Kobayashi et al. Tropical Medicine and Healthhttps://doi.org/10.1186/s41182-021-00323-1(2021) 49:33

Tropical Medicineand Health

LETTER TO THE EDITOR

Open Access

COVID-19 control during a humanitariancrisis; the need for emergency response at
the Thai-Myanmar border as an alternative
channelJun Kobayashi1,2* , Nanae Aritaka2, Ikuma Nozaki3, Aya Tabata2 and Shinichiro Noda1,3

Abstract
Following the coup in Myanmar, humanitarian assistance, including coronavirus disease 2019 (COVID-19) control,
must be implemented on the Thai-Myanmar border in the framework of international cooperation. The actual
number of refugees was expected to increase in the Karen state at the end of March 2021, and they are at risk ofcontracting COVID-19 as they live in overcrowded conditions without access to basic sanitation. The global
community has been hesitant to provide direct support because of fearing that such support would benefit themilitary. To reach this most vulnerable population, further strengthening of support through the Thai-Myanmar
border as an alternative channel that was used before Myanmar's democratic transition in 2011 is necessary.
Keywords: Thai-Myanmar border, Refugee, COVID-19, Alternative channel

Risk of COVID-19 infection among refugees on
the Thai-Myanmar border
Following the February 1st coup in Myanmar, the number of refugees likely preparing to cross the ThaiMyanmar border is expected to increase. Not only is themilitary unilaterally persecuting the general population,
as is occurring in Yangon, but a state of war is likely beginning between the national army and ethnic minorities. From information received from the Mae Taoclinic, a health facility established by refugees fromMyanmar to Thailand in 1989, more than 10,000 people
have fled to the Karen and Karenni states from cities including Yangon and Mandalay, and most seem to be activists, non-governmental organization leaders, andparticipants in civil disobedience. Further, intensified* Correspondence: junkobalao@gmail.com
1
Department of Global Health, Graduate School of Health Sciences,
University of the Ryukyus, 207 Uehara, Nishihara, Nakagami-gun, Okinawa
903-0215, Japan
2
Japan Association for Mae Tao Clinic, 3-21-7 Ginowan, Ginowan, Okinawa
901-2211, Japan
Full list of author information is available at the end of the article

attacks in ethnic areas since December 2020 have internally displaced over 8000 people according to the Free
Burma Rangers [1]. After Myanmar’s military began airstrikes in the Karen state on 27 March (Armed ForcesDay), the Karen Information Center reported that atleast 10,000 local villagers fled into the jungle, and morethan 3000 had crossed into Thailand by 29 March [2].
However, Thai authorities reportedly forced over 2000
refugees back to Myanmar [3] despite danger of furtherattacks. These internally displaced persons would definitely be expected to require immediate humanitarian aid.
Although World Health Organization (WHO) reported that these vulnerable people are generally at low
risk of transmitting communicable diseases to host populations [4], they are at risk of contracting diseases, particularly COVID-19, due to overcrowded conditions
lacking access to basic sanitation [5]. In humanitariansettings, access to health-care services is often compromised due to medicine shortages and lack of health-carefacilities. Additionally, administrative, financial, legal,© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Kobayashi et al. Tropical Medicine and Health(2021) 49:33

and language barriers hinder their access to the healthsystem.
Should COVID-19 spread to the refugees’ border
camps, it would be inhumane to leave them unattended,and ordinary activities of conventional medical facilities
would likely come under great pressure. Further, discrimination and prejudice would deprive the refugees ofwork opportunities and exacerbate domestic violenceand human trafficking [6].

The need for emergency response through analternative channel
We recommend the provision of refugee assistancewithin an internationally coordinated framework at theThai-Myanmar border that includes COVID-19 responseand care. In particular, Japan can play a certain role because of its experience in providing humanitarian assistance to Myanmar both before and after the democratictransition in 2011. Although there are currently no official reports of increased cross-border refugees on theThai side, many ordinary residents on the Myanmar side
are already hiding in the jungle to avoid persecution by
the Myanmar military, and the risk of these people becoming cross-border refugees is high.
Global society is willing to provide direct humanitarian
support to Myanmar, but the Myanmar people are refusing all international support that might benefit the military, including any kind of official developmental
assistance. Thus, we believe that further strengthening ofsupport through the Thai-Myanmar border as an alternative channel, which was used when Myanmar wasunder sanctions, is necessary to reach the people in thismost vulnerable and difficult situation. To aid Indochinese refugees, we have been working with Thai and international societies [7] even though the Thai government
does not officially recognize refugees. This long-time cooperation with other international donors through civilsociety includes the Japan Association for Mae Tao
Clinic. We believe that the global society including Japan
can play a pivotal role in this critical situation.
Although the risk of COVID-19 spreading across theborder is unclear, it is probably not low. In January
2021, just before the military coup, approximately 300 to700 new cases were confirmed daily in Myanmar, andthe number of cases totaled 140,145 [8]. However, due
to the coup itself and civil disobedience of medical professionals, little COVID-19 testing has been performed
after February and especially in March; thus, obtaining
accurate information would be difficult. At the end ofMarch in Tak Province, which borders Myanmar, 126 of
the 344 confirmed cumulative case cases of infection
were acquired from abroad [9].
Even though Thailand has achieved some success in
COVID-19 control, this issue must be addressed within

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the framework of international cooperation beyond thehealth sector. Since before Myanmar’s democratizationin 2011, Japan has continued to provide support to thehealth and education sectors and has worked with theMinistries and Myanmar government to provide humanitarian assistance. Furthermore, Japan’s medical assistance to Indochinese refugees in the 1980s waspioneering in health sector support in Japan. We expect
Japan to continue to work with Thai and international
civil societies to address this potential current crisis at
the Thai-Myanmar border.
Abbreviations
COVID-19: Coronavirus disease 2019; WHO: World Health Organization
Acknowledgements
Not applicable.
Authors’ contributions
JK conceived the present idea. JK, NA, and IK wrote the manuscript in
consultation with AT and SN. All authors read and approved the finalmanuscript.
Funding
There was no specific funding for this report.
Availability of data and materials
Not applicable. The manuscript does not contain any data.

Declarations
Ethics approval and consent to participate
Not applicable. The manuscript does not involve human participants or data.
Consent for publication
Not applicable. The manuscript does not contain any individual’s personal
data.
Competing interests
The authors declare that they have no competing interests.
Author details
Department of Global Health, Graduate School of Health Sciences,
University of the Ryukyus, 207 Uehara, Nishihara, Nakagami-gun, Okinawa
903-0215, Japan. 2Japan Association for Mae Tao Clinic, 3-21-7 Ginowan,
Ginowan, Okinawa 901-2211, Japan. 3Bureau of International Health
Cooperation, National Center for Global Health and Medicine, 1-21-1
Toyama, Shinjuku, Tokyo 162-8655, Japan.
1

Received: 12 April 2021 Accepted: 23 April 2021

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