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A member of the Ukrainian State Border Guard Service wearing a protective mask is seen at the contact line between Ukrainian troops and pro-Moscow rebels in Mayorsk, Ukraine on 17 March, 2020 REUTERS/Gleb Garanich

COVID-19 and Conflict: Seven Trends to Watch

Deadly and disruptive as it already is, and terribly as it could yet worsen and spread, the 2020 coronavirus outbreak could also have political effects that last long after the contagion is contained. Crisis Group identifies seven points of particular concern.

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Overview

The COVID-19 pandemic unquestionably presents an era-defining challenge to public health and the global economy. Its political consequences, both short- and long-term, are less well understood.

The global outbreak has the potential to wreak havoc in fragile states, trigger widespread unrest and severely test international crisis management systems. Its implications are especially serious for those caught in the midst of conflict if, as seems likely, the disease disrupts humanitarian aid flows, limits peace operations and postpones or distracts conflict parties from nascent as well as ongoing efforts at diplomacy. Unscrupulous leaders may exploit the pandemic to advance their objectives in ways that exacerbate domestic or international crises – cracking down on dissent at home or escalating conflicts with rival states – on the assumption that they will get away with it while the world is otherwise occupied. COVID-19 has fuelled geopolitical friction, with the U.S. blaming China for the disease while Beijing tries to win friends by offering aid to affected countries, exacerbating existing great-power tensions that complicate cooperation on crisis management.

It is not yet clear when and where the virus will hit hardest, and how economic, social and political factors may converge to spark or aggravate crises. Nor is it guaranteed that the pandemic’s consequences will be entirely or uniformly negative for peace and security. Natural disasters have sometimes resulted in the diminution of conflicts, as rival parties have had to work together, or at least maintain calm, to focus on preserving and rebuilding their societies. There have been a few signs of governments trying to ease political tensions in the shadow of COVID-19 with, for example, the United Arab Emirates (UAE) and Kuwait offering Iran – centre of one of the worst initial outbreaks outside China – humanitarian assistance. If the pandemic is likely to worsen some crises internationally, it may also create windows to improve others.

Crisis Group is especially concerned with places where the global health challenge intersects with wars or political conditions that could give rise to new crises or exacerbate existing ones.

The coming months will be acutely risky, with the U.S. and European countries focusing on the domestic impact of COVID-19 just as the disease is likely to spread to poor and war-affected countries. With the exception of Iran, in its first phase COVID-19 mainly affected states – including China, South Korea and Italy – that had resources to manage the problem, albeit unevenly and at the cost of severe strains on their health systems and economies. To date, there have been fewer reported cases in countries with weaker health systems, lower state capability or significant internal conflict, where consequences of an outbreak could be overwhelming.

That is of little solace, however. The low numbers are almost certainly a function of insufficient testing or of a delay between the virus’s onset and its manifestation. Confirmed case numbers are ticking up in fragile parts of the Arab world and Africa. If countries struggle to put in place social distancing or other measures to stop the virus’s spread, or delay doing so, they could see spikes of cases like those now overwhelming parts of Europe, but with far fewer emergency care facilities available to save lives. The suffering that would cause is hard to overstate. If the disease spreads in densely packed urban centres in fragile states, it may be virtually impossible to control. The dramatic economic slowdown already under way will disrupt trade flows and create unemployment that will do damage at levels that are hard to forecast and grim to contemplate. A recession could take a particularly heavy toll on fragile states where there is greatest potential for unrest and conflict.

All governments face hard choices about how to manage the virus. Countries from the Schengen area to Sudan have already imposed border restrictions. Many are placing partial or blanket bans on public gatherings or insisting that citizens shelter at home. These are necessary but also costly measures, especially given projections that the pandemic could continue for well over a year until a vaccine becomes available. The economic impact of restricting movement for months on end is likely to be devastating. Lifting restrictions prematurely could risk new spikes in infections and require a return to isolation measures, further compounding the disease’s economic and political impact and requiring further injections of liquidity and fiscal stimulus by governments around the world.

These are universal problems, but as an organisation focusing on early warning and conflict prevention, Crisis Group is especially concerned with places where the global health challenge intersects with wars or political conditions – such as weak institutions, communal tensions, lack of trust in leaders and inter-state rivalries – that could give rise to new crises or exacerbate existing ones. We also hope to identify cases where the disease could, with effective diplomacy, stimulate reductions in tensions. This briefing, the first in a series of Crisis Group publications on COVID-19 and its effects on the conflict landscape, draws primarily from the input of our analysts across the globe, and identifies seven trends to watch during the pandemic.

I. The Vulnerability of Conflict-affected Populations

The populations of conflict-affected countries – whether those in war or suffering its after-effects – are likely to be especially vulnerable to outbreaks of disease.[fn]Except where otherwise noted, this briefing is based on observations from Crisis Group analysts between 1 and 21 March 2020. For previous studies of conflict, public health and pandemics, see Maire A. Connolly and David L. Heymann, “Deadly Comrade: War and Infectious Diseases”, The Lancet, vol. 360 (December 2002); Paul H. Wise and Michele Barry, “Civil War and the Global Threat of Pandemics”, Daedalus, vol. 146, no. 4 (Fall 2017); Nita Madhav, Ben Oppenheim, Mark Gallivan, Prime Mulembakani, Edward Rubin and Nathan Wolfe, “Pandemics: Risks, Impacts and Mitigation”, in D.Y. Jamieson et al. (eds.), Disease Control Priorities, vol. 9 (3rd edition) (Washington, 2017). In many cases, war or prolonged unrest, especially when compounded by mismanagement, corruption or foreign sanctions, have left national health systems profoundly ill-prepared for COVID-19.

In Libya, for example, the UN-backed government in Tripoli has pledged roughly $350 million to respond to the disease, but to what end is unclear: the health system has collapsed due to an outflow of foreign medics during the war.[fn]Libya’s Tripoli government declares emergency, shuts down ports, airports”, Reuters, 14 March 2020.Hide Footnote In Venezuela, as Crisis Group warned would happen in 2016, the standoff between the chavista government and opposition has hollowed out health services. COVID-19 is liable to overwhelm the country’s remaining hospitals very quickly.[fn]Crisis Group Latin America Briefing N°35, Venezuela: Edge of a Precipice, 24 June 2016.Hide Footnote In Iran, the government’s lethargic response compounded by the impact of U.S. sanctions has brought calamity: the virus reportedly is infecting nearly 50 people and taking five to six lives every hour.[fn]“U.S. to Iran: Coronavirus won’t save you from sanctions”, Reuters, 20 March 2020.Hide Footnote In Gaza, where a healthcare system weakened by years of blockade was ill equipped to serve the high-density population long before COVID-19, the Health Ministry is scrambling to gather the experts and obtain the supplies necessary for when the disease sweeps in. It appears to be an uphill climb: medical suppliers serving the region told Crisis Group that they had run out of key items even before the ministry announced two COVID cases on 21 March.

On top of such institutional problems, it can be hard to persuade populations with little trust in government or political leaders to follow public health directives. Reviewing the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone, Crisis Group noted that “the virus initially spread unchecked not only because of the weakness of epidemiological monitoring and inadequate health system capacity and response, but also because people were sceptical of what their governments were saying or asking them to do”.[fn]Crisis Group Africa Report N°232, The Politics Behind the Ebola Crisis, 28 October 2015.Hide Footnote The doubts stemmed in part from misinformation and poor advice about the contagion from the governments involved but also from recurrent political tensions in a region scarred by war in the previous decade.

In cases of active conflict, national and international medics and humanitarian actors may struggle to get relief to people in need. In 2019, the World Health Organization (WHO) and international NGOs struggled to contain an Ebola outbreak in the eastern Democratic Republic of the Congo (DRC), despite support from UN peacekeepers, due to violent local militias that blocked access to some affected areas. At times, combatants targeted doctors and medical facilities themselves. Although the Congolese authorities and WHO apparently succeeded in ending the outbreak in recent months, the disease lasted far longer and claimed far many more lives (with a confirmed 2,264 fatalities) than would have been the case in a stable area.[fn]“DRC Ebola Updates: Crisis Update – March 2020, MSF, 9 March 2020.Hide Footnote Security obstacles are similarly liable to hamper the COVID-19 response in places where hostilities continue.

The areas of active conflict at highest immediate risk of COVID-19 outbreaks may be north-western Syria, around the besieged enclave of Idlib, and Yemen

The areas of active conflict at highest immediate risk of COVID-19 outbreaks may be north-western Syria, around the besieged enclave of Idlib, and Yemen. Both countries have already experienced health crises during their civil wars, with violence impeding the international response to an outbreak of polio in Syria in 2013-2014 and cholera in Yemen from 2016 onward. UN officials have now raised the alarm about COVID-19 infecting the population of Idlib, where a Russian-backed offensive by government forces has systematically targeted hospitals and other medical facilities and led to the displacement of over one million people in the last six months alone.[fn]See also Evan Hill and Yousur Al-Hlou, “‘Wash our hands? Some people can’t wash their kids for a week’”, The New York Times, 20 March 2020.Hide Footnote Many people fleeing clashes sleep in fields or under trees, and basic hygiene and social distancing practices are made impossible by the lack of running water or soap as well as cramped living spaces. Delivery of vital test kits has been delayed by weeks. Humanitarian workers fear that an outbreak of the disease in Idlib would both overwhelm the province’s medical facilities and make it impossible to care for victims of war.

In Yemen, war since 2015 has decimated what even before was a very weak heath system. Over 24 million people already require humanitarian assistance.[fn]“Humanitarian crisis in Yemen remains the worst in the world, warns UN”, UN News, 14 February 2019.Hide Footnote After de facto authorities in the capital city of Sanaa and the internationally recognised government in Aden banned international flights to prevent the virus from spreading, international relief teams reduced their numbers to essential staff. A COVID-19 outbreak could rapidly overwhelm aid efforts and make one of the world’s most serious humanitarian catastrophes even more dire.

In Idlib, Yemen and beyond, internally displaced persons (IDPs), asylum seekers and refugees are particularly exposed to outbreaks of COVID-19, given their frequently squalid living conditions and limited access to health care. Data released by the UN High Commissioner for Refugees in 2019 suggest that over 70 million people fall into these categories of displacement globally, and the number has most likely risen since then, especially given events in Syria.[fn]“Worldwide displacement tops 70 million, UN refugee chief urges greater solidarity in response”, UN High Commissioner for Refugees, press release, 19 June 2019.Hide Footnote Whatever narrow avenues might have existed for displaced persons to move or be resettled to safer and more secure locations are, for all intents and purposes, now shut off due to COVID-19.

There is a long history of contagion spiking in IDP and refugee camps, a risk that now looms again, although in some areas medical services available in camps may be better than those for surrounding populations. UN officials are particularly concerned about the al-Hol camp in north-eastern Syria, home to over 70,000 people, including women and children who fled the Islamic State’s last territorial foothold as it collapsed, among them Syrians, Iraqis and approximately 10,000 nationals of other countries. As we wrote about the camp in the fall of 2019, it was already “a scene of humanitarian disaster, rampant with disease – its residents lacking adequate food, clean water, often cut off entirely from medical services”, leaving its population highly vulnerable to COVID-19.[fn]Crisis Group Middle East Report N°208, Women and Children First: Repatriating the Westerners Affiliated with ISIS, 18 November 2019, p. 4.

Also of concern are the Rohingya refugee camps in Bangladesh, where over one million people live in overcrowded conditions, with sanitation facilities and health care services limited to a bare minimum.[fn]See Crisis Group Asia Report N°303, A Sustainable Policy for Rohingya Refugees in Bangladesh, 27 December 2019.Hide Footnote A government ban on internet and mobile phone services in the camps limits access to vital preventive information, while high levels of malnutrition likely imply that both the refugees and local residents are more susceptible to the disease. Should COVID-19 reach the camps, humanitarian agencies expect it to spread like wildfire, potentially triggering a backlash from Bangladeshis who live in the surrounding areas and are already unnerved by the refugees’ prolonged stay.

In these cases – as for displaced communities in Iraq and elsewhere in the Middle East, Africa and Asia – there is a risk that IDPs and refugees facing large-scale outbreaks of COVID-19 in the camps where they reside may aim to flee again to safety, leading local populations or authorities to react forcefully to contain them, which creates the potential for escalating violence. States attempting to stop the spread of the disease are likely to view new refugee flows fearfully. Colombia and Brazil, for example, closed their borders with Venezuela after previously taking a relatively generous approach to those fleeing the crisis there, but the pressure to escape worsening poverty and health risks in Venezuela could force rising numbers of migrants to use illegal crossings.

The COVID-19 emergency could also exacerbate the humanitarian crisis in Central America tied in part to the Trump administration’s immigration policies, as well as the region’s already high levels of violent crime. Having announced the closure of its southern border to all non-essential traffic from 21 March, the U.S. may seek to strengthen efforts to halt the arrival of migrants and refugees from Central America and return them to host countries. El Salvador and Guatemala nevertheless suspended in mid-March all incoming flights of Central American deportees from the U.S. The service to Guatemala has since resumed, but it remains to be seen whether Washington can continue to export deportees when both these countries have grounded all other international passenger flights. 

At a time of grave threat to Central America’s fragile economies, moves to continue U.S. and Mexican deportation flights could expose growing numbers of displaced people to a frosty reception once they land, as locals may fear that the arrivals are spreading disease. Many deportees are likely to face the choice of heading back to the U.S. border, with the support of trafficking networks, or becoming victims or accomplices of the region’s pervasive criminal groups and street gangs.

In many cases, COVID-19’s impact on refugees and IDPs will be felt disproportionately by women, who often form the majority of displaced populations in conflict-afflicted regions. These women’s access to services and ability to feed their families are already deeply constrained by stigma relating to their ties (real or alleged) to armed groups. Exposed to sexual exploitation or abuse, with their rehabilitation or integration back into communities a low priority for feeble or indifferent governments, displaced women and children stand poised to be affected fast and first by the economic crises that will accompany the spread of the disease.

II. Damage to International Crisis Management and Conflict Resolution Mechanisms

One reason why refugee and IDP populations are likely to be especially vulnerable to COVID-19 is that the disease could severely weaken the capacity of international institutions to serve conflict-affected areas. WHO and other international officials fear that restrictions associated with the disease will impede humanitarian supply chains. But humanitarian agencies are not the only parts of the multilateral system under pressure due to the pandemic, which is also likely to curb peacemaking.

Travel restrictions have begun to weigh on international mediation efforts. UN envoys working in the Middle East have been blocked from travelling to and within the region due to airport closures. Regional organisations have suspended diplomatic initiatives in areas ranging from the South Caucasus to West Africa, while the envoy of the International Contact Group on Venezuela – a group of European and Latin American states looking for a diplomatic solution to the crisis there – had to cancel an already long-delayed trip to Caracas in early March for COVID-related reasons.[fn]A delegation of diplomats planning to visit Nagorno-Karabakh on behalf of the Organization for Security and Co-operation in Europe cancelled the trip, while West African leaders planning to visit Guinea to discuss a contentious referendum also called off their visit.
 Hide Footnote

A delegation of diplomats planning to visit Nagorno-Karabakh on behalf of the Organization for Security and Co-operation in Europe cancelled the trip, while West African leaders planning to visit Guinea to discuss a contentious referendum also called off their visit.
 

Hide Footnote The disease could affect crucial intra-Afghan peace talks planned as a follow-up to the February preliminary agreement between the U.S. and the Taliban, at least reducing the number of those who can participate (although limiting the group to real decision-makers and essential support staff could be conducive to serious talks).[fn]In a possible sign of progress, U.S. Representative for Afghanistan Reconciliation Zalmay Khalilzad tweeted on 22 March that the U.S. and Qatar had facilitated technical talks on prisoner releases between the Afghan government and Taliban “via Skype video conferencing”.Hide Footnote

Covid-19 means that international leaders, focused as they are on dramatic domestic issues, have little or no time to devote to conflicts or peace processes

More broadly, the disease means that international leaders, focused as they are on dramatic domestic issues, have little or no time to devote to conflicts or peace processes. European officials say that efforts to secure a ceasefire in Libya (a priority for Berlin and Brussels in February) are no longer receiving high-level attention. Diplomats working to prevent a deadly showdown in northern Yemen desperately need the time and energy of senior Saudi and U.S. officials but report that meetings with both are being cancelled or curtailed. Kenya’s president Uhuru Kenyatta called off a 16 March summit with counterparts from Ethiopia and Somalia that aimed to defuse dangerously escalating tensions between Nairobi and Mogadishu, with Kenyan officials citing their need to focus on efforts to halt the virus’s potential spread.[fn]“Kenya’s president cancels two foreign meetings over Covid-19”, The East African, 15 March 2020.Hide Footnote A summit between leaders of the EU and the “G5 Sahel countries” (Burkina Faso, Chad, Mali, Mauritania and Niger) will also be cancelled, dealing a blow to efforts to boost counter-terrorism operations in the region.

The disease could also affect multinational peacekeeping and security assistance efforts. In early March, the UN secretariat asked a group of nine peacekeeping troop contributors – including China and Italy – to suspend some or all unit rotations to blue helmet operations due to concerns about the spread of COVID-19.[fn]These initial restrictions reflected requests from host and transit countries (including Uganda, an important UN logistical hub) to the UN not to risk spreading the disease. UN Department of Operational Support correspondence with permanent representatives to the UN, 5 March 2020 (seen by Crisis Group, 9 March 2020).Hide Footnote UN operations have announced further limits to rotations since then, meaning that peacekeepers’ tours of duty will be extended for at least three months in tough mission settings such as the Central African Republic and South Sudan, potentially affecting their morale and effectiveness. A Security Council decision on setting up a new political mission to support Sudan’s transition to civilian rule appears likely to be postponed due to constraints on the Council’s meeting schedule to which its members agreed as part of virus containment measures.[fn]The Security Council postponed meetings from 16 March onward and has tested virtual meeting options, although diplomats will still meet occasionally to vote.Hide Footnote While these diplomatic and operational decisions will have no immediate impact on UN operations, a prolonged pandemic could make it difficult to find and deploy fresh forces and civilian personnel, wearing down missions.

If international organisations may struggle to handle the crisis, media outlets and NGOs may also find it hard to report on conflict and crises due to travel restrictions, even as many readers and viewers are likely at least temporarily to lose interest in non-COVID-19-related stories. Some authoritarian governments seem ready to use the crisis to limit media access. Egypt has, for example, censured Western reporters for their coverage of the disease inside the country – removing the credentials of a Guardian reporter – while China has sent home a number of leading U.S. correspondents. Crisis Group itself has had to place significant limits on our analysts’ ability to travel during the pandemic for their own safety. As this briefing illustrates, we are determined to keep a spotlight on conflicts – whether related to COVID-19 or not – and provide the best coverage possible, but our work will face inevitable constraints.

III. Risks to Social Order

COVID-19 could place great stress on societies and political systems, creating the potential for new outbreaks of violence. In the short term, the threat of disease is likely acting as a deterrent to popular unrest, as protesters avoid large gatherings. COVID-19’s emergence in China precipitated a decline in anti-Beijing protests in Hong Kong (although public discomfort with radical elements of the protest movement may also have been a factor).[fn]Helen Davidson, “Hong Kong: With coronavirus curbed, protests may return”, The Guardian, 15 March 2020.Hide Footnote There has been a decline, too, in the numbers of protesters taking to the streets in Algeria to challenge government corruption.[fn]“Algerians forego weekly protest amid coronavirus”, Reuters, 20 March 2020.Hide Footnote The Russian opposition largely acquiesced in the authorities’ move, ostensibly justified on health grounds, to block protests against President Vladimir Putin’s decision to rewrite the constitution to extend his tenure in office.[fn]“Coronavirus forces Putin critics to scale back protests before big vote”, Reuters, 20 March 2020.Hide Footnote At least one exception to this general caution occurred in Niger, where demonstrators took to the streets against rules barring protest, which the government extended by invoking COVID-19. Three civilians were killed by security forces on 15 March.

Yet the quiet in the streets may be a temporary and misleading phenomenon. The pandemic’s public health and economic consequences are liable to strain relations between governments and citizens, especially where health services buckle; preserving public order could prove challenging when security forces are overstretched and populations become increasingly frustrated with the government’s response to the disease.

Early signs of social disorder already can be seen. In Ukraine, protesters attacked buses carrying Ukrainian evacuees from Wuhan, China, in response to allegations that some were carrying the disease.[fn]“Coronavirus: Ukraine protesters attack buses carrying China evacuees”, BBC, 21 February 2020.Hide Footnote Prison breaks have been reported in Venezuela, Brazil and Italy, with inmates reacting violently to new restrictions associated with COVID-19, while in Colombia prison riots and a reported jailbreak over the perceived lack of protection from the disease resulted in the death of 23 inmates at La Modelo jail on 21 March. In Colombia as well, looters attacked food trucks headed for Venezuela, at least in part to protest the economic effects of the decision taken by both Bogotá and Caracas to close the Colombian-Venezuelan border for health reasons. Even reasonable precautions may inspire angry responses. In Peru, the authorities have arrested hundreds of citizens for breaking quarantine rules, in some cases leading to violence.

The disease’s catastrophic economic impact could well sow the seeds of future disorder.

More broadly, the disease’s catastrophic economic impact could well sow the seeds of future disorder. It could do so whether or not the countries in question have experienced major outbreaks of the disease, although the danger in those that have will be magnified. A global recession of as yet unknown scope lies ahead; pandemic-related transport restrictions will disrupt trade and food supplies; countless businesses will be forced to shut down; and unemployment levels are likely to soar.[fn]Some financial analysts are predicting a “severe global recession” resulting from the outbreak. The U.S. economy, to cite one example, is predicted to contract by 14 per cent in the second quarter of 2020. “Assessing the Fallout from the Coronavirus Pandemic”, JP Morgan, 20 March 2020.Hide Footnote

Governments that have close trading ties with China, especially some in Africa, are feeling the pain of the slowdown emanating from the original Wuhan outbreak.[fn]See, for example, Hannah Ryder and Angela Benefo, “China’s coronavirus slowdown: Which African economies will be hit hardest?”, The Diplomat, 19 March 2020.Hide Footnote Oil producers are already struggling with the collapse of energy prices. Countries like Nigeria, which has strong import/export links to China and relies on oil prices to prop up its public finances, are suffering. Abuja has reportedly considered cutting expenditures by 10 per cent in 2020, meaning that authorities may have to default on promises to raise the minimum wage.[fn]“Silk roadblock: coronavirus exposes Nigeria’s reliance on China”, Reuters, 6 March 2020.Hide Footnote Such austerity measures, combined with other economic effects of COVID-19 – such as the disappearance of tourists in areas that depend heavily on foreign visitors – could lead to economic shocks that last well beyond the immediate crisis, creating the potential for prolonged labour disturbances and social instability.

As Crisis Group noted at the start of 2020, the raucous protests of 2019 stemmed from a “pervasive sense of economic injustice” that could “set more cities ablaze this year”.[fn]Robert Malley, “10 Conflicts to Watch in 2020”, Crisis Group Commentary, 27 December 2019.Hide Footnote Anger over the effects of COVID-19 – and perceptions that governments are mismanaging them – could eventually trigger new demonstrations. The economic decline will have even more immediate effects on societies in low-income countries. Across large swathes of sub-Saharan Africa in particular, millions depend on their daily income to feed their families. An extended lockdown could rapidly create widespread desperation and disorder.

One further reason for worry is COVID-19’s clear potential to unleash xenophobic sentiment, especially in countries with large immigrant communities. Early in the crisis, Chinese labourers in Kenya faced harassment linked to suspicions that China Southern Airline flights were bringing the coronavirus into the country. Some Western politicians, notably U.S. President Donald Trump, have attempted to whip up resentment of Beijing with jibes about the “Chinese virus”. There is anecdotal evidence of an increase in prejudice toward people of Chinese ethnicity in the U.S. and other Western countries, and a serious risk that the diseases will fuel more racist and anti-foreigner violence.[fn]See for example Holly Yan, Natasha Chen and Dushyant Naresh, “What’s spreading faster than coronavirus in the U.S.? Racist assaults and ignorant attacks against Asians”, CNN, 21 February 2020.Hide Footnote

IV. Political Exploitation of the Crisis

Against this background of social pressures, there is ample room for political leaders to try to exploit COVID-19, either to solidify power at home or pursue their interests abroad. In the short term, many governments seem confused by the speed, reach and danger of the outbreak and, in some cases, the disease has infected political elites. An outbreak in Brazil’s isolated capital, Brasilia, has sickened a large number of officials and politicians. In Iran, there have been dozens of cases among senior officials and parliamentarians. In Burkina Faso, where the government is already struggling with the collapse of state authority in large parts of the country, a rash of cases has hit cabinet members. The secondvice president of the parliament was the first recorded fatality in sub-Saharan Africa. In such instances, the disease is more likely to weaken authorities’ ability to make decisions about both health issues and other pressing crises.

Nonetheless, as the crisis goes on, some leaders could order restrictive measures that make public health sense at the peak of the crisis and then extend them in the hope of quashing dissent once the disease declines. Such measures could include indefinite bans on large public gatherings – which many governments have already instituted to stop community spread of COVID-19 – to prevent public protests. Here again there are precedents from West Africa’s Ebola crisis: local civil society groups and opposition parties claim that the authorities prohibited meetings for longer than necessary as a way of suppressing legitimate protests.[fn]Crisis Group Report, The Politics Behind the Ebola Crisis, op. cit., p. 25.Hide Footnote A harbinger of what is to come may have appeared in Hungary, where Prime Minister Viktor Orban asked parliament on 21 March to indefinitely extend a state of emergency that prescribes five-year prison sentences for those disseminating false information or obstructing the state’s crisis response.[fn]“Hungary govt seeks to extend special powers amid coronavirus crisis”, Reuters, 21 March 2020.Hide Footnote

There is ample room for political leaders to try to exploit COVID-19.

Elections scheduled for the first half of 2020, and perhaps later, are also liable to be postponed; here too, the immediate public health justification may be valid but the temptation to use the virus as a pretext for further delays and narrowing of political space could well exist. Indeed, there are likely to be good practical reasons for delaying voting in such cases. In addition to complicating domestic planning, the pandemic will obstruct the deployment of international electoral support and, where planned, observation missions. Still, opposition parties are likely to suspect foul play, especially in countries where political trust is low, there has been recent instability, or the government enjoys dubious legitimacy or has a history of manipulating electoral calendars.

Again, there are already examples. The interim president in Bolivia, Jeanine Añez, announced on 21 March that the presidential election planned for 3 May to find a full-time replacement for Evo Morales – whom the military ousted after controversial polls in 2019 – would be delayed to an unspecified future date. In Sri Lanka, an Election Commission decision to postpone parliamentary elections for public health reasons could grant President Gotabaya Rajapaksa – a hardline nationalist associated with human rights abuses directed at minorities and political critics – enhanced powers. Although Rajapaksa initially wanted the polls to go ahead (reflecting expectations of a landslide victory), should he refuse to recall parliament while elections remain on hold, the length and legality of his interim powers may well stir controversy.

Some leaders may also see COVID-19 as cover to embark on destabilising foreign adventures, whether to deflect domestic discontent or because they sense they will face little pushback amid the global health crisis. No such case has yet surfaced, and there is a risk that analysts will now attribute crises to COVID-19 that are better explained by other factors. Still, at a time when the pandemic is distracting major powers and multilateral organisations, some leaders may surmise that they can assert themselves in ways that they would otherwise deem too risky. A spate of attacks against U.S. targets by Iranian-backed Shiite militias in Iraq may well be part of a pre-existing effort by Tehran to push the U.S. out of the Middle East. But with Iran’s leadership already under enormous domestic pressure, the toll taken by the coronavirus might also affect its calculus. As we wrote, “feeling besieged and with no obvious diplomatic exit ramp, Iran might conclude that only a confrontation with the United States might change a trajectory that’s heading in a very dangerous direction”.[fn]Robert Malley and Ali Vaez, “The coronavirus is a diplomatic opportunity for the United States and Iran”, Foreign Policy, 17 March 2020.Hide Footnote

Similarly, the crisis may create openings for jihadist groups to launch new offensives against weakened governments in Africa and the Middle East. To date, neither ISIS nor any of al-Qaeda’s various branches has displayed a clear strategic vision relating to the pandemic (although ISIS has circulated health guidance to its militants on how to deal with the disease based on sayings by the Prophet Muhammad).[fn]“ISIS tells terrorists to steer clear of coronavirus-stricken Europe”, Politico, 15 March 2020.Hide Footnote Nonetheless, as Crisis Group has previously argued, jihadist forces tend to “exploit disorder”, gaining territory and adherents where conflicts already exist or weak states face social turmoil.[fn]Crisis Group Special Report N°1, Exploiting Disorder: Al-Qaeda and the Islamic State, 14 March 2016.Hide Footnote ISIS, for example, used the post-2011 chaos in Syria to gain a level of power that would otherwise have been impossible. It is possible that social and political disorder may create similar openings for jihadist actors as the crisis goes on. Conversely, those groups – such as al-Shabaab in Somalia – that control significant swathes of territory could, like governments, face a surge of public discontent if they cannot keep COVID-19 in check.[fn]Al-Shabaab’s performance in handling famines in 2011 and 2017 – both exacerbated by conflict and the group’s restrictions on aid – offers scant reassurance as to how it might handle the present pandemic. See Crisis Group Africa Briefing N°125, Instruments of Pain (III): Conflict and Famine in Somalia, 9 May 2017.Hide Footnote

V. A Turning Point in Major Power Relations?

The potential effects of COVID-19 on specific trouble spots is magnified by the fact that the global system was already in the midst of realignment.[fn]Malley, “10 Conflicts to Watch in 2020,” op. cit.Hide Footnote The current moment thus stands apart from other, still relatively recent, international crises. When the financial crash prompted a global economic downturn in 2008, the U.S. still held enough clout to shape the international response through the G20, although Washington was careful to involve Beijing in the process. In 2014, the U.S. took charge of a belated multilateral response to the West Africa Ebola crisis helped by countries ranging from the UK and France to China and Cuba.[fn]See Ted Piccone, “Ebola could bring U.S. and Cuba together”, The Brookings Institution, 31 October 2014.Hide Footnote Today, the U.S. – whose international influence already had considerably weakened – has simultaneously mishandled its domestic response to COVID-19, failed to bring other nations together and stirred up international resentment. President Donald Trump has not only harped on the disease’s Chinese origins but also criticised the EU for bungling its containment.

China, by contrast, after having to cope with the consequences of the initial outbreak, its early and costly decision to hold back information, and its own uneven response, and having sought at times to blame the U.S. by waging an irresponsible misinformation campaign, now sees in the health crisis an opportunity to gain influence over other states through humanitarian gestures.[fn]See Conor Finnegan, “False claims about origins of the coronavirus cause spat between the U.S., China”, ABC, 13 March 2020. Some Chinese diplomats appear uncomfortable with Beijing’s insinuations that COVID-19 came from the U.S. See “Spat between Chinese diplomats shows internal split over Trump”, Bloomberg, 23 March 2020.Hide Footnote China has kicked its diplomatic machine into high gear to position itself as leading the international response to potential widespread outbreaks of COVID-19 on the African continent.[fn]For example, see Laura Zhou, “Will China’s support for nations fighting Covid-19 improve its global image?”, South China Morning Post, 22 March 2020.Hide Footnote On 16 March, Chinese billionaire Jack Ma announced that his foundation would give 20,000 testing kits, 100,000 masks and a thousand units of protective gear to each of the continent’s 54 countries. He said it would channel the donations through Ethiopia, with Prime Minister Abiy Ahmed, the 2019 Nobel Peace Prize winner, coordinating distribution.[fn]“As virus spreads, Africa gets supplies from China’s Jack Ma”, Associated Press, 22 March 2020.Hide Footnote On 19 March, Beijing further bolstered its diplomacy on the subject, announcing plans to build an African Centre for Disease Prevention and Control research facility in Nairobi.[fn]“Kenya to host Sh8 billion Africa disease control centre”, The Standard, 19 March 2020.Hide Footnote Beijing has also rolled out offers of assistance to EU members, blunting European criticisms of its initial handling of the contagion in Wuhan.[fn]“China steps up support for European countries hardest hit by coronavirus”, South China Morning Post, 18 March 2020. On the effects of Chinese aid on European perceptions, see Steven Erlanger, “In this crisis, U.S. sheds its role as global leader”, The New York Times, 22 March 2020.Hide Footnote

Despite the WHO’s pleas for unity, the pandemic is taking on a divisive geopolitical hue

Overall, despite the WHO’s pleas for unity, the pandemic is taking on a divisive geopolitical hue. Some leaders have framed it very clearly in these terms. Serbian President Aleksandar Vučić, for example, declared that – lacking any real support from the EU – “all my personal hopes are focused on China and its president”.[fn]Julija Simic, “Serbia turns to China due to ‘lack of EU solidarity’ on coronavirus”, Euractiv, 18 March 2020.Hide Footnote While Riyadh, which currently presides over the G20, has called for a “virtual summit” of leaders (similar to one already held by the G7), the crisis could increase tensions among Washington, Beijing and other powers. EU experts have warned that Russia is spreading disinformation about COVID-19 in Western countries.[fn]“Russia deploying coronavirus disinformation to sow panic in West, EU document says”, Reuters, 18 March 2020.Hide Footnote Jockeying among the big powers to take advantage of the general disarray could not only complicate technical cooperation against COVID-19, but also make it harder for the powers to agree on how to handle the political disputes it creates or exacerbates.

More broadly, the coronavirus and how it will be dealt with is likely to have a profound influence on the shape of the multilateral order that will emerge in its aftermath. It is too early to assess those implications. For now, one can discern two competing narratives gaining currency – one in which the lesson is that countries ought to come together to better defeat COVID-19, and one in which the lesson is that countries need to stand apart in order to better protect themselves from it.[fn]Yuval Noah Harari calls this the choice between “nationalist isolation and global solidarity”. “The world after coronavirus”, Financial Times, 20 March 2020.Hide Footnote The crisis also represents a stark test of the competing claims of liberal and illiberal states to better manage extreme social distress. As the pandemic unfolds, it will test not only the operational capacities of organisations like the UN and WHO, but also basic assumptions about the values and political bargains that underpin them.

VI. Opportunities to Be Seized

While the warning signs associated with COVID-19 are significant, there are also glimmers of hope. The scale of the outbreak creates room for humanitarian gestures between rivals. The UAE has, for example, airlifted over 30 tonnes of humanitarian aid to Iran to deal with the disease (Bahrain, by contrast, took the opportunity to accuse the Islamic Republic of “biological aggression”).[fn]Nafisa Eltahir and Lisa Barrington, “Bahrain accuses Iran of ‘biological aggression’, Gulf states try to curb coronavirus”, Reuters, 12 March 2020.Hide Footnote States with closer relations with Iran, including Kuwait and Qatar, have also proffered assistance. President Trump wrote to North Korea’s leader, Kim Jong-un, expressing willingness to help Pyongyang confront the disease, prompting a message of gratitude in response.[fn]Choe Sang-Hun, “Trump writes to Kim Jong-un offering help in virus fight, North Korea says”, The New York Times, 21 March 2020.Hide Footnote Despite closing its border with Venezuela, the Colombian government has also had its first official contact with Caracas in over a year under the aegis of the teleconference mediated by the Pan American Health Organization to discuss a joint health care response in border areas. Anti-chavista politicians have also taken tentative steps to work with their rivals to address the crisis, as occurred in the border state of Táchira.

Two other examples: in the Caucasus, the U.S. sent its first aid to the secessionist Georgian region of Abkhazia in over a decade to help counter COVID-19 even though Abkhaz authorities are coordinating with Moscow rather than Tbilisi over the disease. In the Philippines, the normally hawkish President Rodrigo Duterte announced a one-month unilateral ceasefire with communist rebels, to allow government forces time to focus on the pandemic.[fn]“Duterte asks NPA for ceasefire during coronavirus lockdown”, Rappler.com, 17 March 2020.Hide Footnote

As the devastation spreads and economies shrink, pressures may grow on governments and opposition in polarised situations to find common ground.

These are only relatively small positive steps. But as the devastation spreads and economies shrink, pressures may grow on governments and opposition in polarised situations to find common ground if that is a condition for stability and receiving international assistance. Academic surveys show that warring parties frequently respond to natural disasters with agreements to reduce violence. A similar dynamic may apply in some conflicts in the face of COVID-19, although the scale of the crisis – and its emerging impact on international diplomacy – could make it hard for outside mediators and multilateral organisations to support peacemaking efforts as they could in more normal times.[fn]See Joakim Kreutz, “From Tremors to Talks: Do Natural Disasters Produce Ripe Moments for Resolving Separatist Conflicts?”, International Interactions, vol. 8, no. 4 (2012).Hide Footnote

Earlier this month, Crisis Group pressed the U.S. and Iran to seize this moment and reach a mutually beneficial understanding: Tehran would release all its dual national or foreign detainees (who face real risks from the disease in Iranian prisons) while Washington would loosen its sanctions (which are exacerbating the harrowing humanitarian situation Iran faces as a result of its own mismanagement of the COVID-19 crisis).[fn]Malley and Vaez, “The coronavirus is a diplomatic opportunity for the United States and Iran”, op. cit.Hide Footnote Since then, Tehran has made concessions on prisoners – swapping a French detainee for an Iranian held in France and allowing a British-Iranian prisoner to leave jail temporarily. While the U.S. has said it would send humanitarian assistance to Iran, the Islamic Republic’s leadership promptly rejected the offer as disingenuous, pointing to the fact that U.S. sanctions remain fully in place. Supreme Leader Ayatollah Ali Khamenei has cited conspiracy theories blaming the U.S. for the illness.[fn]Jon Gambrell, “Iran leader refuses U.S. help to fight COVID-19, citing conspiracy theory”, Associated Press, 22 March 2020.Hide Footnote

VII. Potential Crisis Mitigation Measures

Looking ahead, governments will have to decide whether to support more cooperative approaches to handling the crisis, not only in global public health terms but also as a political and security challenge. All leaders face pressure to focus on and spend money and political capital on domestic priorities, and in particular to ignore conflict risks in weak states that may seem hard to resolve or simply not important enough to worry about. But there will be a day after, and if the coming period is not dealt with wisely, it could be marked by major disruptions in already conflict-ridden areas, the eruption of new violence and a far more fragile multilateral system. In addition to following the negative and positive trends noted above, Crisis Group will also be watching to see if states and multilateral institutions take preventive and mitigating measures to limit the pandemic’s impact on peace and security.

In that spirit, and to mitigate the possibility that COVID-19 brings about a new generation of security crises, governments aiming to limit the pandemic’s impact could consider the following steps:

  • Follow needs assessments from the UN, the International Committee of the Red Cross and other relevant agencies, and inject essential COVID-19-related funding into humanitarian support, especially for refugees and IDPs, factoring in the disproportionate risks for displaced women;
     
  • Work with the UN, International Monetary Fund and World Bank – which have already started to mobilise funds to address health system failures and economic jolts resulting from COVID-19 – to assess the social and political shocks potentially arising from the pandemic to governments in weak states, and offer financial aid and debt relief;
     
  • Offer sanctions relief to states affected by COVID-19 and that are under sanctions, through multilateral frameworks such as the EU or UN, or through the suspension of unilateral sanctions, as appropriate if only temporarily, on humanitarian grounds, and remove any obstacles to the delivery of humanitarian goods;
     
  • Try to keep peace processes and conflict prevention efforts alive by working with UN envoys and other mediators to, for example, maintain secure electronic communications with conflict parties;
     
  • Where authorities delay elections or other polls for legitimate COVID-19 related reasons, offer outside support – such as declarations of extra-electoral assistance once the disease subsides, or quiet diplomacy between the parties – to reassure citizens that they will eventually get to vote;
     
  • Where possible, establish or strengthen diplomatic back channels among states and non-state actors most affected by the crisis to communicate over potential escalatory risks in tense regions;
     
  • Invest in efforts led by the WHO, independent media, non-governmental organisations and civil society to share impartial news about COVID-19 in weak states to counter rumour and political manipulation of the crisis as well as to keep a spotlight on conflicts that require international help.
     

The COVID-19 pandemic threatens to be long and draining. It will make diplomacy, and especially crisis diplomacy, harder. But it is crucial to keep channels of communication – and a spirit of cooperation – intact in a period when the international system seems as ready as ever to fragment.

New York/Brussels, 24 March 2020

People wearing face masks pick up their food at a community quarantine centre while officers look on inside a military camp in Yangon on April 9, 2020. AFP/Sai Aung Main
Briefing 161 / Asia

Conflict, Health Cooperation and COVID-19 in Myanmar

Conflicts have paused in much of Myanmar, opening a window for the government, military and ethnic armed groups to pursue a holistic response to the coronavirus. The parties should also work together in Rakhine State, where fighting persists, to limit the disease’s spread.

What’s new? Amid a lull in fighting in much of the country, the Myanmar government and ethnic armed groups appear willing to put aside politics and work together to prevent the spread of COVID-19. The exception is Rakhine State, where conflict is escalating, putting medical workers at risk and exacerbating a potential health disaster.

Why does it matter?  Conflict-affected areas of the country are highly vulnerable to COVID-19 but often outside state control. A successful response to the pandemic will require close coordination among the government, the military and ethnic armed groups, many of which have long run their own health systems.

What should be done? The government, military and ethnic armed groups should work together to combat the virus through prevention, surveillance, testing and referrals. In Rakhine, they should ensure the safety of health workers, enable access to displaced populations and strengthen COVID-19 prevention messaging.

I. Overview

A major COVID-19 outbreak could have devastating consequences in a country as conflict-affected as Myanmar, where health spending is limited, governance is weak, hundreds of thousands of people are displaced by fighting, and the government cannot reach many areas held by ethnic armed groups. Reducing transmission as much as possible so that the health system can better cope will require cooperation with these groups, many of which run their own health systems. Promising discussions that have already begun between the government and various ethnic armed groups should continue in earnest to enable a holistic response in areas of the country where conflict is presently limited. The exception is Rakhine State, where fighting continues to escalate between the Myanmar military and Arakan Army, undermining prevention efforts and putting the lives of health workers at risk. Here, all sides should ensure the safety of medical personnel, allow humanitarian access to displaced and other vulnerable populations, and work to improve public adherence to mitigation measures.

Low testing capacity and the geographic distribution of cases mean that COVID-19 is likely to be far more prevalent than reported.

Myanmar was one of the last countries in the world to confirm a case of COVID-19, announcing its first two positive tests on 23 March. So far, the spread of the virus appears to be limited, with fewer than 200 cases and just six deaths recorded, but low testing capacity and the geographic distribution of cases mean that the disease is likely to be far more prevalent than reported. Even a modest outbreak would put considerable strain on resources, particularly hospital beds for severe and critical cases. A holistic response that includes cooperation with ethnic armed groups will be essential for containing the pandemic and avoiding a potentially catastrophic human toll.

Although Myanmar’s military eventually announced a national ceasefire to support the response to COVID-19 in early May, it has excluded areas of Rakhine and southern Chin States where it remains engaged in fierce fighting with the Arakan Army. The Arakan Army, through its alliance with two other ethnic armed groups, has also announced a unilateral ceasefire, but the war shows no sign of abating. Hundreds of combatants and civilians have been killed since the start of the year, and the government’s recent designation of the Arakan Army as a terrorist group has further diminished any prospect of de-escalation. The death of a World Health Organization (WHO) driver, whose vehicle was attacked on 20 April as it took novel coronavirus swabs to Yangon for testing, underscores the risks this conflict poses to health workers and to efforts to combat the virus. With no chance of a ceasefire in the near term, the government, the military and the Arakan Army should instead aim to reach an agreement that guarantees safe access for medical personnel and humanitarian workers.

Elsewhere, cooperation between the government and ethnic armed groups remains very much possible. The pandemic has surfaced in Myanmar at a time when the rest of the country is experiencing a lull in armed conflict. Although the peace process is largely stalled and the most powerful armed groups continue to resist signing the Nationwide Ceasefire Agreement (NCA), there have been few clashes reported in recent months in Kachin, Kayin and Shan States. Combined with this relative calm, the urgent need to respond to COVID-19 has created an opening for discussions. The government has already taken a number of positive steps, including forming a committee to coordinate with ethnic armed groups and developing a response plan that formally recognises the role of ethnic health providers. Tentative talks are now under way on how to take coronavirus cooperation forward.

The government and ethnic armed groups need to find a way to work together.

Keeping discussions focused on technical aspects of health coordination, and avoiding linking the response to the peace process, will ensure the best opportunities for progress. It is of course possible that cooperation on COVID-19 could have benefits beyond the immediate response, including for the peace process. If the government, ethnic armed groups and ethnic health providers are able to work together to respond to the pandemic, this effort should, at a minimum, help build some trust. The most likely positive consequence is that it will prompt future coordination on health-related matters, something for which the NCA already provides but has not yet been pursued by either side. Generating dividends for the peace process should not be the primary objective, however, because it will politicise and thus complicate – even likely derail – collective efforts to respond to the virus. It is important that the focus remains on the pressing need to protect people across the country from contagion, whether they live in government-controlled areas or under an ethnic armed group’s administration.

The government and ethnic armed groups need to find a way to work together, putting aside to the extent possible the political issues surrounding the peace process. The support of the Tatmadaw, as the Myanmar military is known, will be vital. Donors also have an important role to play in providing financing and technical support to facilitate this cooperation.

II. A Late and Limited National Ceasefire

For months prior to the emergence of COVID-19, active conflict in Myanmar had been mostly limited to Rakhine State and neighbouring southern Chin State.[fn]For Crisis Group reporting on Myanmar’s peace process since the 2015 elections, see Asia Report N°287, Building Critical Mass for Peace in Myanmar, 29 June 2017; and Asia Briefings N°s 158, Myanmar: A Violent Push to Shake Up Ceasefire Negotiations, 24 September 2019; 157, Peace and Electoral Democracy in Myanmar, 6 August 2019; 154, A New Dimension of Violence in Myanmar’s Rakhine State, 24 January 2019; 151, Myanmar’s Stalled Transition, 28 August 2018; and 149, Myanmar’s Peace Process: Getting to a Political Dialogue, 19 October 2016.Hide Footnote There, the Myanmar military has been locked in an intense struggle with the Arakan Army since late 2018 that shows no sign of de-escalating.[fn]See Crisis Group Briefing, A New Dimension of Violence in Myanmar’s Rakhine State, op. cit.Hide Footnote The fighting has cost hundreds, possibly thousands, of lives and forced at least 60,000 people into camps for internally displaced persons. According to civil society groups, up to 100,000 more are staying in monasteries, with relatives or in other communities, but they are not officially counted because they are not in recognised camps.[fn]The Myanmar military does not release figures for the number of soldiers killed, but the severity of the fighting means that the death toll on both sides has been substantial. For numbers of internally displaced persons, see “Fresh fighting adds 1,000 to displaced population in Myanmar’s Rakhine”, Radio Free Asia, 25 March 2020.Hide Footnote Since 2020 began, the number of civilian casualties has risen significantly as the Tatmadaw has resorted increasingly to air and artillery attacks, prompting some to accuse it of war crimes and crimes against humanity.[fn]“Myanmar military may be committing new war crimes, says UN envoy”, Reuters, 30 April 2020.Hide Footnote

The Myanmar military has been locked in an intense struggle with the Arakan Army since late 2018 that shows no sign of de-escalating.

Elsewhere in the country, however, fighting has been limited for some time, particularly over the past six months. The ten ethnic armed groups that have signed the NCA have clashed only very occasionally with the military, despite the fact that political negotiations have been stalled for several years.[fn]For further details, see Crisis Group Asia Briefing, Rebooting Myanmar’s Stalled Peace Process, forthcoming.Hide Footnote Around ten other groups have only bilateral ceasefires with the government, or no agreement at all. Although some technically remain in conflict with Myanmar’s military, its attention is focused almost entirely on Rakhine, leaving these conflicts to a slow simmer. An August 2019 joint attack by the Brotherhood Alliance – comprising the Arakan Army, Ta’ang National Liberation Army and Myanmar National Democratic Alliance Army – on police and military posts in northern Shan State was the last major flare-up outside of Rakhine.[fn]See Crisis Group Briefing, Myanmar: A Violent Push to Shake Up Ceasefire Negotiations, op. cit.Hide Footnote

Pressure on all parties to announce a national ceasefire began to build from late March. On 23 March, the day Myanmar confirmed its first COVID-19 cases, UN Secretary-General António Guterres issued an appeal for a global ceasefire to “focus together on the true fight of our lives”.[fn]“Myanmar confirms first two coronavirus cases”, Agence France-Presse, 24 March 2020. For further discussion of Guterres’s appeal, see Crisis Group Commentary, “Global Ceasefire Call Deserves UN Security Council’s Full Support”, 9 April 2020.Hide Footnote With conflict raging in Rakhine State and the peace process stalled, his statement – with its vision of “corridors for life-saving aid” and “precious windows for diplomacy” – seemed almost tailor-made for Myanmar.[fn]For the full text, see the UN Secretary-General’s official website.Hide Footnote

Several ethnic armed groups joined the appeal. On 26 March, the Karen National Union called on the Tatmadaw to announce an unconditional nationwide ceasefire to enable all sides to work together to fight the pandemic; the Chin National Front and Karenni National Progressive Party issued similar statements.[fn]“Chin National Front joins call for truce”, Myanmar Times, 6 April 2020. The Karen National Union statement is posted on its official website.Hide Footnote The Brotherhood Alliance also endorsed Guterres’s call and extended its unilateral ceasefire to the end of April, although this measure did little to stop conflict in Rakhine State.[fn]“Emergency press release of the Three Brotherhood Alliance in the time of the spread of COVID-19”, 1 April 2020.Hide Footnote On 1 April, eighteen foreign ambassadors to Myanmar called on all parties to cease hostilities and ensure humanitarian access to conflict-affected areas, expressing concern at the growing toll in Rakhine and Chin States.[fn]For the ambassadors’ statement, see the official website of the U.S. embassy in Burma.Hide Footnote The following day, a Myanmar military spokesperson rejected the suggestion as “unrealistic”.[fn]“Tatmadaw rejects call for ceasefire during pandemic”, Myanmar Times, 2 April 2020.Hide Footnote

On 9 May, however, the Myanmar military announced a national ceasefire until 31 August so that COVID-19 containment, prevention and treatment activities could be carried out “effectively and rapidly”.[fn]“Tatmadaw releases statement on ceasefire and peace”, Global New Light of Myanmar, 10 May 2020.Hide Footnote The ceasefire applies to “all areas except where terrorist groups declared by the government take positions” – a caveat that refers exclusively to the Arakan Army, which the government had on 23 March formally designated as a terrorist organisation and an unlawful association.[fn]“Myanmar govt declares Arakan Army a terrorist group”, The Irrawaddy, 24 March 2020.Hide Footnote Considering that fighting elsewhere is presently limited, the fact that the ceasefire de facto excludes Rakhine state makes it more of a political gesture than a meaningful attempt to halt conflict.

The nature of the conflict in Rakhine State makes a truly national ceasefire extremely unlikely.

The ceasefire announcement did not represent a sudden about-face by the military. It came amid growing cooperation with the National League for Democracy government on the COVID-19 response, including using military facilities to test swabs from civilians and sending military medical staff to work at a new government health facility.[fn]The government’s decision to create a second national-level response committee, the Coronavirus Disease 2019 Containment and Emergency Response Committee, on 30 March and appoint a former general to lead it has been important for building this cooperation. See, for example, “Myanmar military to lend state-of-the-art machines for public COVID-19 testing”, The Irrawaddy, 27 April 2020; and “Inside Phaunggyi, Myanmar’s ambitious response to COVID-19”, Frontier Myanmar, 23 April 2020.Hide Footnote A looming closed-door UN Security Council meeting to discuss escalating violence in Rakhine and the effect of the pandemic likely also played a role.[fn]“UN Security Council to discuss violence, coronavirus in Myanmar”, Agence France-Presse, 12 May 2020.Hide Footnote

The nature of the conflict in Rakhine State makes a truly national ceasefire extremely unlikely. Despite sustaining heavy casualties, the Myanmar military refuses to countenance the prospect of a ceasefire that would recognise the Arakan Army’s presence in the state, instead insisting that it withdraw to its base in northern Kachin State. For its part, the Arakan Army shows no sign of being worn down despite almost eighteen months of heavy fighting. Its supply lines remain intact and it continues to enjoy strong support among the Rakhine population. As government control weakens over large areas of central and northern Rakhine State, the Arakan Army is increasingly trying to fill the vacuum and take over basic administrative functions.[fn]For a full discussion of the conflict, see Crisis Group Asia Report, An Avoidable War: Politics and Armed Conflict in Myanmar’s Rakhine State, forthcoming.Hide Footnote Its designation as a terrorist group has further reduced the chances for dialogue.

The conflict in Rakhine State has potentially severe consequences for the COVID-19 response, as the WHO driver’s death on 20 April tragically underscored.[fn]“Driver killed in WHO vehicle carrying virus swabs in Myanmar’s Rakhine”, Reuters, 21 April 2020.Hide Footnote The fighting has inhibited the ability of health workers and civil society groups to undertake prevention, surveillance and testing, due to safety concerns and, in some cases, government restrictions on access. Apart from communities recently displaced by the conflict, some 130,000 people, nearly all Rohingya, have been living in squalid camps, with extremely limited access to sanitation and medical care, since communal violence erupted in 2012.[fn]“Myanmar: IDP sites* in Rakhine State (As of 31 December 2019)”, UN Office for the Coordination of Humanitarian Affairs, 12 February 2020.Hide Footnote A mobile internet blackout introduced in June 2019 to curtail the Arakan Army’s operational and intelligence capabilities has deprived more than one million people of access to potentially vital information about COVID-19.[fn]“UN experts concerned at surge in civilian casualties in northwest Myanmar after internet shutdown”, UN Office of the High Commissioner of Human Rights, 18 February 2020.Hide Footnote The state’s weak health system is already stretched and has little capacity to take on the pandemic response. Finally, lack of trust in the government appears to be undermining COVID-19 prevention efforts, with reports of people disregarding social distancing rules.[fn]For further discussion of these issues, see “After WHO driver’s death, fear and foreboding haunt Rakhine’s COVID-19 response”, Frontier Myanmar, 27 April 2020; and “In Myanmar’s Rakhine State, conflict and internet blackout mar COVID-19 response”, Devex International Development, 6 April 2020.Hide Footnote

The priority for all sides should be on de-escalating the conflict to allow for more effective action against the virus.

In Rakhine State, neither a ceasefire nor cooperation with the Arakan Army on the COVID-19 response appears feasible. Instead, the priority for all sides should be on de-escalating the conflict to allow for more effective action against the virus. De-escalation could take the form of an agreement among the government, military and Arakan Army to ensure the safety of health workers in order to ramp up prevention activities. The government should review the restrictions on humanitarian access to strengthen the public health response – particularly in IDP camps – and lift the mobile internet ban to enable the people of Rakhine and Chin States to find information on the pandemic.

III. Ethnic Health Systems: Putting Aside Politics

Often described as the world’s longest civil war, Myanmar’s seven decades of conflict have left the country divided between areas under central government control and territory administered by ethnic armed groups.[fn]See “Ethnic Armed Conflict and Territorial Administration in Myanmar”, The Asia Foundation, July 2015. For a history of Myanmar’s ethnic conflicts, see Martin Smith, Burma: Insurgency and the Politics of Ethnicity, 2nd edition (London, 1999).Hide Footnote Despite efforts since 2011 to reach a Nationwide Ceasefire Agreement with the country’s twenty main ethnic armed groups, and launch negotiations over a power-sharing agreement that would end the fighting permanently, armed groups continue to control large swathes of territory, particularly along the borders with China and Thailand. In most cases territory is not officially or even clearly demarcated, and administrative structures often overlap. People are usually able to move between state-controlled areas and those under the control of ethnic armed groups with relative ease.

Administrative capacity varies significantly among ethnic armed groups. Some have almost no territory or soldiers, but the more established among them, such as the Karen National Union, United Wa State Army and Kachin Independence Organisation, have well-developed governance structures that include health departments, known as ethnic health organisations.[fn]Most observers distinguish between the ethnic health organisations, which are the health departments of the ethnic armed groups, and the ethnic and community-based health organisations with which they work closely. Unless a distinction is necessary, this report refers to both sets of organisations collectively as “ethnic health providers”.Hide Footnote Working together with ethnic and community-based health organisations, they focus mostly on primary care at the community level and tend to refer more complex cases elsewhere. In the past, ethnic health providers sent patients only to Thailand or China, but over the past five years or so some have started informally referring them to public or private hospitals in Myanmar.[fn]Crisis Group interview, expert on ethnic health systems, May 2020. For more information on the ethnic health system in south-eastern Myanmar, see “Achieving Health Equity in Contested Areas of Southeast Myanmar”, The Asia Foundation, June 2016.Hide Footnote Some ethnic health officials have also begun developing links with government counterparts at the township and state level. There is very little institutional cooperation with the government health system, however, including on referrals, even in areas without recent fighting.[fn]Rare examples of cooperation include the response to a 2019 polio outbreak in Hpapun in Kayin State. Crisis Group interview, expert on ethnic health systems, May 2020. See also “Circulating Vaccine-derived Poliovirus Type 1 – Myanmar”, World Health Organization, 22 August 2019.Hide Footnote A long legacy of distrust means that there is little formal sharing of information or resources.[fn]Crisis Group interviews, development expert, April 2020; ethnic armed group leader, May 2020.Hide Footnote

Authorities have sought to avoid a lockdown-style response because of the grave socio-economic implications.

In a country where the national health system is already weak, this legacy of mixed control further complicates Myanmar’s ability to prepare for and respond to COVID-19. An effective response requires a holistic approach that covers areas under both government and non-government control. Such an approach is crucial given that ethnic armed groups control areas adjacent to international borders, which typically have high levels of outward economic migration. The economic impact of coronavirus in neighbouring countries has thrown many Myanmar migrant workers out of work. Tens of thousands have returned home, including to (or through) territory controlled by ethnic armed groups, and many more are soon expected to follow when Thailand relaxes cross-border movement restrictions.[fn]Tens of thousands had been expected to return from 1 May, but most remain in Thailand after the Thai government extended movement restrictions between provinces. See “Myanmar migrant workers await Thai green light to return home”, The Irrawaddy, 5 May 2020, and “Alarm as thousands of returning workers ignore quarantine orders”, Frontier Myanmar, 27 March 2020.Hide Footnote

Despite COVID-19 emerging in neighbouring China, the Myanmar government – like many others around the world – was initially slow to recognise the threat and put in place mechanisms to respond. Once the WHO declared a global pandemic on 11 March, the government formed a high-level committee, headed by Aung San Suu Kyi. It has since implemented strict mitigation measures, including the shutting of airports, cancellation of the annual Thingyan holiday in April and night-time curfews. But authorities have sought to avoid a lockdown-style response because of the grave socio-economic implications, which some have warned could result in more deaths than the disease itself.[fn]“Coronavirus policy response needs and options for Myanmar”, International Growth Centre, April 2020.Hide Footnote With the WHO’s support, the government finalised a response plan on 21 April that recommends continuation of social distancing measures, an expansion of testing and an upgrade for hospital facilities, particularly intensive care unit beds.[fn]“Health Sector Contingency Plan: Outbreak Response on COVID-19 and Other Emerging Respiratory Diseases”, Republic of the Union of Myanmar Ministry of Health and Sports, April 2020.Hide Footnote On 27 April, it also released an economic relief plan that officials say will cost $2.2 billion.[fn]“Govt expects COVID-19 response plan to cost $2 billion”, Myanmar Times, 11 May 2020.Hide Footnote

Ethnic armed groups have also taken a range of steps to protect populations under their control from COVID-19 and prevent the spread of the virus. First, they have closed many illegal crossings, for both people and goods, along the borders with Thailand and China.[fn]Crisis Group interviews, political analyst, April 2020; and ethnic armed group leader, May 2020. “New Mon State party agrees to close Thai-Myanmar border crossings to curb COVID-19”, The Irrawaddy, 27 April 2020.Hide Footnote Secondly, most groups have conducted awareness campaigns, and some have enforced quarantine measures and introduced travel restrictions. Thirdly, they have set up checkpoints at which they check travellers’ temperatures and provide them with health information.[fn]Crisis Group interview, ethnic armed group leader, May 2020. See also “From north to south, ethnic armies confront an unseen enemy”, Frontier Myanmar, 15 April 2020.Hide Footnote When the Kachin Independence Organisation found one suspected COVID-19 case in April, it isolated the patient and sent a swab for testing to a laboratory in China’s Yunnan province (the result was negative).[fn]Ibid.Hide Footnote Overall, these measures have likely helped protect the country, at least to some degree, but the capacity of ethnic armed groups to respond to COVID-19 remains limited.

The deadlock in the peace process since 2017 has undermined prospects for a closer working relationship with ethnic health providers.

A response to the pandemic covering the entire country will require an unprecedented level of coordination between the government and ethnic armed groups, as well as the Myanmar military’s support. So far, coordination has been limited to returning workers, with almost no cooperation on the broader health response. Despite the government’s National Health Plan formally recognising the role of ethnic health providers for the first time in late 2016, describing them as a “key stakeholder”, and the interim arrangements in the NCA creating a potential framework for cooperation on health, the deadlock in the peace process since 2017 has undermined prospects for a closer working relationship.[fn]“Myanmar National Health Plan 2017-2021”, Republic of the Union of Myanmar Ministry of Health and Sports, December 2016. The NCA specifies in its interim arrangements that signatories will coordinate on programs and projects related to “health, education and socio-economic development”.Hide Footnote Although there is some degree of informal interaction at the local level, health officials on both sides are reluctant to work together openly, partly out of fear that they could move faster than peace negotiators. As an expert on the ethnic health system said:

Some government officials at the state and township level are nervous about working with ethnic health providers because they don’t know whether the central government will approve. If they step out of line, they might lose their promotion. That’s actually one of the biggest obstacles in the day-to-day cooperation.[fn]Crisis Group interview, expert on ethnic health system, April 2020.Hide Footnote

Ethnic health providers also feel that some government officials do not sufficiently respect their expertise or contribution to ethnic communities, feeding concerns in the sector that working together will result in being subordinated under a highly centralised state system.[fn]Crisis Group interviews, expert on ethnic health systems, April 2020; ethnic armed group leader, May 2020.Hide Footnote Adding to tensions, the National League for Democracy government has restricted donors from directly supporting ethnic health providers linked to ethnic armed groups. Donors are still able to provide support indirectly – such as through international NGOs – and may otherwise be reluctant to support unregistered organisations linked to ethnic armed groups, or have concerns about their capacity to manage grants. Nevertheless, these restrictions have undermined prospects for cooperation between ethnic armed groups and the government on health.[fn]Crisis Group interviews, peace process analyst and ethnic health system expert, May 2020.Hide Footnote

Whatever the concerns and past grudges may be, if ever the situation demanded that the government and ethnic armed groups put aside politics and work together, it is now. There is an urgent need to share information and coordinate in a range of activities, including prevention messaging, surveillance and referral pathways. Myanmar is in the process of significantly scaling up COVID-19 testing, but unless some formal cooperation is in place, areas under ethnic armed group control will inevitably be overlooked.

There remain enormous obstacles to information sharing or coordination with the Arakan Army.

Promisingly, both sides have begun positioning themselves to enable such cooperation. Ethnic armed groups have been discussing a coordinated COVID-19 response among themselves and have raised the issue of cooperation during informal talks with government negotiators.[fn]Crisis Group interviews, government peace negotiator, ethnic armed group leader and development experts, April and May 2020.Hide Footnote On 27 April, the President’s Office formed a committee led by chief peace negotiator Tin Myo Win to coordinate with armed groups, including sharing information on the return of migrant workers, suspected cases, treatment protocols and contact tracing.[fn]“Myanmar sets up COVID-19 committee with rebel armies”, The Irrawaddy, 28 April 2020.Hide Footnote This step has sent an important signal and potentially opened the door for a more comprehensive framework for technical cooperation that will free local officials of some of the current political constraints. Significantly, the government appears willing to work with both NCA signatories and non-signatories, although there remain enormous obstacles to information sharing or coordination with the Arakan Army.[fn]Crisis Group interview, government peace negotiator, Yangon, May 2020.Hide Footnote

Operationally, too, the government’s position appears to have evolved significantly since March. Early versions of the Ministry of Health and Sports’ COVID-19 response plan essentially ignored ethnic health providers, but the final version issued on 21 April stressed the importance of a “unified response” and “inclusive mechanisms and processes that encourage coordination” with these organisations. As a result, ethnic health providers have been included on proposed state and region level coordination bodies. The plan also proposed that government staff provide support in building their capacity and working with them to deploy rapid response teams and mobile clinics to treat vulnerable populations in conflict-affected areas.[fn]“Health Sector Contingency Plan: Outbreak Response on COVID-19 and Other Emerging Respiratory Diseases”, Republic of the Union of Myanmar Ministry of Health and Sports, April 2020. All versions are on file with Crisis Group.Hide Footnote

These are welcome steps, but it is not yet clear where they will lead. The committee held several meetings with ethnic armed groups since 8 May but no concrete agreement has emerged. Few if any of the coordination mechanisms or conflict area-focused activities in the government’s response plan have been activated or undertaken. Cooperation at lower levels will likely depend on an agreement between government and ethnic armed group leaders, but neither side has quite shown the urgency that the situation dictates, and the political hurdles to working together remain significant on both sides. For ethnic armed groups in particular, the process will also inevitably raise deeper questions about what role ethnic health providers will play in any future federal system. These questions should be put aside for the time being in order to combat COVID-19.

All sides need to speed up the pace of engagement and focus on addressing the most critical issues. These include activating the coordination mechanisms in the government’s response plan, and reaching agreements on information sharing, referral pathways, the provision of equipment (such as personal protective equipment) to ethnic health providers, training for ethnic health staff and a system for conducting tests in ethnic armed group areas.

Fighting a common enemy could help break down barriers at the local level between health officials who have previously been reluctant to work together.

For cooperation to proceed, government officials will need to be sensitive to the aspirations of ethnic health providers, who will expect to be treated as genuine partners, not merely community-based implementers. This will require a significant break with the past. The fact that the Ministry of Health and Sports specified a role for ethnic health providers in its COVID-19 response plan without seriously consulting them during the drafting process underscores the current imbalanced nature of the relationship.[fn]Ibid.Hide Footnote One initiative that could help build trust would be for the government to provide support for an ethnic health organisation facility to conduct rapid tests that would be sent to government labs, and for that organisation to treat infected patients and refer them to government facilities through a formal pathway as necessary.

Although the declaration of a national ceasefire is a positive step, there remains a risk that the Myanmar military could undermine progress if it deems some aspects of the required cooperation a threat to its interests. It has already warned the Karen National Union and Restoration Council of Shan State to cease COVID-19 prevention activities in some areas, claiming that they are encroaching on government-controlled territory. The Karen National Union has also accused the military of destroying several of its screening points.[fn]“Myanmar military increases coronavirus risk and threatens peace in ethnic minority communities”, New Mandala, 30 April 2020.Hide Footnote Highlighting the initial disconnect between the government and military, the Karen National Union also received contradictory letters from the Kayin State government on the same day: one from the military-appointed security minister demanding that it remove some health checkpoints, and the other from the chief minister praising its prevention activities.[fn]Crisis Group interviews, development expert, April 2020; ethnic armed group leader, May 2020.Hide Footnote Now that the military has come on board with the ceasefire announcement, it should not only scrupulously respect it but also support government efforts to work with ethnic armed groups as much as possible.

Although the focus should remain on tackling the immediate threat of COVID-19, cooperation in the coming months could bring about significant benefits to the country’s health capacities on the longer term. Fighting a common enemy could help break down barriers at the local level between health officials who have previously been reluctant to work together or even acknowledge each other’s capabilities. Given that the scale and nature of the health response required for this virus differs significantly from earlier cooperation on polio and malaria, a joint response could build valuable personal relationships and set important precedents for the years ahead, once the pressing danger has passed. “There’s an opportunity to test out working together from the bottom up”, noted one source in the development sector.[fn]Crisis Group interview, April 2020.Hide Footnote

If cooperation materialises, donors will have an important role to play.

If such cooperation materialises, donors will have an important role to play, particularly given ethnic health providers’ limited resources. Even a modest level of cooperation on COVID-19 – on referrals, for example – will require some degree of financial support. Due to the political sensitivity of government staff visiting areas under ethnic armed groups’ control, international expertise will also be needed to assess the capacity of ethnic health providers and to identify gaps that can be addressed in their response. Donors should refrain, however, from linking coronavirus cooperation to the peace process, as politicising it will make negotiations only more difficult.

Government policy remains both a practical and political obstacle to the development of a positive working relationship. Ethnic health providers feel that the government’s insistence that it approve grants to ethnic health providers runs counter to the NCA’s interim arrangements, which emphasise coordination rather than control. Although some development actors will view the government’s recent steps as a green light to scale up cooperation with ethnic health providers, there is also a risk that donors will remain wary of supporting them directly for fear of jeopardising relations with the government.[fn]Ibid.Hide Footnote To avoid this problem, the government’s new coordination committee should relax restrictions on provision of aid directly to ethnic health providers.

IV. Conclusion

Although it has yet to experience a major COVID-19 outbreak, Myanmar remains highly vulnerable to the pandemic. It is crucial that the country’s health response include coordination with the twenty ethnic armed groups that control territory, especially as most of them operate close to the country’s borders with China and Thailand. A truly national ceasefire is unlikely, unfortunately, due to the conflict in Rakhine State, but in other parts of the country the barrier to cooperation in the health sector has less to do with conflict than with lack of political will and trust.

To date, efforts on such cooperation between the Ministry of Health and Sports and armed groups’ health systems have been limited, but COVID-19 presents a concrete opportunity to work together more closely. Joint action against the virus could help overcome some of the mistrust and other obstacles that have hindered cooperation in the past. While it is encouraging that both the government and ethnic armed groups have started to position themselves to enable such cooperation, given the nature of the threat all sides now need to pursue these discussions with a greater sense of urgency. Donors have an important role to play in facilitating and supporting these initiatives, and should dispense with some of the caution they have previously shown to supporting ethnic health providers.

All sides should pursue talks toward an agreement that would enable more effective action against contagion.

Such cooperation will not be possible in Rakhine State, where fighting continues to escalate between the Myanmar military and Arakan Army. The implications for the COVID-19 response could be grave. In many areas of the state, health workers and civil society groups are unable to work safely, as the WHO driver’s tragic death in April clearly demonstrates. The mobile internet blackout has curtailed access to potentially life-saving information about the virus for over one million people, while humanitarian groups face difficulties getting access to vulnerable populations. The Arakan Army’s recent designation as a terrorist organisation means that a ceasefire is almost certainly off the table, but all sides should pursue talks toward an agreement that would enable more effective action against contagion. The government could facilitate containment by lifting its restrictions on mobile internet use and ensuring humanitarian access to affected populations.

Yangon/Brussels, 19 May 2020