Below are reproduced three articles published yesterday Monday 10 March on the health care situation and health care gap in Rakhine following the suspension of activities of Medecins sans Frontieres. One from the Myanmar Times, one from Irrawaddy, and one from VOA. All three are worth reading top to bottom.
Jamie
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Medical gap threatens lives in Rakhine
Fiona MacGregor
Myanmar Times
Monday, 10 March 2014
Nazir Ahmed is dying. It is the rasping, frightened-eyed passing of a man denied even the most basic medical care – an undignified and distressing end he is condemned to suffer because his ethnicity means that he is refused fundamental human rights.
But Nazir Ahmed is a prisoner in Aung Mingalar ghetto, an enclosed area in the centre of the Rakhine State capital Sittwe where – just metres away from bustling town life and tourists sampling the local seafood – about 4000 Rohingya Muslims are trapped in an existence of hunger and misery.
The Rohingya live here without access to healthcare, education or sufficient food. Armed guards and fear prevent them from leaving.
As Nazir Ahmed lies on a thin bamboo mat on the wooden floorboards of his roughly constructed home, his two sons attempt to comfort him by stroking his head and soothing his convulsing limbs.
Everyone in the house is aware that there is a state hospital just a few minutes’ walk away, as well as a team of international healthcare workers nearby who would be happy to help the sick man.
But the staff of Medecins Sans Frontiers (MSF), the only INGO that had been allowed access to Aung Mingalar and had been treating Mr Ahmed since he suffered a stroke in early January, have been banned from working in the region by Myanmar government.
Tensions between the majority ethnic Rakhine and the Rohingya – a minority group not recognised by the government – are so high these days that, even if they could afford to pay the guards to let them out of Aung Mingalar, many Rohingya fear for their safety at the local Rakhine-run state hospital.
“People are frightened they will be attacked if they go the hospital,” explained one community representative, who said Rakhine hardliners patrol the medical facility’s grounds.
He asked not be named for fear of reprisals.
Nazir Ahmed’s condition started to deteriorate in the days before The Myanmar Times met him in Aung Mingalar on March 5.
Three days previously, residents with some medical understanding had urged his family to take him to the hospital in a bid to save his life. But like many in Aung Mingalar, they have no opportunity to work and could not afford the K10,000 required to pay the guards to allow him to leave.
Before MSF staff were expelled from Rakhine, they had facilitated the movement of patients who required hospital treatment and had given them the necessary referrals so they could receive treatment at Sittwe General Hospital.
By the time enough cash had been raised to get Nazir Ahmed to Sittwe General, his family felt it was too late. They said they did not want him to die in a hospital where they believed the Rakhine medical staff would mistreat him because he was Rohingya.
“We did not want to send him there to die,” said his son, Jamal Nasir.
He displayed two notebooks with his father’s name and age, 58, written on the front. The notebooks contained Nazir Ahmed’s MSF medical notes.
The first date recorded was January 7, 2014. There were no entries after February 28, the date MSF was ordered to cease operations in a move the government said was aimed at preventing further community conflict in the region.
The decision to evict MSF at the end of last month came amid growing resentment from Rakhine residents who claimed the organisation was
giving preferential aid to the Rohingya, and government concerns that the INGO’s reports regarding Rohingya patients they had treated following alleged attacks against them were at odds with the authorities’ accounts.
The group had been working in the region for more than 20 years and had 600 staff operating in Rakhine alone, providing vital medical care across the state. They were particularly important in remote communities as well as to those in the IDP camps who had restricted access to state services.
INGOs and UN organisations have expressed concern that local health authorities in Rakhine – Myanmar’s second-poorest state – do not have the facilities to replicate MSF’s services.
However, the deputy director general of the Ministry of Health, U Soe Lwin Nyein, has insisted they do and that state health workers will also provide care for those in the “Bengali” (the term Myanmar officials use to refer to the Rohingya) camps.
He has also asserted the ban is “temporary”, though MSF sources say they have had no confirmation of that.
Temporary or otherwise, any reinstatement will come too late for Nazir Ahmed, and very probably for many other vulnerable patients in Rakhine.
Five days after the MSF ban had come into effect, as Mr Ahmed lay dying, no one from the Ministry of Health had yet visited Aung Mingalar to ask about the residents’ medical needs, according to village head Shwe Zan Aung.
In a tiny bamboo hut a few streets away from Mr Ahmed’s house, a mother showed off her new baby boy, born the night before without medical assistance.
Other mothers soon gathered around to show infants they have given birth to while surviving on the most meagre rations: a tin can full of rice a day to feed a family of nine, a few handfuls of homegrown watercress, and what little extra food they might be able to afford from what is brought into the village by a truck that, after the guards have been paid off, is allowed to leave twice a week to go to a nearby market for supplies.
There is little firewood left in the village, so residents have been reduced to cooking over burning rubbish that often produces toxic fumes.
“Sometimes we just have to eat the leaves from the banana trees,” said Zorina Khatu, 45.
One young woman appears with twins. They are six weeks old but still tiny. They are lucky: Their grandmother is a traditional midwife.
But while the Ministry of Health insists that it can manage vaccinations for all communities without MSF’s help, it remains unclear how, when and who will facilitate the provision of polio and other inoculations to these new Aung Mingalar infants.
The elderly too fear for their future now that the INGO has been banned. Maung Maung, 63, has diabetes. While village residents say MSF did not usually supply regular diabetes medicines in the area, the INGO was able to do so in emergency cases.
Asked how he feels about the MSF ban, U Maung Maung said, “There’s a lot of trouble because of the lack of doctors and treatment, and we cannot go out for treatment. I am frightened I will die.”
The union government is aware of how banning a respected INGO from Myanmar appears on the global stage, especially at a time when the country is doing its best to present itself as a fledgling democracy.
While officials at the state level seem more concerned with appeasing Rakhine hardliners who demonstrate in the streets and make online threats against international aid workers, those heading up the union government’s response appear keen to show they are taking a balanced stance.
During a visit to Sittwe State Hospital on March 3, The Myanmar Times witnessed a police chief interviewing a senior medical official regarding allegations that a three-year-old boy who had been brought to the hospital from Aung Mingalar with breathing problems on February 26 had died five days later due to the mistreatment by medical staff.
Police officers were later seen questioning nurses at the hospital.
According to the policeman, the allegations had appeared online. Aung Mingalar residents said sources in the hospital reported that, while the doctors there “do their best”, other medical staff are less than caring toward Rohingya patients.
It may or may not have been a coincidence that part of the investigation into the boy’s death took place in front of journalists.
According to U Soe Lwin Nyein, who said he was not aware of the incident but would look into it, the government expected the decision to remove MSF would provoke rumours and allegations, and authorities were ready “for [the Rohingya] to test us”.
Under such circumstances, he suggested, it was important that such claims be properly investigated.
While allegations about the boy’s mistreatment remain unsubstantiated, a European medical professional who visited the hospital around the time of the boy’s death said he had been shocked by other treatment he had witnessed there.
He said he had looked into an operating room and seen nurses sewing up the badly slashed face of an elderly Rohingya woman from an IDP camp. Seeing that they were doing a rough job and using thick sutures, he had asked why they weren’t using finer thread on a face wound, and offered his own supplies if necessary.
The response he received, he said, was that “it doesn’t matter. She has no money, she’s a woman and she’s Muslim.”
In a tacit acknowledgement that Rakhine medical staff might not always be the best people to treat the Rohingya population, and might find it difficult to work in the IDP camps, U Soe Lwin Nyein said a rapid response team comprising medical staff from other parts of Myanmar was to be drafted into the region.
However, he said it was expected to be deployed for only a week or two.
With state officials suggesting that it is likely to be at least seven months before MSF will be allowed to resume operations in Rakhine, the future for Rohingya healthcare remains bleak.
They will have to go without care or, if they can find the money, put themselves in the hands of medical staff they do not trust.
As The Myanmar Times left Aung Mingalar, village head Shwe Zan Aung made this plea: “I would like to ask the union government if they will substitute another INGO to bring us medical treatment.”
It does not seem too much to ask.
http://www.mmtimes.com/index.php/national-news/9804-medical-gap-threatens-lives-in-rakhine.html
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Burma Govt Sends Emergency Medics to Arakan After MSF Suspension
Samantha Michaels
The Irrawaddy
Monday, March 10, 2014 |
RANGOON — Burma’s health ministry has deployed an emergency response team to Arakan State following the suspension of Médecins Sans Frontieres (MSF) operations there, but concerns are growing over a sudden gap in medical care for hundreds of thousands of people who previously depended on the humanitarian organization’s services.
MSF Holland, which began operating in the restive western state 20 years ago, claims to be the single biggest provider of health care there. Last year it conducted over 400,000 consultations, including in camps for internally displaced people (IDPs) and in hard-to-reach areas of the state, which has seen communal violence between Buddhists and Muslims since June 2012.
Other NGOs and UN agencies also offer health services in Arakan, but on a smaller scale. Burma has depended largely on outside medical assistance in the aftermath of the violence, due to limited funding and resources at the Ministry of Health.
Ye Htut, a spokesman for President Thein Sein, said the government was moving to fill the gap in care after deciding late last month not to renew MSF’s agreement to operate in the state. However, the medical response appeared limited for the time being.
“The Ministry of Health already sent an emergency response team with eight ambulances to Rakhine [Arakan] to fill MSF’s operation,” he told The Irrawaddy in an email last Thursday, without elaborating, when asked whether the ministry planned to open additional clinics or to send more doctors and nurses to the state.
He did not respond to further requests for comment when asked whether the government’s response would be sufficient to handle the needs of patients who previously sought treatment with MSF, including over 10,000 malaria patients and almost 850 people with HIV. He also declined to comment on whether the government was considering allowing other international medical aid organizations to boost their presence in the state.
Before their operations were suspended, MSF employed more than 500 staff in Arakan, mainly medical staff, who provided primary health care, reproductive services, referral services and treatment for malaria, HIV and tuberculosis. They worked at over 30 sites in eight townships in the state, with a total program worth over US$9 million.
“Humanitarian organizations are very concerned about the potential humanitarian impact in Rakhine [Arakan] State following the government’s request to MSF Holland to temporarily stop its activities,” Pierre Peron, a spokesman for the UN Office for the Coordination of Humanitarian Affairs in Burma, told The Irrawaddy. “Replacing the MSF operation would be very difficult due to the scale and complexity of the operations that MSF has built up over many years, particularly in the northern part of Rakhine.”
Allegations of Bias
MSF Holland announced on Feb. 28 that it had been ordered by the government to halt all its operations in Burma—not only in Arakan, but also in Kachin and Shan States, as well as Rangoon Division. The government justified its decision partly by accusing the aid body of providing preferential treatment to favor the Rohingya, a Muslim minority group that has borne the brunt of violence in Arakan State and is largely denied citizenship in the country.
Rights groups and foreign governments responded critically, and within days the government said MSF could reopen its clinics everywhere except Arakan State. In addition to allegations of preferential treatment, the government accused MSF of violating certain conditions in its memorandum of understanding (MoU), including by employing more foreign staff in the state than agreed, and by running a medical care clinic for newborns without approval.
In the days before the suspension, Arakanese Buddhists had protested in the state capital Sittwe against MSF operations, accusing the aid group of bias and urging Thein Sein to cancel its MoU. The protests appeared to have been sparked by MSF’s claim that it treated 22 patients for injuries in the aftermath of an alleged massacre of Rohingyas in Maungdaw Township. While the UN said it received “credible evidence” to indicate that Arakanese villagers and state security forces were involved in the alleged violence, the government repeatedly denied the killings had occurred and accused MSF as well as international media of misreporting events.
Aye Maung, a lawmaker and chairman of the Rakhine Nationalities Development Party (RNDP), said he supported the suspension of MSF operations in Arakan State. “It was what the people of Arakan wanted. My party respects the people,” he told The Irrawaddy. “A very small amount of medical care was for the Rakhine [Arakanese] people. They should have worked for both the Rakhine community and the Muslim community, but they discriminated, so most of the Arakanese suffered.”
MSF has denied to comment publicly as it continues negotiations with government officials in Naypyidaw, but the aid group has long rejected allegations of bias, saying it operates on the basis of medical need.
Since 2012, Rohingyas have lacked access to health care and other basic services in Arakan State because they have been subject to government-imposed movement restrictions that make it difficult if not impossible for them to travel to medical centers. Certain public hospitals in the state have also been accused of denying them admission for treatment.
MSF offered services in IDP camps and operated mobile clinics that went to Rohingya communities in remote areas, especially in the northern townships, but it also treated local Buddhists and says the majority of its malaria patients in 2013 were Arakanese.
Identifying the Treatment Gap
It is possible that more medical aid groups will face trouble in Arakan State in the coming months. The state legislature is now considering a proposal to block unregistered NGOs from operating in the region, to prevent them from “causing bigger problems” between Buddhists and Muslims, according to a report by Radio Free Asia.
The proposal was submitted by another RNDP lawmaker, Aung Win, on Friday. “There are some INGOs and NGOs that have caused bigger problems between the two communities and some are creating a bad image of the country. Also, we have seen some organizations act disrespectfully to the local people,” he told RFA.
The news agency reported that only 19 international and local NGOs had been approved to operate in the state since 2012, although 70 groups had applied. It said local authorities in the past allowed NGOs to work without formal registration, in an effort to help the more than 140,000 people living in IDP camps and others affected by the communal violence.
For medical aid, various UN agencies fund a wide range of health care services, often collaborating with the government as well as local and international NGOs.
Beyond these programs, about 15 international and local NGOs were offering health services in the state as of late last year, according to the Myanmar Information Management Unit, which assists the UN country team in Burma. Including MSF, only a handful of these offered basic health services, and their programs were much smaller. Other organizations focused on mental health, reproductive health, women’s and children’s health, malaria prevention, HIV treatment and health education.
Few groups offered health services in the northern townships, according to Malteser International, a relief agency of Malta which assists tuberculosis patients and supports local health staff in the area.
“Overall, our intervention is of course much smaller than that of MSF. In northern [Arakan], I think they were the biggest player, partly because they have a lot of funding,” said Johannes Kaltenbach, a spokesman for Malteser in Burma. He said his organization employed about 200 staff in the state, compared to more than 500 staff at MSF.
He said the suspension of MSF operations was unfortunate, particularly for the beneficiaries in the northern townships.
“Still, in magnitude, when it comes to the actual impact it might have, I think we will only feel it in the coming weeks or months. In Sittwe, it might be different,” he added, referring to the state capital, around which many IDP camps are located.
He said he had not heard of government plans to boost care in the state, nor had Malteser been approached to scale up its activities. “We hope MSF will see some return to normalcy. For us, we will wait, the same as other organizations, and see,” he said.
The International Committee of the Red Cross (ICRC), which also supports health services in Arakan, said the removal of any substantial humanitarian provider would have a major impact, but agreed that it was not yet clear how big the treatment gap would be. Michael O’Brien, a spokesman for the ICRC in Burma, said his organization was not planning to expand its reach in the state in the short term.
“At the moment we’re structured to perform the functions that we perform as efficiently as we can. Like most organizations, we wouldn’t have an enormous amount of spare capacity—that doesn’t mean we couldn’t try to provide assistance, but if we’re talking about major health sector assistance, with the structure that we have at the moment, that would be pretty well beyond us in the short term,” he told The Irrawaddy.
“We haven’t been asked to do that either, and I’m not sure at this point that the gap has actually been fully identified. It’s still quite a fluid situation, and so until somebody can be specific about what they would need and then a request comes to us, it’s quite a hypothetical situation.”
Burma’s national health system has been chronically underfunded for decades, as the former military regime prioritized defense spending over social services.
Like in other rural areas across Burma, midwives provide the bulk of health services in Arakan, one of the poorest states in the country. A single midwife is responsible for thousands of patients, and since the outbreak of violence, some midwives have stopped traveling to certain rural villages due to security concerns.
Foreign governments have voiced concerns over the suspension of MSF operations in the state.
“We understand that the Union Government and Médecins Sans Frontières (MSF) are in discussions and want to encourage and fully support their efforts to find a solution that will ensure continued life-saving health services for those in Burma that need it most,” a US Embassy spokesman told The Irrawaddy last week.
“We reiterate the vital importance of allowing the provision of unhindered and regular access to urgently needed health care services and other humanitarian support to communities in need of such assistance, regardless of ethnicity.”
http://www.irrawaddy.org/burma/burma-govt-sends-emergency-medics-arakan-msf-suspension.html
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Activists: Burma’s Foreign Aid Group Ban Puts Thousands at Risk
Gabrielle Paluch
March 10, 2014
SITTWE, BURMA — In western Burma’s Rakhine state, authorities asked international aid group Doctors Without Borders (known by its French name Medecins Sans Frontieres or MSF) to cease operations after accusations of aid bias. Activists say the ban will leave nearly 700,000 people without access to much needed medical care in the country's second-most impoverished region.
HIV-positive Ba Sein is also suffering from tuberculosis. He is living in close quarters with his wife and two children in a temporary camp for ethnic Muslim Rohingya on the outskirts of Sittwe.
Three months ago, doctors at a nearby clinic operated by Doctors Without Borders gave Ba Sein the diagnosis. But he cannot go in for his follow-ups because the clinic has closed.
Sittwe General Hospital is not far, but Ba Sein cannot travel there because security officers charge fees from the ethnic Rohingya minority. He said he has fevers every day, and wants to seek treatment but doesn't know where to go.
In this remote region of Burma, MSF has long been the primary source of reliable healthcare for hundreds of thousands of vulnerable people. The group has been the primary responder to outbreaks of infectious diseases, and provides regular treatments for tuberculosis, malaria, and HIV.
But Doctors Without Borders drew controversy last month following an alleged attack on ethnic Rohingya Muslims in northern Rakhine state. MSF confirmed to international media that its doctors treated patients for wounds after a violent incident in Du Chee Ya Tar village. Human rights groups said at least 40 ethnic Rohingya were killed, a claim denied by the Burmese government.
Shortly after the group reported treating victims, authorities sent MSF an order to cease operations.
Although the Rakhine State Health Department said MSF’s suspension from operating in the region is only temporary, Burmese health authorities are consulting with the United Nations to plan for the sudden increase in patients. They said they will relocate staff from elsewhere in Burma to help with the workload.
"There is huge need here in Rakhine, there are a lot of people who already have inadequate access to health services and other basic services," explained Mark Cutts, who is responsible for the U.N.'s coordination office in Burma. He said they must put the needs of the people first.
"That's why we have a massive humanitarian operation in Rakhine state that's why we're working to support the government to ensure that vulnerable people here receive the essential life-saving services they need," Cutts said. "So when one of the biggest humanitarian organizations is asked to leave clearly that is a huge concern to us but the government have told us that there will be no gap in services."
The ban will primarily affect health care services for the ethnic Rohingya minority, the vast majority of whom live in northern Rakhine state. The ministry of health suggested it would bus patients in northern Rakhine state to Sittwe for treatment, but bringing ethnic Rohingya to a predominantly Rakhine area poses a security threat.
MSF provided anti-retroviral treatment for HIV for at least 650 patients living in northern Rakhine state.
A health professional who wished to remain unnamed told VOA that the government-run clinic in Da Paing IDP camp near Sittwe is already understaffed and lacks the facilities and resources to treat people. He said they often refer their patients to MSF.
http://www.voanews.com/content/burmas-ban-on-foreign-aid-group-puts-thousands-at-risk/1867860.html
