Non-Health for Non-Persons: Rohingya Muslims in Crisis

Feature

In a tightening spiral of human suffering that winds back five decades, the Rohingya have come to be mentioned as a customary precursor to the phrase “most persecuted minority in the world”. The long-disowned nationals of Myanmar are estimated at a population of 1.2 million,[1] stateless victims of humanitarian violations so comprehensive and extensive that the world’s empathy can only be directed towards a vague fog of injustice. However, as flagbearers of the right to health and human dignity, healthcare professionals must be able to shine a torch into the fog and discern the faces within.

Current Situation

While systematic persecution of the Rohingya Muslims has been noted since the stripping of voting rights and the military “purges” of the 1970s, events within the past year have seen violence escalate dramatically. A border attack by a group of radicalised Rohingya Muslims on Myanmar’s police last October resulted in an estimated 10 casualties. Extremist violence is unacceptable and unhelpful, though one can see the desperation, injustice and generations-worth of marginalisation from which this radicalisation was inevitably born. Since the attack, disproportionate and indiscriminate military retaliation has resulted in hundreds of deaths and torrents of Rohingya fleeing Myanmar’s northern Rakhine state, where the situation is worst. The United Nations (UN) reports that from the last week of October 2017 to the first week of September 2017 alone – just two weeks – 270,000 people fled to Bangladesh for safety.[2]

The humanitarian crisis in which the Rohingya find themselves is undeniable. Officially stateless, access to basics such as healthcare, education, employment, security and freedom is often impossible. Tragically, these deprivations are far less confronting than other reasons for which the Rohingya have been forced to flee. With UNHCR reports documenting common experiences of “mass gang-rape, killings, including of babies and young children, brutal beatings, disappearances and other serious human rights violations by the country’s security forces”, returning to Myanmar is not an option.[3]

UNHCR interviews with Rohingya refugees detail random shooting at crowds who were fleeing houses, schools, mosques and markets that had been set alight by Myanmar’s army, police and occasionally civilian mobs.[4] Destruction of food, livestock and food sources; cases where the army or Rakhine civilians have trapped an entire family, including the elderly and disabled, inside a house and set it on fire “killing them all”; mothers assaulted by “security” forces while being forced to watch their babies stabbed and killed – words cannot do it justice.[4]

Recent news reveals that Burmese officials have planted landmines along the Bangladesh border, posing a lethal threat to Rohingya peoples fleeing atrocities. Deemed unlawful for their inability to distinguish between civilians and militants, children and adults, landmines have been banned in many countries under the 1997 Mine Ban Treaty. Not a signatory to this, Myanmar officials continue to use them against Rohingya civilians, protected by the unsurprising denial by the Burmese government that such landmine plantings have taken place.

An assortment of condemnations have been offered by the UN; crimes against humanity,[3] genocide, ethnic cleansing. The UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein, concludes his report on the Myanmar atrocities by despairing, “What kind of ‘clearance operation’ is this? What national security goals could possibly be served by this?”.[3] As Hussein seems painfully aware, these words fall on deaf ears.

Medical Crisis

Humanitarian agencies are floundering, desperately attempting to provide emergency care for the monsoonal influx of Rohingya refugees, most of whom have a variety of physical and psychological conditions. Studies of the health conditions within Bangladesh’s two main registered refugee camps present unsurprisingly dire findings.

One psychiatric study surveyed a group of registered Rohingya refugees and reported experiences of torture (39.9%), sexual abuse (12.8%), rape (8%), forced abortions (2.4%), PTSD (36%), depressive symptoms (89%), suicidal ideations (19%) and deaths of friends or family due to illness or starvation while fleeing (22.4%).[5] Hopelessness was the common theme, with one Rohingyan interviewee asking, “Our future has been spoiled, but what will happen to the future of our children?”

In 2015, another study investigated the general health conditions of Bangladesh’s largest Rohingya refugee camp, Nayapara.[1] With a population of 18,777, the camp was attended by only four trained doctors and six nurses. The infant mortality rate was 45.4 per 1000 livebirths and one quarter of the population was children, most of whom were born in a camp. Additionally, the study reported widespread stunting due to malnutrition (57%), anaemia (49%), and a high prevalence of respiratory (46.9%), endocrine (21.9%) and cardiovascular disorders (14.8%). Mental health conditions were ubiquitously poor; 18.7% of camp injuries were caused by self-harm, and in Bangladesh’s other major camp, 43.3% of Rohingya refugees were diagnosed with a psychotic disorder.

Importantly, health conditions in registered refugee camps far surpass those of the many unregistered camps in countries neighbouring Myanmar. These makeshift shelters, which house twice as many Rohingya as the registered camps, are conferred no security or support from the already-drowning NGOs servicing the area. This, however, is still favourable to staying in the northern Rakhine state of Myanmar where health conditions are so abysmal that, for example, mortality in children under 5 has reached 224 per 1000 livebirths.[6]

Role of Health Professionals in Social Justice

In situations where political and military injustice seem impenetrable, often the most basic human right affordable is emergency medical care, but is the assumption that medical aids are exempt from political and military violence still applicable today? As seen in reports of hospitals targeted in Syria by Western military, it seems that medical neutrality is no longer a guarantee. Combined with the Myanmar government’s notoriously uncooperative relationship with humanitarian organisations, one must ask what responsibility healthcare professionals are expected to bear in the realm of human rights.

In 2014, Médecins Sans Frontières was banned in Rakhine, and a month later, when humanitarian aid agencies were attacked by Buddhist anti-Rohingya radicals, Myanmar’s government only further restricted humanitarian aid.[6] This ban has since been lifted but access is now parlous again due to the Myanmar government’s “formulated and disseminated accusations against the UN and international NGOs, denial of required travel and activity authorisations, and threatening statements and actions by hardline groups”.[7] Also recently, the UNHCR High Commissioner Hussein has struggled with repeated government restrictions on humanitarian access to the worst affected regions of Rakhine, and bans on UN investigative officials entering Rohingyan regions of Myanmar. Forced to work within the law, the UN can only deploy officers to the Bangladeshi border.[2]

These tensions between humanitarian aid and the state beg the question: in health emergencies and human rights violations as staggering as those experienced by the Rohingya Muslims, should human rights and healthcare organisations bend to the will of unjust – even criminal – governments? It is a problem the UN and its subcommittee, the World Health Organization, still grapple with. Do they obey their mandate to respect the sovereignty of their member states? Or do they perform their constitutional role of helping member states “respond to…emergencies with public health consequences”?[8] How can they, when the member state itself is perpetuating the emergency? Additionally, the aforementioned lack of confidence in medical neutrality makes it unsafe for health workers to stand against government and military opposition.

The only solution where a full response to this humanitarian crisis can be appropriated lies in either cooperation with Myanmar’s government – which seems unlikely – or direct actions against the government by UN member states. Ideally, the Burmese government would grant the Rohingya some form of internationally recognised citizenship, allowing for better organisation of refugee status and resettlement programs for the Rohingya in neighbouring countries. Sanctions intended to force the Burmese government’s hand have failed in the past,[6] but if the global community can unite with harsher repercussions for the continued persecution of Rohingya Muslims, surely the situation can only improve.

Conclusion

The Rohingya peoples are born into a cycle of poor health outcomes that begin with low birthweight and continue with dismal access to healthcare. Timid international responses to the systematic abuse, torture and dehumanisation of this minority have allowed for the continuation of historical persecution. The 2015 election of Nobel Prize laurate Aung San Suu Kyi as Myanmar’s Prime Minister presented an opportunity for a Myanmar government to end their denial and dismissal of decades of Rohingyan suffering. However, as stated by her aide, it seems she has “other priorities”,[6] which probably includes avoiding conflict with her majority-Buddhist supporters and the hugely politically influential Burmese military. For now, Rohingya Muslims will have to continue to relying on NGOs who are drowning under resource insufficiencies and legal restrictions, attempting to deal with the desperate masses in any way possible.

History paints a picture of peaceful generations of Rohingya living in Myanmar. Their future seems increasingly uncertain, although ideally it involves them returning safely home. One and a half million people await a saving grace, security for their children, medicine, clean water. If international global health organisations cannot work within Myanmar’s policies, then they must find a conclusive alternative. It is unacceptable that there is still not a light at the end of this half-a-century long tunnel.

Jumaana Abdu

Jumaana is currently finishing her first year of medicine at the University of New South Wales. She aims to find a career path which combines her passion for medicine and human rights. She also hopes her future involves as a side-profession of writing, fiction or otherwise.

Photo credit

EU/ECHO/Pierre Prakash

Accessed from https://www.flickr.com/photos/eu_echo/17337141093/in/photostream/

Conflicts of interest

None declared

Correspondance

jumaana.a6000@gmail.com

References

1. Milton, A. H., Rahman, M., Hussain, S., Jindal, C., Choudhury, S., Akter, S., … & Efird, J. T. (2017). Trapped in Statelessness: Rohingya Refugees in Bangladesh. International Journal of Environmental Research and Public Health, 14(8).

2. United Nations (2017). UN scales up response as 270,000 flee Myanmar into Bangladesh in two weeks. Retrieved from http://www.un.org/apps/news/story.asp?NewsID=57480#.WbZ6eK2B3Vo

3. United Nations (2017). UN report details ëdevastating crueltyí against Rohingya population in Myanmarís Rakhine province. Retrieved from http://www.un.org/apps/news/story.asp?NewsID=56103#.WbZ4w62B3Vp

4. OHCHR Zeid Raíad Al Hussein (2017). Interviews with Rohingyas fleeing from Myanmar since 9 October 2016. Retrieved from http://www.ohchr.org/Documents/Countries/MM/FlashReport3Feb2017.pdf

5. Riley, A., Varner, A., Ventevogel, P., Taimur Hasan, M. M., & Welton-Mitchell, C. (2017). Daily stressors, trauma exposure, and mental health among stateless Rohingya refugees in Bangladesh. Transcultural Psychiatry, 54(3), 304-331.

6. Mahmood, S. S., Wroe, E., Fuller, A., & Leaning, J. (2017). The Rohingya people of Myanmar: health, human rights, and identity. The Lancet, 389(10081), 1841-1850.

7. Médecins Sans Frontières (2017). Myanmar: International humanitarian access to Rakhine State must urgently be permitted. Retrieved from http://www.msf.org/en/article/myanmar-international-humanitarian-access-rakhine-state-must-urgently-be-permitted

8. Kennedy, J., & McCoy, D. (2017). WHO and the health crisis among the Rohingya people of Myanmar. The Lancet, 389(10071), 802-803.

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