9. Rights to Education and Health
“Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care.”
- Article 25 of the Universal Declaration of Human Rights
Burma has one of the poorest health records and lowest standards of living in the developing world. Health and education are given incredibly low priorities in the national budget, and lip-service to these issues often takes the place of substantial reforms or programs. The root causes of problems in these arenas, such as the affects of landmines and forced labor on health and the effect of school closings and censorship on education, are not dealt with in meaningful ways because of political considerations. Low salaries and lack of transparent and effective supervision has made it easy for corruption to flourish among medical personnel and educators. Patients more often than not have to pay a bribe to be seen by a doctor, get a bed in a hospital or receive essential medicine. Primary school students can pay to receive better grades or get private tutoring from their teachers. Higher education in Burma is particularly substandard with students, during those times that the universities are actually open, being given rush degrees in order to prevent any political opposition to the military regime from springing up on college campuses.
The political situation in Burma has a direct impact on the poor quality of education and healthcare available to the general public. The level of access a person has to health and education infrastructure depends on economic level, geographical location and individual, family or ethnic group relations with the military regime. For example, a Burmese military officer and his family living in Rangoon have access to education and medical treatment that are unavailable to a family that is part of an ethnic and religious minority group living in a conflict area on the border. As yet, the military regime has been unwilling to address these inequalities to ensure that all people living in Burma, regardless of their ethnic group, religion, political affiliation, economic status or geographical location have access to adequate health care and education. (For more information about the health and education situations of specific populations such as refugees, women, children, political prisoners and IDPs, please see appropriate chapters).
Government Spending on Health and Education
An August 2002 report by Nonviolence International, Myanmar’s Expenditures on the Military, Health and Education, states that: "Myanmar’s military expansion comes at the cost of ordinary people’s health and education." According to this report, Burma has the highest rate of military expenditure, in comparison to health and education spending, of any other ASEAN nation.
Since 1988, the SPDC has focused the majority of the country’s resources on increasing the size of its standing army and equipping troops with advanced weaponry. In recent years the number of soldiers in the Burmese army has increased 242 percent, from 186 000 in 1988 to 450 000 in 1999. This figure gives Burma the highest per-capita number of soldiers in the world. The SPDC’s expenditure on military development has come at a high cost for civilians and the current state of government health and education infrastructure in Burma clearly reflects government spending priorities. (Source: Nonviolence International, for full report see www.nonviolenceinternational.net) The most recent statistics available in 2002 cited the SPDC’s expenditures on health and education as equivalent to less than 1% of the national GDP. Total government spending on health has declined by more than 70% since 1990. In recent years government expenditure on public health has been cut even more dramatically than spending on education and in 1998-99 the SPDC’s health budget was equal to only 0.3 % of GDP. (Source: Country Reports on Human Rights Practices - 2002, Bureau of Democracy, Human Rights, and Labor, US State Department)
The Asian Development Bank’s April 2002 report, Outlook 2002, Economic Trends and Prospects in Developing Asia, analyzes the current economic and humanitarian situation inside Burma stating: "In a context where there is so much that now needs to be done, it is difficult to prioritize. Nevertheless, deficits in the provision of basic education and health services stand out. In terms of the public sector budget, each receives less than 0.5% of GDP in terms of recurrent and capital expenditures. Yet from the perspective of promoting both durable and equitable growth, international experience attests that investments in these sectors are crucial. A realignment of priorities in this direction, combined with policies that promote the liberalization of agriculture, could do much to help reduce poverty."
9.2 Situation of Education
"A good education system is necessary for the long-term development of a country and we all are responsible to work for the improvement of the education system."
(Daw Aung San Suu Kyi, speech given on National Day, November 2002)
"The State shall pay special attention to the young and promote their education."
Section 34, Chapter IV of the 1947 Constitution
Education in Burma has been severely impacted by more than four decades of military rule. The military regime views potentially politically active university and high school students as one of the biggest threats to their grip on power, so all-non military education is treated as expendable. All civilian schools and universities throughout Burma suffer from a lack of resources and qualified educators, a problem found in many developing countries, however, unique to Burma is the fact that the ruling government actively tries to thwart universal and advanced higher education.
In order to receive higher education in Burma several conditions must first be in place: the student must not be politically active or have politically active family members; the universities must be open and the student must be from a social and economic group and have an educational background that makes higher education feasible. When these conditions are met, a student then faces a university system where teaching materials and classroom topics are heavily censored, group activities are restricted and freedom of thought is generally hindered. Students are then rushed through courses that focus on memorization rather than critical thinking and upon graduation are ill-equipped to find quality employment. (See chapter on children for information on primary education)
A January 2002 report by Images Asia gives the following information on adult, and specifically women’s, illiteracy:
"The 1983 census is the most widely quoted source of demographic information, and its figures for illiteracy, in the absence of others, continue to be used by many UN agencies. At the time the census was conducted, the measured literacy rate for men was 82% and for women 71.3%. However, it is not known to what degree these figures accurately reflected the situation in rural areas, since many areas had been excluded from assessment for decades by poor infrastructure and civil war. As the education system has deteriorated over the past 16 years since this survey was taken, it is likely that these figures do not reflect present levels of literacy. UNICEF estimated in 1995 that overall literacy had dropped to about 55%, and reiterated a figure of between 50 to 60% in its 1999 "Situation Analysis," on the basis of the "significant proportion of adults who claim they have never been to school."
All figures appear to conceal significant variations not only between the sexes but also between different areas of the country. The 1983 census shows male to female literacy rates of 86%: 77% in the predominantly Burman divisions, compared to 65% : 50% in the predominantly ethnic states. Community leaders in some border areas, where there is very little data available, have estimated a female illiteracy rate as high as 80%. Surveys conducted in the mid- 1990s in refugee camps along the Thai-Burmese border showed that less than 50% of Mon women between the ages of 20 and 30 were literate and that 50 to 60% of Karenni women in all age groups were literate. Among both these ethnic groups, rates of literacy generally decreased with age, evidence that more young women are gaining access to education with time, a reason for cautious optimism. However, in both ethnic groups and among all age categories, male literacy remained notably higher than female, usually by 10% or more. Surveys conducted in Karen refugee camps during the same period showed similar results to those of the Karenni, with average literacy rates among women 20 to 40 years of age slightly over 60%, while men in the same age groups averaged nearly 75%. These studies also indicated that women’s illiteracy inhibited their access to non-formal education, including various kinds of training offered in the camps.
According to the women we interviewed, illiteracy in Burmese is prevalent in areas of Burma where ethnic languages are more commonly used, particularly among women who rarely leave their villages. Since teaching of ethnic languages is discouraged in many areas, for students, learning to read and write Burmese often means studying a second or third language. Even literacy in women’s mother tongues often is not perceived to be important in farming communities where it is does not always serve any immediate purpose in terms of vocation or life skills.
The most common reasons behind high illiteracy rates among women are non attendance and drop out. Government attendance surveys in 1991 showed that one third of the population overall had not completed any standard of schooling and only 7% had completed 9th or 10th standards, with much lower attainment for women than men. Again, significant differences were recorded between urban and rural areas. Almost 77% of women in urban areas attended school compared with less than 56% of rural women." (Source: Belak, Brenda, Gathering Strength Women from Burma on Their Rights. Images Asia, January 2002)
High School Education
According to government statistics, as of August 2002 there were a total of 42,000 basic education high schools in the country as a whole, which served over 7 million students. Beginning in 2001-2002 the SPDC announced plans to initiate a six-phase 30 year long plan to improve education. The goals of this plan are to rapidly improve human resources to the meet the needs of the current knowledge age. (Source: "More school-age children in school in Myanmar," Xinhua, August 7, 2002)
However in January 2002 Images Asia released a report stating that in actuality there are fewer than 1,600 high schools in the country, and these are disproportionately concentrated in urban areas. Most of these schools are overcrowded and many reportedly lack even basic materials and furnishings. In some areas, communities cooperate to build their own schools and parents contribute to pay teachers a small salary or else provide them with basic food and accommodation. In border areas, some opposition groups have established their own high schools, however these schools almost always suffer from a lack of funding and other resources. (Source: (Belak, Brenda, Gathering Strength Women from Burma on Their Rights. Images Asia, January 2002)
In addition, ongoing armed conflict in border areas frequently interrupts students’ education and a number of high school age male students join armed groups instead of attending school.
While education is more accessible to students in urban areas, high schools in cities also suffer from a lack of educational resources. For example, most high schools do not have enough textbooks for all the students, so for each course students have to draw lots to see who will get a copy of the textbook. Those students who do not receive a textbook have to either copy or buy another textbook.
Students also suffer from the lack of qualified teachers. In 2000, the SPDC’s education research department released statistics showing that 60,843 primary school teachers and 49,920 secondary-level school teachers had been unable to receive teacher training. These figures however include only those teachers who are directly appointed by government authorities. In many schools there is an extreme shortage of teachers which forces local education officials and school administrators to hire additional teachers using school funds or money collected from local residents. Many of these teachers, especially those teaching at the high school level lack training and qualification. Thus government statistics about the number of teachers who have not received training are likely to understate the problem.
Students are also constrained by rigid and outdated teaching methods employed within the classroom. In Burma learning is not student centered and students are expected to learn by attending lectures and memorizing facts. Students are not encouraged to participate in discussions, to critique material, or to offer their own knowledge and experiences during classes. This teaching style directly correlates with the current political structure, where people are prohibited from openly criticizing or questioning government officials or anyone of higher rank or status. (For information on academic freedom see chapter on Freedom of Opinion, Expression, and the Press).
Students and their parents also face a large financial burden when they are forced to pay for private tuition classes to supplement what they learn in the classroom. High School teachers in Burma make only 5,000- 6,000 kyat per month, which is not enough to live on. In order to supplement their government salaries, most teachers are forced to teach private classes after school hours. Increasingly students report that teachers intentionally leave out information they need to pass state exams from the classroom lectures, forcing students to attend tuition classes if they want to pass the course. In addition, many teachers reportedly favor those students who attend their tutorials outside the classroom and are more likely to give them better grades. High school students reportedly pay from
3000 - 20,000 Kyats per month for private tuition classes.
Due to the deteriorating levels of education available at government schools, students and parents are increasingly turning to other educational options when these are available. In Arakan State, a large number of students are reportedly leaving government schools to enroll in schools run by Buddhist monasteries. Many people in this area believe that monastic education is better quality and less expensive than education at state-run schools. In March 2002, Narinjara News reported that there were approximately 500 students enrolled in just one monastery in Sittwe, the capital of Arakan State. (Source: Narinjara)
In urban areas, private schools, which include a student hostel, are also becoming more common. Students attending these schools register with public schools to sit for nation-wide examinations, but take all their classes at private facilities. However these schools are too expensive for most high school students and their parents. In Rangoon, a year of private school tuition costs from 500,000 - 900,000 Kyats. In 2001 the SPDC announced that students could not sit for their high school matriculation exams if they did not attend a government school. This move was a conscious effort to undermine the growing popularity of non-government educational options for high school. (Source: Education Report 2002, Foreign Affairs Committee-All Burma Federation of Student Unions. May 2003)
Only a small percentage of people in Burma are able to continue their education past high school. The majority of students are unable to pursue higher education for economic reasons. In order to support their families, many students have to quit school to take jobs that don’t require a high education level, sometimes migrating to other countries where there are more employment opportunities. Other people cannot attend universities because they have fled their homes or been imprisoned for political activities. According to a 2002 report by Images Asia, "Extrapolating from 1991 figures, there are currently approximately 10.5 million people between the ages of 15 and 24. Figures from the Ministry of the National Public Education Department in 1997-98 indicated that of these, there were a total of only 374,112 students at the country’s 53 post-secondary institutions." (Source: Belak, Brenda, Gathering Strength Women from Burma on Their Rights. Images Asia, January 2002)
Those students who have attempted to continue, or begin, university studies, have faced numerous obstacles in obtaining a quality education, including frequent school closures and low standards for materials, facilities and educators.
The erratic nature of civilian higher education in Burma since 1988 has deprived a generation of young people of the chance for quality higher education. In the 8 years between the military coup in 1988 and the December 1996 student uprising universities and colleges in Burma were open for only a total of 30 months. In August 1998 the SPDC allowed universities to open for one month and students were called to take examinations. Following this however, universities remained closed until June 2000. When the universities were finally reopened, students whose education had been interrupted when schools shut in 1996 were allowed to return and take entrance exams. Only an estimated 25,000 to 60,000 new students were permitted to enroll, out of the more than 400,000 students who had matriculated from high school since the closures in December 1996.
When the universities reopened in 2000, the SPDC instituted key changes to minimize possibilities for students to engage in political activities on campus. In the new curriculums, one year’s course content was packed in to 3 months and 2/3 of the available courses were offered by mail. Before students could enroll they had to take an oath that they would not become involved in political activities or join any political parties. Many students refused to agree to these terms, and only 1/3 of previously enrolled students were allowed to re-enroll in 2000. Those students who were permitted to enroll found that they were not allowed to choose which campus they would attend, but instead were assigned to one by government authorities.
The military government also went to the extra expense of building university facilities on the outskirts of major cities near military barracks in order to stop students from gathering and protesting. The main campuses of Rangoon University and Rangoon Institute of Technology, which had been centers of student protest in the past, were moved 20 kilometers outside of Rangoon. Students from the provinces were being spread out among the new universities in order to prevent a concentration of students. The distance of the campuses prevented some students from attending classes regularly because they couldn’t afford transportation. In light of the restrictions placed on higher education, in 2001 the United Nations Commission on Human Rights stated:
"[The UN Commission on Human Rights welcomes] the reopening of some university courses, but remains concerned that the right to education continues to be a right that is only exercised by those willing to refrain from exercising their civil and political rights and concerned at the reduction in the length of the academic year, the division of the student population to distant campuses, and inadequate allocation of resources…."
(Source: "Situation of Human Rights in Myanmar," Economic and Social Council Resolution on Burma at the United Nations Commission on Human Rights 2001,
Fifty seventh session, Agenda item 9, 12 April 2001)
Disparity between Civilian and Military Education
The hallmark of the current education system in Burma is the discrepancy between education received by the military and their families and that which is available to the civilian population. Following the 1988 pro-democracy movement, the military authorities embarked on a campaign to strengthen the armed forces and began to set up military institutions for education. To date the government has yet to release information on military educational institutes, and so student enrollment and government budget allocation given to these institutions is unknown. However, a comparison of civilian and military institutes of higher learning clearly shows that the SPDC has put most of the resources allocated for education into military institutions while neglecting and oppressing civilian education.
While the civilian population has to struggle to pay education expenses for their children as a result of the ongoing financial crisis, the children of the military get higher quality education with financial support from the government. Although the SPDC manages all primary schools in the country, it has also founded and operates 15 primary schools open only to the children of military elite. During summer holidays, the military runs computer training, English courses and field trips for students from military families. Upon completion of high school these students are usually easily accepted into any Military Institute and are eligible for scholarships and scholastic awards. In order to qualify for this preferential treatment, older students in addition to having parents who have high-level connections to the regime are also themselves required to join the USDA. (For more information on primary level education see chapter on children)
The majority of university students in Burma are forced to struggle to pay ever rising tuition costs, while contending with insufficient facilities and learning materials. In direct contrast, members of the military elite are able to attend Military Institutes for free or at reduced cost, which feature computer access, modern libraries, well-equipped scientific labs and other resources. Students at these institutions are also sometimes given the opportunity to attend short-term trainings given by foreign scholars and professionals in specific subjects. While civilian high schools and universities have faced frequent closures since the 1988 military coup, military institutions have remained open. As a result, to some degree military school graduates have been trained to run the civilian education system, and reportedly a third of the graduates of military schools enter civilian universities as lecturers and tutors.
At the post-secondary level, the government has in recent years opened the Defense Services Academy (DSA), the Defense Services Institute of Medicine, the Defense Services Institute of Nursing, the Defense Services Technological Academy and the Defense Services Technical Colleges. In 2002, the government opened the Maritime University which operates under the auspices of the Ministry of Transportation. This university offers bachelors degrees in engineering with concentrations in naval architecture, marine engineering, river and ocean engineering and marine electrical systems and electronics. The Maritime University also offers a bachelors of Science degree specializing in nautical science. An Aerospace Engineering University was also opened in 2002 by the Ministry of Science and Technology. This institution offers undergraduate degrees in engineering with concentrations in aerospace propulsion and flight vehicles, and aerospace electronic systems and instrumentation. Entrance into these programs is highly competitive, and only 100 students are accepted annually for each program. Students who are able to obtain recommendations from military gazette officers or have other high-level military connections have a distinct advantage in the application process as the selection boards for entrance into these programs are run by military officials.
Due to the poor quality of civilian education, students from non-military backgrounds have become interested in applying to military institutes. While civilian students may be accepted into military institutes, the government has created a strict system of application, which includes mandatory recommendations from various government officials, including military officials. This system ensures that the applicants, or the applicants’ relatives, have had no history with opposition political parties and no criminal history. The applicants must also promise not to be involved in politics and pledge to serve in the army for a number of years upon graduating. In some universities, which are affiliated with but not directly under the auspices of the military government, students are screened for such things as USDA membership and political affiliations before they are allowed to take entrance exams. Students who attend these universities are also required to go into military or government service upon graduating. Students who are related to the military elite are favored above civilian applicants and in many cases military students do not have to pay tuition unlike civilian students.
Following graduation, those students loyal to the military are rewarded with educational and employment opportunities not open to the rest of the population. The military government provides well for its army students and gives them stipends, scholarships, and for the very elite, chances to study abroad. In January 2002 the Japanese government committed to providing 203 million yen through their ODA programme to establish The Human Resources Development Scholarship fund which would allow Burmese students to undertake postgraduate studies at Japanese universities in a wide range of fields. According to the Myanmar Times, at the beginning of 2002, 300 students from Burma were studying in Russia and the Russian ambassador had expressed interest in establishing further educational assistance programs, especially in the fields of science and technology.
In addition, members of the military elite are also able to attend diploma trainings and post-graduate programs at civilian universities with financial support from Defense Services. Due to the high cost of these programs, which include courses for languages, computer science, and technical subjects, civilian students who do not receive government support are usually unable to enroll. (Source: Education Report 2002, Foreign Affairs Committee-All Burma Federation of Student Unions. May 2003)
Universities Supported by the Military
1. Sagaing Regional Co-operative College
2. University of Development of National Races, Sagaing
3. Mandalay University of Foreign Languages
4. Defense Services Technical College, Mandalay
5. Nationalities of Youth Resource Development Degree College,Mandalay
6. Defense Services Academy, Maymyo, Mandalay
7. Defense Service Technological Academy, Mandalay
8. Mandalay Regional Co-operative College
9. Myanmar Aerospace Engineering University, Meikhtilar, Mandalay
10. Yangon University of Foreign Languages
11. Defense Services Institute of Medicine, Yangon
12. Yangon Co-operative Degree College
13. Central Co-operative College, Phaunggyi, Yangon
14. Nationalities Youth Resource Development Degree College, Yangon
15. Defense Service Institute of Nursing, Yangon
16. Myanmar Maritime University, Yangon. (Source: ABSFU)
Access to IT Education
In January 2001 the SPDC launched an official program for ‘e-education.’ Prior to this the government had been pressuring public high schools to build multi-media classrooms. In January 2003, Secretary General Khin Nyunt announced that 1,300 government high schools had built multi-media classrooms. However, even if these numbers are accurate, this still represents only 2.2% of the 58,082 high schools that the government claims to run throughout the nation. As only 7.5% of the government budget goes towards education, government officials generally force teachers and parents to fundraise or contribute their own money to build these IT facilities. Many parents reportedly were required to pay 5,000 to 10,000 kyat each towards the cost of these multi-media classrooms.
In some cases when school administrators are unable to collect enough money to build these multi-media classrooms, they resort to temporarily renting computers and other IT equipment from other schools or corporations. This equipment remains in place only long enough for government authorities to host official opening ceremonies and then computers and other resources were returned. Even those schools that are able to purchase this equipment often do not have the funds to maintain it, and in many cases these multi-media classrooms are shut down soon after opening.
In border areas IT facilities are non-existent, and students living in these areas, especially those who are members of ethnic minority groups, are extremely unlikely to ever have access to computers. Even in urban areas, most students have little chance to use computers, unless their parents can afford to enroll them in expensive private courses. Students are also hampered by government restrictions on Internet access that apply throughout the country. (For more information on restrictions on the internet see chapter on Freedom of Opinion, Expression, and the Press)
Burma receives the greatest amount of assistance in IT education through The Center for the International Cooperation for Computerization (CICC) from Japan. The CICC regularly holds IT training courses in Japan for Burmese students. However these programs are open only to members of the government organized "Myanmar Computer Science Association." As with most other coveted educational opportunities, preference is always given to those applicants with connections to the military elite. (Source: Education Report 2002, Foreign Affairs Committee-All Burma Federation of Student Unions. May 2003)
Troops Shut Down Two Universities Following Gang Fighting
On 14 February 2002, it was reported that soldiers were called to intervene following fighting between students from the Institute of Economics and the Culture University in Ywarthargyi in South Dagon Township, Rangoon. It is rumored that, what the SPDC has called ‘riots,’ began when a fight broke out between members of the Scorpion Gang controlled by Kyaw Ne Win, a grandson of former dictator U Ne Win, and the rival White Snake Gang. This fighting reportedly developed into a clash between approximately 200 students from the two universities.
Eyewitnesses to the incident reported that four military trucks from the War Office in Rangoon arrived at the scene after midnight and raided the campuses of the two universities. Following the incident the two universities were temporary closed, and there has been no further information available regarding the arrest of students involved in the fighting. (Source: DVB)
Military University Closed and 2 Students Arrested Following Strikes
On 11 June 2002, several Burmese news services reported that the Defense Services Technical College (DTC) had been closed since the previous week. The closure reportedly was in response to growing unrest among the cadets about perceived discriminatory treatment between DTC students and students at the adjacent Defense Services Academy (DSA).
The DTC was opened only two years ago and is located adjacent to the prestigious Defense Services Academy (DSA), in Pyin Oo Lwin (also know as Maymyo), Mandalay Division. The DSA is considered to be the country’s most prestigious military academy and many of the Burma’s military leaders are graduates of the academy, including Gen Maung Aye, the army chief and second most powerful member of the SPDC; Lt-Gen Tun Kyi, a former trade minister who was forced to resign in 1997; and the late Maj-Gen Nyan Lin, a former junta member.
Recently, DTC students reportedly initiated a series of strikes, and complained to school officials that DSA students received preferential treatment and better food then they did.
On 17 June 2002 DVB reported that two DTC students had been arrested and sentenced to 7 years imprisonment by a military tribunal from Maymyo. It was also reported that other students were being held at the school and their parents were unable to visit them, while the military conducted interrogations. Many other students were reportedly expelled.
DVB reported that the government is currently preparing to relocate the DTC to a location in Shan State. (Source: RFA, DVB, Irrawaddy)
9.3 Situation of Health
In December 2002, General Khin Nyunt announced that "the health situation in Myanmar has improved dramatically in recent years." (Source: New Light of Myanmar) This improvement has not been readily evident to the thousands within the country who continue to die annually from diseases that are preventable and treatable. The ongoing civil war in Burma has meant that non-military expenditures, including those for health care, are given a low priority in government spending. This results in a health care system with insufficient facilities, too few health care workers, inadequate health education programs and lack of rural services. At the same time, the health problems of many are exacerbated by the ongoing armed conflict which disproportionately affects ethnic minorities. People living in conflict areas are directly affected by things such as landmines and military violence, while migration and forced relocations are the cause of malnutrition and other conditions that lead to the spread of disease.
According to the WHO World Health Report 2000, Burma is ranked 139th out of 191 countries in terms of the overall level of health of the population. People in all groups can expect to live an average of 51.6 years in full health. Women can expect to live 7.1 years with a disability and men 7.4 years. Life expectancy for men is 54.6 years, for women 59.9 years, in the ASEAN Region only Cambodia and Laos have lower life expectancies. Many of the countries ranked lower than Burma are suffering from the ravages of AIDS, a problem which has yet to come to a head in Burma. Lt. Gen Khin Nyunt condemned the findings of the WHO report saying that "The WHO report, based on false information from antigovernment sources aimed at tarnishing the image of the country is unjust and unacceptable…The ministry totally rejects the assessment." However it is difficult to see how the SPDC can effectively argue that public health is a national priority. According to WHO, in 2000 the SPDC spent only 4 ‘international dollars’ per year on health for each citizen. In comparison, neighboring Thailand spent 136 international dollars per person, and even developing countries like Bangladesh and India spent 17 and 13 dollars per person, respectively.
Women, children and ethnic minorities are disproportionately affected by the lack of health care. More than 92 500 of the 1.3 million children born each year in Burma will die before they reach their first birthday. Another 138 000 children will die before the age of 5. Many more children will suffer from acute respiratory infections, diarrhoeal diseases, tuberculosis or malaria, which are the leading causes of morbidity and mortality among children in Burma. More than one third of children under age 5 will become malnourished, most commonly when they are between 1 and 3 years old. (For more information on children’s health see chapter on children). (Source: UNICEF)
A significant percentage of women continue to die in childbirth, especially those women who live in rural areas. Estimates vary from between 100-580 maternal deaths per 100,000 live births. While more than half of these maternal deaths occur at home, over a third occur in government facilities, which lack the resources to provide adequate emergency obstetric care. Many other women die from unsafe abortions, which are illegal in Burma and must be obtained outside the public health system. (For more information on women’s health see chapter on women). (Source: UNICEF)
Access to Health Care
In January 2002 the SPDC reported that "there are 750 hospitals in the nation, up 119 from 631 in 1988. There are now 13 township hospitals and 37 station hospitals in the border areas. The number of dispensaries has increased to 346 at present from 247 in 1988. There are now 1 402 rural health centers and 64 regional health centers. In the past there were 1 337 rural health centers. Within a three-year period, the Government has used US $ 12 million from its funds to buy modern health, medical and hospital equipment in fulfilling the health requirements. There are now 13 institutes of medicine and other universities of the health sector." (Source: Myanmar Information Committee, Myanmar Medical Association 48th Conference, January 17, 2002)
However in reality, most illnesses and deaths in Burma continue to result from inappropriate or inadequate treatment and/or knowledge, which ultimately stem from a lack of resources. In government hospitals, patients often have to pay a bribe to be seen by a doctor, get a bed, or to receive essential medicine. Families of patients must provide all essential drugs and supplies in public facilities, or else rely on unregulated private practices. Only the very wealthy can afford to go to private clinics with high levels of care. Despite efforts made by NGOs to extend the public health care system, huge disparities in access to health services and information continue to exist, most acutely in border regions and in poor urban areas. (Source: UNICEF) Burma’s health care system has been found to be more discriminatory than that of any other country in the ASEAN region in terms of responsiveness. People’s access to healthcare is directly correlated to their ethnic background, income level and whether they are civilians or military personnel. In 2000, WHO ranked Myanmar 190 out of 191 countries in terms of the gap between potential health services and actual performance.
In 1999, WHO statistics showed that Burma had 29.7 physicians, 26.1 nurses, 22.1 midwives, and 2.1 dentists per 100,000 people. This rates Burma on the level with countries like Cambodia, which has 29.7 doctors per 100,000 but far below neighboring India with 48 doctors. In addition, medicines in Burma are often expensive and difficult to obtain. The only high-quality drug manufacturer in Burma is the government-owned Burma Pharmaceutical Industry. As this company fails to produce the amount of medicine needed, approximately 95% of all medicine is smuggled in from India and Bangladesh and sold on the black market. A tablet of Paracetamol (an analgesic) sells for 25 kyat on the black market, while a day laborer is paid a maximum of 500 kyat a day. (Source: Narinjara)
Access to Clean Water and Sanitation
Throughout the developing world, lack of sanitation and access to clean water is a major concern. When adequate systems are not in place for the disposal of human waste, cholera and diarrhoeal diseases can rapidly spread, causing illnesses and deaths. A 2000 Survey conducted by UNICEF estimated that in rural Burma only 57% of the population had access to improved sanitation, where in urban areas 84% of the population had access. A previous survey conducted in 1997 estimated that 34% of the population nationwide lacked access to safe drinking water. (Source: UNICEF)
In 2002, arsenic levels in tube wells in the coastal and delta regions of the country were discovered to be 50 times higher than the level deemed safe by WHO. The SPDC Department of Health Planning said: "the local community were unable to be informed about arsenic when the water samples were collected, as the confirmatory tests needed to be conducted first." There is no information available on how many people have suffered poisoning, however the SPDC has failed to publicize any government-sponsored medical treatment for these people.
The SPDC has labeled malaria the top priority disease in the National Health Plan. According to government figures, about 600,000 malaria cases and 3,000 malaria deaths are registered annually, with the highest number of cases and highest mortality rates in the remote border areas. However these figures only represent the number of patients who visit official health centers and UN statistics estimate that in fact around 30,000 people die annually of the disease. (Source: UNICEF)
On 23 January, Narinjara news reported that there had been an outbreak of malaria and diarrhea in northern Maungdaw Township, Arakan State. Several foreign doctors working with Danish NGO, Doctors without Boundaries (AZG) treated victims in some of the worst affected areas. Many of the malaria patients were suffering from drug-resistant strains of the disease, and the foreign medical team reportedly had difficulty coping with the large number of patients. The foreign doctors also found that there was little or no medical treatment available at government hospitals or dispensaries in the area. Local residents report that there have been a number of deaths from malaria and diarrhea already this year. This drug resistant strain of malaria has reportedly now crossed the border from Arakan State into the Chittagong Hills in neighboring Bangladesh. (Source: Narinjara)
The SPDC has stated that tuberculosis is the second priority disease in the country’s national health program. In 2002 a WHO study reported that approximately 20,000 people die annually from tuberculosis, and about 85,000 people contract the disease each year. WHO has been working to set up "TB control centers" with the goal of establishing one in every township. WHO has categorized Burma as one of 22 countries with a high rate of TB, however the organization has stated that the cost of treatment in Burma is low compared to other countries. WHO estimates that 4.5% of TB patients are infected with HIV, and 60 to 80% of AIDS cases suffer from TB.
HIV prevalence is rising rapidly in Burma/Myanmar, fuelled by population mobility, poverty and frustration that breeds risky sexual activity and drug-taking. Already, one in 50 adults are estimated to be infected, and infection rates in sub-populations with especially risky behaviour (such as drug users and sex workers) are among the highest in Asia. Because of the long lag time between HIV infection and death, the true impact of the epidemic is just beginning to be felt…Recently, there have been signs that the government is crawling out of its deep denial about the true magnitude of the HIV epidemic in Myanmar and is preparing to take real measures to stem its spread. …HIV is an unforgiving epidemic: once the initial opportunity for effective prevention is lost and a critical mass of infection builds up, the epidemic assumes a life of its own. Prevention becomes more and more difficult, and care needs begin to swamp health and community services, diverting resources that could otherwise be used for other development priorities. Myanmar stands perilously close to an unstoppable epidemic. (Source: Myanmar: The HIV/AIDS Crisis, International Crisis Group April 2, 2002)
Burma has the highest incidence of HIV infection in Asia after Cambodia. At the end of 2001, UNAIDS estimated that 180,000 to 400,000 people in Burma were living with AIDS and that AIDS will be a major, if not the major, cause of death for young adults in the next decade. A number of factors have contributed to the growth of the AIDS epidemic in Burma, these include: government denial and lack of political will to address the disease; a deteriorating health sector; an unclean blood supply; a growing sex industry; high population mobility; extremely high rates of infection in drug users; and a large, poorly paid and poorly educated army. (Source: The Washington Quarterly: "the Regional Impact of HIV and Aids Accelerating and Disseminating across Asia". 2001 Winter. Vol. 24, No. 1; Pg. 211)
As in many other countries, those hardest hit with the disease initially have been intravenous drug users and commercial sex workers. By 1989, UNAIDS figures show that 73% of drug users in Rangoon were HIV positive, and since then infection rates among drug users in Rangoon and Mandalay have ranged from 50 to 85%. HIV infection rates among Burma’s addicts are among the highest in the world, and as there is a shortage of syringes along with other medical supplies, the spread of the disease is facilitated by widespread needle sharing. HIV infection among sex workers in Rangoon and Mandalay has also increased from a median of 4% in 1992 to 26% in 1997. HIV rates among military recruits tested in Rangoon and Mandalay grew from 0.5% in 1992 to 1.4% in 2000.
Internal migration for the purpose of employment is also a cause of the spread of HIV. Hundreds of thousands of people work seasonally in the jade and ruby mines in Shan and Kachin states and it has been found that most young adults who are HIV positive in central Burma have worked in the mines, bringing HIV with them when they return home. The virus is also spreading in prisons where needles are often re-used several times, and in monasteries where young men shunned by their families move to die. One doctor said that he has treated a number of monks, including elderly monks, who have AIDS.
Burma’s already overburdened health system is ill equipped to deal with the medical needs of growing numbers of AIDS patients. People who are living with HIV/AIDS in Burma rarely have access to counseling or anti-HIV drugs. In addition there is a countrywide shortage of antibiotics for TB, which kills most AIDS patients. It has been reported that once a patient is diagnosed with AIDS he or she usually dies within 3 months.
People in Burma also often lack the necessary information and services to protect themselves from the spread of the disease. Condoms are too expensive for most people and are not yet widely socially acceptable, having only been legal since 1993. HIV tests are rarely free and many people cannot afford the US$10 dollars it costs to take one. The government has been extremely slow to respond to the AIDS epidemic, for many years simply denying that it existed. Lately the regime has been more proactive in addressing HIV/AIDS, labeling it ‘priority disease number three’ in their national health program, and cooperating with a number of INGOs and UN organizations to initiate programs for prevention and treatment. Despite this, the government continues to place the disease in a moral context, which serves to further stigmatize people who are HIV positive. At a speech on National AIDS Day in December 2002, General Khin Nyunt stated that: "the cultural and social values of Myanmar society are found to have a protective effect to a greater extent in many population groups."
State media are largely banned from reporting about AIDS, and healthworkers complain that HIV/AIDS education materials released by the government are outdated and confusing. Most of these campaigns avoid mention of sex and condoms or the need for drug addicts to use clean needles, instead blandly urging people to "respect family values" and "stay faithful to your spouse." Homosexual relations are never acknowledged or addressed in these campaigns.
This denial of the facts affects not only Burmese citizens, but also neighboring countries. As drugs, migrant workers and sex workers leave the country, Burma has become an AIDS exporter. In neighboring China, India and Thailand, the provinces with the highest HIV rates are those that border Burma. A report released by Johns Hopkins School of Public Health has connected outbreaks of HIV and injection drug use with overland heroin trafficking routes originating in Laos and Burma and spreading throughout the region.
Mental health is an often overlooked aspect of health care in many societies and the situation is exacerbated in Burma by the lack of resources allocated to health care in general. Ongoing civil war and violence is accompanied by an increase in mental health disorders. Studies of refugees on the Thailand-Cambodia border found that 55% suffered from some form of depression and 15% from post-traumatic stress disorder. The literature on the subject indicates that because mental trauma is a concern for a sizeable portion of war-affected populations, it should be addressed as a major public health issue.
International Humanitarian Aid
INGOs began re-entering Burma in 1991, with the majority of them working in the health sector. This was a controversial move because many people felt that an INGO presence in Burma would provide legitimacy to the military regime. However, INGOs that decided to work in Burma argued that some issues, such as the spread of HIV, could not wait for a change in the political situation. From the start, the SPDC has shown a preference for working with intergovernmental organizations such as the United Nations. U.N. bodies, such as UNICEF, UNDP and WHO, play a larger role in funding than INGOs. Many of these organizations have taken a lead in development, especially in the areas of management and assessment and often they are the only buttresses against the collapse of government health and education programs. INGOs have been more active in implementing development projects at the community level and have focused their efforts on training rather than providing hard resources or cash. In 1994, the SPDC decided to accept offers of assistance from international agencies and NGO’s in areas covered by the Border Areas Development Program "as long as they do not threaten national security and solidarity." As a result, some organizations have established their own programs and some have funded projects through local community groups, however they have not used a common structure, system or method.
In order to work in Burma, INGOs have to sign a Memorandum of Understanding (MOU) which outlines the conditions under which they are allowed to work. To be granted a MOU, INGOs first must approach the relevant ministry, such as the Ministry of Health and then have their case presented by a ministry representative to the Foreign Affairs Committee. After this, if all goes well, final permission to operate is granted by the Cabinet.
Problems faced by INGOs working in Burma include: lack of accurate information; lack of access to all parts of the country and an inability to address the underlying problems that affect health such as forced labor, forced relocations, and armed conflict. INGO’s are also hampered by a shortage of trained personnel in ethnic areas and political restrictions on who they associate with. They are also frequently subject to arbitrary whims of local military commanders and SPDC officials regarding their status.
Throughout 2002 the debate on humanitarian aid in Burma intensified. Several organizations including the International Crisis Group, Altsean-Burma, and NCGUB released reports analyzing the debate and stating a position on if and under what conditions, humanitarian aid should be given. The International Crisis Group (ICG) report, Myanmar: The Politics of Humanitarian Aid, gave an "unequivocal yes" to increased humanitarian assistance. The report argued that the current humanitarian crisis in Burma cannot wait for a political resolution which may be years in coming. The ICG also urged "working with the government and through government institutions" to address issues such as HIV/AIDS.
In contrast, ALTSEAN-Burma, NCGUB and a number of Burmese activists have argued that humanitarian aid cannot be divorced from a political context, as the problems such aid is addressing are at root political. In January 2002, a Strategic Coordinating Committee of the Burmese democracy and ethnic movements released a statement on humanitarian aid. The statement called for aid to be distributed only in consultation with NLD and local community leaders; that aid be delivered directly to the recipients through credible INGOs without SPDC involvement; and that delivery of aid to border areas be monitored by an independent body. Burma activists have further urged that aid should contribute to the process of national reconciliation including political and economic reforms. Daw Aung San Suu Kyi has stated that "better governance, not increased funding" is the answer to Burma’s humanitarian crisis. She emphasized "Unless there is good governance, you cannot ensure that the assistance will really benefit the country."
9.4 Personal Account
Age: 22 years
Interview Conducted by: HRDU
Date: July 1, 2003
Place: Mae Sot
I have gone to government schools all of my life. I went to primary school and high school in my hometown in Chin State. When I was in 10th standard we didn’t have any textbooks. This was a big problem because at the end of 10th standard students around the country have to take a matriculation exam and we knew that the information in these textbooks would be on the exam. During the year the Minister of Education, U Than Aung came to visit our school. He stood in front of our class and asked us what we needed for our education. We told him that we needed textbooks so that we could study for the exams. Then he started laughing and told us that we could just bring in a sheet with all the answers to copy from. All of the students were upset and even the teacher was angry at him when he said this.
Because the government school was not very good, in the evening and at night I attended extra classes at a private boarding school. The tuition for this school was 40,000 kyat for 8 months, so most of the other students at the government school could not afford to take classes there. Even though the private school was much better, the government forced us to attend the government school if we wanted to take the exams. When we took our exams I got first place for English in Chin State.
I finished 10th standard in 1999 so at that time all of the universities were closed, except for the military colleges. Soon after I graduated 3 SPDC soldiers from battalion 266 came to meet me and invited me to join the army and attend the military college. They told me that there were no Chins in the military and since I had done so well on my exams I would have a lot of opportunities if I joined them. I refused, because in Chin State the soldiers are very bad and everybody hates them. When they go in to villages they take chickens and pigs from the villagers and they also make us carry their weapons without pay. Five or ten years ago some Chin people became soldiers, but because they were Chin they never got promoted. Instead they were just sent to the front lines. This happens not only with Chin people, also other ethnic minority people like Karen and Shan have no chance for promotion in the army.
I worked as a teacher for two years until the universities reopened at the end of 2000. Then I was accepted to the Government Technical College (formerly the Rangoon Institute of Technology) in Rangoon. This was very unusual. Usually the government doesn’t allow Chin people to go to university in Rangoon, if Chins want to attend university then they must go to Mandalay or Magwe Division.
I began my studies at the Government Technical College (GTC) in January 2001. The college was located 40 miles away from Rangoon and there was no school hostel, so we had to pay to stay in boarding houses. In classes we never had textbooks, only our teacher had a textbook which he would give us chapter by chapter to photocopy. All the subjects we were learning were explained in English in the text book but none of our teachers could speak English, so they just explained the subjects in Burmese. However they couldn’t translate the meaning of the text. Most teachers themselves had never graduated from engineering college so they didn’t know very much about the subject. Our university lacked many facilities, we didn’t have a library, or any computers, and we didn’t have the equipment necessary to do practical labs. According to the school law all the students were prohibited from discussing politics or from forming groups or organizations. In February or March 2001 many of the students asked the college principle to try and improve the school facilities. One day, almost all of the students wore T-Shirts on which we had drawn an upside down pyramid with:
This showed that our school was very good when it was Rangoon Institute of Technology (RIT) but after the government had separated RIT into Yangon Technical University and Government Technical College the standard of education had been getting worse and worse.
That day the principle of the college took our T-shirts and warned us that if we wore them again we could be arrested. The next day some military soldiers came to our college. About 10 of them stood outside holding guns and guarding the school for the next two weeks. Our school was surrounded by military barracks so it was very easy for the government to send troops to our school. Later we kept reading in the newspapers that government schools were very good and that GTC was a very good college. This wasn’t true. When the college principle refused to respond to our requests to improve the college, we wrote letters to Khin Nyunt, as well as the Minster of Education and the Minister of Science and Technology. Almost all of the approximately 70 students signed their names to the letter, except for some of the women students. The government ministers never answered our letter. However soldiers began coming to the school every morning and evening and recording the students who were getting on and off the buses to go into town. They were doing this to intimidate us.
None of the students were happy at the school, and in the first year several students dropped out. After the first year the student population grew as a new class of first year students joined GTC. People believed that there were many MI spies among the first year students. During the first semester of our second year my classmates and I again wrote letters to Khin Nyunt, the minister of Education, and the Minister of Science and Technology but again we received no reply. In one of our subjects that year the teachers only taught 40% of the material that we needed to study for the exams, also they only gave us chapters of the textbook to copy one by one, so we didn’t have a chance to study the whole textbook. Then at the end of the year when we had to take our final exam many of the questions on the exam were from parts of the course that we hadn’t covered in class. The authorities gave us these questions because they knew that we couldn’t answer them and they wanted us to fail. When we got our exam results, 37 out of the 43 students had failed. The only students who had passed were the 6 girls who had never signed the letters to the government ministers. In the other section of 2nd year students the same thing had happened. When we asked the teachers if we could retake the exam they refused. University students in Burma almost never fail because if they fail they are allowed to retake exams. Many of my classmates left school after this. I went home to my family and told them that I wanted to quit school and join some of the revolutionary or opposition groups, because I was very angry about what had happened. My parents however wanted me to go back to Yangon and back to school. Before I had gone home, the principle had announced that students should bring their fathers to the school to pledge that their children would follow school laws.
When I arrived back at GTC for my third year, the deputy principle of the college called all the students one by one to come and stand before his desk. He asked me why I didn’t bring my father. I told him that I was 22 years old, and my parents lived far away. Also my parents support me and everything I say was in accord with my parents’ views.
Then he asked me, "do you know the purpose of this school?"
I said, "yes."
He asked, "do you know the meaning of discipline?
I said "yes I understand discipline, but I don’t understand the discipline at this school."
He said: "so you failed your subjects, and you don’t understand discipline."
Then I said: "I followed all the college rules, I have never drunk alcohol or broken discipline."
Then the deputy principle said: "This is a government school, if you criticize the government you are breaking the most important college rule."
I said: "Even though none of the students are happy in this school we have never criticized the government because we just want to stay peacefully and study, but we cannot study without the necessary facilities."
Then he said: "You are so low that you should never have dared to write letters to the government ministers. If you criticize the government you will lose your opportunity to study. Why don’t you nod your head when I say this? Many other students born in Rangoon nod their heads when I say this."
I said "I didn’t nod my head because you asked me a question which I know the answer to in my heart..many other students feel like me, maybe they agree and nod their heads because they are afraid."
Then he said: "You should not stay in school, I had better expel you."
Then I asked "Why?"
He said: "I know you are a person who criticizes the government by the way you have been speaking.
When he told me this I felt very sad and angry and wanted to cry. After I left many of my friends warned me that I had better run away because many other students and teachers had heard my discussion and some of them were sure to be MI agents. They said that if I was expelled from school I was sure to be arrested. So first I tried to apply for a passport but I was rejected, and then I ran away and came to Thailand. I hope in the future when democracy comes to Burma I will have a chance to continue my studies.
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