Responding to health needs under fire in Myanmar implications of, and responses to, the 2021 military coup in Karenni State

Despite committed urban medical and rural ethnic health organisation workforces, decades of dictatorship in Myanmar have resulted in inadequately resourced healthcare and poor health outcomes. Following improvements during the post-2011 democratisation process, the military coup d'état in 2021 have seen conditions sharply deteriorate, with frequent attacks on health personnel, dismantling of public health programs and large-scale internal displacement of populations. Facing these challenges, health workers have battled to find ways of addressing health needs using whatever resources are available. To assist with these efforts, detailed assessments are required both of the problems and how the population has responded to them. Focusing on the eastern state of Karenni, this qualitative study collected eyewitness data from healthcare professionals about health and social conditions, challenges to the delivery of care, and community responses. Data were obtained via semi-structured interviews conducted remotely in 2024 and 2025. The interviews were recorded, transcribed and subjected to thematic analysis using accepted techniques. A total of 19 participants were interviewed, representing a wide range of roles and experiences, covering medical and nursing practitioners and ethnic health organisation workers across the State. Social conditions were often harsh, especially for displaced populations, as a result of poverty, insufficient food and water and minimal or absent public health programs. Health conditions included war-related traumatic injuries, communicable and non-communicable disease, especially affecting women and children, and mental health issues. The workforce has evolved to incorporate new arrivals from urban areas, often working innovatively in challenging conditions, in partnership with established practitioners and ethnic health workers. Risks and stresses are considerable and despite high levels of individual commitment the achievement of effective integration and coordination remains elusive. In Karenni State, the pressures on health and healthcare are intense, reflecting the direct and indirect effects of long-term dictatorship, the breakdown in social conditions and the ongoing armed conflict. A complex and precariously balanced system of healthcare delivery has developed, incorporating workers from different backgrounds and ethnicities. Working courageously but not always harmoniously, these health professionals support the civilian resistance to the military forces and deliver much-needed care to local populations.