We left at 6:30am. Eleven pairs of sleepy eyes in one of the MSF speedboats, custom made in Myanmar in order to be large enough to carry a full medical team.
I was the only international member of staff joining that day.
After an hour of bouncing over the waves, green mountains rose up out of the water
The team was led by the clinic administrator; the kind of person to maintain his cool through every challenge, of which there are many in Rakhine State. He is a local Rakhine, one of the Buddhist ethnic minorities within Myanmar but who make up the majority of people in Rakhine State.
Most of the others were doctors and nurses – a diverse mix of colleagues from different parts of the country, who left home to work with MSF. With no medical school in Rakhine State, it is hard to recruit locally.
Green mountains and greetings
After an hour of bouncing over the waves, green mountains rose up out of the water.
A small, wooden boat, long and narrow, motored out to us. One by one we clambered in, carefully balancing by crouching and evenly lining the sides, each of us with umbrellas up to shield from the sun.
But we could not reach the beach and had to jump out – wet up to the knees, (my skinny jeans and flip flops were not the best choice of attire) and wade ashore.
I was greeted with handshakes and smiles from our community healthcare workers, who had come to help carry the medical boxes to the clinic.
Picturesque and beautiful enough to resemble a tourist hot spot in Thailand, this isolated and remote location is, in fact, the place where a few thousand Rohingya and Kaman, who were displaced by violence in 2012, have been stuck in a camp ever since. In total 128,000 Rohingya Muslims are similarly contained in over 20 different sites.
After walking for half an hour, we reached the clinic shelter – a wooden and bamboo structure where around 50 people were already waiting.
The team rapidly set things up, as more and more people arrived.
A lady who could not walk was carried in on a plastic chair attached to a rod of flexible bamboo that breached the shoulders of two men, crouched and sweating under the weight. There were many small children and babies, some crying whilst their mothers tried to soothe them. Two Rakhine women came in and sat on the benches to wait together with everyone else.
I walked further into the camp to see the conditions and speak to people.
Bamboo longhouses, packed in together, lined the main walkway – many people crammed into each one.
The main living area was, as is traditional in village houses, raised above the ground. With no trees for shade, the ground level should provide a much-needed cooler spot during the hottest hours of the day, yet sewage and remnants of floodwater ran beneath these structures.
Still, some chickens ran around, and little children played there.
I spoke to a man standing outside his shelter, holding his little baby. He told me that many years ago he studied at university. That would not be allowed now. Detained in the camp and denied citizenship, he cannot move legally within his own country.
Even when people have all the paperwork, they continue to face discrimination
Whilst citizenship was arbitrarily deprived of the Rohingya through the 1982 “Citizenship Law”, the Kaman – a Muslim ethnic minority that is officially recognised by the Government, and who make up the majority of this particular camp’s population – also struggle to obtain citizenship.
Even when people have all the paperwork, they continue to face discrimination and challenges to their freedom of movement, inhibiting their ability to access livelihoods and services such as healthcare, and education.
Obstacles to humanitarian aid
Imposed restrictions also impact upon the provision of humanitarian aid.
Upon returning to the MSF clinic, I found out that we had an unprecedented instruction for the entire medical team to report in person to the local authorities. Calculations of the tides and weather conditions dictate all our movements so this would be, at best, a time-consuming diversion for a tired medical team.
However, after finishing the clinic, and as we were approaching the shore, we came across two injured people requiring emergency aid.
Our medical doctors advised that their medical conditions were serious enough for a referral to Sittwe General Hospital – a transfer that must be fully facilitated by MSF. Fortunately, our smaller emergency speedboat was already in the area and could come quickly.
As with every referral, upon reaching Sittwe jetty, MSF would have to hand over the patients to an ambulance containing an armed policeman (required by the authorities for Muslim patients due to “security” reasons) in order to reach the hospital itself.
Our team finally left in our own speedboat around 14:00. We headed to the local township authorities, a 45-minute detour across the water.
The team trooped into the office and were shown into a large meeting room, where our travel and activity authorisation paperwork were scrutinised. Each member of the team had their name called out and had to raise their hand as "present", like children at school. It was explained that the requirement to report in person was a new procedure, apparently required for our own safety.
Debrief and diplomacy
Back in Sittwe town, it was almost evening.
After a rapid debrief in the office and some discussion on how to approach this latest constraint on our ability to provide medical care, I washed off the mud and seawater and got changed.
The work day was not over just yet. Next, I was to attend a dinner with a diplomat to discuss “access to health” challenges with plenty to talk about from the day.