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Home > Main Library > Health > Threats to Health > Conflict and health, including violations of humanitarian and human rights standards as threats to health

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Conflict and health, including violations of humanitarian and human rights standards as threats to health
These include violations of economic, social and cultural rights as well as civil and political rights

Websites/Multiple Documents

Title: Health and Human Rights
Description/subject: "Many of CPI's local partners serve ethnic communities located in Myanmar's conflict-affected zones that are not adequately served by governmental organizations or large humanitarian agencies — areas that also often suffer from chronic human rights abuses. See links at rights for peer-reviewed articles and reports documenting the connection between systemic abuses and poor health in Myanmar's border regions....Diagnosis Critical (CPI Partners, Oct. 2010)... After the Storm (CPI Partners, March 2009)... Chronic Emergency (CPI partners, Sep. 2006)... Displacement and Disease (Conflict and Health, March 2008)... Health and human rights and political transition (Intl Health & Human Rights, May 2014)... Maternal health and human rights violations (PLoS Medicine, Dec. 2008)... Quantifying associations between human rights violations and health (Epidemiology & Community Health, Sep. 2007)... The Gathering Storm (CPI partners, July 2007)... Community-based Assessment of Human Rights (Conflict and Health, April 2010).
Language: English
Source/publisher: Community Partners International
Format/size: html, pdf
Date of entry/update: 20 August 2014

Individual Documents

Title: The implementation of rules protecting the provision of health care in armed conflicts and other emergencies: A guidance tool
Date of publication: 28 February 2015
Description/subject: TABLE OF CONTENTS: INTRODUCTORY REMARKS... INTERNATIONAL LEGAL FRAMEWORK FOR PROTECTING THE PROVISION OF HEALTH CARE... DOMESTIC IMPLEMENTATION MEASURES: Protection for the wounded and sick, health-care personnel and facilities, and medical transports ; Legal and regulatory measures ; Dissemination and training measures; Coordination and institutional capacity measures ; Rules on health-care ethics and medical confidentiality; Legal and regulatory measures; Dissemination and training measures; Coordination and institutional capacity measures; Use of the distinctive emblems protected under international humanitarian law (IHL); and of other signs to identify health-care providers ; Legal and regulatory measures; Dissemination and training measures; Sanctions: Sanctioning violations against health-care personnel and facilities and medical transports ; Legal and regulatory measures; Dissemination and training measures; Coordination and institutional capacity measures... ANNEX 1: International Legal Framework... ANNEX 2: Recommendations from the Workshop on Domestic Normative Frameworks for the Protection of the Provision of Health Care (Brussels, 29-31 January 2014)... ANNEX 3: Checklist of Measures for the Domestic Implementation of International Rules Protecting the Provision of Health Care... ANNEX 4: Table of Treaties and Abbreviations... BIBLIOGRAPHY.
Language: English
Source/publisher: International Committee of the Red Cross (ICRC)
Format/size: pdf (200K)
Date of entry/update: 22 May 2015

Title: The Jungle Surgeon of Myanmar - One medic finds that moves towards political reform have not benefited his patients in Burma's remote border areas. (video)
Date of publication: 13 January 2014
Description/subject: "One medic finds that moves towards political reform have not benefited his patients in Burma's remote border areas. "Nyunt Win is a surgeon and medical trainer working with a mobile clinic in the East Burma jungle. He is also a former soldier of the Karen National Liberation Army. Nyunt Win's patients are the displaced Karen people who as well as suffering the effects of years of civil war are without any healthcare whatsoever. With moves towards political reform and international aid going directly to the government under the guise of development projects, there is an increase in resource exploitation, human rights abuses and displacement of ethnic populations. The plight of Nyunt Win's patients seems to be more acute than ever...The Jungle Surgeon of Myanmar exposes what life is like in the remote areas of Myanmar. It shows this marginalised community's fight for survival and thoughts on longterm peace, providing an alternative perspective on the ceasefire."
Author/creator: Gigi Berardi
Language: Karen (voice), English (sub-titles)
Source/publisher: Al Jazeera (Witness)
Format/size: Adobe Flash (25 minutes)
Date of entry/update: 14 January 2014

Title: Bitter Wounds and Lost Dreams: Human Rights Under Assault in Karen State, Burma
Date of publication: 27 August 2012
Description/subject: Findings: "Out of all 665 households surveyed, 30% reported a human rights violation. Forced labor was the most common human rights violation reported; 25% of households reported experiencing some form of forced labor in the past year, including being porters for the military, growing crops, and sweeping for landmines. Physical attacks were less common; about 1.3% of households reported kidnapping, torture, or sexual assault. Human rights violations were significantly worse in the area surveyed in Tavoy, Tenasserim Division, which is completely controlled by the Burmese government and is also the site of the Dawei port and economic development project. Our research shows that more people who lived in Tavoy experienced human rights violations than people who lived elsewhere in our sampling area. Specifically, the odds of having a family member forced to be a porter were 4.4 times higher than for families living elsewhere. The same odds for having to do other forms of forced labor, including building roads and bridges, were 7.9 times higher; for being blocked from accessing land, 6.2 times higher; and for restricted movement, 7.4 times higher for families in Tavoy than for families living elsewhere. The research indicates a correlation between development projects and human rights violations, especially those relating to land and displacement. PHR’s research indicated that 17.4% of households in Karen State reported moderate or severe household hunger, according to the FANTA-2 Household Hunger Scale, a measure of food insecurity. We found that 3.7% of children under 5 were moderately or severely malnourished, and 9.8% were mildly malnourished, as determined by measurements of middle-upper arm circumference. PHR conducted the survey immediately following the rice harvest in Karen State, and the results may therefore reflect the lowest malnutrition rates of the year.....Conclusion: PHR’s survey of human rights violations and humanitarian indicators in Karen State shows that human rights violations persist in Karen State, despite recent reforms on the part of President Thein Sein. Of particular concern is the prevalence of human rights violations even in areas where there is no active armed conflict, as well as the correlation between economic development projects and human rights violations. Our research found that human rights violations were up to 10 times higher around an economic development project than in other areas surveyed. Systemic reforms that establish accountability for perpetrators of human rights violations, full political participation by Karen people and other ethnic minorities, and access to essential services are necessary to support a successful transition to a fully functioning democracy..."
Author/creator: Bill Davis ,MA, MPH; Andrea Gittleman, JD, PHR; Richard Sollom, MA, MPH, PHR; Adam Richards, MD, MPH; Chris Beyrer, MD, MPH; Forword by Óscar Arias Sánchez
Language: English
Source/publisher: Physicians for Human Rights (PHR)
Format/size: pdf (749K)
Date of entry/update: 28 August 2012

Title: Thaton Interview: Daw Ny---, April 2011
Date of publication: 27 January 2012
Description/subject: "This report contains the full transcript of an interview conducted during April 2011 in Pa’an Township, Thaton District by a villager trained by KHRG to monitor human rights conditions. The villager interviewed Daw Ny---, who described an incident which occurred in November 2010, during which Tatmadaw Border Guard soldiers fired small-arms at her husband without warning and without attempting to hail him, seriously injuring his leg and necessitating 3,800,000 kyat [US $4,935.06] in medical expenses, which has had a deleterious effect on her family’s financial situation. Daw Ny--- told the villager who conducted this interview that her husband was visited in hospital by government officials investigating the incident but that no compensation or redress was offered. Daw Ny--- also described arbitrary demands for food and money, and the illegal logging of teak trees from A--- village by Border Guard soldiers; she mentioned that the imbalance in local power dynamics between armed soldiers and unarmed villagers deters villagers from attempting to engage and negotiate with perpetrators. Daw Ny--- raised concerns about the lack of livelihoods opportunities, and corresponding food insecurity, for villagers who do not own farmland; she notes that, in spite of these challenges, villagers offer voluntary material support to schoolteachers and often attempt to support their livelihoods by selling firewood or cutting bamboo. Daw Ny--- notes that some villagers choose to seek employment opportunities in larger towns but strongly expresses her unwillingness to move to an urban area, believing that food insecurity would only be exacerbated by a lack of money and an absence of alternative livelihood opportunities."
Language: English
Source/publisher: Karen Human Rights Group (KHRG)
Format/size: pdf (267K), html
Alternate URLs: http://www.khrg.org/khrg2012/khrg12b8.html
Date of entry/update: 29 January 2012

Title: Attacks on Health and Education: Trends and incidents from eastern Burma, 2010-2011
Date of publication: 06 December 2011
Description/subject: "This report presents primary evidence of attacks on education and health in eastern Burma collected by KHRG during the period February 2010 to May 2011. Section I of this report details KHRG research methodology; Section II analyses general trends in armed conflict and details a loose typology of attacks identified during the reporting period. Section III applies this typology to 16 particularly illustrative incidents, and analyses them in light of relevant international humanitarian law and UN Security Council resolutions 1612, 1882 and 1998. These incidents were selected from a database detailing 59 attacks on civilians documented by KHRG between February 2010 and May 2011."
Language: English
Source/publisher: Karen Human Rights Group (KHRG)
Format/size: html. pdf (166K)
Alternate URLs: http://www.khrg.org/2011/12/khrg1105/attacks-health-and-education-trends-and-incidents-eastern-burm...
Date of entry/update: 19 January 2012

Title: Definitional ambiguity and UNSCR 1998: Impeding UN-led responses to attacks on health and education in eastern Burma
Date of publication: 06 December 2011
Description/subject: "This paper highlights impediments to effective international responses to attacks on health and education in eastern Burma presented by lack of clarity regarding the meaning of “attacks” within the monitoring and reporting framework established by UN Security Council resolutions 1612 and 1998. In order to address this definitional ambiguity and enable recent developments in the UN Security Council to potentially provide support to communities facing attacks in eastern Burma, this paper argues for interpreting “attacks” in a fashion that is consistent with applicable international humanitarian law. The analysis below concludes that UN-led monitoring, reporting and response pursuant to UNSCRs 1612 and 1998 should include acts by parties to armed conflict that both: a) violate relevant international law; and b) attack or threaten to attack personnel related to schools or medical facilities and/ or destroy, damage or force the closure of a school or medical facility."
Language: English
Source/publisher: Karen Human Rights Group (KHRG)
Format/size: html, pdf (62K)
Alternate URLs: http://www.khrg.org/sites/default/files/khrg11w1.pdf
Date of entry/update: 18 January 2012

Title: Health and Human Rights in Chin State, Western Burma: A Population-Based Assessment Using Multistaged Household Cluster Sampling
Date of publication: 08 February 2011
Description/subject: Abstract:- Background: "The Chin State of Burma (also known as Myanmar) is an isolated ethnic minority area with poor health outcomes and reports of food insecurity and human rights violations. We report on a population-based assessment of health and human rights in Chin State. We sought to quantify reported human rights violations in Chin State and associations between these reported violations and health status at the household level. Methods and Findings Multistaged household cluster sampling was done. Heads of household were interviewed on demographics, access to health care, health status, food insecurity, forced displacement, forced labor, and other human rights violations during the preceding 12 months. Ratios of the prevalence of household hunger comparing exposed and unexposed to each reported violation were estimated using binomial regression, and 95% confidence intervals (CIs) were constructed. Multivariate models were done to adjust for possible confounders. Overall, 91.9% of households (95% CI 89.7%–94.1%) reported forced labor in the past 12 months. Forty-three percent of households met FANTA-2 (Food and Nutrition Technical Assistance II project) definitions for moderate to severe household hunger. Common violations reported were food theft, livestock theft or killing, forced displacement, beatings and torture, detentions, disappearances, and religious and ethnic persecution. Self reporting of multiple rights abuses was independently associated with household hunger. Conclusions Our findings indicate widespread self-reports of human rights violations. The nature and extent of these violations may warrant investigation by the United Nations or International Criminal Court..."
Author/creator: Richard Sollom , Adam K. Richards, Parveen Parmar, Luke C. Mullany, Salai Bawi Lian, Vincent Iacopino, Chris Beyrer
Language: English
Source/publisher: PLOS Medicine
Format/size: html
Date of entry/update: 05 November 2016

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: MYANMAR: Health crisis amid conflict - new report
Date of publication: 19 October 2010
Description/subject: A new report by NGOs indicates health conditions in conflict-affected eastern Myanmar are dire, with women and children suffering most. According to "Diagnosis: Critical", a survey of 5,754 households by health organizations working in the Thai border town of Mae Sot and others from neighbouring Myanmar, health conditions in eastern Myanmar have deteriorated due to constant conflict and persistent state neglect.
Language: English
Source/publisher: IRIN_ humanitarian news and analysis
Format/size: html
Date of entry/update: 22 October 2010

Title: Burma Human Rights Yearbook 2008 - Chapter 11: Right to Health
Date of publication: 23 November 2009
Description/subject: "For the people of Burma, 2008 has been another difficult year. The difficulties related to lack of healthcare facilities continued, while other factors relating to poverty remained key influences on the health of the nation. The enduring story from Burma from 2008 was the humanitarian consequences of Tropical Cyclone Nargis, which hit the country on 2-3 May 2008. However, even at the beginning of the year, there were worrying reports and statistics emerging from Burma regarding the health status of the population. In January 2008, the United Nations Children’s Fund (UNICEF) released figures which showed Burma had the second highest child mortality rate in the world, with between 270 and 400 children dying on a daily basis, many from preventable causes. By year end, the combination of the estimated 130,000 deaths due to Cyclone Nargis and the increasing HIV/AIDS crisis lead Médecins Sans Frontières (MSF) to describe the current situation in Burma as “critical”, and also contributed to Burma being included in MSF’s list of the ten worse humanitarian situations in the world. While it has been estimated that approximately half of Burma's annual budgetary allocation goes towards military expenditure, less than half a percent of Burma’s Gross Domestic Product (GDP) is allocated to healthcare. Burma’s per capita spending on healthcare has been reported to be "the lowest in the world". As a direct result, deaths arising from easily preventable and readily treatable diseases are common. Burma also has the second highest child mortality rate in all of Asia, with ten percent of children dying before their fifth birthday; only Afghanistan’s child mortality rate is higher. While the State Peace and Development Council (SPDC) military regime makes little to no effort to actively promote good health or to provide adequate healthcare, in some areas it actively prevents the population’s access to healthcare through restrictions on movement and other human rights abuses. For example, in August 2008, it was reported that medical students were to be forced to take an exam on the current political situation in the country before being allowed to take up medical placements in hospitals. Presumably, those students who failed to toe the SPDC line would not have been permitted to commence their placements. Although this was denied by the SPDC, it was confirmed by lecturers at Rangoon’s Medical Institute..."
Language: English
Source/publisher: Human Rights Docmentation Unit (HRDU)
Format/size: pdf (217K)
Date of entry/update: 05 December 2009

Title: Burma's Prisons and Labour Camps: Silent Killing Fields
Date of publication: 11 May 2009
Description/subject: "In October 2008, reports emerged from Burma that the military junta had ordered its courts to expedite the trials of political activists. Since then, 357 activists have been handed down harsh punishments, including sentences of up to 104 years. Shortly after sentencing, the regime began to systematically transfer political prisoners to prisons all around Burma, far from their families. This has a serious detrimental impact on both their physical and mental health. Medical supplies in prisons are wholly inadequate, and often only obtained through bribes to prison officials. It is left to the families to provide medicines, but prison transfers make it very difficult for them to visit their loved ones in jail. Prison transfers are also another form of psychological torture by the regime, aimed at both the prisoners and their families. Since November 2008, at least 228 political prisoners have been transferred to jails away from their families. The long-term consequences for the health of political prisoners recently transferred will be very serious. At least 127 political prisoners are currently in poor health. At least 19 of them are in urgent need of proper medical treatment. Political prisonersâ' right to healthcare is systematically denied by the regime. Burma's healthcare system in prisons is completely inadequate, especially in jails in remote areas. There are 44 prisons across Burma, and at least 50 labour camps. Some of them do not have a prison hospital, and at least 12 of the prisons do not even have a prison doctor. The regime's treatment of political prisoners directly contravenes the 1957 UN standard minimum rules for the treatment of prisoners. The International Committee of the Red Cross (ICRC) carried out its last prison visit in Burma in November 2005. In January 2006 the ICRC suspended prison visits in the country, as it was not allowed to fulfil its independent, impartial mandate. Since 1988 at least 139 political prisoners have died in detention, as a direct result of severe torture, denial of medical treatment, and inadequate medical care. Many, like Htay Lwin Oo, were suffering from curable diseases such as tuberculosis. He died in Mandalay Prison in December 2008. He had been due for release in December this year... 1. Political Prisoners In Poor Health There are currently at least 127 political prisoners known to be in poor health..."
Language: English
Source/publisher: Assistance Association for Political Prisoners (Burma)
Format/size: pdf (681K)
Date of entry/update: 11 May 2009

Title: After the Storm: Voices from the Delta
Date of publication: 27 February 2009
Description/subject: An independent, community-based assessment of health and human rights in the Cyclone Nargis response...DISCUSSION AND CONCLUSIONS: "To date, this report is the only community-based independent assessment of the Nargis response conducted by relief workers operating free of SPDC control. Using participatory methods and operating without the knowledge or consent of the Burmese junta or its affiliated institutions, this report brings forward the voices of those working “on the ground” and of survivors in the Cyclone Nargis-affected areas of Burma. The data reveal systematic obstruction of relief aid, willful acts of theft and sale of relief supplies, forced relocation, and the use of forced labor for reconstruction projects, including forced child labor. The slow distribution of aid, the push to hold the referendum vote, and the early refusal to accept foreign assistance are evidence of the junta’s primary concerns for regime survival and political control over the well-being of the Burmese people. These EAT findings are evidence of multiple human rights violations and the abrogation of international humanitarian relief norms and international legal frameworks for disaster relief. They may constitute crimes against humanity, violating in particular article 7(1)(k) of the Rome Statute of the International Criminal Court, and a referral for investigation by the International Criminal Court should be made by the United Nations Security Council".
Author/creator: Voravit Suwanvanichkij, Mahn Mahn, Cynthia Maung, Brock Daniels, Noriyuki Murakami, Andrea Wirtz, Chris Beyrer
Language: English
Source/publisher: Emergency Assistance Team (EAT BURMA), Center for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health
Format/size: pdf (1.57MB)
Alternate URLs: http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDocUnidFilename/ASAZ-7PRKLM-full_report.pdf/$File/full_report.pdf
Date of entry/update: 17 November 2010

Title: Burma’s Man-Made Suffering
Date of publication: 09 February 2009
Description/subject: "...Chronic divestment in health, alongside draconian restrictions, harassment and the incarceration of relief workers, remain the root drivers of the health and humanitarian crises in Burma. These are the real human rights violations that affect health—not sanctions...official restrictions governing the work of international aid agencies have been tightened, particularly the rules covering domestic travel and data collection. Their priorities are clear: until the global community has the moral fortitude to address this underlying reality, the humanitarian crises of Burma will continue, especially for the 70 Burmese HIV patients who will die today from lack of care"
Author/creator: Voravit Suwanvanichkij and Chris Beyrer
Language: English
Source/publisher: "The Irrawaddy"
Format/size: html
Alternate URLs: http://www.jhsph.edu/humanrights/_pdf/Vit_Man-MadeCrisis_Irrawaddy_9Feb09.pdf
Date of entry/update: 10 February 2009

Title: Beyond the International Spotlight, Critical Health Needs in Myanmar Remain Unmet
Date of publication: 22 December 2008
Description/subject: "...The people of Myanmar cannot wait until the next big disaster for their critical health needs to be recognized; both the government of Myanmar and the international community urgently need to act in order prevent thousands of unnecessary deaths..."...contains a 6-minute podcast: "MSF Frontline Reports - Myanmar Cyclone Emergency II May 2008" and a slide show: "A Preventable Fate: The Failure of HIV/AIDS Treatment in Myanmar... Thousands of people are needlessly dying due to a severe lack of lifesaving HIV/AIDS treatment in Myanmar. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the government of Myanmar and international organizations urgently and rapidly scale-up the provision of antiretroviral therapy (ART)."
Language: English
Source/publisher: "Top ten humanitarian crises of 2008" Medecins Sans Frontieres (Doctors without Borders)
Format/size: html
Alternate URLs: http://www.doctorswithoutborders.org/news/allcontent.cfm?id=52
Date of entry/update: 26 October 2010

Title: An unnatural disaster in Burma
Date of publication: 02 December 2008
Description/subject: "IN THE FIELD of disaster relief studies it is a truism that the first responders, whether in an earthquake or a cyclone, are generally ordinary people in the affected area who have survived. They are the first to start digging out the rubble or tending the wounded. Civilian volunteers are the backbone of the later phases of emergency responses too - people who bring food and water, volunteer at shelters, give what they can. Only in a system as profoundly inhumane as Burma would such good Samaritans be punished for their compassion. But that is precisely what happened last week..."
Author/creator: Chris Beyrer and Frank Donaghue
Language: English
Source/publisher: "The Boston Globe"
Format/size: pdf (24K)
Date of entry/update: 28 February 2009

Title: A preventable fate: The failure of ART scale-up in Myanmar
Date of publication: November 2008
Description/subject: Executive Summary: The situation for many people living with HIV in Myanmar is critical due to a severe lack of lifesaving antiretroviral treatment (ART). MSF currently provides ART to more than 11,000 people. That is the majority of all available treatment countrywide but only a small fraction of what is urgently needed. For five years MSF has continually developed its HIV/AIDS programme to respond to the extensive needs, whilst the response of both the Government of Myanmar and the international community has remained minimal. MSF should not bear the main responsibility for one of Asia’s most serious HIV/AIDS epidemics. Pushed to its limit by the lack of other services providing ART, MSF has had to make the painful decision to restrict the number of new patients it can treat. With few options to refer new patients for treatment elsewhere, the situation is dire. An estimated 240,000 people are currently infected with HIV in Myanmar. 76,000 of these people are in urgent need of ART, yet less than 20 % of them receive it through the combined efforts of MSF, other international non-governmental organizations (NGOs) and the Government of Myanmar. For the remaining people the private market offers little assistance as the most commonly used first-line treatment costs the equivalent of a month’s average wage. The lack of accessible treatment resulted in 25,000 AIDS related deaths in 2007 and a similar number of people are expected to suffer the same fate this year, unless HIV/AIDS services - most importantly the provision of ART - are urgently scaled-up. The Government of Myanmar and the International Community need to mobilize quickly in order to address this situation. Currently, the Government spends a mere 0.3% of the gross domestic product on health, the lowest amount worldwide4, a small portion of which goes to HIV/AIDS. Likewise, overseas development aid for Myanmar is the second lowest per capita worldwide and few of the big international donors provide any resources to the country. Yet, 189 member states of the United Nations, including Myanmar, endorsed the Millennium Development Goals, including the aim to “Achieve universal access to treatment for HIV/AIDS for all those who need it, by 2010”. As it stands, this remains a far cry from becoming a reality in Myanmar. As an MSF ART patient in Myanmar stated, “All people must have a spirit of humanity in helping HIV patients regardless of nation, organization or government. We are all human beings so we must help each other”. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the Government of Myanmar and international organizations urgently and rapidly scale-up ART provision. A vast gulf exists between the needs related to HIV/AIDS and the services provided. Unless ART provision is rapidly scaled-up many more people will needlessly suffer and die.
Language: English
Source/publisher: Medecins Sans Frontieres (MSF)
Format/size: pdf (735K)
Date of entry/update: 27 November 2008

Title: Exploitative governance under SPDC and DKBA authorities in Dooplaya District
Date of publication: 11 July 2008
Description/subject: "With largely consolidated control over Dooplaya District in southern Karen State the SPDC and DKBA, as the two dominant (and allied) military forces, operate under a system of coexistence. The local civilian population, in turn, faces exploitative governance on two fronts as both SPDC and DKBA soldiers seek to extract money, labour, food and other supplies from them. Enforcing heavy movement restrictions on top of persistent exploitative demands, local communities are facing deteriorating livelihood opportunities, increasing poverty, and a constriction of educational and health care opportunities. Persistent human rights abuses thus foster the economic pressures fuelling the continuing migration of rural communities in Dooplaya District to refugee camps in Thailand and towards livelihood opportunities at urban centres in Burma and Thailand. This report examines the situation of abuse in Dooplaya District from January to June 2008..."
Language: English
Source/publisher: Karen Human Rights Group Field Reports (KHRG #2008-F8)
Format/size: html, pdf (666 KB)
Alternate URLs: http://www.khrg.org/sites/default/files/khrg08f8.pdf
Date of entry/update: 01 November 2009

Title: Health security among internally displaced and vulnerable populations in eastern Burma
Date of publication: January 2008
Description/subject: Conclusion: "Continued conflict and consistent human rights violations have increased mortality rates and worsened the health status of IDPs and other vulnerable populations in Burma. Collaboration with and partnerships among border-based health organisations have proved to be viable solutions towards providing primary health care to these vulnerable populations, and should be a focus for the international public health community. Without an end to human rights violations in Burma, however, any improvements in health status are unlikely to be sustained".
Author/creator: Mahn Mahn, Katherine C. Teela, Catherine I. Lee and Cara O’Connor
Language: English
Source/publisher: 2007 Myanmar/Burma Update Conference via Australian National University
Format/size: pdf (229K)
Alternate URLs: http://epress.anu.edu.au/myanmar02/pdf_instructions.html
Date of entry/update: 30 December 2008

Title: Borderline Health
Date of publication: 2008
Description/subject: As a "slow-motion genocide" envelops ethnic minorities in eastern Burma, health workers rely on innovative strategies and raw courage to save the lives of mothers and infants.
Author/creator: Cathy Shufro
Language: English
Source/publisher: "Johns Hopkins Public Health" Online Edition, FAll 2008
Format/size: html
Date of entry/update: 21 December 2008

Title: MSF material on Burma/Myanmar (2008)
Date of publication: 2008
Description/subject: Collection of MSF public documents, 2008, largely on the aftermath of Cyclone Nargis: "A Preventable Fate: The Failure of ART Scale-Up in Myanmar"..."Myanmar: Urgent Lack of HIV/AIDS Treatment Threatens Thousands"..."Myanmar: Three Months after Cyclone Nargis, MSF Still Providing Assistance"..."Irrawaddy Delta, Myanmar: Survivors Living in Dire Conditions"..."Myanmar: Two Months After Cyclone Nargis, Needs Remain Critical"..."Myanmar: Critical Needs Remain for a Traumatized People"..."One Month After Cyclone Nargis Struck Myanmar, Survivors Still Living in Dire Conditions"..."After Cyclone Enormous Needs Unmet in Myanmar"..."Myanmar: MSF Operations in Cyclone-Hit Areas"..."Doctors Without Borders Calls For Immediate and Unobstructed Escalation of Myanmar Relief Operations"..."First MSF Relief Plane Arrives in Myanmar (Burma)"..."Doctors Without Borders Cargo Plane Arrives in Myanmar"..."MSF Dispatches Three Cargo Planes with 110 Tons of Relief Materials to Myanmar (Burma)"..."Cyclone in Myanmar (Burma): MSF teams intensify emergency response, a first relief plane is due to land in Yangon"..."Emergency Update: Doctors Without Borders/Médecins Sans Frontières (MSF) Activities in Myanmar"... "People tell stories of spending the night of the cyclone hanging onto trees all night long"..."Myanmar Cyclone: MSF Teams Bring Immediate Assistance While Additional Staff and Relief Materials are Ready to be Sent ...MSF Response to Aid Myanmar Cyclone Victims"..."Doctors Without Borders Releases Tenth Annual "Top Ten" Most Underreported Humanitarian Stories of 2007"..."Top Ten" Most Underreported Humanitarian Stories of 2007"..."People in Southeast Asia Needlessly Becoming Blind Due to a Neglected Virus"..."Myanmar Refugees in Bangladesh: Nowhere to Go"..."Dr. Hervé Isambert, MSF program manager Prevented from working, the French Section of MSF leaves Myanmar"..."Prevented From Working, the French Section of MSF Leaves Myanmar (Burma)"..."EMERGENCY UPDATE: Aid Operations to Disaster Areas in South Asia"..."Frank Smithuis, MD: "Impatience is the most important thing""
Language: English
Source/publisher: Medicins Sans Frontieres (Doctors Withour Borders)
Format/size: html
Date of entry/update: 22 December 2008

Title: Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma
Date of publication: September 2007
Description/subject: Background: Case reports of human rights violations have focused on individuals’ experiences. Populationbased quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma... Objective: We describe the association between mortality and morbidity and the household-level experience of human rights violations among internally displaced persons in eastern Burma... Methods: Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months... Results: Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost onethird of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations... Conclusions: Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population-level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere.
Author/creator: Luke C Mullany, Adam K Richards, Catherine I Lee, Voravit Suwanvanichkij, Cynthia Maung, Mahn Mahn, Chris Beyrer and Thomas J Lee
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

Title: Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma
Date of publication: July 2006
Description/subject: Objectives: To estimate mortality rates for populations living in civil war zones in Karen, Karenni, and Mon states of eastern Burma.... Methods: Indigenous mobile health workers providing care in conflict zones in Karen, Karenni, and Mon areas of eastern Burma conducted cluster sample surveys interviewing heads of households during 3-month time periods in 2002 and 2003 to collect demographic and mortality data.... Results: In 2002 health workers completed 1290 household surveys comprising 7496 individuals. In 2003, 1609 households with 9083 members were surveyed. Estimates of vital statistics were as follows: infant mortality rate: 135 (95% CI: 96–181) and 122 (95% CI: 70–175) per 1000 live births; under-five mortality rate: 291 (95% CI: 238–348) and 276 (95% CI: 190–361) per 1000 live births; crude mortality rate: 25 (95% CI: 21–29) and 21 (95% CI: 15–27) per 1000 persons per year.... Conclusions: Populations living in conflict zones in eastern Burma experience high mortality rates. The use of indigenous mobile health workers provides one means of measuring health status among populations that would normally be inaccessible due to ongoing conflict..... Keywords: Burma, mortality, internally displaced persons, malaria, landmines, civil conflict
Author/creator: Thomas J. Lee, Luke C. Mullany, Adam K. Richards, Heather K. Kuiper, Cynthia Maung and Chris Beyrer
Language: English
Source/publisher: "Tropical Medicine and International Health" Volume 11 no 7 pp 1119–1127 July 2006
Format/size: pdf (230K)
Alternate URLs: http://www.ghap.org/about_us/news/pdfs/tmi_1651.pdf
Date of entry/update: 21 December 2008