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Health care for all in Arakan? Critics say reality belies state counsellor’s assertion

People displaced by violence walk on the banks of the Mayu River with their belongings while moving to another village, in Buthidaung Township, Arakan State, on 13 September 2017. (Photo: Reuters)

As Burma’s de facto leader Aung San Suu Kyi addressed the country last week on the continuing crisis in Arakan State, she claimed that all people in the state “have access to education and healthcare services without discrimination.” For critics of her nationally televised speech, however, that’s simply not true — and their contention is supported by a report that Suu Kyi’s own government has fully embraced.

The end-of-mission report released last month by the Advisory Commission on Rakhine State, chaired by former UN Secretary-General Kofi Annan, points to disparities in the provision of health care that can be both situational and institutional.

“While all communities suffer from inadequate medical services, access to health is particularly low within the Muslim community in the northern and central parts of the state,” reads the report, which was released on 24 August.

“In some areas, Muslims face discriminative obstacles that prevent available lifesaving services from being accessed,” it continues. “Movement restrictions, but also language difficulties, inability to pay, limited availability of services in IDP [internally displaced persons] camps, as well as the refusal of some health facilities to treat Muslim patients all prevent ready access to health facilities.”

Regarding education, the report reads: “Many Muslims find it extremely difficult to attend university in or outside of Rakhine [Arakan] State because of discriminatory practices and practical limitations on freedom of movement — especially security concerns — which must be clearly addressed by the Government to ensure access for Muslim students and safety of all students.”

It is within this context that some have highlighted the apparent disconnect between State Counsellor Aung San Suu Kyi’s assurances last week and on-the-ground realities; the findings of the Annan commission report on the state of health care and education in Arakan State were by no means groundbreaking, and merely confirmed what many have known to be true for years.

“Contrary to Aung San Suu Kyi’s claims, Rohingya are essentially segregated in Rakhine State, effectively denied citizenship and face severe barriers in accessing health care and other basic services,” said James Gomez, Amnesty International’s regional director for Southeast Asia and the Pacific.

Though discrimination against the Rohingya has existed for decades, the situation has deteriorated in the years since 2012, when inter-communal violence between Buddhists and Muslims wracked Arakan State, sending more than 100,000 Rohingya into displacement camps. Added restrictions on movement, and a renewed push in 2015 to enforce a three-decades-old Citizenship Law — by invalidating so-called “white cards” that conferred a degree of legitimacy on holders’ claims to citizenship — have exacerbated the Rohingya’s stateless plight.

Asked about Suu Kyi’s assertion on healthcare and education access, Human Rights Watch’s Asia deputy director, Phil Robertson, told DVB: “She’s in la-la land if she believes that is true in Rakhine State.”

He continued, “Severe movement restrictions have frustrated efforts to provide assistance to Rohingya, and those groups like MSF [Médecins Sans Frontiers, or Doctors Without Borders] that were really making inroads in providing assistance were chased out by the government.”

Matthew Smith from the human rights group Fortify Rights agreed, saying, “Several aspects of her speech were patently untrue. … The Rohingya have been living under severe state-imposed restrictions and deprived of basic rights and freedoms for decades.”

Zaw Htay, a government spokesperson, referred inquiries about the healthcare situation in Arakan State to the Ministry of Health and Sports. He did not, however, provide contact details for the relevant individual within the ministry in a follow-up communiqué from DVB.

Healthcare, education in a critical state

Access to health services in Arakan State is low, for both the Buddhist Arakanese and Muslim populations.

The provision of health care is not standardised throughout the state and was described as a “patchwork of inconsistent services” by the Annan commission.

Part of the issue, the commission reported, is this: “Many health workers are hesitant to spend time in Muslim villages and hard-to-reach areas, especially when not assisted with transportation costs and per diem. Some health workers also avoid such areas due to real or perceived security risks.”

The International Committee of the Red Cross (ICRC) is helping to fund critical operations in the country and says since the latest crisis kicked off at the end of August they had helped over 13,000 people stranded at the border between Burma and Bangladesh as of 15 September.

Fabrizzio Carboni, the ICRC’s head of delegation in Burma, said: “Lives of those affected by this tragic situation have become simply unbearable. We continue scaling up aid to support all people fleeing violence, but more funding is urgently needed.”

While aid organisations try to address the gaps, security and conflict researcher Kim Jolliffe said “schools have been explicitly closed and universities have explicitly blocked Rohingya enrolment. Individual doctors and clinics have also refused to see Muslim patients.”

Aid has remained a sensitive issue and Jolliffe says in hindsight, a lack of “conflict sensitivity” has contributed to the reasons that Arakanese people remain so sceptical of aid agencies.

Speaking to DVB on 19 September, he added, “This is at least partly understandable from their perspective as they have been among the country’s poorest and got no support for decades. But this is mostly the junta’s fault.”

NGOs as enemy

MSF’s spokesperson in Bangladesh, Benoitde Gryse, told DVB via phone, “In the pre-crisis situation, already access to hospitals, for example, was something that was very difficult for the Rohingya.” MSF would make referrals from clinics in northern Arakan State to Maungdaw, yet already existing travel restrictions complicated the situation, particularly in emergency cases.

Now, in the heat of the continuing crisis, Gryse warns about two pressing concerns: “Part of the Rakhine population felt that we exclusively, or NGOs in general, were exclusively helping Rohingyas. … What is worrying is the state counsellor on her website actually accusing us of working together with the opposition group, … which of course doesn’t help that perception.”

This fear-mongering toward NGOs arguably spiked at the end of July, when the Facebook page of the government’s “Information Committee” published pictures of World Food Programme (WFP) energy biscuits found at an insurgent camp, suggesting the UN agency was supporting the insurgents.

The second concern is the administrative and bureaucratic hurdles that aid organisations have to leap through. “The travel authorisations, there is an unclarity between what is expected from INGOs in regards to asking for authorisations at state level or Union level, and I think that’s very problematic to see who actually decides on those things,” explained Gryse.

Aid pushed to the limits in Bangladesh

The situation in Arakan State, which the UN human rights agency’s chief said was “a textbook example of ethnic cleansing,” remains unstable. The International Organization for Migration (IOM) has reported that health facilities at Cox’s Bazar in Bangladesh have struggled to cope with new arrivals estimated at more than 420,000.

As many refugees have walked in intense heat or monsoon rains through the jungle, with little or no shelter and clean water, it is the youngest among them and the elderly who are at greatest risk from waterborne and contagious diseases.

“Newly arrived children are at high risk of vaccine preventable diseases,” said Dr. Samir Kumar Howlader, IOM national health programme officer, in a statement.

Many have also arrived with injuries.

“I was living with a gunshot wound for five days. I would have lost my leg if I didn’t get treatment,” said Anayet Ullah, 18, who was in critical condition when he was treated by an IOM medical team at the Ukhiya health complex run by the Bangladeshi government.

According to the IOM, the two camps run by the UN refugee agency (UNHCR), in the Cox’s Bazar sub-districts of Ukhiya and Teknaf, now tally an estimated 600,000 people, two-thirds of whom have arrived since 25 August.

As refugees continue to flow into Bangladesh, the UN Population Fund (UNFPA) has estimated that 67 percent are women and girls. Among them, 13 percent are pregnant or breastfeeding. And, the UNFPA says warns, these numbers may rise.

“Women do not stop getting pregnant or having babies just because an emergency hits,” said Iori Kato, UNFPA’s acting representative in Bangladesh.

This article was updated on 2 October.