The body of Nur Husain, 27 was prepared for burial. it was unclear precisely what killed him, according to a western doctor who reviewed the four medicines that were given to him. But almost certainly, proper monitoring and the oxygen ordinarily administered by Doctors Without Borders could have saved him, the doctor said. Adam Dean for The New York Times
By Jane Perlez
May 02, 2014
SITTWE, Myanmar — By the time the baby girl was brought to the makeshift pharmacy, her chest was heaving, her temperature soaring. The supply of oxygen that might have helped was now off limits, in a Doctors Without Borders clinic shut down by the government in February.
A hospital visit was out of the question; admission for Rohingya Muslims, a long-persecuted minority, always requires a lengthy approval process — time that the baby, named Parmin, did not have. In desperation, the pharmacy owner sent the family to the rarely staffed Dapaing clinic, the only government emergency health center for the tens of thousands of Rohingya Muslims herded into displaced people’s camps. Although it was just 4 p.m., the doors were shuttered.
“We became like crazy people, running everywhere,” the child’s grandmother, Daw Mu Mu Lwin, said. With no good choices left, the family returned to the pharmacy, where Parmin died, untreated, three and a half hours later, cradled in her grandmother’s arms.
The baby’s death was part of a rapidly expanding death toll and humanitarian crisis among the Rohingya, a Muslim minority that Myanmar’s Buddhist-led government has increasingly deprived of the most basic liberties and aid even as it trumpets its latest democratic reforms.
The crisis began with the government’s expulsion of Doctors Without Borders, one of the world’s premier humanitarian aid groups and the lifeline to health care for more than a million Rohingya increasingly denied those services by their own government. But the situation has grown more dire in recent weeks, as local Buddhist officials began severely restricting other humanitarian aid to the camps and the rest of Rakhine State, where tuberculosis, waterborne illnesses and malnutrition are endemic.
Some aid workers fear they are being kept away so there are fewer witnesses to rampant mistreatment and occasional bloodletting; the doctor’s group was expelled from Rakhine State after caring for victims of a violent assault on a Rohingya village that the government denies ever happened.
The scope of the government crackdown is serious enough that it has inspired at least some rebukes from world leaders after near silence even as Myanmar’s government ignored violence by local Buddhists in 2012 that left hundreds of Muslims dead and drove many others into the displaced people’s camps. Loath to criticize the government as it moves the country away from a military dictatorship, international leaders also fear losing out in an international scramble for Myanmar’s business, and allegiance.
The Obama administration — which has been eager to keep strategically positioned Myanmar away from China — weighed in when the president admonished Myanmar’s leaders during his recent Asian tour, saying: “Myanmar won’t succeed if the Muslim population is oppressed.”
And Tomas Ojea Quintana, who was the United Nations representative responsible for human rights in Myanmar until March, says the government’s obstruction of humanitarian aid “could amount to crimes against humanity.”
Even those foreign aid workers who have been able to return to work in recent days, do so amid heightened security fears. State government officials recently allowed a radical Buddhist monk to preach for 10 days in the region, stirring up passions among Buddhists. After the visit by the monk, Ashin Wirahtu, radical Buddhists ransacked the facilities of more than a dozen aid and U.N. agencies, including the Red Cross, forcing more than 300 foreign aid workers to evacuate.
Two battalions of riot police officers, and a Myanmar Army division remained in their barracks.
With most foreign aid workers gone, it is impossible to accurately assess the number of deaths caused by the absence of lifesaving medical services; the government fails to keep or share health records. Aid workers, however, say they see the evidence of a building crisis.
“For sure the deaths are accelerating,” said Dr. Liviu Vedrasco, the head of the health care cluster for the World Health Organization in Myanmar.
One indicator of the seriousness of the situation: Doctors Without Borders had sent about 400 emergency cases every month to local hospitals. In March, fewer than 20 people got referrals required by the government, according to W.H.O.
Some of the only aid currently being provided is food rations from the World Food Program, which has been allowed to deliver rice and oil to the camps, a move some aid agencies say they believe is aimed at averting the bad publicity that could come with mass starvation. Even before the slashing of other aid, though, the World Health Organization reported that the food program was not sufficient to prevent malnutrition in the camps in Rakhine State or to stop the chronic acute malnutrition in northern areas of Rakhine State where many other Rohingya live.
At a temporary clinic set up by wealthy out-of-state Muslims after Doctors Without Borders was banned, U Maung Maung Hla, a volunteer medical assistant, surveyed the women clustered on the floor in front of him, holding emaciated babies. The children, he said, needed more than the one-time ration of vitamins he was offering.
“These children are only being fed rice,” he said. “If these conditions continue, all the babies will die.”
The Rohingya, denied citizenship, have long been outcasts in Myanmar, formerly called Burma. Many in the Buddhist-majority country believe the Rohingya should go to Bangladesh, even though many are not from there, or come from families that have been in Myanmar for generations.
The camps outside Sittwe, where more than 100,000 of the 1.3 million Rohingya in Myanmar live, were set up after the 2012 burning of the Rohingya neighborhoods in the town, a dilapidated trading center on the Bay of Bengal. Aid workers say the camps, where tight security prevents people from leaving, even to work, have become little more than sprawling prisons.
Until Doctors Without Borders was chased out of the region, some of the few people who got to leave the camps were the desperately ill, bound for the town’s hospital. Now, even few of the sick leave.
In response to the recent international criticism, the Myanmar government spokesman, Ye Htut, this week told a radio network that “there is no state-sanctioned discrimination against Muslims.” He also said there was no “outbreak of disease” in the camps because Myanmar’s Ministry of Health had stepped in to provide health care, sanitation and water.
But Dr. Vedrasco of the World Health Organization noted that Myanmar was ranked second to last — just above Sierra Leone — in the organization’s list of medical services, and could not fulfill its promises.
Five government mobile medical teams were sent to Sittwe at the end of March, but they were barely seen.
In the camps, the deaths often occur behind closed doors, in the cramped rooms of the bamboo rowhouses built by the United Nations. Other people die in the small mom-and-pop pharmacies where desperate families like Parmin’s go as a last resort.
Some of the most desperate cases are women with complicated pregnancies. Prenatal care is scarce, resulting in high numbers of precarious births.
These days, most pregnant women are reluctant to go to Sittwe General Hospital until it is too late, put off by the elaborate series of permissions needed, and by fear. As violence has increased, many Rohingya believe they will never emerge from the 14-bed ward set aside for them that used to be the prison ward.
Zhara Katu, 20, was one of many too frightened to go to the hospital. In pain and pregnant with twins, she instead chose the government-run Dapaing clinic. A Burmese doctor determined the babies had died and recommended she go to the Sittwe hospital for an urgent operation.
She went home instead.
Two days later, she returned to the clinic but was so ill, she was transferred to the hospital. Her father, Abdullah Mi, a scrawny, weather-beaten man, was terrified. “I worry that the Rakhine will kill her there,” he said.
His daughter survived the procedure to remove the babies, but died in the hospital a week later of maternal sepsis, a very serious condition that Dr. Vedrasco said could have been alleviated with earlier care.
By the last week of April, some aid workers for international agencies were trickling back to the camps, but reported facing conditions far less than the “return to normalcy” declared by the national Ministry of Home Affairs.
A new emergency coordinating committee established to oversee foreign assistance was dominated by two Rakhine Buddhist community leaders who demanded approval rights over their aid operations, a memo from the aid workers to the United Nations said. The memo said the committee “is failing absolutely in its role to facilitate the delivery of humanitarian assistance in Rakhine.”
It also urged the United Nations to take a more aggressive stance with the government, saying “there is a sense among nongovernmental organizations that at times the U.N. advocacy could have been more robust.”
Sometimes, wondrously, camp medicine works.
One of the busiest men in the camps is Chit San Win, who once worked as a medical assistant in Sittwe, and is now a popular amateur doctor racing from call to call on his motorcycle.
He arrived at one call recently to find 4-year-old Roshan Bebe, lying unconscious, her head gushing blood after a motorcycle knocked her over. He came equipped with a medical kit he totes in a shopping bag — bandages, a few ointments, needle and thread.
As he cleaned and stitched the gaping wound, Mr. Chit San Win said he was concerned about internal bleeding that could prove fatal, but the child’s mother refused to try the government hospital.
A few days later the girl was sitting up, eating and talking, and Mr. Chit San Win declared “a miracle.”
There was no such happy ending for Nur Husain, 27.
On a recent day, he traveled to the same pharmacy where Parmin died. He slumped in a chair in the withering heat, gasping for air and running a temperature of 104 degrees. U Maung Maung Tin, one of the pharmacy owners, called a doctor 400 miles away, and on that advice injected Mr. Husain with four drugs.
Two hours later, the muscular young man was dead.
It was unclear precisely what killed him, according to a Western doctor who reviewed the four medicines, which are commonly prescribed for asthma. But almost certainly, proper monitoring and the oxygen ordinarily administered by Doctors Without Borders could have saved him, said the doctor, who declined to be named because he did not oversee the case.
Mr. Husain’s boss at a rudimentary bakery called him a “dynamic” man, who held one of the few steady jobs in the camp, earning two dollars a day as manager. His wife, Roshida Begum, says she has no idea how she will now feed her two small children, and a third who is on the way.
The family buried Mr. Husain in a sandy plot on the shore of the Bay of Bengal within sight of tall, slender coconut trees etched against the blue sky. His shallow grave site, fenced with fresh bamboo, was surrounded by rows and rows of other graves dug in recent months.
Wai Moe contributed reporting.