Haar Rohini J, Crawford Katerina, Fast Larissa, Win Than Htut, Rubenstein Leonard, Blanchet Karl, Lillywhite Louis, Tint-Zaw Nicholus, Mon Myo-Myo
University of California, Berkeley School of Public Health, Berkeley, CA, USA.
RIAH Project; Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK.
Confl Health. 2024 Aug 20;18(1):52. doi: 10.1186/s13031-024-00611-7.
In Myanmar, ongoing conflict since the 2021 military coup d'etat has been characterized by targeted violence against health workers (HWs), particularly those participating in the pro-democracy movement. Existing knowledge about the challenges faced by health workers in Myanmar is scant, including their perspectives on mitigating their suffering and the broader impact on community health. This knowledge gap prompted our study to assess the extent of the violence, its impact on the workers and the community, and identify resource priorities.
This qualitative study employed purposive and snowball sampling to recruit health workers affiliated with the Civil Disobedience Movement (CDM). We interviewed 24 HWs in Myanmar between July and December 2022, predominantly physicians and nurses. We used a semi-structured interview guide and conducted interviews remotely due to the security situation. We adopted content analysis to understand participation in the CDM movement, experiences of violence, personal and professional impacts, the sequelae to community health, how HWs responded as well as their ongoing needs.
Thematic content analysis revealed that violence was both individually targeted and widespread. Health workers faced professional, financial, and personal impacts as a result. The health system as a whole has been severely diminished. Health workers have had to adapt to continue to provide care, for example some fled to rural areas and worked clandestinely, exchanging their services for food and shelter. In those settings, they continued to face insecurity from airstrikes and arrests. Health workers have also experienced moral distress and burden due to their resistance and protest against the regime.
The coup and ensuing violence severely disrupted the healthcare system, resulting in shortages of supplies, reduced quality of care, and exacerbated challenges during the COVID-19 pandemic. Despite facing significant hardships, HWs remained resilient, engaging in resistance efforts within the CDM and seeking support from local communities and international organizations. They expressed a need for increased awareness, financial assistance, and concrete support for the health system to address the crisis.
在缅甸，自2021年军事政变以来持续不断的冲突表现为针对医护人员的暴力行为，尤其是那些参与民主运动的医护人员。关于缅甸医护人员所面临挑战的现有知识匮乏，包括他们对减轻自身痛苦以及对社区健康更广泛影响的看法。这一知识空白促使我们开展此项研究，以评估暴力行为的程度、其对医护人员和社区的影响，并确定资源优先事项。
这项定性研究采用目的抽样和滚雪球抽样方法，招募与公民抗命运动（CDM）有关联的医护人员。2022年7月至12月期间，我们采访了24名缅甸医护人员，主要是医生和护士。由于安全形势，我们使用半结构化访谈指南并通过远程方式进行访谈。我们采用内容分析法来了解参与CDM运动的情况、暴力经历、个人和职业影响、对社区健康的后遗症、医护人员的应对方式以及他们当前的需求。
主题内容分析表明，暴力行为既有针对性的个体行为，也有广泛存在的情况。医护人员因此面临职业、经济和个人方面的影响。整个卫生系统已严重受损。医护人员不得不做出调整以继续提供护理，例如一些人逃到农村地区并秘密工作，用服务换取食物和住所。在这些地方，他们仍然面临空袭和逮捕带来的不安全因素。医护人员还因抵制和抗议政权而经历道德困扰和负担。
政变及随之而来的暴力严重扰乱了医疗保健系统，导致物资短缺、护理质量下降，并加剧了新冠疫情期间的挑战。尽管面临巨大困难，医护人员依然坚韧不拔，在CDM内部参与抵抗行动，并寻求当地社区和国际组织的支持。他们表示需要提高认识、提供财政援助以及为卫生系统提供具体支持以应对危机。
