On the first of February this year, Myanmar’s slow creep towards democracy came to a halt. The brittle scaffold of Daw Aung San Suu Kyi’s government was brushed aside. Refusing to accept her landslide victory in November elections, the military crushed Myanmar’s democracy. After ten precarious years of civilian government the country is again under direct military rule. Ms Aung San Suu Kyi has disappeared, facing mysterious charges in a secret court. Political darkness descends again.

Political morality suggests that where governments are illegitimate, duties to obey laws weaken. Presented with returning tyranny, many in Myanmar have chosen the route of peaceful civil disobedience. Health professionals are among them. Doctors, nurses, medical students, and pharmacists have taken to the streets in protest at the toppling of the civilian government. Strikes and boycotts have been widespread. In February, up to 1000 doctors from 70 hospitals across the country went on strike.

Some reports suggest the initial military response was restrained. No longer. As the protests have deepened, so military tactics have hardened. Amnesty International’s reports on the intensifying savagery of the response are sobering. Military units are increasingly using battlefield weapons against peaceful protesters. According to Amnesty’s Crisis Evidence Lab, the security forces are engaged in the planned and systematic use of lethal force, with many of the killings amounting to extrajudicial execution. Military units notorious for their assaults on ethnic groups in Myanmar—including against the Rohingya—have been deployed in cities across the country. As of 23 March, the military put the number killed in protests at 164. Local activists say it is at least 261. Many have been killed by a single shot to the head. Save the Children reports that more than 20 children are among the dead.

Highly visible during their white-coated protests, health professionals have been targeted by security forces. They have been beaten, arrested without charge, and summarily dismissed from their jobs. They have also been targeted for providing emergency healthcare to injured demonstrators. According to the World Medical Association “private clinics, medical personnel carrying out emergency treatment and ambulances have been shot at without any reason.” They have also received reports of doctors being arrested or fleeing their homes to hide from the military.

A descent into dictatorship profoundly affects every citizen. It turns consensual politics into rule by force. Every member of the polity is thereby lessened. But as we have seen time and again, doctors and other professionals can become bellwethers. Partly it is to do with their status: they are indelibly part of a country’s educated elite: their opinions matter; their testimony has authority. As we have seen in Turkey, where political power wishes to crush dissent and emaciate civil society, doctors are seldom far from the firing line. But it is also to do with their professional roles and their binding obligations to treat those in need. Where political conflict turns violent, you will always find health professionals treating the injured.

With the suspension of democracy, and the recourse to lethal violence in the streets, engaged doctors have been subject to dual pressures: a citizen’s duty to protest, but also a physician’s duty to treat. In both dimensions they are protected by strong international norms. The right to peaceful protests is protected by rights of assembly and association set out in major international treaties, including the Universal Declaration of Human Rights—rights ratified by all modern and democratic societies. 

Medical obligations to treat the sick, including those injured during protest, are protected by principles of medical neutrality. These draw together powerful injunctions to protect medical personnel and facilities, to ensure the humane treatment of civilians and provide treatment to the sick and injured solely on the basis of need.

Some of those who stand to lose the most from the coup d’état are those who have already lost so much. Aung San Suu Kyi’s fall from power was preceded by her fall from grace over her government’s shameful complicity in the genocide of the Rohingya people since 2016. However, her fall from power can at best be described as “bittersweet” for the Rohingya, who have real fears about a return to military rule. The Buddhist military are no friends to the Muslim Rohingya minority, having been responsible for the systematic brutality against them, and with all the tools of government back under military control, there are no obstacles to their continuing campaign of terror. The BMA is covering this issue extensively in its forthcoming health and human rights report. International observers, as well as history, suggest that this latest military coup will bode ill for the Rohingyas.

International solidarity may seem fragile in the face of brute military force. But the military will at some point again seek to legitimise the institutions of government in Myanmar. They will seek, howsoever tentatively, the authority that comes from the consent of the governed. Which is why international opinion matters—and will matter again. And this is surely why medical organisations across the globe must unite in condemning the shattering of civilian rule, further ethnic violence, the targeting of peaceful protesters and any assault on doctors’ obligations to provide care and treatment to the sick and injured. In the global order, reputation still matters.

John Chisholm, Chair BMA ethics committee.

Kitty Mohan, Chair BMA international committee.

Arthy Santhakumar, Head of international, BMA.

Julian Sheather, Specialist advisor ethics and human rights, BMA.

Dominic Norcliffe-Brown, Senior policy adviser ethics and human rights, BMA.

Competing interests: none declared.