Letter from Public Health Experts to Thein Sein regarding Rohingya/MSF suspension

His Excellency Thein Sein

President Republic of the Union of Burma

Ministry of the President's Office Naypyidaw, Burma

Dear President Thein Sein:

We, the undersigned health care professionals, are alarmed that Médecins Sans Frontières (MSF) was forced to cease its humanitarian operations in Rakhine State, and we urgently call on you to reverse the order expelling the organization from the region, as you did for other parts of the country. Removing MSF from the health infrastructure in Rakhine State is an inexcusable act that will have devastating consequences. Therefore, we also urge you to commit the relevant authorities at the national and state level to join nongovernmental organizations in effectively delivering health services in an impartial manner to all those in need.

MSF was the leading health service provider in the state, conducting nearly 500,000 consultations each year. Members of the Rohingya community, who are rendered stateless under Myanmar law, were especially reliant upon health services provided by MSF because they face significant obstacles in accessing such services elsewhere.

Humanitarian organizations, including MSF, operate under the principle of impartiality. They administer care based only on medical need, not ethnicity, race, or religion. MSF provided unbiased care, treating stateless Rohingya, ethnic Rakhine, and others in need of medical assistance. They should not be expelled for adhering to this professional ethical obligation. The expulsion of humanitarian assistance agencies and health providers where populations are in need of basic and essential services violates international norms of governance, and suggests disregard for the lives of the vulnerable, particularly women and children, who suffer the greatest losses of life and health when such assistance is denied.

Refusing to allow MSF to continue treating those in need in Rakhine State will leave hundreds of thousands of people without necessary health care, and - in the long term - MSF's expulsion may create a public health disaster. MSF was forced to cease administering

anti-retroviral treatment to an estimated 850 people living with HIV/AIDS. Interrupting this course of treatment is dangerous to the patient and increases the risk of building drug resistance. The estimated 30,000 people reliant upon treatment for tuberculosis will also face severe consequences if they can no longer turn to MSF for care. Malaria is endemic in Rakhine State, and over the past 10 years MSF has treated 1,240,000 individuals suffering from malaria in this state alone. In addition to the resistance concerns with interruptions of HIV treatment, both drug resistant tuberculosis and malaria have recently emerged in Myanmar, and are widely considered threats to regional health and security. The expulsion of MSF and the interruption of HIV, TB, and malaria treatment programs are of ASEAN and Asian regional concern, as well as national ones. Internally displaced people in Rakhine State will likely face heightened vulnerability to these and other diseases, and providing accessible health care to displaced populations should be a priority for regional and national authorities. Myanmar risks undermining the tremendous work of her health professionals in attempting to control drug resistant TB and malaria through the reckless expulsion of MSF.

Again, we reiterate the need for you to immediately reverse this order, as you did for the rest of the country and region, and ensure all people living in Rakhine State enjoy access to health care services.

Sincerely,

Michael J. Klag, MD, MPH 

Dean, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Peter C. Agre, MD

Bloomberg Distinguished Professor, 2003 Nobel laureate in Chemistry, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Professor Arjuna Aluwihare, MD

Emeritus Professor of Surgery at the University of Peradeniya in Sri Lanka, Former President of the National Academy of Sciences of Sri Lanka, Peradeniya, Sri Lanka

Holly G. Atkinson, MD, FACP

Director, Human Rights Program, Arnhold Global Health Institute at Mount Sinai, Former President of Physicians for Human Rights, New York, New York

Eric B. Bass, MD, MPH

Professor of Medicine, Johns Hopkins University, Baltimore, Maryland

Donald S. Burke, MD

UPMC - Jonas Salk Chair in Global Health Dean, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

Richard Carmona, MD, MPH, FACS

17th Surgeon General of the United States; Distinguished Professor, University of Arizona, Tucson, Arizona

G. Thomas Chandler, MSc, PhD 

Dean, Arnold School of Public Health, and Professor, Environmental Health and Marine Sciences, University of South Carolina, Columbia, South Carolina

Jane E. Clark, PhD 

Professor and Dean, School of Public Health, University of Maryland, College Park, Maryland

Paul D. Cleary, PhD 

Anna M.R. Lauder Professor of Public Health, Dean, Yale School of Public Health, New Haven, Connecticut

James W. Curran, MD, MPH 

Dean of Public Health, Rollins School of Public Health, Emory University, Atlanta, Georgia

Abdallah S. Daar, FRS (C), DPhil (Oxon), FRCP (Lon), FRCS, FRCSC

Professor of Public Health Sciences and Professor of Surgery, University of Toronto, Canada, Member of the UN Secretary-General's Scientific Advisory Board

Felton Earls, MD

Professor Emeritus of Social Medicine, Harvard Medical School, Boston, Massachusetts

Omur Cinar Elci, MD, PhD, FRSPH 

Professor and Chair, Department of Public Health and Preventive Medicine, School of Medicine, St. George's University, True Blue, Grenada, West Indies

Greg Evans 

Dean, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia

Lynn Goldman, MD 

Michael and Lori Milken Dean of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C.

Howard Hiatt, MD

Professor of Medicine, Harvard Medical School, and Former Dean, Harvard School of Public Health, Boston, Massachusetts

Pascal James Imperato, MD, MPH&TM, MACP 

Dean and Distinguished Service Professor, School of Public Health, SUNY Downstate Medical Center, New York, New York

Adeeba Kamarulzaman, MBBS, FRACP, FAMM, FASc

Dean, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Richard S. Kurz, PhD 

Professor and Dean, UNTHSC School of Public Health, Fort Worth, Texas

Robert S. Lawrence, MD, MACP, FACPM

Professor of Environmental Health Sciences, Health Policy and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Jay Maddock, PhD 

Professor and Director, Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii

Martin Philbert, FRSC 

Dean, School of Public Health, University of Michigan, Ann Arbor, Michigan

Professor Peter Piot, CMG, MD, PhD, DTM, FRCP, FMedSci

Director, London School of Hygiene & Tropical Medicine, Former Executive Director, UNAIDS, London, United Kingdom

Irwin Redlener, MD

Professor of Health Policy and Management; Director, National Center for Disaster Preparedness, Earth Institute at Columbia University, New York, New York

Barbara K. Rimer, DrPH 

Dean, Alumni Distinguished Professor, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina

Sir Richard Roberts, PhD

Chief Scientific Officer at New England Biolabs; Recipient of the 1993 Nobel Prize for Physiology or Medicine, Ipswich, Massachusetts

Professor Gerry V. Stimson

Emeritus Professor, Imperial College London; Visiting Professor, London School of Hygiene and Tropical Medicine, London, United Kingdom

Paul Volberding, MD

Director of University of California, San Francisco AIDS Research Institute and Director of Research for University of California, San Francisco Global Health Sciences, San Francisco, California

Torsten N. Wiesel, MD, FRS

President Emeritus; Nobel laureate 1981 in Physiology or Medicine; The Rockefeller University, New York, New York

This letter was sent to President Thein Sein on April 3rd, 2014.