By Paul Mooney and Thin Lei Win
INN DIN Myanmar (Reuters) - Visitors to the medical facility in one of Myanmar's poorest and most remote regions are greeted by a padlocked gate and a sign reading: "Clinic closed until further notice."
A vehicle that used to ferry around doctors and patients parked next to the neat compound of bamboo and brick buildings in the western state of Rakhine is covered in thick dust.
Since international aid groups were forced out of the area in February and March, members of the minority Muslim Rohingya community who relied on them say basic health care services have all but disappeared.
Worst affected are those in Northern Rakhine State (NRS), home to most of Myanmar's 1.3 million Rohingya who are stalked by sickness and malnourishment and as yet untouched by reforms under a semi-civilian government which took power in 2011.
Many people in and around the village of Inn Din, a collection of bamboo houses with thatched roofs and earthen floors a two-hour drive from NRS's biggest town Maungdaw, speak of disease and preventable death.
Nurfasa, born in late May, fidgeted in her grandmother's arms, her chest rising and falling with labored breaths. The desperately weak infant opened her mouth wide as if to cry, but no sound came out.
For the first 20 days of her life, all Nurfasa had for nutrition was ground-up rice powder mixed with water, because her mother, legs swollen and womb racked with pain, could not produce enough milk to feed her.
"We don't have the money to go to Maungdaw and the MSF clinic here is closed," said her grandmother Montai Begum. "We showed the baby to the government midwife in the village, but she asked for money."
GLIMMER OF HOPE?
The expulsion of international aid organizations stems from the violence that erupted across Rakhine state in 2012 between ethnic Rakhine Buddhists and Rohingya Muslims, killing at least 200 people and displacing 140,000, most of them Rohingya.
When Medecins Sans Frontieres-Holland said it had treated people it believed were victims of sectarian violence near Maungdaw in January, the government expelled the group for flavoring Muslims. Myanmar denies the attack took place.
And after a foreign staff member from another aid organization, Malteser International, was rumored to have desecrated a Buddhist flag, NGO and U.N. offices in Rakhine came under attack and groups withdrew.
MSF's departure has had "a major humanitarian impact", said Pierre Peron, spokesman for the United Nations' coordination agency UNOCHA.
"MSF had built up a program over 20 years and it was reaching places that were very difficult to reach, and that's not something that can be done overnight," he said.
MSF hopes it can return soon after the government announced on Thursday that the group could go back to Rakhine, a decision the organization welcomed.
Whether that commitment is fulfilled, and under what conditions, may be questions for talks over the coming days.
Some aid workers fret that the announcement has more to do with politics than resolving the humanitarian crisis.
Yanghee Lee, the new UN human rights envoy to Myanmar, is in the country on a 10-day visit that included a trip to Rakhine.
U.S. Secretary of State John Kerry may visit Myanmar for the ASEAN foreign ministers' meeting in August, and President Barack Obama is also expected before the end of 2014.
Timing is crucial. The health crisis could worsen as monsoon rains set in, making sanitation more difficult, and experts warn of the risk of diseases such as malaria and tuberculosis spreading in the absence of reliable medical care.
Than Tun, a Buddhist community leader and member of the Emergency Coordination Center (ECC) set up by the government to oversee international NGOs (non-governmental organizations), confirmed MSF-Holland would be allowed back to NRS.
But he underlined the level of mistrust between the Buddhist community and anyone it suspected of siding with Muslims.
"Although we have agreed to allow them in, we are rather worried that they will not cooperate with us with full transparency like other INGOs," he told Reuters. "We find it difficult to trust them."
TRUST IS SCARCE
Rohingya, who are stateless because the government considers them to be illegal Bengali immigrants, often do not dare go to state-run hospitals and clinics for fear of what may happen.
Aisyah Begum, 25, was still mourning for her husband, Kamal Husor, who was injured while working in the forest in May.
According to Aisyah, the private doctor in Maungdaw, a bone-jarring two-hour drive away, said he could not help.
She decided against going to the public hospital - she had heard Rohingya die there - and treated the wound with medicine from a make-shift pharmacy. Nineteen days later, Husor, 55, passed away from what was probably a treatable infection.
"Had MSF been open, I would have taken him there," she said, looking forlorn. "I trusted them."
Assessing the impact of the aid group's exit is difficult, with no one to provide reliable data on disease and death rates.
But in the last quarter of 2013, MSF treated about 9,000 patients every month, and about 1,000 pregnant women in the six clinics it ran in NRS. Over the same period, it referred 160-200 people monthly to hospitals for life-saving treatment.
Rakhine officials play down the role of international aid organizations.
Government medical teams have been making limited visits to Rohingya areas, but foreign aid workers say they are inadequate.
"The Ministry of Health has been providing better health care than MSF or Malteser," Than Tun said. "And we can see this with our own eyes."
Access to NRS is severely restricted and only a handful of foreign reporters have been there.
A Reuters team traveled seven hours by boat and car from Rakhine's capital Sittwe on a recent visit, one of the few times an international news organization has been allowed into NRS.
They witnessed evidence of a growing health crisis in a region where Rohingya say their basic human rights are denied.
International news coverage of the Rohingyas' plight has focused on sprawling, squalid camps outside Sittwe where those displaced by violence live. In NRS, many more Rohingya exist in what they call apartheid-like conditions.
NRS's maternal mortality rate is double Myanmar's national average - which, at 200 deaths per 100,000 live births, is already one of Asia's worst.
In Buthidaung and Maungdaw, two of NRS's three townships, malnutrition rates rival those in war-torn regions of sub-Saharan Africa.
Myanmar was a military dictatorship for almost 50 years until a semi-civilian government took power in 2011, but reforms have largely passed NRS by - many Rohingya cannot travel, marry or seek medical treatment without official permission.
Opposition leader Aung San Suu Kyi, who led the fight for democracy while the military ran the country, has faced rare criticism abroad for her failure to defend the Rohingya.
(Editing by Mike Collett-White)