Key Event Details

• Case Study locations: Incidents in 16 locations and four in-depth case studies in the following locations:

  • Ma Le Thar village (မလဲသာရွာ), Ayadaw township (အရာတော်မြို့နယ်), Sagaing region (စစ်ကိုင်းတိုင်းဒေသကြီး) [22.115030, 95.455742]

  • Pa Dat Taing village (ပဒတ္တိုင်းရွာ), Myinmu township (မြင်းမူမြို့နယ်), Sagaing region (စစ်ကိုင်းတိုင်းဒေသကြီး) [22.074769, 95.448303]

  • Ma Gyi Kan village (မကြီးကန်ရွာ) in Myaing township (မြိုင် မြို့နယ်), Magway region (မကွေးတိုင်းဒေသကြီး) [21.724870, 94.813232]

  • Pekon township, (ဖယ်ခုံမြို့နယ်), Shan state (ရှမ်းပြည်နယ်) [19.669828, 96.889449]

• Date/Time of Incident:

  • 16 events between 1 February 2023 and 30 April 2023

• Alleged Perpetrator(s) and/or Involvement:

  • Myanmar Air Force (MAF)

  • Myanmar Military

  • Myanmar Police

  • People’s Defence Force (PDF)

• Summary of Investigation:

  • The healthcare sector has been impacted by the ongoing conflict. Medical facilities and medical personnel have been the subject of airstrikes, raids, arson, looting, arrests, harassment, and an array of other violation types.

  • 16 incidents impacting medical facilities across Myanmar in the three-month time frame between February and April 2023 were identified and analysed by Myanmar Witness.

  • Most of the incidents happened in official medical facilities, half of them involved the use of fire, and airstrikes were reported in seven cases.

  • The majority of the incidents were located within the dry zone — the epicentre of the conflict, which has been consistently reported on and monitored by Myanmar Witness. Of the 16 incidents, half were in Sagaing, a state located in the dry zone. This aligns with previous investigations which show increased violence in these areas.

  • Of the 16 incidents, four case studies were investigated in more depth. User-generated content (UGC) showing the damage to medical facilities in Ayadaw, Myinmu, Myaing, and Pekon townships was geolocated and verified.

  • This report demonstrates that hospitals and clinics have previously been targeted by the MAF and Myanmar military, thus minimising access to medical services in hard-to-reach places and impacting medical provision for civilians.

  • Of the 16 incidents, the PDF were reported as an involved actor but no mentions of the PDF being the perpetrators were recorded.

Executive Summary

Since the occurrence of the February 2021 coup, access to essential services has continued to increase across Myanmar, largely being driven by the instability of ongoing conflict. Medical facilities throughout the country, from small rural clinics to large city hospitals, have been widely affected both by violence and the harassment of medical staff. 

Through the collection and analysis of user generated content (UGC), alongside data from Armed Conflict Location & Event Data (ACLED), Myanmar Witness has investigated, verified, and reported on human rights interferences associated with conflict impacts on medical facilities across Myanmar. In 2019, the incumbent Burmese government released a map of public hospitals and clinics within Myanmar; as this was the most contemporary data set available, it was used to visualise known and documented facilities. The map itself is still available on the Myanmar government's official website, of which is now under the control of the SAC, giving reason to believe that the SAC is aware of the locations of most public medical facilities. 

Between February and April 2023, 16 incidents of conflict impacts on medical facilities were identified and analysed by Myanmar Witness. A majority of these cases appear in isolated, rural and regional areas of Myanmar, particularly across the Dry Zone (The Dry Zone covers more than 54,000km, encompassing 58 townships which span from lower Sagaing region, to the western and central parts of Mandalay region and most of Magway region. It is estimated that approximately one-quarter of the country’s population live in this area. Source: Mimu). Given the relative isolation of some of the facilities, and the ongoing conflict that surrounds them, the need for unobstructed medical care is all the more dire.

In half of the analysed incidents, there were reports of the seemingly intentional use of fire, leading to widespread destruction across the facilities, and in extreme cases, to whole villages. Airstrikes, which the Myanmar Air Force (MAF) are the only actor capable of conducting, were reported in seven of the analysed incidents. Previous reporting by Myanmar Witness has clearly shown the interconnected and strategic use of fire and airstrikes in the Myanmar military modus operandi. Since well before the February 2021 coup, the intentional use of fire has been a mainstay of conflict in Myanmar.

From these 16 incidents, four case studies in Ayadaw, Myinmu, Myaing, and Pekon townships were investigated in more detail. Through the use of airstrikes, fire and raids, these examples clearly show how the conflict across Myanmar is impacting medical facilities - sites that come with special protections under international law. 

While there is information to suggest that all sides to the conflict bear some responsibility for attacks which have impacted medical facilities, and the disruption of the services they provide, the involvement  of the Myanmar military has been widely apparent throughout this investigation, more so when compared to other parties to the conflict. Pro-Myanmar military media channels and outlets have also explicitly stated that the violence documented in some of these case studies was targeted towards the People’s Defense Force (PDF) and ethnic armed organisations (EAOs). The targeting of parties to the conflict should not detract from the impact such violence has on places where civilians seek medical attention and assistance. 

The provision of medical treatment is clearly impacted following such attacks. Additionally, violence specifically towards medical personnel has been referenced in this report. Three examples, one from May 2021 and two more recently in 2023, emphasise the direct targeting of healthcare services that were associated with the Civil Disobedience Movement (CDM) or connected to the National League for Democracy (NLD) party — which was ousted during the February 2021 coup. 

These sites hold special protections under international humanitarian law, yet the provision of public health services continues to be impacted by the ongoing conflict.

Methodology

Myanmar Witness follows a methodology of digital preservation and rigorous, replicable analysis. Digital evidence is collected and archived in a secure database and preserved with hashing to confirm authenticity and prevent tampering.

To read the Methodology and Limitations, download the PDF.

Background and Context

This report by Myanmar Witness seeks to provide insight into this modus operandi of the Myanmar military by assessing data and specific case studies. This paper reviews what are alleged to be intentionally set fires in Myanmar, which has been a consistent feature of the conflict., led by Aung San Suu Kyi, and replaced it with members of the military, through the SAC. In response to this, thousands of people took to the streets in protest and a civil disobedience movement formed across Myanmar. Since then, the conflict in Myanmar has evolved and spread; what  started  as  the  violent  repression  of  largely  peaceful pro-democracy protests in major urban areas has developed into a country-wide civil war. Together with the increasing assault from airstrikes, fire, and ground troops, there appears to be a concerted, escalating effort to violently suppress opposition to the military regime.

Myanmar Witness  has  actively  monitored  events  following  the  February  2021  coup  and continually  investigated  cases  where  alleged  human  rights  interferences  have  occurred. Additionally, Myanmar Witness has monitored the use of specific tactics directed towards an essential public service: the healthcare sector. These tactics, which include unguided airstrikes, fires, raids, destruction of property, confiscation of medical supplies, arrests, and targeted intimidation of medical workers, amongst an array of other violation types,  all increase the risk of harm to local communities. Myanmar Witness has documented the use of similar tactics against schools, religious buildings and public administration and concert events.

Medical facilities are sites where “...sick or injured people are given care or treatment (as a hospital, urgent care centre, or a clinic)”. In a resolution adopted by the United Nations General Assembly in 1970, it was stated that “places or areas designated for the sole protection of civilians, such as hospital zones or similar refuges, should not be the object of military operations”. There are a plethora of international agreements and laws which outline the shared understanding that there is not only a need to protect medical facilities, but also an obligation. This includes rule 28 of the International Committee of the Red Cross’s (ICRC) International Humanitarian Law (IHL) database, which states that “intentionally directing attacks” against “hospitals and places where the sick and the wounded are collected, provided they are not military objectives” constitutes a war crime in non-international armed conflict (NIAC). 

Attacks on hospitals, clinics, and other medical facilities have been reported and documented repeatedly since the February 2021 coup, with several locations allegedly being intentionally targeted, as explored in the Attacks on Medical Personnel section of this report. There continue to be airstrikes, raids, fires, and forced closures on such sites throughout Myanmar. In a previous investigation into the MAF’s use of airstrikes, Myanmar Witness reported on an incident which impacted a medical facility. This is documented within Myanmar Witness’s report Eyes on the Skies (published on 31 January 2023).

Since the February 2021 coup, Myanmar Witness has regularly identified and verified incidents where medical facilities have been impacted as part of the conflict. In May of 2023, the focus on this type of violation became far more pronounced, leading to the construction of this report and the verification of the events within it. Shortly after this, in July 2023, in-depth reporting from SkyNews continued to shine a light on the issue of medical issues being impacted as part of the conflict, further highlighting how dire the conflict has become, even for places which carry special protections under international law. Shan state, located in the east of Myanmar, was subject to frequent attacks impacting medical facilities, according to the Sky News reporting. One of the case studies analysed by Myanmar Witness, Pekon hospital airstrike, lends support to this reporting.The coverage produced by Sky News can be viewed here. The coordinated, yet unintentional, reporting on this violation type continues to lend credence to its importance in the conflict. Places where everyone should be able to seek medical attention are being attacked.

Early attacks on medical facilities following the February 2021 coup

The quantitative aspect of this report focused on events which had occurred from February to April 2023; however, the impact the conflict in Myanmar has had on medical facilities far predates these parameters. The allegations below highlight that both medical facilities, and those that work with them, have been impacted since the coup occurred.

Near the beginning of the 2021 coup, some facilities that had been impacted by the conflict had close ties to the CDM; for example, their donors or employees may have shown support for the CDM online. One such example allegedly occurred in Taunggyi city (တောင်ကြီးမြို့), Taunggyi township (တောင်ကြီးမြို့နယ်), Shan state (ရှမ်းပြည်နယ်), on 15 February 2021. Employees of Sao San Tun Hospital (စဝ်စံထွန်းဆေးရုံကြီး) [20.803647, 97.036313] began posting images and messages of support for the CDM online, as early as 3 February 2021 (source redacted due to privacy concerns). Following this, 100 armed police officers raided the hospital, reportedly looking for CDM supporters; they used grenades and other weapons on the facility during the raid. Despite the heavy police presence, no-one was officially arrested or injured, though damage to the buildings was reported. According to Myanmar now,  employees and locals near the hospital prevented the police from entering and allowed CDM-supporting employees to escape. The police presence was live-streamed online by Kanbawza Tai Broadcasting. 

A further incident where a medical facility was allegedly targeted occurred on 24 January 2022. Reports from Myanmar Now state that Myanmar Military and Police members carried out a joint raid on a charity clinic in Dawei city (ထားဝယ်မြို့), Dawei township (ထားဝယ်မြို့နယ်), Tanintharyi region (တနင်္သာရီတိုင်းဒေသကြီး), arresting seven healthcare assistant volunteers. An ambulance, various medications, and other medical supplies were confiscated during the raid. The reason for the raid is unknown, but Mohinga Matters published claims that the volunteers were associated with the CDM.

Extensive damage was also reported in Gar Ga Law village (ဂါးဂလော်ရွာ), Kanbalu township (ကန့်ဘလူမြို့နယ်), Sagaing region (စစ်ကိုင်းတိုင်းဒေသကြီး) on 17 December 2022. Both Radio Free Asia (RFA) and Myanmar Pressphoto Agency reported on this event, claiming that 23 homes, a monastery, and a rural clinic were burnt down. Pyu Saw Htee (Pro-military supporting militia) and Myanmar military forces were allegedly responsible, specifically the 368th Light Infantry Battalion. The fire damage appeared extreme, with building structures entirely destroyed.

These three examples demonstrate a range of impacts on medical facilities and medical staff, including material damage (from grenades and fire), the confiscation of property and medical supplies, and the arrests of employees. These events affect local communities by hampering the ability to provide medical services. 

Myanmar’s Medical Services

As part of this investigation, Myanmar Witness accessed an official listing from the Myanmar government's Department of Medical Services website (Note: This is an unsecured link to a website of the Myanmar government which is now under the control of the State Administration Council). This page was last edited on 18 March 2019, with the embedded maps being last updated between 1 April 2019 and 2 April 2019. Of note, the website of the Department of Medical Services (forming part of the Ministry of Health) has been updated multiple times since the February 2021 coup, indicating that it is now being operated by the SAC. This also indicates that the SAC is aware of the locations of most public medical facilities, with the exception of emergency clinics that have been established since the coup. Other medical facilities that might not appear on this map are military hospitals, private hospitals, and those built after April 2019.

The availability of this type of information to a party to the conflict has the ability to be used for nefarious reasons - such as in a targeting list. As the maps have not been updated since the 2021 coup, limited access to information on the availability of medical care continues to impact the people of Myanmar. The frequent post-coup updates to the Department of Medical Services site, but the absence of updates to the embedded maps, suggests the SAC may have access to more updated information on medical facilities across the country, but is not sharing this information publicly.

Myanmar Witness used these maps to compare locations where medical facilities were allegedly attacked with the presence of a facilities listed location. The map below presents all the hospitals, numbering over a thousand, that were included within the above listed site.

Figure 1: Map of public medical facilities in Myanmar created using data released in April 2019. Map created by Myanmar Witness using Quantum Geographic Information System (QGIS) (WARNING: data was sourced from an SAC controlled website).

Timeline of Events

The impact of the conflict on medical facilities

Myanmar Witness has monitored attacks on medical facilities since the coup in February 2021. During this investigation, Myanmar Witness has sought to identify and investigate a number of incidents which impacted medical facilities (and in some cases health workers) between February and April 2023. The research has relied upon three streams of data: the Burmese government list of hospitals; ACLED’s data on events impacting health workers; and, Myanmar Witness’ primary research which identified a number of incidents through a deep analysis of UGC posted on Facebook. The result of this research is the identification of 16 key incidents and the creation of four in-depth case studies which are partially or fully verified.

16 incidents that warranted further investigation 

During this investigation 16 specific incidents, which occurred between February and April 2023, were identified as requiring further analysis. This was done in order to understand if these locations appeared to have been specifically targeted and/or if attribution could be determined. 

Frequency and location of the incidents

The 16 incidents analysed by Myanmar Witness were spread fairly equally over the time period. Six cases were reported in February 2023, five cases in March and five cases in April 2023. This data suggests that an incident impacting a medical facility happened approximately every five and a half days. 

Myanmar Witness analysed ACLED data between February 2021 and February 2023 to establish whether this reflected a broader trend. While ACLED data is largely not verified, it did reveal a continuous trend in reported attacks against medical workers during the timeframe. For example, 22 events impacting health workers were reported between February and April 2021 and 17 incidents were reported between February and April 2022.

Figure 2: Map of incidents logged by ACLED as impacting medical workers in Myanmar. The incidents are from February - April 2021 and February - April 2022. Additionally, 16 incidents that were analysed by Myanmar Witness are shown in this map; however, the pins for Ma Le Thar and Pa Dat Taing overlap in the Sagaing Region. Map created using QGIS.

Figure 3: Monthly breakdown of analysed incidents between February and April 2023.

The location of the 16 incidents can be seen on the map below (Figure 4). Most of the incidents were located in the dry zone area of Myanmar. More specifically, half (eight) of the incidents were reported within Sagaing state. The rest of the cases were reported in seven different states across the country. Six states had a single incident while Kayah state had two.

Figure 4: Map showing the locations of 16 incidents where medical facilities were impacted by the conflict between February and April 2023 as identified and investigated by Myanmar Witness. Map created using QGIS. 

Figure 5: Breakdown of the 16 incidents by state between February and April 2023.

Incidents in the dry zone 

Nine of the 16 cases occurred in Myanmar’s ‘dry zone’ area. This dry zone consists of regions from Magway, Mandalay, Naypyidaw, and Sagaing — a large expanse that stretches over the central area of Myanmar. Proportionately, this area only makes up roughly 8% of the country, according to Myanmar Information Management Unit (MIMU) data. Despite this, the region encompasses more than 50% of the case studies identified by Myanmar Witness in this investigation. 

Analysis of the data from the Burmese government shows that a large number of hospitals are located within the dry zone. While most of the incidents happened in the dry zone, the number of incidents impacting medical facilities in this area are disproportionate to the number of hospitals in comparison to the rest of Myanmar. Interestingly, an analysis of the data from the Burmese government on hospital locations reveals that there are a large number of hospitals in the dry zone area. While the dry zone has been the site of most attacks, it has a higher than average number of medical facilities. Figure 6 shows the case studies analysed by Myanmar Witness in the dry zone region. 

Figure 6: A map of the incidents investigated by Myanmar Witness between February and April 2023, with a focus on the dry zone in Myanmar (highlighted in yellow). Nine cases were recorded in the dry zone. Map created using QGIS. 

The intensity of the conflict across the dry zone has, by and large, been proportionately more severe and regular when compared to other areas across Myanmar. A high density of PDF operations in this area, a notable historic lack of a structured EAO having control in Sagaing, and the small geographic distance to Mandalay all go some way in explaining this increased intensity. 

Specifically in Sagaing, a heavy amount of violence has been documented, particularly in the Southeast. 

Myanmar Witness has frequently reported on events in the dry zone, including the use of fire, airstrikes and beheadings; for example, a number of significant cases include the Tabayin school attack, village burnings in Sagaing, and a spate of beheadings in Sagaing. The Myanmar military has used violent tactics to quell the rebellion in this region, including through the dismemberment of alleged enemies. 

Further reading on specific MAF and Myanmar military violence and intimidation tactics can be found in Myanmar Witness’ reports: eyes on the skies, tortured, beheaded, and dismembered, and villages burn in Sagaing. This region is closely monitored by Myanmar Witness due to frequent human rights violations and risk to civilian lives, and will continue to be monitored in order to investigate and report on further human rights abuses. 

Official and unofficial medical facilities

The incidents analysed impacted official and unofficial medical facilities. In this investigation, Myanmar Witness defined official medical facilities as sites that are both publicly and visually identifiable as medical facilities. These marks are either physical (including hospital signs and medical cross signs), or publicly viewable, such as through an online presence in Google Maps or in the government’s official hospitals list. 

Unofficial medical facilities were defined as medical facilities that did not have any visual indications of the sites being used for healthcare. Unofficial medical facilities are common in areas of violent conflict and are usually used by impacted civilians and parties of the conflict. In order to not disclose their purpose, unofficial medical facilities are often not publicly indicated as medical facilities.

Although this approach was applied through the analysis, Myanmar Witness could not always determine the status of a facility not beyond any doubt due to limited information availability for the sites.

Figure 7: Mapping of the 16 incidents, broken into official and unofficial medical facilities. Map created using QGIS.

Figure 8: Breakdown of the analysed incidents to official and unofficial medical facilities between February and April 2023.

Type of incident 

During the analysis of the incidents, Myanmar Witness identified a variety of incident types. In order to simplify the analysis, several categories including (non-exhaustively) airstrikes, fires, occupation and ‘other’ were used to track the type of impact on the facilities. When a relevant category was lacking, the details were written down under ‘other’. Seven of the incidents had more than one type of impact reported and were logged accordingly.

Reports of fires and airstrikes were prevalent in the cases examined; for example, half of the analysed incidents reported on the use of fire. Seven incidents mentioned the occurrence of airstrikes, which the MAF is the only actor capable of perpetrating as they possess aircraft. 

Figure 9: Breakdown of the 16 incidents by type of incident reported.

Four Case Studies of Attacks on Medical Facilities

After identifying 16 incidents within the timeframe of analysis, four case studies were selected for deeper investigation both due to the intensity of the event, alongside the presence of verifiable open source content. These case studies are outlined below. Each case involves a physical attack on a medical facility, allegedly by the Myanmar military and/or MAF. Airstrikes, fires, raids, destruction of property, and even claims of employee detainment have been referenced below. 

All four cases are partially verified through the process of geolocation, whilst chronolocation was completed on three of the cases. Figure 10 below shows the location of these four events. 

Map showing the four case study locations

Figure 10: Map showing the locations of the four case studies of medical facilities that were damaged between February to April 2023. Map created using QGIS. 

1. Ma Le Thar District Hospital [22.113646, 95.451554]

Ayadaw, Sagaing, 23 February 2023

On 23 February 2023, MAF reportedly launched airstrikes against Ma Le Thar village (မလဲသာ) [22.115030, 95.455742] in Ayadaw township, Sagaing, with an Mi-35 helicopter. This violence was allegedly followed by, or coincided with, a Mi-17 helicopter delivery of ground troops who conducted a raid on Ma Le Thar District Hospital (မလဲသာကျေးရွာတိုက်နယ်ဆေးရုံ) [22.113646, 95.451554] — also referred to as Cottage Hospital (တိုက်နယ်ဆေးရုံ) on Google Maps. Footage surfaced in the following days showing damage to the hospital structure, multiple locations of fires and destroyed medical equipment. 

A local news media site claimed that the attack started around 1400 local time. Myanmar Witness has geolocated UGC showing damage to structures and vehicles in the village, but could not verify if the attacks occurred on 23 or 24 February 2023 as the posts were published on 25 and 26 February 2023. Other reports stated that a Myanmar military column arrived in Ma Le Thar on 24 February 2023, after the airstrikes and troop incursion the previous day had cleared a path for them.

Figure 11: Imagery from the claimed airstrike on Ma Le Thar. (Left) Damage to Ma Le Thar District Hospital wall [22.113461, 95.452112]. (Right) Damage to a nearby medical facility building [22.114029, 95.451988] connected to the hospital (source: Ayadaw Post). 

Figure 12: Graphic showing UGC which has been geolocated by Myanmar Witness to the Ma Le Thar Hospital (source: Ayadaw Post).

Analysing the Incident 

The Ayadaw Post released images purporting to show the aftermath of the attack (including figures 13 and 14 below). Myanmar Witness confirmed that the images show various locations within the hospital gates and multiple locations where the remnants of fires are visible.

The images show the destruction of medical supplies. Piles of burnt medical supplies and equipment, including syringes, IV bags, and surgical tools can be seen surrounded by ash. The localised nature of the burn markings on the ground suggests that the fires were set intentionally. The images also suggest that vehicles were piled together and set on fire near the medical centre. The destruction of medical supplies and vehicles prevents the delivery and provision of basic medical care, by reducing the capability of mobilising medical supplies into the village or mobilising people to other healthcare facilities nearby.

Figure 13: Medical equipment and supplies, geolocated by Myanmar Witness to be within the hospital yard, show signs of destruction through fire and physical damage (source: Ayadaw Post).

Images of the hospital yard reveal further isolated incidents of fire, damage to structures and intimidating graffiti. The damage to the wall and roof of the hospital building suggest that heavy machinery was used, which supports the claim that an air attack took place.

One of the images shows graffiti in the hospital grounds (figure 14 below) that translates to “will kill the informants/spy first” (ဒလံအရင်သတ်မှာ). The cross on the wall, which appears to have collapsed (fallen or been pushed down) during or after the attack (see figure 11 above for initial imagery), indicates that the graffiti marks are in front of Ma Le Thar hospital gate. 

Although imagery from the hospital grounds prior to the attack does not appear to have the same graffiti, Myanmar Witness cannot confirm whether the graffiti was left by the Myanmar military during this attack. Despite this, intimidation in the form of graffiti has been seen in other cases; for example, Myanmar Witness has investigated other cases where intimidating graffiti has been left, likely by Myanmar military forces. For more information, see the Myanmar Witness report School teacher killed and body mutilated. 

Figure 14: Graffiti seen across from the entrance to Ma Le Thar District Hospital translates to “will kill the informants/spy first” (ဒလံအရင်သတ်မှာ) [22.113266, 95.452186]. The other side of the wall before it collapse can be seen in figure 11 (source: Ayadaw Post). 

Further analysis and attribution reporting has been conducted on this event in Mar Le Thar village in the Myanmar Witness Report Tortured, beheaded and dismembered, which focussed on multiple beheadings cases in Sagaing region in early 2023. 

2. Pa Dat Taing village medical clinic [22.075511, 95.449803]

Myinmu, Sagaing, 25 February 2023

On 25 February 2023, it is claimed that Myanmar military troops set fire to a clinic in Pa Dat Taing village (ပဒတ္တိုင်းရွာ), Myinmu township, Sagaing region. UGC and claims reported by Insecurity Insight suggest that a library and 65 houses were also destroyed in the attack. Damage to the medical clinic was geolocated by Myanmar Witness (see figure 16 below).

The date and time of the incident could not be determined by Myanmar Witness, but Sentinel satellite imagery did show a large fire in the village between 24 February and 1 March 2023, lending support to the claim that the fire took place on 25 February 2023. 

Myanmar Now reported (warning: graphic link) that two PDF members were arrested near Pa Dat Taing and that their arrest could have been the reason for the military raid and fire; however, this is not confirmed.

Figure 15: Graphic of the attack on Pa Dat Taing Village medical clinic (sources: Myengmu Township news agency, additional source was redacted for privacy).

Analysing the Incident 

Footage following this event shows extensive fire damage to a medical clinic. From the geolocated footage, the front entrance gate (shown at the top right of figure 15) states the clinic name — Pa Dat Taing village medical clinic (ကျေးလက်ကျန်းမာရေးဌာနခွဲ ပဒတ္တိုင်းကျေးရွာ) — confirming that the site is a medical facility. 

Myanmar Witness geolocated an image showing damage to a  green walled building adjacent to the medical facility. The image showed ash/burn marks above the windowsill of the windows on the first floor, likely to be the result of smoke escaping from the building's interior. Additional imagery confirms that there was a lack of scorch marks, or other fire debris including ash, outside the building, suggesting the fire was set alight from the inside. Myanmar Witness was unable to determine if the medical clinic was intentionally set on fire or not. With that said, the proximity of the green walled building indicates that it is likely that the clinic was burnt from an intentionally set fire.

This event is allegedly linked to case study 1 in Ayadaw, as it was reportedly perpetrated by the same military troops. The event has been further investigated in the Myanmar Witness Report Tortured, beheaded and dismembered, which focussed on the beheading cases in Sagaing region beginning in February 2023. The attack and widespread destruction to the village allegedly resulted in the displacement of many villagers. For those who stayed behind, access to medical care will be greatly hampered. 

3. Ma Gyi Kan village hospital [21.722567, 94.811919]

Myaing, Magway, 18 April 2023 

On 18 April 2023, Myanmar military troops reportedly launched a ground raid and an airstrike with an Mi-35 helicopter near a hospital in Ma Gyi Kan village (မကြီးကန်) [21.722567, 94.811919], Myaing township (မြိုင်မြို့နယ်၊), Magway region (မကွေးတိုင်းဒေသကြီး). While Myanmar Witness has been unable to verify that an airstrike took place, UGC showing significant damage to the hospital building (as well as surrounding buildings and vehicles) was geolocated to the hospital grounds. According to a sign on the hospital wall, the hospital was donated in 2014 by the Japanese government (sign shown in figure 16 and 18 below). 

The ground troops reportedly set buildings on fire during the raid. Local eyewitnesses reported that medical staff and patients were captured and taken away in a helicopter. Myanmar Witness also identified and analysed a video showing individuals — likely Myanmar military ground troops — leaving the area in a Mi-17 from a field near the hospital. This could align with claims that the military took medical personnel with them; however, this cannot be confirmed due to the granularity of the video (figures 16 and 17 below). The helicopter was located about 150 metres from the hospital. A number of people in the video appear to be carrying a heavy, unknown object — possibly medical equipment seized from the hospital.

Figure 16: Graphic of geolocated UGC from Ma Gyi Kan village hospital (sources: Myanmar Labour News;  MYGPDF; Red News Agency).

Myanmar Witness geolocated time-stamped images showing the destruction of the hospital, nearby structures and vehicles. The time stamps were consistent with Sentinel 2 imagery (see figure 20 below) which showed fire damage from between 15 and 20 April 2023 (as can be seen in figure 16 above).

The video showing the soldiers moving towards the helicopter was also geolocated, as shown by figure 17 below.

Figure 17: An Mi-17 helicopter that landed in a field [21.722826, 94.810762] in Ma Gyi Kan village (မကြီးကန်), showing several soldiers walking towards the helicopter from the hospital direction. Bottom right image shows the video zoomed in on the Mi-17 helicopter with ground troops entering the aircraft (source: Red News Agency).

Myanmar Witness also geolocated imagery showing a sign which revealed that the hospital had been supported by the Japanese Government (figure 18).

Figure 18: Sign seen from the hospital wall announcing the Japanese ties to the facility from 2014, which translates to: "health infrastructure and equipment development project in Central Myanmar. The project is supported by the Japanese people and expresses the friendship and cooperation between Japan and the Republic of Myanmar."  (source: Myanmar Labour News).

Analysing the Incident 

UGC from the hospital suggests that the fire was set alight from within the building. This can be deduced because there are no visible burn marks around the outside of the hospital building. For example, the vegetation along the hospital’s exterior walls (as seen in figure 19 below) do not appear to be burnt, while the inside of the building has suffered from extensive fire damage.

The damage and dispersal of material and equipment across the ground also lends support to the claim that a raid occurred within the hospital before it was set alight.

Figure 19: Damage shown from the exterior and interior of the facility shows that the vegetation outside has not been burnt and more fire damage is shown internally and not on the outside walls, suggesting the fire most likely was set from inside (source: Myanmar Labour News). 

Figure 20: Sentinel 2 imagery from 20 April 2023 showing fire damage (marked purple) north of Ma Gyi Kan village hospital (marked yellow) [21.722574, 94.812111] (source: Sentinel Hub).

Multiple vehicles that were located 100 metres north of the hospitals were also set alight. UGC showed multiple burnt motorcycles that were piled up near to a car and set on fire (figure 21).  On 19 April 2023, Fifty Two news, a pro Myanmar military telegram channel, posted images of the vehicles before they were burnt. The same cars were visibly parked at the same position as in the images taken after the motorcycles were burnt, likely indicating that the images were taken a short time before the fires. Additionally, the motorcycles weren’t positioned by the cars in the earlier imagery, indicating they were moved there later. 

Multiple motorcycles were seen in another image posted by Fifty Two news, but Myanmar Witness could not verify if these are the same motorcycles. Fifty Two news has frequently posted images of vehicles or structures prior to their destruction or prior to arson events. Myanmar Witness also investigated this trend in the report Tortured, beheaded and dismembered, where Fifty Two news posted images of the deceased before and after decapitation.

Figure 21: Two vehicles that were burnt near Ma Gyi Kan village hospital [21.722574, 94.812111]. Both of the images were posted on the same day. (Sources: left - Fifty Two news; right - MYGPDF).

Figure 22: Two separate signs outside the medical facility, one stating that the location is a ‘department of rural health’ centre (left) and the other stating the facility's objective of health care responsibility (right) (source: Private, available on request).

An analysis of the UGC from this event reveals extensive airstrike and fire damage. Scorch marks, ash, and heavy damage to the roofing and walls of structures are all present within the footage. The presence of a Mi-17 helicopter, geolocated nearby, which is known to be regularly used by the MAF to transport Myanmar military ground troops, also adds weight to the claims of fires and military raids. The use of fire by the Myanmar military has been frequently documented in other cases, lending support to the notion that the fire in the medical facility was likely perpetrated by the Myanmar military. The additional claims that staff were arrested, and that a facility which had been donated by Japan, could increase the gravity of this attack.   

4. Pekon Hospital [19.669828, 96.889449]

Pekon township, Shan - 25 April 2023

On 25 April 2023, an airstrike was reportedly conducted by the MAF over a Kayan National Health Committee (KNHC) (ကယန်းအမျိုးသားကျန်းမာရေးကော်မတီ) medical facility in Pekon township, Shan state, affecting a rural medical facility and an internally displaced persons (IDP) camp. Unlike the other case studies included in this report, this facility was not located within a village.

RFA claimed that a military Mi-35 attack helicopter was responsible for the damage, but local Karenni Nationalities Defense Force (KNDF) media stated that a fighter jet was used. The attack allegedly impacted civilians in the area, injuring three people including a nurse. People Media, a pro-military media outlet, states that the airstrike was conducted because local PDF and Karenni National Progressive Party (KNPP) members were present at this location. Myanmar Witness has been unable to verify this claim, but has verified damage to a medical facility in the area and identified at least one injured individual in a nearby IDP camp.

Figure 23: Graphic of the Pekon township airstrike that affected the local rural hospital (sources: Karenni’s Voice; additional sources were redacted for privacy). 

Analysing the Incident

A video shared online (still image in figure 26) shows a sign at the entrance to the hospital that translates to ‘Kayan National Health Committee’ (ကယန်းအမျိုးသားကျန်းမာရေးကော်မတီ) followed by the distinct blue and white cross used to signal that a location is a medical facility in Myanmar. There are claims that this facility is funded by Kayan National Unity and run by the KNPP, but this has not been independently verified by Myanmar Witness.

Figure 24: Blue cross on the sign indicating the role of the facility as a hospital and/or medical facility (source: redacted due to privacy concerns). 

Myanmar Witness geolocated UGC of the aftermath, revealing the extent of the damage to the hospital. The hospital walls were largely destroyed, with debris and glass scattered throughout the hospital's interior. The outer walls appear to have come under fire, with countless bullet holes visible, some of which had pierced through the concrete walls. In one of the rooms, a hanging bottle of saline was seen above one of the beds. The bed was made and personal belongings are visible by it, indicating that it was likely in use at the time of the strike.

Figure 25: Destruction in one of the rooms of KNHC hospital [19.669733, 96.889476] (Source: Spokesperson, National Unity Government President Office). 

Due to the hospital’s rural location, the lack of surrounding buildings (the facility was not located within a village, like the other examples analysed), and the acknowledgement by pro-SAC media that the attack was targeted due to the presence of resistance fighters in the area, it is likely that the airstrike was intentional. Additionally, the footage of ordnance in the field next to the hospital supports claims that an airstrike took place. 

Further analysis of the incident can be found in Myanmar Witness’s Spot Report: Pekon Hospital Bombing published on 2 May 2023. 

Attacks on Medical Personnel

During this investigation, Myanmar Witness also identified other types of incidents beyond physical attacks (including airstrikes, fire, and other physical damage) on medical facilities. For example, medical professionals have been arrested, prevented from treating patients and some facilities have been closed down in cases where their funding came from anti-SAC sources. 

For example, in May 2021, in one of the first cases following the coup, pro-SAC groups (potentially police and/or Myanmar military members) arrested several medical professionals and patients at the National Aids Centre (NAC) in Yangon, under claims that the centre was making bombs. The centre was known to be funded and run by an NLD politician named Daw Phyu Phyu Thin, leading locals to believe that the raid was both calculated and targeted. 

More recent cases, in 2023, show that these same tactics are being used across a wider area of Myanmar. In February 2023, Delta News Agency reported that medical staff in various townships around Yangon were being checked by the SAC for ties to the CDM. A range of facilities from large public hospitals to small private clinics were searched. Similar claims were made in Mandalay. Also in February 2023, in Myingyan township, Mandalay, two midwives (a mother and son) were shot and killed within a rural medical facility in Tu Ywin Boet village (တူရွင်းဘို့). Online UGC claims that five people arrived on two motorcycles, they ran into the facility and left shortly after the attack. 

It is hard to quantify the impact of this form of intimidation and the increased risk for medical personnel. Closures of facilities, as well as the arrests and killings of medical staff can cause long term damage to the delivery of medical care, and thus risk the health of society at large. 

Hospitals and medical facilities are protected under an array of international legal instruments; thus, this activity warrants further investigation and verification.  

Conclusion 

This report has revealed the efforts taken by the Myanmar military as it struggles to maintain control and quell opposition across the country. Physical damage to medical facilities in the form of airstrikes and fire, and the harassment or detention of medical personnel has become a key part of the Myanmar military’s offensive, occurring regularly since the February 2021 coup. 

Through a mixed methods approach, this research has helped to shine further light on the modus operandi of the Myanmar military. The Myanmar military, which is heavily reliant upon aircraft manufactured in Russia and China, is putting the population of Myanmar in a precarious position by targeting medical facilities with fighter jets and helicopters. As traditional air assets are only available to the MAF, and several events investigated involved helicopters and fighter jets, it remains highly likely that the SAC is responsible for these attacks. 

The case studies also reveal the use of fires, raids and the resultant destruction of medical facilities by ground troops. Areas of known resistance, namely the dry zone of Myanmar — an area that has been widely reported on by Myanmar Witness as it represents the epicentre of the conflict — have suffered from a concentration of attacks. While the extent of the impact on medical provision across Myanmar remains unknown, it is clear that the conflict is having a sustained and long-term impact on civilian’s access to medical support. 

Myanmar  Witness  will  continue  to monitor, identify, verify, analyse and report on the events which impact medical facilities and other essential services across Myanmar, with a particular focus on how they impact the daily lives and safety of civilians. Myanmar Witness seeks to shed light on atrocities and determine attribution so that the responsible parties are held  to  account. 

List of Abbreviations

• Armed Conflict Location & Event Data - ACLED

• Civil Disobedience Movement - CDM

• Ethnic Armed Organisation - EAO

• Fire Information for Resource Management System - FIRMS

• Internally Displaced Persons - IDPs

• International Committee of the Red Cross - ICRC

• International Human Rights Law - IHRL

• Karenni National Progressive Party - KNPP

• Karenni Nationalities Defense Force - KNDF

• Kayan National Health Committee - KNHC

• Myanmar Air Force - MAF

• Myanmar Information Management Unit - MIMU

• National Aids Centre - NAC

• National League for Democracy - NLD

• People’s Defense Force - PDF

• Quantum Geographic Information System - QGIS

• Radio Free Asia - RFA

• State Administration Council - SAC

• User generated content - UGC

  
  

Further Reading 

• Eyes on the skies 

• Tortured, beheaded and dismembered 

• Villages burn in Sagaing

• The Tabayin School Attack 

• School teacher killed and body mutilated