SITTWE, Myanmar (AP) -- When the kicking stopped, Zura Begum suspected something was wrong with the twins she was supposed to deliver that month. When the pain started shooting through her body, all doubt was erased.
She needed help, but had nowhere to turn. She was trapped with thousands of other Muslim Rohingya in a squalid, dusty camp in western Myanmar's Rakhine state.
The foreign aid workers she had relied on early in her pregnancy were gone -- forced out by a distrustful government and extremist Buddhist mobs. Getting help outside the camps, in hospitals run by the Buddhist Rakhine majority, requires special permission that is harder than ever to obtain.
And there is one more obstacle: The fear that has grown over two years in which ethnic violence in Rakhine, mostly by Buddhist mobs against Rohingya, has left up to 280 people dead and forced another 140,000 from their homes. Rohingya worry Buddhist doctors and nurses will hurt or even kill them, though aid workers, now just beginning to return to Rakhine, say there is nothing to suggest that the rumors are true.
All those factors weigh on Rohingya who need medical attention -- especially pregnant women like Begum. Her family said that instead of getting the treatment she and her twins needed, the 20-year-old lay at the camp in a "long house" -- a shelter of bamboo and corrugated metal where multiple families live. Her mother stroked her hand and placed packs of ice on her huge belly between screams.
Myanmar, a predominantly Buddhist nation of 60 million, has been gripped by ethnic and religious violence -- mostly in Rakhine -- since it began its bumpy transition to democracy three years ago.
Though many Rohingya here are from families that arrived generations ago, the government considers them all illegal migrants from Bangladesh and has denied them citizenship. Many of those displaced by recent violence live under apartheid-like conditions on the outskirts of Sittwe, the capital of Rakhine.
There are reports almost daily about deaths, many of them pregnant women experiencing complications that could have been prevented, according to aid workers and Rohingya in the camps. Before Doctors Without Borders was kicked out of Rakhine, pregnant women made up a quarter of the group's emergency referrals.
The government expelled the group in February. It had angered officials by hiring some Rohingya staff, and by saying it had treated victims of an attack on a village in northern Rakhine state early this year. The United Nations has said more than 40 people may have been killed in that attack, but the government says the only death was that of a policeman.
Weeks later, more than 700 other foreign aid workers were forced to flee after their guest houses, offices and warehouses were attacked by Buddhist mobs.
The government insisted it could fill the gap, though the health care system across the country is still rebuilding after years of neglect. The former military government spent around $1 per person on medical care annually before it was replaced in 2011.
The state deployed dozens of its own doctors into Muslim camps, but some initially refused to go, saying they felt unsafe. Now they show up several times a week, but only for a few hours.
Long lines form with hundreds of patients, each getting only a few minutes of attention. Some suffer from respiratory infections and diarrhea, the two biggest child-killers worldwide. And experts fear cholera or other waterborne outbreaks will flare when the sprawling camps, now blanketed by choking clouds of dust, turn to mud when the rainy season starts.
The government also promised to let aid workers from Save the Children, Oxfam and other humanitarian groups return to Sittwe within days, but few staff have returned so far.
Most are working out of hotel rooms with cardboard boxes turned into makeshift filing cabinets. While a few started visiting camps this week with supplies, they say the must operate under greater restrictions than they had before.
They point to the Emergency Coordination Center as one of the most worrying signs. Comprised of state and central government officials, as well as representatives from the United Nations, nonprofits and members of the local Buddhist Rakhine community, its role initially was to be an information-sharing mechanism.
But last week, one of most influential members, Than Tun, told aid workers their terms of engagement had changed. Now aid groups' activities must be approved by the center, and must give Buddhists and Rohingya equal amounts of aid.