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Health and internal displacement/forced migration

Websites/Multiple Documents

Title: Back Pack Health Worker Team (BPHWT) home page
Description/subject: Mission Statement: "The Back Pack Health Worker Team (BPHWT) is an independent, nonprofit, multi-ethnic organization dedicated to providing primary health care to ethnic groups and vulnerable populations in armed conflict and rural areas of Burma, where access to healthcare is otherwise unavailable. Furthermore, by equipping communities with the skills and knowledge necessary to manage their own health issues, the Back Pack Health Worker Team is dedicated to the long-term, sustainable development of a healthy society in Burma. To accomplish its mission, BPHWT utilizes mobile health teams to provide a range of primary medical care, maternal and child health services, and community health education and prevention programs to internally displaced and vulnerable populations in Burma."..... Emergency Assistance Team; Services; Reports and Publications; About Us; Partners; Contact Us; Links... How to Help: Volunteer; Wish List; Donations Download Videos
Language: English
Source/publisher: Back Pack Health Worker Team (BPHWT)
Format/size: html
Date of entry/update: 01 November 2010

Title: Back Pack Health Worker Team (BPHWT) Reports and Publications
Description/subject: Annual and mid-term reports from 2002; 10-year report (1998-2009); special reports; proposals (2010, 2011) survey (2011)
Language: English, Burmese, Thai
Source/publisher: Back Pack Health Worker Team ( BPHWT)
Format/size: htmlk, pdf
Alternate URLs: http://www.backpackteam.org/?page_id=208
Date of entry/update: 05 September 2011

Individual Documents

Title: Situation Update: Conflict and Displacement in Burma’s Border Areas 31st August 2011
Date of publication: 31 August 2011
Description/subject: "Armed conflict in Burma’s Karen, Shan and Kachin States continues to fuel large‐scale displacement of civilians both internally and into neighbouring countries. Between 5,000 and 7,000 civilians remain in temporary, unofficial sites along the Thai‐Burma border in Thailand's Tak Province; approximately 20,000 remain internally‐displaced in Kachin State along the border with China; and thousands have been forced to flee their homes in Shan State due to ongoing armed conflict. Community‐based groups continue in their efforts to provide assistance to these populations, who have no access to international protection mechanisms, and little or no assistance from international humanitarian organisations. The shortage of funding to such community‐based aid networks is a serious cause for concern, particularly with a high likelihood of further fighting resulting in more displacement. There is an urgent need for protection mechanisms and humanitarian assistance for civilians fleeing conflict and human rights abuses in Burma..."
Language: English
Source/publisher: Back Pack Health Worker Team
Format/size: pdf (360K)
Alternate URLs: http://www.backpackteam.org/wp-content/uploads/2011/09/BPHWT%20Border%20Situation%20Update_%20July-...
Date of entry/update: 05 September 2011

Title: Provision of Primary Health Care among Internally Displaced Persons and Vulnerable Populations of Burma - BPHWT 2010 Annual Report:
Date of publication: 10 June 2011
Description/subject: 1) Executive Summary Over sixty years of civil war in Burma have resulted in the displacement of hundreds of thousands of people. These people have fled their homes, been obliged to go into hiding for their own safety and have faced forced relocation. Compounding the loss of homes and security is a lack of basic human rights, including the right to health. People living along the country’s borders as well as inside ethnic nationalities’ areas have been severely affected. The Back Pack Health Worker Team (BPHWT) has been providing primary health care for over ten years in the conflict and rural areas of Burma, where access to healthcare is otherwise unavailable. The BPHWT provides a range of medical care, community health education and prevention, and maternal and child healthcare services to internally displaced persons (IDPs) and other vulnerable community members in Burma. Doctors and health workers from Karen, Karenni, and Mon States established the BPHWT in 1998. The organization initially included 32 teams, comprising 120 health workers. Over the years and in response to increasing demand, the number of teams has gradually increased. In 2010, the BPHWT included 81 teams, with each team being comprised of 3 to 5 health workers. BPHWT teams now target displaced and vulnerable communities with no other access to healthcare in Karen, Karenni, Mon, Arakan, Kachin, and Shan States, and the Tenasserim Division. The teams deliver a range of health care programs to a target population of 180,000 IDPs and other vulnerable people. The BPHWT aims to equip people with the skills and knowledge necessary to manage and address their own health problems, while working towards long-term sustainable development with respect to community healthcare. In 2010, the BPHWT continued to work with communities in its target areas to implement its three health programs, namely Medical Care Program, Mother and Child Healthcare Program and Community Health Education and Prevention Program. Three new Back Pack teams were created in Kachin, Shan-Kayah and Palaung areas to serve communities with no other access to healthcare. BPHWT also worked in collaboration with Burma Medical Association, National Health and Education Committee and ethnic health organizations serving the Karen, Karenni, Mon, Shan and Palaung communities to plan, design and implement a health and human rights survey in eastern Burma; the results of this survey were published in October 2010 in the report entitled Diagnosis: Critical - Health and Human Rights in Eastern Burma. Displaced Mother with a Child 2010 4 The BPHWT’s Ten Years Report 1998-2009, detailing the BPHWT’s programs and organizational development from 1998 through 2009, was also published in 2010. The BPHWT continued to conduct its regular monitoring and evaluation activities throughout 2010. In addition, BPHWT workers were given technical support by the Global Health Access Program (GHAP) to implement an Impact Assessment Survey so as to evaluate the outcomes of the BPHWT’s three health programs in target communities. The results of this survey will be published in 2011. At the March 2010 Donors’ Meeting, it was decided that an external evaluation would be conducted, in order to assess the BPHWT’s programs and management structure. A consultant was recruited and is currently conducting consultations with target communities, partner organizations and BPHWT medics, staff and Leading Group. The results of this evaluation will be published in 2011. After the November 2010 elections in Burma, increased armed conflict and conflictrelated abuses in areas of Karen State opposite Thailand’s Kanchanaburi, Tak and Mae Hong Song Provinces drove large displacement of populations, both inside Karen State and into Thailand. On the Thai side of the border, the pattern of civilian influxes evolved. The first large battles in November led to larger influxes of Burmese civilians openly fleeing into Thailand, where they were provided with temporary shelter in sites recognised by Thai authorities. But by the end of December, Thai authorities had shut down the last of the temporary shelter sites and the community network, under the overall coordination of the Mae Tao Clinic, was supporting a total of 9852 newly-displaced people - comprised of 2039 households with 7867 men and 3779 women. Out of these 9852 displaced people, there were 5212 children under five years of age among the newly-displaced people in hiding sites along the Thai-Burma border areas. Since the escalations in armed conflict and displacement in the aftermath of Burma’s elections, the Back Pack Health Worker Team has worked with the network of community organizations providing assistance to civilians displaced by ongoing conflict and human rights abuses along the Thai-Burma border. Inside Karen State, eight teams of Back Pack Health Workers were deployed to provide health services to civilians affected by the increases in conflict and conflict-related abuses. The BPHWT also set up a number of borderline mobile Out- Patient Department (OPD) clinics, to provide health care and assistance to displaced civilians hiding along the Thai-Burma border. Each borderline mobile OPD clinic was staffed by three to five experienced BPHWT medics and supplied with the medicines and equipment needed for the Displaced Mother and Children 5 provision of healthcare to the displaced civilians. On the Thai side of the border, BPHWT has worked as part of the community based Emergency Relief Team (ERT) providing assistance to thousands of newly displaced civilians in unofficial or hiding sites. BPHWT health workers worked with the Mae Tao Clinic and Burma Medical Association as part of the health team, providing medical assistance to civilians in hiding along the Thai-Burma border, particularly to those more vulnerable such as pregnant women, children and the elderly
Language: English
Source/publisher: Back Pack Health Worker Team ( BPHWT)
Format/size: pdf (1.8MB - OBL version; 2.6MB - original)
Alternate URLs: http://www.backpackteam.org/wp-content/uploads/2011/07/BPHWT%202010%20Annual%20report%20final%20upd...
Date of entry/update: 05 September 2011

Title: Life, Liberty and the Pursuit of Health - BPHWT 10-year report - A decade of providing primary health care in Burma's displaced and vulnerable communities
Date of publication: January 2011
Description/subject: Preface: "Ten years ago, health workers from the Mon, Karen, and Karenni States in Burma came together as the Back Pack Health Worker Team (BPHWT) in partnership with the Mae Tao Clinic in Mae Sot, Thailand. The need for mobile healthcare services grew out of increasing military attacks against civilians in eastern Burma in the late 1990s, coupled with a lack of local, official healthcare. These circumstances prevented a large proportion of the population from receiving basic primary and preventative healthcare services. Since 1998, BPHWT has stayed true to its founding mission: to equip internally displaced persons with enough knowledge and skills that they are able to address the health problems of their own communities and work towards the development of a sustainable health infrastructure. The Back Pack Health Worker Team established key principles that have guided our work since the inception of the organization: to provide healthcare services to all, regardless of ethnic group, age, gender, religion, or political affiliation; to focus on communities where access to primary and preventive healthcare services is severely limited; to collaborate with local organizations and communities; to improve health through a multi-sectorial development and integration approach; and, to foster inter-ethnic unity and trust, thereby promoting democracy in Burma. Over the past ten years, BPHWT has expanded from 32 teams serving 64,000 people in the eastern border region of Burma to 80 teams serving over 187,000 people in eastern and western Burma. Over time, the scope of BPHWT’s services and programs has expanded as well. BPHWT has trained more than 1,300 multi-ethnic health workers who are currently living and working in their communities in Burma, providing primary and preventive healthcare services and enabling communities to address and prevent health problems. As BPHWT has grown, so has our reputation, and we have gained support and assistance from an expanding base of local and international health and education professionals and donors. As BPHWT looks towards the next ten years, we will continue to focus on strengthening and expanding our community-based primary healthcare system in Burma. Whether the future brings continued conflict or peace and democracy. BPHWT remains committed to our community-based approach, aimed at empowering local populations and bringing ethnic groups together in the name of improving health for all."
Language: English
Source/publisher: Back Pack Health Worker Team
Format/size: pdf (2.8MB - OBL vertion; 3.7MB - original)
Alternate URLs: http://www.backpackteam.org/wp-content/uploads/2011/01/bp%20report%20online.pdf
Date of entry/update: 05 September 2011

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 figure. 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 new constitution. 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 labor. 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: Living conditions for displaced villagers and ongoing abuses in Tenasserim Division
Date of publication: 29 October 2009
Description/subject: "Villagers in SPDC-controlled parts of Tenasserim Division, including 60 villages forced to move to government relocation sites in 1996, continue to face abuses including movement restrictions, forced labour and arbitrary demands for 'taxation' and other payments. In response, thousands of villagers continue to evade SPDC control in upland jungle areas. These villagers report that they are pursued by Burma Army patrols, which shoot them on sight, plant landmines and destroy paddy fields and food stores. This report primarily draws on information from September 2009. Because KHRG has not released a field report on the region since 2001, this report also includes quotes and photographs from research dating back to 2007..."
Language: English
Source/publisher: Karen Human Rights Group Field Reports (KHRG #2009-F19)
Format/size: html, pdf (473K)
Alternate URLs: http://www.khrg.org/sites/default/files/khrg09f19.pdf
Date of entry/update: 11 November 2009

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
Language: English
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