RANGOON — On the heels of renewed anti-Muslim violence this week in western Burma, and as President Thein Sein concludes a rare visit to the region, health care providers say discriminatory practices at local government hospitals are preventing Muslim patients with life-threatening conditions from accessing treatment.
Since sectarian clashes first broke out in Arakan State last year, Muslims facing state-imposed restrictions on their movement have been forced to rely on doctors with mobile clinics who can reach them in isolated villages or camps for internally displaced persons (IDPs). But in emergency cases that require more specialized treatment, these doctors have struggled to make referrals to many public hospitals, which often refuse to accept Muslim patients.
Of 70,000 medical consultations conducted in the state during the first six months of this year, Médecins Sans Frontières (MSF), an international humanitarian organization, could only make 46 hospital referrals, a number it says is far below the amount needed.
“There is a gap between the number of referrals we’re able to make and the number of people that need referral, and as a result people are dying,” Vickie Hawkins, deputy head of mission in Burma for MSF-Holland, told The Irrawaddy on Wednesday. A number of life-threatening conditions cannot be treated at mobile clinics, she said, adding that women with complicated pregnancies were among those who most frequently required hospital referrals.
Several factors have prevented referrals, she said. Among the biggest challenges is the fact that Muslim patients are not accepted at public township hospitals in the townships surrounding Sittwe, the state capital. MSF said these township hospitals cite security concerns as a reason for excluding Muslims, saying staff members in the past have been threatened by local community members for admitting the religious minority.
Muslim patients are accepted at township hospitals in northern Arakan State and some township hospitals in southern Arakan State.
Muslims comprise about 5 percent of the 60 million or so population in Buddhist-majority Burma. In Arakan State, a Muslim group known as the Rohingya faces particular discrimination and makes up the majority of those displaced from their homes in clashes last year. They are seen by local Buddhists as illegal immigrants and are largely denied citizenship by the government, although many have lived in the country for generations.
Township hospitals in townships surrounding Sittwe deny admission not only to the Rohingya, but also to Muslims of other ethnicities, such as the Kaman, who are recognized by the government as citizens.
As a result, Muslim patients must travel far distances to Sittwe, where they are accepted at a state-level public hospital known as Sittwe General Hospital. For example, if doctors at a mobile clinic in Mrauk-U Township encounter a Muslim woman experiencing a difficult labor or another medical issue, they cannot drive her about 30 minutes to the nearest township hospital, but must instead refer her to Sittwe General Hospital, about three hours away by car.
Once at Sittwe General Hospital, she would be confined to a separate ward for Muslims. The roughly 200-bed hospital has about 18 beds for Muslim patients, Hawkins of MSF estimated, while there is an identified target population of 178,000 in the townships surrounding Sittwe. Due to the limited number of beds, the hospital can only accept patients who meet specific referral criteria. The criteria, developed by state health authorities, are stricter for Muslims than for Buddhists, Hawkins said, because fewer beds are available for them.
State authorities must also individually authorize referrals for each Muslim patient, a process that takes time and creates a bottleneck. “I’ve never seen a situation where it has been so difficult to refer patients—never,” said Hawkins, who has worked with MSF for 15 years, including stints in Afghanistan, Pakistan, China and Zimbabwe.
In Myebon Township, at a camp with about 4,000 Muslims, the humanitarian organization has made only two successful emergency referrals since last November, both when high-profile UN officials were visiting.
The referral situation has improved somewhat in recent months, however. Sittwe General Hospital has started accepting a broader selection of patients, including some Muslims who require specialized treatment but are not necessarily in life-threatening situations. MSF has doubled its number of emergency referrals in the last three months to 46, as opposed to the same number in the first six months of the year, and Sittwe General has also started to accept outpatient referrals in the last eight weeks.
But Hawkins added: “There’s still a long way to go, there’s still a big backlog and many more patients out there who still need a referral and simply are not getting it because of all the challenges,” including lack of access to township hospitals and limited beds at available facilities. She said the increase in patient numbers at Sittwe General Hospital also placed enormous strains on the staff and resources there, considering the large population served.
Once a referral is approved, transportation from remote villages to the state capital is a challenge. Due to the geography of the coastal state, patients in some villages require boat transport, but local boat captains are reluctant to offer their services, fearing threats by community members for helping Muslims. A number of speedboats are deployed, primarily by UN agencies, but these agencies have other work ongoing. With a lack of available boats, MSF teams have been forced in some situations to defer a referral overnight. “Unfortunately, when the teams have returned the next day to transfer the patient, some of those patients have not survived the night,” Hawkins said.
MSF could not provide definitive concrete data on the number of people who have died due to a lack of access to hospital care in the state, but confirmed that this situation has arisen with its teams on a number of occasions even since establishing an improved referral system in March.
When boats arrive at a jetty near Sittwe, patients are driven to the hospital. The International Committee of the Red Cross (ICRC) transported about 1,000 patients—mostly Muslims but also Buddhists—to and from Sittwe General Hospital from January through July, in collaboration with the Myanmar Red Cross Society. Patients are driven in a Toyota Land Cruiser that is well identified with a red cross. “It’s a basic service but a vital service,” said Bart Vermeiren, the ICRC deputy head of delegation in Burma. “For 24-hour [medical transport] service, I think we are the only organization.”
Sittwe is a sensitive environment, he adds, when asked whether drivers have been threatened for transporting Muslim patients. “A driver would never be alone in a car, always with a team,” he said. “Sometimes, and I would not call it regularly, there is a misunderstanding about what we are doing, and we have to explain to people very clearly that we are driving straight to the hospital and driving straight back to the camp or to the boat after discharge.
“Up until now we have managed. We have never had physical threats, but it happens that you need to clearly explain, because people might think or perceive that we are bringing people into towns, which is not the case.”
Sectarian clashes in western Burma broke out in June and October last year, leaving about 200 people dead and more than 140,000 displaced. The majority of victims were Rohingya Muslims. Anti-Muslim riots have spread this year to several other locations across the country.
This week in Arakan State, Buddhists and Muslims clashed again near the coastal town of Thandwe, with Buddhist mobs burning dozens of homes, injuring dozens of people and leaving at least five people dead, including a 94-year-old Muslim woman. Authorities increased security in Thandwe on Wednesday, hoping to restore order after four days of violence.
The rioting came as Thein Sein traveled to the restive state for the first time since violence broke out last year. The president’s three-day trip this week included visits to camps in Sittwe and meetings with community leaders. He also went to Thandwe and to Mrauk-U, where he left instructions on how to promote stability and socioeconomic development, according to state-run media.
Anti-Muslim violence has been a major stain on Thein Sein’s administration during the country’s transition from about five decades of military rule. In a message to religious leaders published in state newspapers on Wednesday, the president said the ongoing conflict between Muslims and Buddhists “harms and delays the state reforms and tarnishes the national image internationally.”
“We are building a new national identity representing the entire country,” he said. “While accepting diversity, it is advised to make collective efforts for ending discrimination.”
Earlier this week, at the UN General Assembly in New York, Burma’s foreign minister called for inclusive socioeconomic development to achieve the Millennium Development Goals (MDGs) by 2015. These goals include improvements in health care, with a focus on reducing child mortality rates, promoting maternal health, and combating HIV, malaria and other diseases.
“In many developing countries, especially least developed ones, a large proportion of populations are still grappling with poverty, hunger, economic and social disparity, and environmental degradation,” Wunna Maung Lwin said, as quoted by state media. “On our part, we have been exerting relentless efforts to raising socioeconomic conditions of the people with poverty alleviation as the core priority of the national economic strategy in commensurate with the MDGs.”
He added: “We try our best to ensure that no one from communities or our national ethnic groups are left behind and excluded from enjoying the fruits of our reforms and the exciting life of the nation. It includes our extensive efforts, in cooperation with the UN and NGO humanitarian organizations, to improve the living conditions and livelihoods of all affected peoples without discrimination.”
Arakan State government spokesman Win Myaing was not available on Thursday to comment on efforts to improve health care in the state, according to a staff member at his office, who said nobody else at the office could speak with media.
Burma’s Ministry of Health, whose budget is equivalent to about 3 percent of the national budget, has made some efforts to provide medical relief in Sittwe. It established a small emergency hospital known as Dar Pai near camps west of Sittwe, where Muslim patients are sent if they need to stay in a hospital but do not require specialized care. Two doctors work for about two hours daily at the hospital, five days a week. The rest of the time, a nurse and health assistant are on duty. The UN Population Fund (UNFPA), which supports reproductive health services, says the hospital is equipped to provide normal and complicated deliveries as well as post-abortion care, but health care providers say more resources are required for emergency care.