Liminal health systems: health seeking behaviour of migrants and internally displaced people from Myanmar along the Thailand-Myanmar border

Partners: Burnet Institute, Community Partners International [opens a new tab], Queen Margaret University, Liverpool School of Tropical Medicine,

This study aims to document the complex web of health systems used by Myanmar’s migrants and internally displaced populations (IDPs) on both sides of the Thailand-Myanmar border in the Mae Sot/Myawaddy area.

Background to the study

For several decades, there has been significant cross-border migration between Myanmar and Thailand, with many Myanmar nationals residing and working (to different legal extents) in neighbouring Thai provinces. In 2020, it was estimated that approximately 2.3 million Myanmar people were living in Thailand. Following the Military Coup in February 2021, there has been a surge of displacements within Myanmar and an influx of both legitimate and illegal immigrants into Thailand.

Also, in Myanmar’s Karen State (which borders Thailand), the conflict following the coup has resulted in the displacement of an estimated 105,000 individuals, most of whom have sought shelter in informal settlements located in the jungle or mountainous areas near the Thai border. While some efforts have been made to provide these individuals with access to humanitarian aid and essential services, they are inherently difficult to reach and remain vulnerable. The provision of healthcare services in these areas is mostly dependent on mobile medical health teams that travel from community-based organisations or local ethnic health organisations to provide services. Unfortunately, access and resources are limited resulting in suboptimal care.

A patchwork of actors supports healthcare service provision for displaced people on both sides of the border, with access complicated by the differing legal statuses of organisations and individuals – both care receivers and care givers. Available literature supports this perception, however, a comprehensive understanding of the roles and capacities of healthcare providers is not available. This research seeks to fill that gap, helping to strengthen understanding of the liminal health system and identify opportunities for collaboration among local stakeholders. Furthermore, the study can equip local health actors with information to develop advocacy tools to leverage support for local communities. Importantly, as the conflict context continues to evolve, an understanding of the resilience mechanisms of this health system, and the coping strategies of local communities to shocks and stressors, will be valuable in identifying target areas that can be leveraged to effect change in times of prolonged crisis. The study will also explore the consideration of gender in this health system, to inform decision makers and service providers about gender-equitable services in a complex health system.

Research questions and objectives

The study seeks to answer the following questions:

1. Which bodies providing healthcare for Myanmar migrants and IDPs operate along the Thailand-Myanmar border? What type of providers are delivering healthcare?
2. How do different providers work together to ensure that individuals of all genders who require complex healthcare services receive them effectively? How do resources flow to/through providers in these liminal health systems?
3. How do migrants and IDPs navigate these complex, sometimes overlapping, health systems while maintaining their own safety? What are the financial and logistical implications for patients of different health services offered by different providers?
4. Are there any gaps and differences in access by gender?
5. What lessons in resilience can be drawn from the experiences of health providers and patients in this system? What coping strategies can be identified among community members and healthcare providers in these contexts?

Image: Dr Kyu Kyu Than from Burnet Institute introduces an inception workshop conducted by the research team from Burnet and CPI. The session involved key health actors who are working along the Thai-Myanmar border and helped them to explore methods for the identification and selection of participants for inclusion in the study. Participants included Myanmar nationals who are refugees or internally displaced and Thai-Myanmar border health service users and providers of all genders.