Conflict and health, including violations of humanitarian and human rights standards as threats to health
These include violations of economic, social and cultural rights as well as civil and political rights
|Title:|| ||Health and Human Rights
|Description/subject:|| ||"Many of CPI's local partners serve ethnic communities located in Myanmar's conflict-affected zones that are not adequately served by governmental organizations or large humanitarian agencies — areas that also often suffer from chronic human rights abuses.
See links at rights for peer-reviewed articles and reports documenting the connection between systemic abuses and poor health in Myanmar's border regions....Diagnosis Critical (CPI Partners, Oct. 2010)...
After the Storm (CPI Partners, March 2009)...
Chronic Emergency (CPI partners, Sep. 2006)...
Displacement and Disease (Conflict and Health, March 2008)...
Health and human rights and political transition (Intl Health & Human Rights, May 2014)...
Maternal health and human rights violations (PLoS Medicine, Dec. 2008)...
Quantifying associations between human rights violations and health (Epidemiology & Community Health, Sep. 2007)...
The Gathering Storm (CPI partners, July 2007)...
Community-based Assessment of Human Rights (Conflict and Health, April 2010).|
|Source/publisher:|| ||Community Partners International|
|Format/size:|| ||html, pdf|
|Date of entry/update:|| ||20 August 2014|
|Title:|| ||The Jungle Surgeon of Myanmar - One medic finds that moves towards political reform have not benefited his patients in Burma's remote border areas. (video)
|Date of publication:|| ||13 January 2014|
|Description/subject:|| ||"One medic finds that moves towards political reform have not benefited his patients in Burma's remote border areas.
"Nyunt Win is a surgeon and medical trainer working with a mobile clinic in the East Burma jungle. He is also a former soldier of the Karen National Liberation Army.
Nyunt Win's patients are the displaced Karen people who as well as suffering the effects of years of civil war are without any healthcare whatsoever.
With moves towards political reform and international aid going directly to the government under the guise of development projects, there is an increase in resource exploitation, human rights abuses and displacement of ethnic populations. The plight of Nyunt Win's patients seems to be more acute than ever...The Jungle Surgeon of Myanmar exposes what life is like in the remote areas of Myanmar. It shows this marginalised community's fight for survival and thoughts on longterm peace, providing an alternative perspective on the ceasefire."|
|Author/creator:|| ||Gigi Berardi|
|Language:|| ||Karen (voice), English (sub-titles)|
|Source/publisher:|| ||Al Jazeera (Witness)|
|Format/size:|| ||Adobe Flash (25 minutes)|
|Date of entry/update:|| ||14 January 2014|
|Title:|| ||Bitter Wounds and Lost Dreams: Human Rights Under Assault in Karen State, Burma
|Date of publication:|| ||27 August 2012|
"Out of all 665 households surveyed, 30% reported a human rights violation. Forced labor was
the most common human rights violation reported; 25% of households reported experiencing
some form of forced labor in the past year, including being porters for the military, growing
crops, and sweeping for landmines. Physical attacks were less common; about 1.3% of households
reported kidnapping, torture, or sexual assault.
Human rights violations were significantly worse in the area surveyed in Tavoy, Tenasserim
Division, which is completely controlled by the Burmese government and is also the site of the
Dawei port and economic development project. Our research shows that more people who lived
in Tavoy experienced human rights violations than people who lived elsewhere in our sampling
area. Specifically, the odds of having a family member forced to be a porter were 4.4 times
higher than for families living elsewhere. The same odds for having to do other forms of forced
labor, including building roads and bridges, were 7.9 times higher; for being blocked from accessing
land, 6.2 times higher; and for restricted movement, 7.4 times higher for families in
Tavoy than for families living elsewhere. The research indicates a correlation between development
projects and human rights violations, especially those relating to land and displacement.
PHR’s research indicated that 17.4% of households in Karen State reported moderate or severe
household hunger, according to the FANTA-2 Household Hunger Scale, a measure of food insecurity.
We found that 3.7% of children under 5 were moderately or severely malnourished, and
9.8% were mildly malnourished, as determined by measurements of middle-upper arm circumference.
PHR conducted the survey immediately following the rice harvest in Karen State, and
the results may therefore reflect the lowest malnutrition rates of the year.....Conclusion:
PHR’s survey of human rights violations and humanitarian indicators in Karen State shows that
human rights violations persist in Karen State, despite recent reforms on the part of President
Thein Sein. Of particular concern is the prevalence of human rights violations even in areas
where there is no active armed conflict, as well as the correlation between economic development
projects and human rights violations. Our research found that human rights violations
were up to 10 times higher around an economic development project than in other areas surveyed.
Systemic reforms that establish accountability for perpetrators of human rights violations,
full political participation by Karen people and other ethnic minorities, and access to essential
services are necessary to support a successful transition to a fully functioning democracy..."|
|Author/creator:|| ||Bill Davis ,MA, MPH; Andrea Gittleman, JD, PHR; Richard Sollom, MA, MPH, PHR; Adam Richards, MD, MPH; Chris Beyrer, MD, MPH; Forword by Óscar Arias Sánchez|
|Source/publisher:|| ||Physicians for Human Rights (PHR)|
|Format/size:|| ||pdf (749K)|
|Date of entry/update:|| ||28 August 2012|
|Title:|| ||Thaton Interview: Daw Ny---, April 2011
|Date of publication:|| ||27 January 2012|
|Description/subject:|| ||"This report contains the full transcript of an interview conducted during April 2011 in Pa’an Township, Thaton District by a villager trained by KHRG to monitor human rights conditions. The villager interviewed Daw Ny---, who described an incident which occurred in November 2010, during which Tatmadaw Border Guard soldiers fired small-arms at her husband without warning and without attempting to hail him, seriously injuring his leg and necessitating 3,800,000 kyat [US $4,935.06] in medical expenses, which has had a deleterious effect on her family’s financial situation. Daw Ny--- told the villager who conducted this interview that her husband was visited in hospital by government officials investigating the incident but that no compensation or redress was offered. Daw Ny--- also described arbitrary demands for food and money, and the illegal logging of teak trees from A--- village by Border Guard soldiers; she mentioned that the imbalance in local power dynamics between armed soldiers and unarmed villagers deters villagers from attempting to engage and negotiate with perpetrators. Daw Ny--- raised concerns about the lack of livelihoods opportunities, and corresponding food insecurity, for villagers who do not own farmland; she notes that, in spite of these challenges, villagers offer voluntary material support to schoolteachers and often attempt to support their livelihoods by selling firewood or cutting bamboo. Daw Ny--- notes that some villagers choose to seek employment opportunities in larger towns but strongly expresses her unwillingness to move to an urban area, believing that food insecurity would only be exacerbated by a lack of money and an absence of alternative livelihood opportunities."|
|Source/publisher:|| ||Karen Human Rights Group (KHRG)|
|Format/size:|| ||pdf (267K), html|
|Alternate URLs:|| ||http://www.khrg.org/khrg2012/khrg12b8.html|
|Date of entry/update:|| ||29 January 2012|
|Title:|| ||Attacks on Health and Education: Trends and incidents from eastern Burma, 2010-2011
|Date of publication:|| ||06 December 2011|
|Description/subject:|| ||"This report presents primary evidence of attacks on education and health in eastern Burma collected by KHRG during the period February 2010 to May 2011. Section I of this report details KHRG research methodology; Section II analyses general trends in armed conflict and details a loose typology of attacks identified during the reporting period. Section III applies this typology to 16 particularly illustrative incidents, and analyses them in light of relevant international humanitarian law and UN Security Council resolutions 1612, 1882 and 1998. These incidents were selected from a database detailing 59 attacks on civilians documented by KHRG between February 2010 and May 2011."|
|Source/publisher:|| ||Karen Human Rights Group (KHRG)|
|Format/size:|| ||html. pdf (166K)|
|Alternate URLs:|| ||http://www.khrg.org/2011/12/khrg1105/attacks-health-and-education-trends-and-incidents-eastern-burm...|
|Date of entry/update:|| ||19 January 2012|
|Title:|| ||Definitional ambiguity and UNSCR 1998: Impeding UN-led responses to attacks on health and education in eastern Burma
|Date of publication:|| ||06 December 2011|
|Description/subject:|| ||"This paper highlights impediments to effective international responses to attacks on health and education
in eastern Burma presented by lack of clarity regarding the meaning of “attacks” within the monitoring and
reporting framework established by UN Security Council resolutions 1612 and 1998. In order to address
this definitional ambiguity and enable recent developments in the UN Security Council to potentially
provide support to communities facing attacks in eastern Burma, this paper argues for interpreting
“attacks” in a fashion that is consistent with applicable international humanitarian law. The analysis below
concludes that UN-led monitoring, reporting and response pursuant to UNSCRs 1612 and 1998 should
include acts by parties to armed conflict that both: a) violate relevant international law; and b) attack or
threaten to attack personnel related to schools or medical facilities and/ or destroy, damage or force the
closure of a school or medical facility."|
|Source/publisher:|| ||Karen Human Rights Group (KHRG)|
|Format/size:|| ||html, pdf (62K)|
|Alternate URLs:|| ||http://www.khrg.org/sites/default/files/khrg11w1.pdf
|Date of entry/update:|| ||18 January 2012|
|Title:|| ||Diagnosis: Critical – Health And Human Rights in Eastern Burma
|Date of publication:|| ||19 October 2010|
|Description/subject:|| ||Executive Summary: "This report reveals that the health of populations in conflict-affected areas of eastern Burma, particularly women and children, is amongst the worst in the world, a result of official disinvestment in health, protracted conflict and the abuse of civilians..."Diagnosis: Critical" demonstrates that a vast area of
eastern Burma remains in a chronic health
emergency, a continuing legacy of longstanding
official disinvestment in health, coupled with
protracted civil war and the abuse of civilians. This
has left ethnic rural populations in the east with
41.2% of children under five acutely malnourished.
60.0% of deaths in children under the age of 5 are
from preventable and treatable diseases, including
acute respiratory infection, malaria, and diarrhea.
These losses of life would be even greater if it were
not for local community-based health organizations,
which provide the only available preventive and
curative care in these conflict-affected areas.
The report summarizes the results of a large scale
population-based health and human rights survey
which covered 21 townships and 5,754 households
in conflict-affected zones of eastern Burma. The
survey was jointly conducted by the Burma Medical
Association, National Health and Education
Committee, Back Pack Health Worker Team and
ethnic health organizations serving the Karen,
Karenni, Mon, Shan, and Palaung communities.
These areas have been burdened by decades of civil
conflict and attendant human rights abuses against
the indigenous populations.
Eastern Burma demographics are characterized by
high birth rates, high death rates and the significant
absence of men under the age of 45, patterns more
comparable to recent war zones such as Sierra
Leone than to Burma’s national demographics.
Health indicators for these communities, particularly
for women and children, are worse than Burma’s
official national figures, which are already amongst
the worst in the world. Child mortality rates are
nearly twice as high in eastern Burma and the
maternal mortality ratio is triple the official national
While violence is endemic in these conflict zones,
direct losses of life from violence account for only
2.3% of deaths. The indirect health impacts of the
conflict are much graver, with preventable losses
of life accounting for 59.1% of all deaths and malaria
alone accounting for 24.7%. At the time of the
survey, one in 14 women was infected with Pf
malaria, amongst the highest rates of infection in
the world. This reality casts serious doubts over
official claims of progress towards reaching the
country’s Millennium Development Goals related to the health of women, children, and infectious
diseases, particularly malaria.
The survey findings also reveal widespread human
rights abuses against ethnic civilians. Among
surveyed households, 30.6% had experienced
human rights violations in the prior year, including
forced labor, forced displacement, and the
destruction and seizure of food. The frequency and
pattern with which these abuses occur against
indigenous peoples provide further evidence of the
need for a Commission of Inquiry into Crimes
against Humanity. The upcoming election will do
little to alleviate the situation, as the military forces
responsible for these abuses will continue to
operate outside civilian control according to the
The findings also indicate that these abuses are
linked to adverse population-level health outcomes,
particularly for the most vulnerable members of
the community—mothers and children. Survey
results reveal that members of households who
suffer from human rights violations have worse
health outcomes, as summarized in the table above.
Children in households that were internally
displaced in the prior year were 3.3 times more
likely to suffer from moderate or severe acute
malnutrition. The odds of dying before age one was
increased 2.5 times among infants from households
in which at least one person was forced to provide
The ongoing widespread human rights abuses
committed against ethnic civilians and the blockade
of international humanitarian access to rural
conflict-affected areas of eastern Burma by the
ruling State Peace and Development Council (SPDC),
mean that premature death and disability,
particularly as a result of treatable and preventable
diseases like malaria, diarrhea, and respiratory
infections, will continue.
This will not only further devastate the health of
communities of eastern Burma but also poses a
direct health security threat to Burma’s neighbors,
especially Thailand, where the highest rates of
malaria occur on the Burma border. Multi-drug
resistant malaria, extensively drug-resistant
tuberculosis and other infectious diseases are
growing concerns. The spread of malaria resistant
to artemisinin, the most important anti-malarial
drug, would be a regional and global disaster.
In the absence of state-supported health
infrastructure, local community-based organizations
are working to improve access to health services in
their own communities. These programs currently
have a target population of over 376,000 people in
eastern Burma and in 2009 treated nearly 40,000
cases of malaria and have vastly increased access
to key maternal and child health interventions.
However, they continue to be constrained by a lack
of resources and ongoing human rights abuses by
the Burmese military regime against civilians. In
order to fully address the urgent health needs of
eastern Burma, the underlying abuses fueling the
health crisis need to end."|
|Language:|| ||Burmese, English, Thai|
|Source/publisher:|| ||The Burma Medical Association, National Health and Education Committee, Back Pack Health Worker Team|
|Format/size:|| ||pdf (OBL versions: 5.3MB - English; 4.4MB Thai; 3.5MB-Burmese) . Larger, original versions on BPHWT site|
|Alternate URLs:|| ||http://www.burmalibrary.org/docs11/Diagnosis_critical(th)-red.pdf
|Date of entry/update:|| ||05 September 2011|
|Title:|| ||MYANMAR: Health crisis amid conflict - new report
|Date of publication:|| ||19 October 2010|
|Description/subject:|| ||A new report by NGOs indicates health conditions in conflict-affected eastern Myanmar are dire, with women and children suffering most.
According to "Diagnosis: Critical", a survey of 5,754 households by health organizations working in the Thai border town of Mae Sot and others from neighbouring Myanmar, health conditions in eastern Myanmar have deteriorated due to constant conflict and persistent state neglect.|
|Source/publisher:|| ||IRIN_ humanitarian news and analysis|
|Date of entry/update:|| ||22 October 2010|
|Title:|| ||Burma Human Rights Yearbook 2008 - Chapter 11: Right to Health
|Date of publication:|| ||23 November 2009|
|Description/subject:|| ||"For the people of Burma, 2008 has been another difficult year. The difficulties related to lack
of healthcare facilities continued, while other factors relating to poverty remained key
influences on the health of the nation. The enduring story from Burma from 2008 was the
humanitarian consequences of Tropical Cyclone Nargis, which hit the country on 2-3 May
2008. However, even at the beginning of the year, there were worrying reports and statistics
emerging from Burma regarding the health status of the population.
In January 2008, the United Nations Children’s Fund (UNICEF) released figures which
showed Burma had the second highest child mortality rate in the world, with between 270
and 400 children dying on a daily basis, many from preventable causes. By year end, the
combination of the estimated 130,000 deaths due to Cyclone Nargis and the increasing
HIV/AIDS crisis lead Médecins Sans Frontières (MSF) to describe the current situation in
Burma as “critical”, and also contributed to Burma being included in MSF’s list of the ten
worse humanitarian situations in the world. While it has been estimated that approximately
half of Burma's annual budgetary allocation goes towards military expenditure, less than half
a percent of Burma’s Gross Domestic Product (GDP) is allocated to healthcare. Burma’s
per capita spending on healthcare has been reported to be "the lowest in the world". As a
direct result, deaths arising from easily preventable and readily treatable diseases are
common. Burma also has the second highest child mortality rate in all of Asia, with ten
percent of children dying before their fifth birthday; only Afghanistan’s child mortality rate is
While the State Peace and Development Council (SPDC) military regime makes little to no
effort to actively promote good health or to provide adequate healthcare, in some areas it
actively prevents the population’s access to healthcare through restrictions on movement
and other human rights abuses. For example, in August 2008, it was reported that medical
students were to be forced to take an exam on the current political situation in the country
before being allowed to take up medical placements in hospitals. Presumably, those
students who failed to toe the SPDC line would not have been permitted to commence their
placements. Although this was denied by the SPDC, it was confirmed by lecturers at
Rangoon’s Medical Institute..."|
|Source/publisher:|| ||Human Rights Docmentation Unit (HRDU)|
|Format/size:|| ||pdf (217K)|
|Date of entry/update:|| ||05 December 2009|
|Title:|| ||Burma's Prisons and Labour Camps: Silent Killing Fields
|Date of publication:|| ||11 May 2009|
|Description/subject:|| ||"In October 2008, reports
emerged from Burma that the
military junta had ordered its
courts to expedite the trials of
political activists. Since then,
357 activists have been handed
down harsh punishments,
including sentences of up to 104
years. Shortly after sentencing,
the regime began to
systematically transfer political
prisoners to prisons all around
Burma, far from their families. This has a serious detrimental impact on both their
physical and mental health. Medical supplies in prisons are wholly inadequate, and often
only obtained through bribes to prison officials. It is left to the families to provide
medicines, but prison transfers make it very difficult for them to visit their loved ones in
jail. Prison transfers are also another form of psychological torture by the regime, aimed
at both the prisoners and their families. Since November 2008, at least 228 political
prisoners have been transferred to jails away from their families. The long-term
consequences for the health of political prisoners recently transferred will be very serious.
At least 127 political prisoners are currently in poor health. At least 19 of them are in
urgent need of proper medical treatment. Political prisonersÃ¢' right to healthcare is
systematically denied by the regime. Burma's healthcare system in prisons is completely
inadequate, especially in jails in remote areas. There are 44 prisons across Burma, and at
least 50 labour camps. Some of them do not have a prison hospital, and at least 12 of the
prisons do not even have a prison doctor.
The regime's treatment of political prisoners directly contravenes the 1957 UN standard
minimum rules for the treatment of prisoners. The International Committee of the Red
Cross (ICRC) carried out its last prison visit in Burma in November 2005. In January
2006 the ICRC suspended prison visits in the country, as it was not allowed to fulfil its
independent, impartial mandate.
Since 1988 at least 139 political prisoners have died in detention, as a direct result of
severe torture, denial of medical treatment, and inadequate medical care. Many, like Htay
Lwin Oo, were suffering from curable diseases such as tuberculosis. He died in
Mandalay Prison in December 2008. He had been due for release in December this year...
1. Political Prisoners In Poor Health
There are currently at least 127 political prisoners known to be in poor health..."|
|Source/publisher:|| ||Assistance Association for Political Prisoners (Burma)|
|Format/size:|| ||pdf (681K)|
|Date of entry/update:|| ||11 May 2009|
|Title:|| ||After the Storm: Voices from the Delta
|Date of publication:|| ||27 February 2009|
|Description/subject:|| ||An independent, community-based assessment of health and human
rights in the Cyclone Nargis response...DISCUSSION AND CONCLUSIONS:
"To date, this report is the only community-based independent assessment of the Nargis response
conducted by relief workers operating free of SPDC control. Using participatory methods and
operating without the knowledge or consent of the Burmese junta or its affiliated institutions, this
report brings forward the voices of those working “on the ground” and of survivors in the Cyclone
Nargis-affected areas of Burma.
The data reveal systematic obstruction of relief aid, willful acts of theft and sale of relief supplies,
forced relocation, and the use of forced labor for reconstruction projects, including forced child
labor. The slow distribution of aid, the push to hold the referendum vote, and the early refusal to
accept foreign assistance are evidence of the junta’s primary concerns for regime survival and
political control over the well-being of the Burmese people.
These EAT findings are evidence of multiple human rights violations and the abrogation of
international humanitarian relief norms and international legal frameworks for disaster relief. They
may constitute crimes against humanity, violating in particular article 7(1)(k) of the Rome Statute
of the International Criminal Court, and a referral for investigation by the International Criminal
Court should be made by the United Nations Security Council".|
|Author/creator:|| ||Voravit Suwanvanichkij, Mahn Mahn, Cynthia Maung, Brock Daniels, Noriyuki Murakami, Andrea Wirtz, Chris Beyrer|
|Source/publisher:|| ||Emergency Assistance Team (EAT BURMA), Center for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health|
|Format/size:|| ||pdf (1.57MB)|
|Alternate URLs:|| ||http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDocUnidFilename/ASAZ-7PRKLM-full_report.pdf/$File/full_report.pdf|
|Date of entry/update:|| ||17 November 2010|
|Title:|| ||Burma’s Man-Made Suffering
|Date of publication:|| ||09 February 2009|
|Description/subject:|| ||"...Chronic divestment in health, alongside draconian restrictions, harassment and the incarceration of relief workers, remain the root drivers of the health and humanitarian crises in Burma. These are the real human rights violations that affect health—not sanctions...official restrictions governing the work of international aid agencies have been tightened, particularly the rules covering domestic travel and data collection. Their priorities are clear: until the global community has the moral fortitude to address this underlying reality, the humanitarian crises of Burma will continue, especially for the 70 Burmese HIV patients who will die today from lack of care"|
|Author/creator:|| ||Voravit Suwanvanichkij and Chris Beyrer|
|Source/publisher:|| ||"The Irrawaddy"|
|Alternate URLs:|| ||http://www.jhsph.edu/humanrights/_pdf/Vit_Man-MadeCrisis_Irrawaddy_9Feb09.pdf|
|Date of entry/update:|| ||10 February 2009|
|Title:|| ||Beyond the International Spotlight, Critical Health Needs in Myanmar Remain Unmet
|Date of publication:|| ||22 December 2008|
|Description/subject:|| ||"...The people of Myanmar cannot wait until the next big disaster for their critical health needs to be recognized; both the government of Myanmar and the international community urgently need to act in order prevent thousands of unnecessary deaths..."...contains a 6-minute podcast: "MSF Frontline Reports - Myanmar Cyclone Emergency II
May 2008" and a slide show:
"A Preventable Fate: The Failure of HIV/AIDS Treatment in Myanmar...
Thousands of people are needlessly dying due to a severe lack of lifesaving HIV/AIDS treatment in Myanmar. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the government of Myanmar and international organizations urgently and rapidly scale-up the provision of antiretroviral therapy (ART)."|
|Source/publisher:|| ||"Top ten humanitarian crises of 2008" Medecins Sans Frontieres (Doctors without Borders)|
|Alternate URLs:|| ||http://www.doctorswithoutborders.org/news/allcontent.cfm?id=52|
|Date of entry/update:|| ||26 October 2010|
|Title:|| ||An unnatural disaster in Burma
|Date of publication:|| ||02 December 2008|
|Description/subject:|| ||"IN THE FIELD of disaster relief studies it is a truism that the first responders, whether in an earthquake or a
cyclone, are generally ordinary people in the affected area who have survived. They are the first to start
digging out the rubble or tending the wounded. Civilian volunteers are the backbone of the later phases of
emergency responses too - people who bring food and water, volunteer at shelters, give what they can. Only
in a system as profoundly inhumane as Burma would such good Samaritans be punished for their
compassion. But that is precisely what happened last week..."|
|Author/creator:|| ||Chris Beyrer and Frank Donaghue|
|Source/publisher:|| ||"The Boston Globe"|
|Format/size:|| ||pdf (24K)|
|Date of entry/update:|| ||28 February 2009|
|Title:|| ||A preventable fate: The failure of ART scale-up in Myanmar
|Date of publication:|| ||November 2008|
|Description/subject:|| ||Executive Summary: The situation for many people living with HIV in Myanmar is critical due to a severe lack of lifesaving antiretroviral treatment (ART). MSF currently provides ART to more than 11,000 people. That is the majority of all available treatment countrywide but only a small fraction of what is urgently needed. For five years MSF has continually developed its HIV/AIDS programme to respond to the extensive needs, whilst the response of both the Government of Myanmar and the international community has remained minimal. MSF should not bear the main responsibility for one of Asia’s most serious HIV/AIDS epidemics. Pushed to its limit by the lack of other services providing ART, MSF has had to make the painful
decision to restrict the number of new patients it can treat. With few options to refer new patients for treatment elsewhere, the situation is dire.
An estimated 240,000 people are currently infected with HIV in Myanmar. 76,000 of these people are in urgent need of ART, yet less than 20 % of them receive it through the combined efforts of MSF, other international non-governmental organizations (NGOs) and the Government of Myanmar.
For the remaining people the private market offers little assistance as the most commonly used first-line treatment costs the equivalent of a month’s average wage. The lack of accessible treatment resulted in 25,000 AIDS related deaths in 2007 and a similar number of people are expected to suffer the same fate this year, unless HIV/AIDS services - most importantly the provision of ART - are urgently scaled-up.
The Government of Myanmar and the International Community need to mobilize quickly in order to address this situation. Currently,
the Government spends a mere 0.3% of the gross domestic product on health, the lowest amount worldwide4, a small portion of which goes to HIV/AIDS. Likewise, overseas development aid for Myanmar is the second lowest per capita worldwide and few of the big international donors provide any resources to the country. Yet, 189 member states of the United Nations, including
Myanmar, endorsed the Millennium Development Goals, including the aim to “Achieve universal access to treatment for HIV/AIDS for all those who need it, by 2010”. As it stands, this remains a far cry from becoming a reality in Myanmar. As an MSF ART patient in Myanmar stated, “All people must have a spirit of humanity in helping HIV patients regardless of nation, organization or government. We are all human beings so we must help each other”. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises,
MSF insists that the Government of Myanmar and international organizations
urgently and rapidly scale-up ART provision. A vast gulf exists between the needs related to HIV/AIDS and the services provided. Unless ART provision is rapidly scaled-up many more people will needlessly suffer and die.|
|Source/publisher:|| ||Medecins Sans Frontieres (MSF)|
|Format/size:|| ||pdf (735K)|
|Date of entry/update:|| ||27 November 2008|
|Title:|| ||Exploitative governance under SPDC and DKBA authorities in Dooplaya District
|Date of publication:|| ||11 July 2008|
|Description/subject:|| ||"With largely consolidated control over Dooplaya District in southern Karen State the SPDC and DKBA, as the two dominant (and allied) military forces, operate under a system of coexistence. The local civilian population, in turn, faces exploitative governance on two fronts as both SPDC and DKBA soldiers seek to extract money, labour, food and other supplies from them. Enforcing heavy movement restrictions on top of persistent exploitative demands, local communities are facing deteriorating livelihood opportunities, increasing poverty, and a constriction of educational and health care opportunities. Persistent human rights abuses thus foster the economic pressures fuelling the continuing migration of rural communities in Dooplaya District to refugee camps in Thailand and towards livelihood opportunities at urban centres in Burma and Thailand. This report examines the situation of abuse in Dooplaya District from January to June 2008..."|
|Source/publisher:|| ||Karen Human Rights Group Field Reports (KHRG #2008-F8)|
|Format/size:|| ||html, pdf (666 KB)|
|Alternate URLs:|| ||http://www.khrg.org/sites/default/files/khrg08f8.pdf|
|Date of entry/update:|| ||01 November 2009|
|Title:|| ||Health security among internally displaced and vulnerable populations in eastern Burma
|Date of publication:|| ||January 2008|
"Continued conflict and consistent human rights violations have increased
mortality rates and worsened the health status of IDPs and other vulnerable
populations in Burma. Collaboration with and partnerships among border-based
health organisations have proved to be viable solutions towards providing
primary health care to these vulnerable populations, and should be a focus for
the international public health community. Without an end to human rights
violations in Burma, however, any improvements in health status are unlikely
to be sustained".|
|Author/creator:|| ||Mahn Mahn, Katherine C. Teela, Catherine I. Lee and Cara O’Connor|
|Source/publisher:|| ||2007 Myanmar/Burma Update Conference via Australian National University|
|Format/size:|| ||pdf (229K)|
|Alternate URLs:|| ||http://epress.anu.edu.au/myanmar02/pdf_instructions.html
|Date of entry/update:|| ||30 December 2008|
|Title:|| ||Borderline Health
|Date of publication:|| ||2008|
|Description/subject:|| ||As a "slow-motion genocide" envelops ethnic minorities in eastern Burma, health workers rely on innovative strategies and raw courage to save the lives of mothers and infants.|
|Author/creator:|| ||Cathy Shufro|
|Source/publisher:|| ||"Johns Hopkins Public Health" Online Edition, FAll 2008|
|Date of entry/update:|| ||21 December 2008|
|Title:|| ||MSF material on Burma/Myanmar (2008)
|Date of publication:|| ||2008|
|Description/subject:|| ||Collection of MSF public documents, 2008, largely on the aftermath of Cyclone Nargis: "A Preventable Fate: The Failure of ART Scale-Up in Myanmar"..."Myanmar: Urgent Lack of HIV/AIDS Treatment Threatens Thousands"..."Myanmar: Three Months after Cyclone Nargis, MSF Still Providing Assistance"..."Irrawaddy Delta, Myanmar: Survivors Living in Dire Conditions"..."Myanmar: Two Months After Cyclone Nargis, Needs Remain Critical"..."Myanmar: Critical Needs Remain for a Traumatized People"..."One Month After Cyclone Nargis Struck Myanmar, Survivors Still Living in Dire Conditions"..."After Cyclone Enormous Needs Unmet in Myanmar"..."Myanmar: MSF Operations in Cyclone-Hit Areas"..."Doctors Without Borders Calls For Immediate and Unobstructed Escalation of Myanmar Relief Operations"..."First MSF Relief Plane Arrives in Myanmar (Burma)"..."Doctors Without Borders Cargo Plane Arrives in Myanmar"..."MSF Dispatches Three Cargo Planes with 110 Tons of Relief Materials to Myanmar (Burma)"..."Cyclone in Myanmar (Burma): MSF teams intensify emergency response, a first relief plane is due to land in Yangon"..."Emergency Update: Doctors Without Borders/Médecins Sans Frontières (MSF) Activities in Myanmar"... "People tell stories of spending the night of the cyclone hanging onto trees all night long"..."Myanmar Cyclone: MSF Teams Bring Immediate Assistance While Additional Staff and Relief Materials are Ready to be Sent ...MSF Response to Aid Myanmar Cyclone Victims"..."Doctors Without Borders Releases Tenth Annual "Top Ten" Most Underreported Humanitarian Stories of 2007"..."Top Ten" Most Underreported Humanitarian Stories of 2007"..."People in Southeast Asia Needlessly Becoming Blind Due to a Neglected Virus"..."Myanmar Refugees in Bangladesh: Nowhere to Go"..."Dr. Hervé Isambert, MSF program manager
Prevented from working, the French Section of MSF leaves Myanmar"..."Prevented From Working, the French Section of MSF Leaves Myanmar (Burma)"..."EMERGENCY UPDATE: Aid Operations to Disaster Areas in South Asia"..."Frank Smithuis, MD:
"Impatience is the most important thing""|
|Source/publisher:|| ||Medicins Sans Frontieres (Doctors Withour Borders)|
|Date of entry/update:|| ||22 December 2008|
|Title:|| ||Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma
|Date of publication:|| ||September 2007|
|Description/subject:|| ||Background: Case reports of human rights violations have focused on individuals’ experiences. Populationbased
quantification of associations between rights indicators and health outcomes is rare and has not been
documented in eastern Burma...
Objective: We describe the association between mortality and morbidity and the household-level experience
of human rights violations among internally displaced persons in eastern Burma...
Methods: Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household
surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children,
malaria parasitaemia status of respondents and household experience of various human rights violations
during the previous 12 months...
Results: Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost onethird
of households reported forced labour (32.6%). Forced displacement (8.9% of households) was
associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and
landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households)
was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82),
child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations
(14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate
ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased
more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations...
Conclusions: Widespread human rights violations in conflict zones in eastern Burma are associated with
significantly increased morbidity and mortality. Population-level associations can be quantified using
standard epidemiological methods. This approach requires further validation and refinement elsewhere.|
|Author/creator:|| ||Luke C Mullany, Adam K Richards, Catherine I Lee, Voravit Suwanvanichkij, Cynthia Maung, Mahn Mahn, Chris Beyrer and Thomas J Lee|
|Source/publisher:|| ||J. Epidemiol. Community Health 2007;61;908-914|
|Format/size:|| ||pdf (370K)|
|Date of entry/update:|| ||21 December 2008|
|Title:|| ||Chronic Emergency - Health and Human Rights in Eastern Burma
|Date of publication:|| ||07 September 2006|
|Description/subject:|| ||This link leads to a document containing the Table of Contents of the report, with links to the English, Burmese and Thai versions...
Executive Summary: "Disinvestment in health, coupled with widespread poverty, corruption, and the dearth of skilled personnel have resulted in the collapse of Burma’s health system. Today, Burma’s health indicators by official figures are among the worst in the region. However, information collected by the Back Pack Health Workers Team (BPHWT) on the eastern frontiers of the country, facing decades of civil war and widespread human rights abuses, indicate a far greater public health catastrophe in areas where official figures are not collected.
In these eastern areas of Burma, standard public health indicators such as population pyramids, infant mortality rates, child mortality rates, and maternal mortality ratios more closely resemble other countries facing widespread humanitarian disasters, such as Sierra Leone, the Democratic Republic of the Congo, Niger, Angola, and Cambodia shortly after the ouster of the Khmer Rouge. The most common cause of death continues to be malaria, with over 12% of the population at any given time infected with Plasmodium falciparum, the most dangerous form of malaria. One out of every twelve women in this area may lose her life around the time of childbirth, deaths that are largely preventable. Malnutrition is unacceptably common, with over 15% of children at any time with evidence of at least mild malnutrition, rates far higher than their counterparts who have fled to refugee camps in Thailand. Knowledge of sanitation and safe drinking water use remains low.
Human rights violations are very common in this population. Within the year prior, almost a third of households had suffered from forced labor, almost 10% forced displacement, and a quarter had had their food confiscated or destroyed. Approximately one out of every fifty households had suffered violence at the hands of soldiers, and one out of 140 households had a member injured by a landmine within the prior year alone. There also appear to be some regional variations in the patterns of human rights abuses. Internally displaced persons (IDPs) living in areas most solidly controlled by the SPDC and its allies, such as Karenni State and Pa’an District, faced more forced labor while those living in more contested areas, such as Nyaunglebin and Toungoo Districts, faced more forced relocation. Most other areas fall in between these two extremes. However, such patterns should be interpreted with caution, given that the BPHW survey was not designed to or powered to reliably detect these differences.
Using epidemiologic tools, several human rights abuses were found to be closely tied to adverse health outcomes. Families forced to flee within the preceding twelve months were 2.4 times more likely to have a child (under age 5) die than those who had not been forcibly displaced. Households forced to flee also were 3.1 times as likely to have malnourished children compared to those in more stable situations.
Food destruction and theft were also very closely tied to several adverse health consequences. Families which had suffered this abuse in the preceding twelve months were almost 50% more likely to suffer a death in the household. These households also were 4.6 times as likely to have a member suffer from a landmine injury, and 1.7 times as likely to have an adult member suffer from malaria, both likely tied to the need to forage in the jungle. Children of these households were 4.4 times as likely to suffer from malnutrition compared to households whose food supply had not been compromised.
For the most common abuse, forced labor, families that had suffered from this within the past year were 60% more likely to have a member suffer from diarrhea (within the two weeks prior to the survey), and more than twice as likely to have a member suffer from night blindness (a measure of vitamin A deficiency and thus malnutrition) compared to families free from this abuse.
Not only are many abuses linked statistically from field observations to adverse health consequences, they are yet another obstacle to accessing health care services already out of reach for the majority of IDP populations in the eastern conflict zones of Burma. This is especially clear with women’s reproductive health: forced displacement within the past year was associated with a 6.1 fold lower use of contraception. Given the high fertility rate of this population and the high prevalence of conditions such as malaria and malnutrition, the lack of access often is fatal, as reflected by the high maternal mortality ratio—as many as one in 12 women will die from pregnancy-related complications.
This report is the first to measure basic public health indicators and quantify the extent of human rights abuses at the population level amongst IDP communities living in the eastern conflict zones of Burma. These results indicate that the poor health status of these IDP communities is intricately and inexorably linked to the human rights context in which health outcomes are observed. Without addressing factors which drive ill health and excess morbidity and mortality in these populations, such as widespread human rights abuses and inability to access healthcare services, a long-term, sustainable improvement in the public health of these areas cannot occur..."|
|Language:|| ||English, Burmese, Thai|
|Source/publisher:|| ||Back Pack Health Worker Team|
|Format/size:|| ||pdf (1.8MB, 2.2MB - English; 1,2MB - Burmese; 1.6MB - Thai)|
|Alternate URLs:|| ||http://burmalibrary.org/docs3/ChronicEmergencyE-ocr.pdf
|Date of entry/update:|| ||06 December 2010|
|Title:|| ||Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma
|Date of publication:|| ||July 2006|
|Description/subject:|| ||Objectives: To estimate mortality rates for populations living in civil war zones in Karen, Karenni, and
Mon states of eastern Burma....
Methods: Indigenous mobile health workers providing care in conflict zones in Karen, Karenni, and
Mon areas of eastern Burma conducted cluster sample surveys interviewing heads of households during
3-month time periods in 2002 and 2003 to collect demographic and mortality data....
Results: In 2002 health workers completed 1290 household surveys comprising 7496 individuals. In
2003, 1609 households with 9083 members were surveyed. Estimates of vital statistics were as follows:
infant mortality rate: 135 (95% CI: 96–181) and 122 (95% CI: 70–175) per 1000 live births; under-five
mortality rate: 291 (95% CI: 238–348) and 276 (95% CI: 190–361) per 1000 live births; crude mortality
rate: 25 (95% CI: 21–29) and 21 (95% CI: 15–27) per 1000 persons per year....
Conclusions: Populations living in conflict zones in eastern Burma experience high mortality rates.
The use of indigenous mobile health workers provides one means of measuring health status among
populations that would normally be inaccessible due to ongoing conflict.....
Keywords: Burma, mortality, internally displaced persons, malaria, landmines, civil conflict|
|Author/creator:|| ||Thomas J. Lee, Luke C. Mullany, Adam K. Richards, Heather K. Kuiper, Cynthia Maung and Chris Beyrer|
|Source/publisher:|| ||"Tropical Medicine and International Health" Volume 11 no 7 pp 1119–1127 July 2006|
|Format/size:|| ||pdf (230K)|
|Date of entry/update:|| ||21 December 2008|