Naw Ku Paw, the Director of the Karenni Health Department (KnHD) explained how the recent sudden cuts to USAid have affected the provision of aid to No. 1 and No. 2 Karenni Refugee Camps in Thailand’s Mae Hong Son Province.
Describing the situation she said: “The situation is not normal anymore, everything is now severely limited.”
The US Government ordered a temporary 90 day suspension of all international aid as of 28 January 2025.
From that day all the services provided by the International Rescue Committee (IRC) were cancelled due to a lack of funds. In 2025 IRC was expecting to get about 42%, or $650 million of its 2025 budget paid for by the US government, according to its president David Milliband.
This meant that from 28 January IRC funding to KnHD, which was being used to provide health services and run medical clinics in No. 1 and No. 2 Karenni Refugee Camps, was all cut.
On 28 January, the health clinics in Camp 1 and Camp 2 had to close to all patients except emergency cases.
Fortunately, KnHD still has enough funding to pay for three shifts of staff to deal with emergency admissions.
Unfortunately there is very little medicine available to treat those emergency patients. All the staff can do is to advise them on where they might be able to buy the medicine they need to treat themselves and what they can do to help themselves and stop their conditions worsening.
Both the clinics are now receiving nearly no new medication for patients because previously, IRC bought its medicines using the aid money from the US that has now been cut. They still have some medicine left from before the aid cuts, but it is rapidly running out.
Naw Ku Paw said: “When patients arrive, we unfortunately have no medicines available. As a result, they have no access to medication. In such cases, we advise patients on how to protect themselves and find alternative sources of medicine, even though we cannot provide it directly at the clinic”
Naw Ku Paw explained that the IRC is trying to source and supply medicine using funding other than US Government funding. Every week the clinics need to submit a list of medicines they need to IRC which then tries to supply what it can. The clinics have also been receiving a small amount of medication from the non-junta Karenni Health Ministry.
The KnHD has met with IRC and outlined to them its plan to stay open for carrying out lifesaving emergency treatment, but IRC has yet to officially approve these plans.
This means that nearly all of the clinic’s non-emergency work will have to be suspended for the next 90 days.
According to Naw Ku Paw, out of 220 staff at both clinics, only 100 will be retained, but to continue that for longer than 90 days, KnHD will need to receive more donor funding.
It will be a significant challenge according to Naw Ku Paw who said it would still entail cuts in services. Clinics will be short-staffed, with two or three fewer staff members. Community healthcare services and mental health services will have to stop.
Talking of the staffing cuts, Naw Ku Paw said: “In total, there are more than 200 staff across both camps, and some regular services will be impacted. Community healthcare services, particularly those focused on prevention, will also have to stop. Nearly all work will be suspended over the next three months.”
But, the clinics will be able to provide some services. In order of priority these are treating serious injuries followed by the treatment of infectious and non-infectious diseases. The clinics will also try to manage people’s medication as well as they can.
Reproductive and Child Health (RCH) services will also be maintained. As far as maternal and child welfare services go, the clinics will continue to provide child vaccination, prenatal care, childbirth assistance, and healthcare for children under five. But, broader maternal and child welfare services will be suspended. Regular family planning will continue, but it will no longer be part of the essential Emergency Life Saving activities, according to Naw Ku Paw.
She also said that the clinics’ laboratory, which is essential for diagnosing diseases, will remain operational, as will the Health Information System (HIS) which tracks disease trends.
The clinics’ three major departments, medicine, mental health care, and essential treatments are all essential services and will also continue to function. But, community health workers and staff dedicated to treating mental health will also have to be reassigned to other cases because clinics will be short-staffed.
Ancillary equipment used by the clinics to treat patients has also been hit. The IRC has taken back oxygen and gas cylinders, though the clinics have managed to keep some for emergencies. But, the clinics face problems getting those cylinders refilled and urgently need donors to help with this.
Naw Ku Paw said: “We currently have oxygen and gas cylinders, and we use steam pots to sterilise bandages. Materials are also sterilised after providing care to pregnant patients. However, the gas and dry batteries needed for emergency patients have run out.”
The clinics have asked the revolutionary Karenni State government to help them. Currently, the government is providing some medicines and paying the cost of transporting medication, from it and other donors, to the clinics, but not for refilling the cylinders and recharging the batteries. The revolutionary Karenni State Health Ministry has sent some funds and is petitioning the government for more.
Another problem the clinics now face is a lack of diesel and petrol to fuel generators. This leads to a shortage of electricity which is vital for the treatment of some patients.
“The worst part is that if we have an emergency patient at night, we have to rely on the generator. However, we have no diesel or petrol. In the laboratory, we need the generator to diagnose diseases, as we rely on it to power the microscope. Unfortunately, there are no donors available to help us purchase the necessary petrol and diesel,” said Naw Ku Paw.
Another large problem facing the clinics since the cuts is the lack of transport from the clinics to local Thai hospitals for patients with chronic diseases, those who cannot stop their medication and people with scheduled appointments.
The clinic at Camp No. 1 still has a vehicle that is supplied by the Karenni National Relief Committee (KnRC), but it can only work for the clinic when it does not have too much other work. There is no longer a vehicle for the clinic at Camp No. 2. Often the vehicle from Camp No. 1 is too busy to take patients to hospital, but sometimes it can and if it has time and availability it also transports patients from Camp. No 2 to hospital.
As a result nearly all of the patients from Camp No. 2 and many of the patients from Camp No. 1 who want to go to hospital have to arrange and pay for their own transport. This is not cheap, from Camp No. 1 a round trip to Khun Yuam Hospital is about 4,000 Thai baht (THB) whilst a return trip to Mae Hong Son Hospital is 6 to 7,000 THB. From Camp No. 2 the transport costs are even higher.
Transporting patients remains a significant challenge, according to Naw Ku Paw.
To make matters worse, though the patients being taken to Thai hospitals come from KnHD clinics none of their paperwork can say that the patients have been sent by KnHD because US donors may assume that their funds have been illegitimately used to transport patients and demand refunds. Instead the paperwork has to say that the patients have come from KnRC which is only supplying the vehicles. Because the hospitals have an arrangement with KnHD to treat its patients, but not with KnRC they are sometimes demanding fees from the patients, even though they are not required to pay because KnHD has already covered the fees.
Some patients have incurred significant costs as a result of the cuts in US aid. For instance treating appendicitis in a Thai hospital costs more than 20,000 THB and delivering a baby costs more than 15,000 THB.
Such costs can put a very high financial burden on patients and their families and leave them in debt. Even worse, it means that some patients are foregoing necessary and urgent treatment because they cannot afford to go to hospital.
Some patients are even avoiding or delaying going to the clinics in the camps because they worry that they will be sent on to Thai hospitals and asked to pay money they cannot afford, according to Naw Ku Paw. She said this had directly led to the deaths of at least two children and an adult.
She told of a patient who was worried about treatment costs and only taken to the clinic after losing consciousness. They were sent to hospital the next morning but unfortunately died soon after. A child also died from a respiratory disease in a Chiang Mai hospital because their parents had worried about hospital costs and had arrived at the hospital too late. This was the second child to die in a Thai hospital after their parents had hesitated for too long to seek treatment because they worried about the cost.
With the current cuts KnHD is struggling, but it is still trying to provide the best healthcare it can under such circumstances.
Naw Ku Paw said that if the US aid situation is not resolved after 90 days it would be ideal if Thailand took responsibility for the Karenni refugees. However if it does not Naw Ku Paw and the staff at the clinics in No. 1 and No. 2 Karenni Refugee Camps will continue to provide whatever healthcare they can with their constrained finances.
She said: “We will continue to provide healthcare services within our capacity. We will do our best to seek help for our people and our region.”
