It was a remarkable, but secretive, ceremony that took place earlier this week for a class of 21 students graduating with nursing degrees in Myanmar. Hidden away from the spy drones of the country’s military junta, and working around internet blackouts, the students had trained as part of an underground health system, which has been evolving in Myanmar since the coup in February 2021 crushed a pro-democracy uprising and ignited civil war.
“Safety is never guaranteed,” says Khun Sue Reh, 23, who on Monday was among the group graduating with the specially designed three-year nursing qualification.
Alongside the usual coursework and exams, the students face airstrikes on the hospitals where they are training, government spy drones overhead, roadblocks and internet blackouts.
The UN estimates that since the coup, 18.6 million people in Myanmar have required humanitarian assistance, 3.2 million have been internally displaced, and more than 55,000 civilian buildings destroyed. More than 200,000 people have fled to neighbouring countries including Bangladesh, India and Thailand.
A parallel secret health system has emerged, treating those who cannot risk government-controlled hospitals or who live in the vast areas of the country which are outside the regime’s control.
Khun and his colleague Rosetta were already students when the coup happened, and felt compelled to join the opposition Civil Defence Movement (CDM).
Khun says being part of the CDM “allowed me to stand up for my beliefs, and participate in peaceful change and take responsibility for my country’s future”.
“It was the right thing to do,” says Rosetta. “I could not continue working as usual when many people around me were facing so many difficulties.”
Being a nursing student, she went to community mobile clinics that were providing basic services to displaced people.
“Since the very beginning, nurses joined the movement – including me,” says April, a Burmese nurse educator.
“We started with peaceful demonstrations. Then, later on, the junta cracked down on those protesters. They beat them, they used guns, and there were casualties.
“So the nurses and doctors stepped up and set up secretive clinics in the community, so that’s how we started providing services to those injured in the protests.
“Later on, it became worse and worse, so we could no longer work in the big cities, and we had to disperse across the country.”
April contacted colleagues in the UK, and together, nurses in Myanmar and Britain arranged video masterclasses on topics such as how to deal with protest injuries.
When the junta started controlling internet access, and the price of data increased sharply, videos filmed in the UK were smuggled on memory sticks across the country.
Access to even basic healthcare in Myanmar, from vaccination to medication for chronic diseases, has been heavily disrupted by war, with about 1,900 incidents of violence or obstruction recorded since 2021. Hospitals and clinics have been damaged or destroyed, and at least 170 workers killed and 909 arrested. About 70% of incidents are attributed to the Myanmar armed forces.
April and her colleagues realised training videos already in circulation were not enough.
“What became very clear very quickly was that that wasn’t going to work – and what we’d have to do instead was to record an entire undergraduate degree from start to finish,” says Marcus Wootton, associate director of international nursing at the UK’s Royal College of Nursing (RCN), who became involved in the project.
Dozens of international academics recorded lectures for the 58 modules needed to cover Myanmar’s curriculum – from newborn care to tropical diseases – and the Phoenix Bachelor of Nursing Science qualification was born.
April and colleagues “set up a nursing school completely inside of the jungle”. Facilitators in a basic classroom with Starlink internet take students through pre-recorded sessions, supplemented by practical activities.
“They don’t have clean water, they don’t have shelter, the living conditions are really basic,” Wootton says. “They are at constant risk of drone attack. They are at constant risk of air attack. We’ve had bombs land right next to the classroom.
“We’ve had to move the students, we’ve had to move campuses, because of the risk of fighting.”
They are working in poorly resourced hospitals, says April. “Even things like paracetamol are really difficult to get in bulk purchase because the junta block every route to get those resources into jungle hospitals. From the very basic necessities to big equipment like MRI scanners, even portable ultrasound is not very easily available.”
Khun says: “During my clinical placement in the first semester of the final year, the hospital was directly attacked by an airstrike.” He had to evacuate with patients.
Rosetta said there had been times she was studying in temporary shelters, hiding from government drones.
Internet connections are limited and heavily monitored, the students say, and study sessions need careful planning to avoid attracting unwanted attention.
“It is also the emotional stress, for me and many of us,” says Khun. “Many of us feel fear and worry not only for ourselves, but also our family, our friends and the community.”
He adds: “I hope people outside Myanmar understand that our lives here are not just about struggle. We have dreams, we have hopes and we have determination, and we want to contribute to a better future.”
There is no compromise on quality. “It is an international standard degree,” says Wootton, who describes the new nurses’ achievement as “extraordinary”.
There are five cohorts currently studying, and others on a one-year programme for diploma nurses who want to upgrade to degree level.
In a letter of thanks to the RCN, one of the students wrote: “The name Phoenix itself is powerful for us. It symbolises rising from the ashes of the destruction the coup has caused.
“Our cohort represents the reconstruction of Myanmar’s ethical healthcare system, built by students committed to compassion, democracy and professionalism. We are the living proof that education and hope cannot be extinguished by violence.”
