In the shadow of the census, a health crisis unfolds

By Fiona MacGregor

The Myanmar Times

April 3, 2014

In Sittwe, the number of preventable deaths grows by the day. Fiona MacGregor reports from the Te Chaung IDP camp.

Sunday: Mahmoud Thrakis, 5, died without medical care after suffering post-appendix operation complications.

Monday: Rusmai Ga, 1, died without medical care after contracting an infection and developing a fever.

Tuesday: Mahmad Farouk, 40, father of four, died without medical care from symptoms related to diabetes.

Three fewer people for enumerators to count when they arrived in the Thaechaung IDP camp on April 1 for the first census in Myanmar in 30 years. In the event, most people living in the camp on the outskirts of state capital Sittwe did not have their details recorded.

As the enumerators passed from house to house, refusing to collect information from anyone who identified themselves as being Rohingya, a humanitarian disaster was unfolding just inside the walls.

Speaking the day after his granddaughter Rusmai Ga died on March 31, Mahmoud Sayad explained the human tragedy now unfolding amid the event. He had taken the baby to Dapaing Hospital, a facility within the camp that had been overseen by INGOs until they were evacuated from the area last week following violent attacks, “but there was no one there”.

“There was no ICRC (International Committee of the Red Cross) and so we could not get a referral to take the baby to Sittwe State Hospital,” the 54-year-old camp resident said.

"If the situation continues in this way there will be no-one left alive because of lack of medical care."

For months foreign and local organisations had been warning the census would provoke ethnic tensions in regions across the country. Their predictions have proved devastatingly accurate in Rakhine state.

The region is the scene of conflicts between ethnic Rakhine and ae Muslim minority who call themselves "Rohingya". The government and most Rakhine insist they are "Bengali" – illegal immigrants from over the border in Bangladesh.

The months leading up to the census threats have brought threats against international aid workers and accusations of bias towards Muslim patients, and prompted all INGOs in the area to halt operations.

Now people are dying without access to medical care and looming food and water shortages have provoked warnings of an imminent humanitarian disaster. The three in Thaechaung are just some of those who have passed away in the days since international aid organisations stopped providing hospital referrals and bringing in medical supplies.

When Médecins Sans Frontières was ordered to cease operations in Rakhine on February 28 – ending the provision of vital medical care to about 140,000 Muslim IDPs as well as Rakhine living in remote areas of the state – there were warnings hat thousands of lives would be endangered.

State officials told The Myanmar Times that the MSF ban had been issued because of fears its presence would stoke tensions around census time.

They said local health authorities would be able to meet the gap left by the organisation’s departure. The claim was disputed by international aid agencies, and even state health leaders at the time of the ban acknowledged it would pose a challenge.

A month later, all other INGOs in Rakhine were forced to cease operations and evacuate their staff after mob violence broke out on March 26 and 27 when an INGO staff member allegedly mishandled a Buddhist flag that was erected as part of an anti-census protest by Rakhine hardliners.

With no international health support left at all, an already precarious situation has worsened.

State health leaders said they are trying to find ways to get the most seriously ill residents of IDP camps to hospital now the ICRC is unable to facilitate referrals. In the camps around Sittwe, however, their efforts will come too late for many.

Mahmad Farouk, 40, died on April 1 of complications arising from diabetes. His wife and the mother of his four young children, Husana Begum, 33, can hardly speak through her tears.

"I am very sad because my husband did not get any medication," she said as she looked at his body, wrapped in cloth, on the wooden floor of their home.

"There was no ICRC. If my husband had got to Sittwe [Hospital] he would still be alive. I do not know what will happen to me and my four children now."

U Aye Nyein, head of the Rakhine State Health Department, told The Myanmar Times that it was unclear when INGOs, including MSF, would return.

"We had been working on a handover with MSF and during those discussions the union minister had a meeting with the president of MSF in which there were discussions [about MSF resuming work] ... starting after the water festival.

"But that was before the crisis,” he said, referring to the recent anti-INGO violence.

U Aye Nyein described a series of innovative emergency measures being established to try and arrange urgent hospital evacuations for people in the camps. On April 2, The Myanmar Times spoke to staff from the Myanmar Health Assistant Association as they brought tuberculosis medicine into the camp in collaboration with the Ministry of Health.

However, U Aye Nyein said most local state health workers were too scared to enter the camps, which made it hard for the government to provide assistance.

Asked about the timing of the census, U Aye Nyein, who is a member of the Rakhine State Census Advisory Committee, said, "The census is for the whole country, but for my state Rakhine then maybe it was the wrong time."

And the situation looks set to worsen. On April 2 international humanitarian organisations who had been working in the camps warned of an impending humanitarian disaster and said some IDP areas had sufficient drinking water for only the next 10 days. Food supplies were expected to run out within a fortnight.

At Baw De Baw 2 IDP camp outside Sittwe, camp residents who gathered on April 2 in the shade of a teashop said food was already running out. Rations were last delivered on March 16 and more supplies should have arrived on March 30 but there were no INGO workers to deliver it. Among them was Ali, 28.

"We have very little left, food, medicine, soap for keeping things clean,” said Ali, 28. “We need everything.”