Yan Naing
Medical workers in Mon State are struggling to keep outbreaks of chickenpox and malaria under control following the pullout of France's international aid group Medecins Sans Frontieres.
Health workers in Mon State say their ability to cope with medical emergencies has been severely impeded by MSF's withdrawal.
"A chickenpox outbreak has taken place since the second week of December. At least one person from every family was suffering," said Dalai Htaw, a local medical worker.
"We gave villagers medicine for prevention and every child ate Vitamin A. We also organised health education training so refugees can protect themselves. But we don't know what will happen in the future," Dalai Htaw said.
MSF halted their operations in Mon State in December saying travel restrictions were making it impossible for workers to do their jobs.
The group left enough medicine to last nine months but local health workers are worried conditions in the area could deteriorate.
"We are technically weak and we also have inadequate medical supplies. So when we have to do an operation, it is difficult for us," said Sadaw Nom, a Mon medical worker.
"We have an HIV-positive patient and some people with serious tuberculosis in our hospital now. Women giving birth, and treating other emergency patients is also really hard for us."
Patients needing complex medical care could cross the border into Thailand but medical staff say this is not a solution.
"If we are going to send patients to Thai hospitals, nobody would be able to pay medical treatment fees for them. So, we just keep them here and give them some medicines. If the medicine is gone, we don't know what we will do," said Sadaw Nom.
Patients are being treated at Mon refugee hospitals, which are still stocked with supplies provided by MSF.
Before MSF started operations in Mon State in 1992, the main illnesses faced by residents were malaria, malnutrition and chickenpox. MSF was able to bring the number of cases down but since their withdrawal the threat of malaria and chickenpox outbreaks has returned.
"The disease lately is chickenpox. When MSF was aiding Mon refugees, they could have preventative treatment for a disease like chickenpox. But there is no medicine for chickenpox now. Medicines for some diseases are nearly gone, and some are now totally gone, so it is becoming a great problem for local people," said Nai Chan Mon, a local reporter.
Nai Kasauh Mon, a spokesperson for the New Mon State Party, said Mon refugee camps are largely undeveloped and are breeding grounds for malaria and tuberculosis, particularly during the monsoon season.
Nai Kasauh Mon said if there was no new source of medical aid by the time MSF stocks ran out, the Mon people would face a serious health crisis.
"We could negotiate with the local Thai authorities to transport patients to the Thai side, but we can't help them financially. Unless other NGOs can substitute, we can send patients to a Burmese hospital, but Burmese hospitals are not really good," Nai Kasauh Mon said.
Mon refugees first crossed into Thailand following fighting between the Burmese Army and NMSP in 1990. Initially, local Thai authorities allowed the Mon people to stay in refugee camps. Then, with the help of international aid agencies, the refugees were able to establish their own camps near Sangkhlaburi.
When NMSP reached a ceasefire agreement with the Burmese government in 1995, the junta asked the group not to allow NGOs into Mon state. In March 1996 all remaining Mon refugees were forcibly repatriated to Mon State.
The Mon National Relief Committee continues to assist the repatriated refugees and has three settlement sites, Halockhani, Bee Ree, and Tavoy inside Burma.
The Burmese military are also thought to have pressured Thai authorities, accusing them of allowing foreigners with Thai visas to move across the Thai-Burma border illegally.
According to Niphon Ninbut, an MSF worker from Mon state, "The Burmese military government put pressure on the Thai authorities not to allow any foreigner to cross the Thai-Burma border and enter Burma. And, moreover, they accused [Thai authorities] of letting foreigners with Thai visas bypass its borders."
The Thai government appeared to bow to the junta's demands and it soon became hard for MSF to cross the Thai border and organise medical treatment for the Mon people.
"We could not cross the border. The border is closed by the Thai authorities. We can't reach the Mon area to aid them. So, we cannot continue," said MSF's country director in Thailand Franck Joncreg.
"We'd like to go back and help them, if we are allowed to cross the Thai border and enter the Mon refugee camps," Joncreg said.
According to reports, MSF almost withdrew in 2003 for the same reason but in 2004, NMSP allowed MSF to work closely with patients in the area, giving the NGO a reason to stay on.
According to a 2004 Burmese Border Consortium report there are about 40,000 Mon refugees internally displaced or in temporary settlements inside Burma.