ethnic groups aspired to independence from the Burmese state.  An uneasy partnership began with the students establishing offices at the Karen National Union (KNU) headquarters at Manerplaw, and also setting up about 30 of their own ‘student’ camps.

We mention camps in three contexts;

Refugee camps in Thailand comprised (at least initially), of border ethnic minorities fleeing conflict, the first of which was established in 1984.  At the end of 2008 the population in refugee camps in Thailand was estimated at around 150,000, including many unregistered people.[3]

‘Student’ camps comprised of the pro-democracy activist groups who had fled mainly from Rangoon to take refuge in ethnic controlled areas.  The ‘student’ camp numbers declined quickly from 10,000 in 1988 to 3,000 in 1989.  By 1997, the Burmese Army took control of the border area which pushed the remaining ‘student’ camps into Thailand.  At this time, most of their numbers were integrated into refugee camps.  The term ‘student’ is used, although the groups consisted of students, teachers, university professors, young professionals, monks, and other activists.

IDP camps comprised of those forced to relocate internally in Burma since 1996.  This population includes approximately 224,000 people currently in temporary settlements of ceasefire areas administered by ethnic nationalities authorities.[4]

Mae Tao Clinic’s current patient population, listed below, comes from an overlapping constellation of groups, each facing different challenges in health care prevention, education and treatment:

  • Migrant workers and their families living in Thailand, population estimated at 2 million.
  • Unaccompanied or orphaned children living in Thailand
  • Refugees in camps in Thailand (est. 150,000)
  • Cross-border patients from civil society unable to obtain or afford health care in Burma
  • Internally displaced persons (IDPs) living in camps or in temporary locations in Burma (estimated to be between 500,000 and 2 million)[5]

Even though the migrant population is difficult to quantify, it represents an enormous group with unmet health care needs.  The Burmese migrant population is typically estimated at about 2 million, most of whom have little access to health care, are exposed to tropical and infectious diseases, and have little access to pre-natal care and overall preventative care.  Moreover, many migrant workers do not possess legal residency in Thailand; therefore they have difficulty travelling to a health care provider without fear of arrest, harassment, or deportation, and don’t have legal access to Thai health providers.  On the positive side, CBOs can often access these populations in their places of employment, such as in factories, for health and reproductive education initiatives.

Children of migrant populations at times reside in boarding houses or other informal living arrangements which are often overcrowded.  There are usually very few adults present which results in the older children caring for younger children.  This makes early identification of health problems difficult.  Even after identification, there is typically little funding available for transport or treatment expenses.

Refugee camps in Thailand administered and managed by INGOs and CBOs have clinics and/or hospitals onsite.  At times however, their patients are referred to MTC either due to a special patient need or preference.  Additionally, cross border patients seek health care at MTC for a variety of reasons.  They may not have access to health care in Burma due to their security situation or political status.  If they do have access and can afford associated costs, patients report that care is expensive and of poor quality.  Many patients are forced to make the journey to the MTC because of a lack of service provision or prohibitive costs in Burma.  This can sometimes entail a journey of thousands of kilometers.  These cross-border patients come from both civil and IDP populations. Although difficult to confirm or qualify, research suggests that: “Burma’s healthcare system is the most discriminatory in the ASEAN region, with responsiveness likely to depend upon an individual’s ethnic group, income level, or civilian versus military status.  The health problems are exacerbated by the ongoing armed conflict, which disproportionately affects the ethnic groups.”[6]

Naturally, any other patient who ‘falls through the cracks’ may seek care at Mae Tao Clinic.  For example, members of the non-state armed groups, military, government in exile, monks, and others from all states of Burma also seek care at MTC.

[1] For further detail on the border conflict, refer to TBBC 2008 Report, Appendix F.

[2] TBBC 2008 Report, page 159.

[3] TBBC 2008 Report, page 159.

[4] TBBC 2008 Report, page 162.

[5] “Burma:  The Impact of Armed Conflict on the Children of Burma”, submission by the Burma UN Service Office – New York & the Human Rights Documentation Unit,  August 2002.

[6] “Burma:  The Impact of Armed Conflict on the Children of Burma”, submission by the Burma UN Service Office – New York & the Human Rights Documentation Unit,  August 2002., p. 10.