Myanmar’s crimes against public health

by Cesar Chelala

NEW YORK — During four decades of rule, the Myanmar military has neglected people’s health needs to such an extent that it amounts to an attack against the people, whose health status remains one of the most precarious in the region. This is more proof that the military leadership has been more interested in keeping their own privileges than in improving the welfare of the population.

As Dr. Rhona MacDonald recently wrote in The Lancet: “Decades of neglect, civil war and corruption have rendered Myanmar’s health system incapable of responding to infectious diseases and other health risks. And as the country closes its doors to more and more aid agencies, the situation only looks set to worsen.”

Malaria, HIV/AIDS and tuberculosis (TB) are major health problems throughout the country. Almost 90 percent of the country’s population is at risk of malaria, which is the leading cause of morbidity and mortality in the country. What makes the situation particularly serious is that many anti-malarial drugs sold in the country contain substandard levels of active components or no active component at all.

The country has one of the highest rates of TB in the world. More than 100,000 new cases are detected every year. The disease has a significant economic impact since those most affected are 25 to 44 years old, a vital sector for the economy. Although TB drugs are available on the black market, they are taken in many cases without supervision, which leads to increased drug resistance. As a result, Myanmar is experiencing increasing rates of multidrug-resistant tuberculosis.

The situation with HIV/AIDS is equally gloomy. It is estimated that there are 25,000 new HIV infections every year, with the disease rapidly spreading among the young and high-risk groups. Because Myanmar’s surveillance methods are not reliable, the rates may even be higher. According to officials from China’s Ministry of health, Myanmar’s actual number of infections may be four or five times higher than indicated. Although there has been some progress in prevention efforts, they are still inadequate to deal with the situation.

According to UNICEF figures, the national infant mortality rate (number of deaths per 1,000 live births) was 76 in 2003. This compares to 23 in Thailand, 19 in Vietnam and 7 in Malaysia.

For infants who survive, the picture remains grim. It is estimated that one in three children in Myanmar is chronically malnourished, and 15 percent of the population is without food security. A high number of low-birth-weight babies is probably an indication of pregnant women’s poor nutritional status.

In addition, goiter, due to lack of iodine, is present in approximately 28 percent of children nationwide. Deficiencies of vitamin A are widespread both among children and adults, increasing the risk of infections, and iron deficiencies provoke anemia, which is found in over 30 percent of children between 6 and 16. Anemia increases susceptibility to infections and hinders school performance and physical activity.

The number of street children is increasing, particularly in Myanmar’s main cities. Because they are marginalized by society, these children’s lifestyle threatens their well-being. Some go into prostitution, or survive by petty theft or drug-related activities.

Many young Burmese, particularly girls, flow into neighboring countries to find work. Too often, these girls end up in brothels where they are kept in slave-like conditions, unable to escape.

Women face considerable health problems due to poor living conditions, inadequate health services and lack of basic education. Inadequate health care is more evident in the ethnic-minority regions, where constant relocation and heavy loss of life among the male population have left women with the responsibility of providing for children by themselves.

Maternal mortality rates, an important indication of the quality of health services, are estimated to be among the highest in the region, although it is very difficult to obtain correct figures. Although midwives are the main providers of health care to women in rural areas, there is a shortage of them, particularly in minority areas.

Although UNICEF has provided substantial support to enable midwives to meet people’s health needs at the community level, over 25 percent of Burmese women deliver their babies without the assistance of a trained health worker.

People’s health cannot be isolated from the political situation in the country. It is tempting to think that a change of health policies can change the health situation in the country. It is tempting but naive. Unless there is a change of government, people’s health will continue to be one of the main casualties of this brutal regime.

Cesar Chelala, M.D, Ph.D., is an international public health consultant, and a writer on human rights.