Whether or not international aid organisations should operate in the repressive, authoritarian state of Myanmar provokes passionate debate. On one side are many exile groups and their supporters—predominantly based in Thailand, the US and the UK—who argue that it is impossible to provide aid inside Myanmar without strengthening the military regime.
On the other side are aid organisations that have chosen to work inside the country. They argue that aid can be delivered responsibly and reach people in need of assistance without undue advantage to the junta.
The debate is acrimonious and brings out half-truths on both sides: the exile groups exaggerate the regime’s excesses and the benefits accrued from international aid, and in-country agencies, in response, downplay the constraints imposed on them by the military regime.
MSF-France Supporting KNU On Thai-Burma Border
The experience of Médecins Sans Frontières in Myanmar falls squarely within this polemic.The French section of MSF withdrew from the country in 2006 after five years of efforts to mount an effective malaria treatment programme in conflict-affected areas bordering Thailand.
It publicly denounced “the unacceptable conditions imposed by the authorities” which, if accepted, would render MSF “nothing more than a technical service provider subject to the political priorities of the junta”.
The French section of MSF began working with refugees from the Karen ethnic group in Thailand in early 1984 and was active until the 2000s in villages and camps along the border and in running cross-border operations into territory held by the rebel Karen National Union (KNU).
MSF-Holland (AZG) Supporting Bengali-Muslims on Bangladesh-Burma Border
At the other end of the spectrum lies the Dutch section of MSF which runs the largest medical programme of any aid organisation in Myanmar. It treats twice as many AIDS patients as the government and all aid agencies combined, and runs clinics across four of the country’s states and divisions.
Somewhere in between these positions, wracked with uncertainty, sits the Swiss section of MSF. It has faced major impediments to its projects since it intervened in 1999, but chose to quietly challenge government restrictions and persevere with its medical programmes.
The common explanation—whispered in the corridors of aid offices in Yangon and throughout the MSF movement—for the Dutch section’s success operating in this authoritarian state is that “the head of MSF-H plays golf with the generals”.
Like all good rumours, it is part based on fact. Unable to secure a meeting with the regional commander to discuss opening a clinic in a mining area of Kachin State, the head of MSF-Holland visited the golf club in Myitkyina where he knew the commander to be playing, and asked for his authorisation.
The request was granted and MSF established the clinic. In the moralistic tones often employed in the aid world, particularly in MSF, this story grew into a generalised myth that the head of MSF-Holland— who stayed an unprecedented fifteen years in the same post—had special relations with certain generals and was for all intents and purposes “a collaborator”.
The person in question did little to dispel the myth, avoiding debate on activities proposed, rejecting suggestions of public advocacy construed as critical of the regime, and publicly denying the difficulties of operating in Myanmar.
Nevertheless, that “playing golf” has become a euphemism for “collaboration” is indicative of a broader difficulty all MSF sections faced adapting their principles and methods of working to the Myanmar context.
After all, playing golf is a small price to pay for good relations with a commander who determines what MSF can and cannot do for the population. It might be different were MSF asked to buy the commander golf clubs, or renew his club membership.
But rather than ana-lysing how MSF-Holland mounted this ambitious programme in such a difficult context and questioning the methods employed, all MSF sections, including the Dutch section’s headquarters in Amsterdam, preferred to stick with, and then turn a blind eye to, the fallacy of an unhealthy and privileged relationship.
This chapter explores the political choices made by the three MSF sections in response to the constraints and dilemmas they faced working in Myanmar. How could two sections of the same organisation have reached such different conclusions over the ability to work in a country? What were the compromises made and strategies pursued by each that lead to such different levels of engagement with the Myanmar people?
The Choice to Intervene
Having no official mandate to determine the types of situations to which it ought to respond, MSF freely chooses where it will and will not offer its humanitarian medical assistance.
The French section of MSF began working with refugees from the Karen ethnic group in Thailand in early 1984 and was active until the 2000s in villages and camps along the border and in running cross-border operations into territory held by the rebel Karen National Union (KNU).
Although the refugee context was highly politicised, it seemed less problematic to assist victims of the junta outside the country than from within. So when MSF-Holland requested authorisation to enter Myanmar in 1989, it faced considerable scepticism from within the MSF movement.
The Dutch section’s primary rationale for intervening was to investigate health needs in border areas beset by armed conflict, and to be a witness for the outside world of what was going on.
The Myanmar army was conducting brutal counterinsurgency campaigns in several ethnic states bordering Thailand, Laos and China, which aimed to deprive insurgents of a support base by forcing villagers to move to government-controlled settlements and razing their homes and crops. Reports of rape, forced conscription and labour, and summary executions circulated among the communities of 140,000 refugees who escaped to Thailand.
Less was known about the hardships faced in Kachin State bordering China, where the Dutch section initially wished to go. Speaking publicly about the causes of suffering constituted an important element in MSF’s desire to intervene.
Repression elsewhere in Myanmar also “qualified” the country for MSF’s attention. Northern Rakhine State is home to Muslim Rohingyas and smaller Hindu minorities who are denied citizenship, and as such are more vulnerable than most to the arbitrary abuse of power by Myanmar officials.
Harsh laws govern almost every aspect of their lives, from the age at which they may marry to whether they may travel outside their home village, with sometimes dire consequences for their ability to access medical services. Unlike the Karen and Mon in Thailand, most Rohingyas who fled state repression were not given sanctuary in a neighbouring country, but were twice pushed back from Bangladesh, once in 1978, and again in 1994–95.
They returned to similar repression and brutality from which they had fled, exacerbated for many by the seizure of land and property by the government in their absence. Both the Dutch and French sections of MSF worked with the refugees in Bangladesh and were vocal critics of the government’s refoulement to Myanmar and the complicity of the UNHCR in the process.
In addition to the border conflicts and generalised repression, the Myanmar people suffer from a state of abject poverty brought about by the incompetence and investment priorities of the junta, which are sharply skewed towards maintaining power and military might over internal and external enemies—both real and imagined.
democracy for burma 