The trials, tribulations and recent relative triumph of the international health charity Médecins Sans Frontières in Myanmar are a salutary reminder that the Southeast Asian nation’s much heralded transition from military dictatorship to quasi-civilian administration has not been an entirely smooth ride.

No one with any understanding of the country ever believed it would be. Early heady optimism has gradually settled into a mixture of cautious hope seasoned with liberal doses of regular frustration.In a new report this week, the Institute for Peace and Conflict Studies described 2014 as a “year of ups and downs for Myanmar” and predicted that, with a general election scheduled, “2015 will be an eventful year for the country”.

It is hard to find fault with that analysis, and the start of the year has provided ample evidence of Myanmar’s stop-go progress.

Small signs of progress

Médecins Sans Frontières-Holland (MSF) announced this week that it had quietly resumed work in Rakhine state after a 10-month hiatus.

The Myanmar government ordered MSF out of the country last February, accusing the organization of being biased in favor of Rakhine’s Muslim Rohingya minority. Tens of thousands of Rohingya – who are not recognized by the government as citizens of Myanmar – have been displaced by fighting with Buddhists, which has flared sporadically since 2012.

Rakhine state is named after the ethnic Rakhine Buddhist majority but also has a sizeable Muslim population, including the Rohingya minority. Communal violence in the past two years has killed more than 170 people and destroyed more than 10,000 homes. Those who fled to camps often endure squalid conditions. The resumption of MSF’s operations in Rakhine follows what the charity describes as “complicated negotiations” with the central government, state authorities and local community leaders.

MSF is not alone in struggling for access to respond adequately to the crisis in Rakhine. "The humanitarian situation is still unacceptably dire for far too many people,” concluded John Ging, operations director at the UN Office for the Coordination of Humanitarian Affairs (OCHA), after a two day visit to the state last September.

Perhaps MSF’s success is a sign of better things to come?

In a written response to questions from IRIN, MSF’s operational advisor on Myanmar, Martine Flokstra, made clear the organization is now able to provide health care to both communities in Rakhine. But MSF is calling on the government to go further.

“While we welcome the progress made so far in renegotiating access to those populations unable to reach the medical care they need, it should be noted that we are not doing as much as we were previously (before Feb 2014),” Flokstra said. “Meanwhile, many people remain unable to access the healthcare they urgently need.”

Brickbats and row backs

The atmosphere for fruitful discussion about the role of international humanitarian organizations in Myanmar in general, and Rakhine in particular, has, however, been poisoned after a controversial Buddhist monk aimed sexist remarks at a UN special envoy. Ashin Wirathu, a firebrand nationalist, described Yanghee Lee as a “bitch” and a “whore” after the South Korean envoy said publically that the Rohingya faced discrimination. The government is under pressure to resolve the row but is hugely reluctant to censure Wirathu – who commands a wide following.

Meanwhile other ethnic tensions are faring no better. Signs for peace in northern Kachin state, home to one of the most intractable of Myanmar’s many ethnic conflagrations, look increasingly bleak. The government has been seeking a nationwide peace pact encompassing all groups to bring an end to six decades of volatility. But the chances of success in an election year look slim.

As does the prospect of further political reform, given recent statements from the military making clear what most had already assumed - it is not prepared to give up any of its still considerable power and influence. Predicting that 2015 will be an eventful year for Myanmar is already looking like a staggering understatement.

This is printed with permission from IRIN, an independent, non-profit media organization.