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Posted by on in Business

YANGON, Myanmar - One of the world's most challenging and deadly races is underway in the forests of this turbulent country.

A new strain of drug-resistant malaria has emerged in Myanmar just as the country is emerging from a half-century of isolation, increasing the risk that the lethal scourge will spread into India and Africa.

If the strain reaches other regions, it could undo huge gains made over the past decade - at a cost of billions - to corral the illness.

Malaria mortality has fallen 42 percent worldwide since 2000, but the disease continues to sicken more than 200 million people and kill 500,000 children a year, or about one every minute of every day, according to the World Health Organization (WHO).

Fighting malaria has been a Sisyphean task over the past century. Major attempts to eradicate the disease - caused by a parasite transmitted by a particular mosquito species - failed in part because it's a moving target that evolves and develops resistance to drugs and pesticides.

Yet the latest push has brought eradication in sight, at least for some experts and for the Seattle-based Bill & Melinda Gates Foundation. Eliminating the disease is one of the most ambitious projects the world's largest philanthropy has undertaken.

With more than $2 billion committed, the foundation is the leading private supporter of research into new treatments, vaccines, diagnostic tools, disease mapping and other weapons to fight malaria.

This research should help the foundation press the global community for a renewed attack that could begin about 2020, putting to use new drugs now in the pipeline.

As long as the drug-resistant strain spreading in the forests of Myanmar can be contained, that is.

"Myanmar is the linchpin country, really," said Tom Kanyok, a former WHO scientist and now the foundation's senior malaria program officer for the Greater Mekong region, which includes Myanmar, Thailand, Cambodia and Vietnam.

This comes as Myanmar - formerly called Burma - emerges from 50 years of repression, moves toward a democratic state and opens to trade, tourism and foreign investors.

"People are flooding in," Kanyok said. "All the business-class seats are full and the other seats are full of tourists wanting to go see the country. After the opening up of the country it's just a sea change."

In the commercial capital of Yangon, formerly known as Rangoon, ancient golden pagodas share the skyline with dozens of construction cranes. Shoeless children play soccer in dusty side streets below stately, crumbling buildings built a century ago under British rule.

Burma was the most prosperous country in Southeast Asia until a military coup in 1962. It's now one of the poorest in all of Asia.

Myanmar borders 40 percent of the world's population, with China to the north, Thailand and Laos to the east and India and Bangladesh to the west.

Being a crossroads may help the country catch up to the economic growth that Vietnam and Thailand have seen, but it also positions Myanmar to export drug-resistant malaria.

After decades of spending little on health care, the country is especially hard hit by the disease. Myanmar accounts for nearly 80 percent of malaria cases and 75 percent of malaria deaths in the Mekong region, according to a 2012 assessment funded by the Gates Foundation and Australia.

Overall, more than 40 million of Myanmar's about 60 million people live in malaria-endemic areas, according to WHO.

As the economy grows, people may travel and unwittingly bring malaria parasites along. One carrier may infect 100 others, who may infect 1,000 others.

Migrants may follow the path of Than Toe of Yangon. As a teen, he worked in the fishing industry along the border with Thailand, where drug resistance is concentrated.

Toe was sickened by malaria and treated with a cheap medicine. Later he moved to the city to drive a cab and start a marketing business.

Timing was on his side. Toe, now 43, was infected before the resistant strain emerged. His treatment worked and he's now raising three girls in the city.

Hard-won gains at risk Myanmar's government appears to be moving in the right direction as it builds up a health care system. It's working with WHO, the Gates Foundation and other groups to tackle malaria.

"From our region we're now trying to scale up our activities - all our activities," said Dr. Thaung Hlaing, deputy director of the Ministry of Health's National Malaria Control Programme.

Hlaing said the plan is to contain the resistant strain and eliminate it before it spreads west to India and then to Africa, creating "more disaster."

"This is not about a Myanmar problem; this is a global concern," he said.

The risk that this strain of malaria could spread and reverse hard-fought gains isn't hypothetical. It happened before with tragic results.

Eradication was in sight in the 1950s and succeeded in the U.S. and southern Europe.

But the effort faltered because of funding shortfalls, war, scattershot participation - and the emergence in the 1960s of a drug-resistant strain in Southeast Asia. It reached India and Africa, where severe cases and deaths doubled or tripled in some countries.

Research in China led to artemisinin, a derivative of wormwood and traditional herbal treatment. It took years for this medicine to emerge from China, and it wasn't widely used until after 2000.

Then it became a key part of a renewed attack on malaria funded largely by the Global Fund, a coalition of governments and private funders to which the Gateses have given $1.4 billion. Over the past decade, this attack saved more than 3 million lives.

"Now it's such a magical drug we're doing everything we can to avoid drug-resistance," Bill Gates said at an April health product forum in Seattle. "We're super dependent on it."

He's helping fund a new arsenal for the malaria fight, including next-generation drugs, but they won't be ready for perhaps four or five years. A single-dose malaria pill isn't expected until 2023.

"I think there probably isn't the right tool kit yet to say with confidence that we can get to elimination and eradication, but there's an entire field pointed in this direction," said Dyann Wirth, chair of Harvard's Department of Immunology and Infectious Disease.

Artemisinin resistance was detected in Cambodia in 2006, and has since been found around the Mekong region. Today, with international travel more common, resistance could spread farther and faster.

"If it happens now, we are going to have a big problem," said Dr. Gawrie Nirdoshi Loku Galappaththy, malaria technical officer in the WHO Yangon office. "That's why it's really important. We have to stop (it) here."

Gawrie has a team of 15 funded partly by a $100 million Global Fund grant to fight drug-resistant malaria in the Mekong. The largest share, $40 million, went to Myanmar, but it will last only until 2016.

Gawrie has been an intermediary of sorts between the ambitious attack on malaria the Gates Foundation is pursuing and the government's measured approach.

Somewhat controversial is the foundation's interest in mass administration of drugs, carpet-bombing parasites by treating everyone in problem areas whether they seem sick or not, an approach it's testing in the region.

In April, Bill and Melinda Gates flew to Cambodia to see progress firsthand. They talked to people about whether they understood they could be carrying the disease.

Success with pilot programs could help make the case for a new, aggressive malaria-eradication plan. The work also helps them learn about drug distribution and other aspects of the challenge.

"I think this is going to be a great learning time for our team as we start to look at these very local eliminations - about all the pieces in the chain that need to get done," Melinda Gates said at the Seattle forum.

While Myanmar supports the malaria work, it's also sensitive to being used as a laboratory for new approaches.

Locally, the malaria crisis is overshadowed by ethnic tensions and a highly anticipated election in 2015, seen as a test of whether Myanmar is truly reforming and legitimizing its government.

The country also struggles with other health risks.

"There's a lot of other things that kill not just children but all ages," said Simon Khin, a former software engineer who as a child lived in border areas. "That includes the war, dengue fever, TB, typhoid."

Khin, who immigrated to Seattle 30 years ago and now runs a refugee-assistance program, said people who live around malaria generally aren't as alarmed by its prevalence.

"It's pretty much a fact of life," he said.

Such acceptance complicates the issue of administering drugs to masses of people, including those without symptoms. WHO isn't yet pursuing this approach. But with drug resistance now an emergency, it has called for large-scale pilot studies.

Meanwhile, the Gates Foundation is testing mass drug administration in border areas and hopes to treat 250,000 people by 2016.

"There's a little bit (of) unhappiness or misunderstanding about this with the national program, but we were not consulted by anyone," Gawrie said.

The foundation's Kanyok said he meets regularly with the health ministry and they have a good relationship. In Myanmar, it's deferring to the government, he said.

"It's a health and humanitarian issue that everyone can grab on to because people see the results of malaria in the country," he said.

It's largely a question of timing, deciding how much longer new approaches should be researched versus using them sooner, according to Chris White, a British tropical-medicine expert in Yangon.

White is senior malaria technical adviser with Population Services International (PSI), a Washington, D.C.-based charity.

Myanmar's government, he said, is right to want evidence before plunging ahead, yet it's also time to "get very aggressive in our control efforts" and "possibly taking some risks."

(EDITORS: STORY CAN END HERE)

Being a top priority among charities when it comes to malaria is a big opportunity for Myanmar.

Maps and infrastructure created to track malaria and deliver drugs will help provide other care, and eliminating malaria would bring economic gains.

At the same time, there's a risk that Myanmar's broader progress could stall and interrupt the malaria fight at a critical point.

The country began opening up after the 2010 election of its current president, Thein Sein, a relatively moderate former general.

Reforms he initiated led the U.S. and Europe in 2012 to end sanctions for human-rights violations.

But it's a country in transition, with lawless regions controlled by drug traffickers and militias, concerns about corruption and harsh oppression of ethnic minorities.

"I would say this is without doubt the most challenging operational environment I've ever worked in my entire career," said White, who earlier spent 12 years in Africa.

"All the places where you really need to reach in terms of malaria transmission are often forested, mountainous border areas that are also areas of high sensitivity politically, areas with conflict, internal displacement, let alone logistically difficult," White said.

PSI uses private-sector approaches to improve global health, including a franchising model to build a network of clinics in Myanmar.

Now PSI is attempting to stem the use of substandard malaria drugs, a $25 million project funded mostly by the Gates Foundation and the U.K.

Of particular concern are cheap "monotherapy" drugs with a single active ingredient, currently artemisinin. They may treat malaria but increase the risk of parasites mutating to resist that ingredient, as they have in the Mekong.

Malaria monotherapies are banned in much of the world and are steadily being replaced with more effective drugs that have multiple active ingredients.

PSI works with drug companies to flood the market with better drugs. It packages them in boxes mimicking those of the older drugs people recognize and trust - like putting carrots in a Cheetos bag.

Donors subsidize the cost, so a full course of drugs sells for 50 cents - about what people had been paying for a partial dose of monotherapy.

So far it's working better than expected. In the first nine months, the market share of good malaria drugs in Myanmar grew from 3 to 73 percent.

(EDITORS: STORY CAN END HERE)

Funding and research are only part of the story, though.

Bill and Melinda Gates also brought a new perspective, leading to "a major paradigm shift," said Wirth, of Harvard.

The field previously thought of malaria as a disease to be mitigated or controlled. Now it's looking more at how it's transmitted, with an eye toward elimination.

Wirth said the turning point was having the Gateses "basically say, ‘Why don't we think about elimination and eradication? It's the right thing to do from a moral standpoint and let's figure out what the technical and implementation obstacles are.' "

This thinking is influencing researchers from South Lake Union to Switzerland.

It's even reaching through to the opaque leadership of Myanmar, where Seattle's outsized role and research are changing the malaria conversation and potentially helping snuff out the emerging threat.

"Seattle," said WHO's Dr. Gawrie, "is always there."

---

©2014 The Seattle Times

Visit The Seattle Times at www.seattletimes.com

Distributed by MCT Information Services

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MYANMAR: Divide And Keep Conquered

July 30, 2014: Growing popular opposition to the remaining military control of the government is not making much progress. The military still controls (via corruption or coercion) the government bureaucracy, especially the courts, police and, of course, the military. This enables the generals to hit back hard at opponents. Journalists are being sent to jail and popular demonstrations are suppressed by police. The courts regularly rule against tribes that bring lawsuits against illegal land grabs and similar misbehavior (by military owned or backed companies) in the north. Meanwhile the anti-Moslem paranoia of the Buddhist clergy is largely left alone. The generals know that the continuing attention Islamic terrorist atrocities get in the international media makes it difficult for sufficient international pressure to build against Burma for bad treatment of the Moslem minority in Burma.

The military continue to work out peace deals with tribal rebels while also continuing attacks on troublesome (to military economic interests) tribal rebels along the borders. The army believes it has to maintain an aggressive stance or else the tribal rebels will unite and become a serious problem. As far as the tribal minority in the north is concerned the government is continuing to break promises like they have been doing since 1948 when modern Burma was created by the departing British colonial officials. The British gave Burma control of remote tribal areas that the pre-colonial Burmese kingdoms had generally left alone and, at best, considered buffers with China and Thailand. After 1948 the ethnic Burmese saw the tribal territories as an economic opportunity and moved in like never before. This created friction and the tribes and the ethnic Burmese down south have been fighting ever since.

The government effort to negotiate peace with the tribes is hampered by distrust and the refusal of the tribes to disband the governmental institutions the tribes have built. The government is particularly hostile to the tribes taking over police and taxation in the areas the tribal militias control. The taxation often includes road checkpoints by the tribal “police” that collect fees from any vehicles that wish to get through the area. The tribes don’t trust police or taxpayers from the south because the ethnic Burmese who work those jobs are seen as hopelessly corrupt and not very efficient either.

International banks and other lenders (like the IMF) are telling Burma some fundamental changes are necessary before Burma will see a lot of foreign investment. In particular something must be done about the extensive corruption. This makes it difficult for all businesses to operate. Then there is the lingering power of the army. The foreign investors and most Burmese are pressuring the Burmese military must allow the 2008 constitution (created when the military government was still in control) to be modified to eliminate the excessive power of the military in the new democratic government. For example, the 2008 constitution guarantees the military 25 percent of the seats in parliament and requires 75 percent of the votes in parliament to get the constitution changed. The generals are reluctant to allow these changes because so many Burmese are still angry at the decades of bad behavior by the military government. Without some control over the government the generals who ran the military dictatorship (and many of their subordinates) could be prosecuted for their crimes. The generals are under a lot of pressure over the constitutional reform issue. Burmese businessmen and foreign investors also back a reduction of military control, mainly because the military is the main source of the widespread corruption that cripples the economy.

Speaking of corruption, the neighbors are having more problems with the growing drug trade in Burma. Since 2006 Burma has gone from being the source of seven percent of the world illegal production of opium and heroin to 18 percent. The largest state in the north (Shan state) has illegal drugs as the mainstay of the economy. The Burmese methamphetamine production is possibly the largest in the world and a major regional problem. Methamphetamine is the most popular drug in Southeast Asia and there are believed to be at millions of meth addicts in China and Thailand, plus many tourists who indulge.  Most of the meth goes to China, followed by Thailand and most of it is coming from meth labs in northern Burma. The Burmese meth has become hugely popular in China, which is pressuring the Burmese government to do more about the problem and that has resulted in more police activity up there, but not enough to put a dent in the drug business. The smugglers have become more resourceful and less of the smuggled meth is seized by police. The main beneficiaries of the drug trade are the tribal armies along the borders of China and Thailand.

The UN, the United States and most Moslem countries continue, without much success, pressuring Burma to make the Moslem Rohingya people in Burma citizens. This would, according to the foreigners, halt the violence between Moslems and Buddhists in Burma. That’s unlikely as far as the Burmese are concerned. The Burmese also point out that the problem of countries refusing to grant citizenship to a minority is an old one that is not easily solved. The most notorious example of this is found in Arab nations where it is quite common. The most troublesome example is the Palestinians, who are refused citizenship in most Arab countries. This citizenship for migrants issue is less of a problem in Western nations and a few Middle Eastern ones (like Israel and Jordan) but is not really an anti-Palestinian effort as much as it is the continuation of an ancient practice which are common in eastern Asia as well. Burma refuses to consider making the Rohingya Burmese citizens, despite the fact that most Rohingya have lived in Burma for over a century. Some Rohingya still have kin back in Bangladesh but tend to consider themselves Burmese. Meanwhile there is growing popular anger among Burmese towards Moslems in general and the Rohingya in particular. This is fed by the continuing reports of Islamic terrorism word-wide and especially in the region (Thailand, India, Bangladesh and China). The wealthy Arab oil states have put their considerable diplomatic and economic pressure on the UN to make a fuss but the Burmese generals know this can be safely ignored as they have been ignoring UN criticism for over half a century and getting away with it. The Arabs don’t get a lot of sympathy outside the Moslem world because anyone who can count notes that there is a lot more oppression and violence against non-Moslems by Moslems than the other way around.

The generals are hard negotiators. The tribes find that peace agreements with the government require continued negotiations (and concessions) to get government compliance. Case in point is the current effort by the tribes to get the military to remove old mines. Since the 1960s over 100,000 landmines were planted by the military. These were used to protect infrastructure (roads, electricity lines, bridges) and major bases or government controlled towns. Few of these mines were ever cleared and the government refuses to start work on that despite all the talk of peace. The mines are a constant hazard in the thinly populated tribal areas and make a lot of grazing and farm land too dangerous to use. The military has offered to clear some mines if the tribes will reduce their operations or move their gunmen away from key roads or new economic enterprises up there that the military has an interest in. The tribes are reluctant to do this because that means abandoning tribal people who are being forcibly displaced from land they have occupied for centuries.

July 29, 2014: A meeting of tribal leaders in the north agreed to press the government for a federal form of government. This would give the tribes more control over their own affairs. But the way politics and economics currently work in Burma the military can block any tribal interference that hurts military business interests in north by using force. The military is not going to give up its power in the north easily or willingly.

July 24, 2014: The government has now agreed to allow foreign aid groups return to the camps used by Moslem refugees in the northwest. Between February and April officials increased restrictions on foreign aid groups working along the northwestern coastal area. These aid groups provided essential support for the refugees as well as many other Moslems in the area. This amounted to aid for over half a million people, most of them Moslems. The government found itself on the receiving end of considerable international diplomatic and media pressure to back off here. What the government was really angry about was the fact that aid groups had become a prime source of data for foreign journalists on violence against Burmese Moslems. The government accused the aid groups of giving out exaggerated and one-sided information, which is very common with foreign aid groups everywhere. These groups depend on donations to operate and their most effective pitch for donations is via international media. The media is more likely to do stories on extreme events than something that has become ordinary and routine. The government was also angry at the fact that the aid groups’ version of events was considered more reliable than what the government put out and tended to ignore the casualties suffered by non-Moslem Burmese. What the government really wants is for the foreign aid workers to shut up but that wasn’t happening. Many foreign aid workers are idealists and many are volunteers who feel a duty to report what they see. The government believes they have an understanding with the foreign aid groups now, but that remains to be seen. With the aid groups back in action the government saves millions of dollars they would otherwise have to spend to supply the refugees. The Burmese have a long standing policy of not backing down to pressure from foreign media and aid groups so this new unspoken deal may work.

July 21, 2014: The government said that a 2011 deal with China to extend the Chinese railroad system through Burma via a new 1,200 kilometer line to Burma’s northwest coast has been cancelled. There was much popular opposition in Burma to the project, especially in the north. The tribes saw the Chinese railroad as another opportunity for the southerners to seize tribal land and bring in more settlers from the south. When the deal was signed both the government and China realized that there was a lot of opposition in Burma to it and believed they could placate that opposition before the three year “start by” clause in the contract expired. That did not work out as hoped.  This does not mean that the Chinese will not try again.

July 20, 2014: In the north (Shan state) the army attacked and eventually took a camp of the SSA-N tribal rebels. Elsewhere in Shan state the army moved more troops to confront units of the United Wa Army, which is the one tribal army up north that continues to refuse to even talk peace with the government. Low level combat has continued in Shan state throughout July has it also did in June.

State controlled media admitted what many Burmese already believed; that a false rape claim by a Buddhist woman was the cause of recent (July 1st) anti-Moslem riots in Mandalay that left two dead, over 20 injured and caused thousands of Moslems to flee their homes over several days. Much damage was done to Moslem businesses and residences. Early on there were rumors of anti-Moslem activists paying the woman to give false testimony. Hundreds of people have been arrested in connection with the riots and many non-Moslems are angry about the curfew imposed to halt the unrest. The Chinese minority (about a third of the million people in the city) are particularly angry at the Buddhists activists who were believed to have staged the unrest.

July 12, 2014: The government began a widely publicized crackdown on smuggling along the Thailand border. In particular the security forces were out to interfere with drug smuggling. The drug trade up there is largely controlled by the (often rebellious) tribal militias. Without the drug profits these tribal militias would not be able to restrict army operations in the north. More vehicle traffic is now being inspected, forcing the drug producers to move the opium, heroin and amphetamine into Thailand off the roads (using porters and animals). This is slower and more expensive, but does not do significant damage to the tribal drug income. Not all the drugs are produced by anti-government tribes. Some tribal militias have made peace with the government in return for unofficial permission to produce drugs. This has become a problem because a lot of these drugs end up being sold to locals (especially young men) and a coalition of Karen tribes recently formed an anti-drug alliance to try and shut down the government supported drug production by some pro-government Karen tribes. The government has used these divide and conquer tactics in the tribal territories for decades.

July 11, 2014: Neighboring Bangladesh enacted a law that prohibits Burmese Rohingyas from marrying Bangladeshi Rohingyas in order to obtain Bangladesh citizenship. The Rohingya tribes have long lived on both sides of the border and Bangladesh (90 percent Moslem) wants Burma (4 percent Moslem) to grant citizenship to the Rohingyas who migrated to Burma over the last two centuries.

 

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Posted by on in Business
 
Passengers walking over an ANA logo in Tokyo airportANA had been keen to expand its operations in emerging nations like Myanmar

Japan's ANA Holdings (ANA) has cancelled its plan to buy a 49% stake in Asian Wings Airways (AWA), an airline based in Myanmar, also known as Burma.

In August last year, ANA said it would pay some $25m (2.5bn yen; £16m) for a stake in the Burmese carrier.

ANA Holdings is the parent company of Japan's All Nippon Airways.

In a statement, ANA said rising competition in Myanmar was one reason for cancelling the deal.

"Competition between new and old airlines in Myanmar has intensified," ANA said, "bringing rapid changes in the external environment, and calling into question the assumptions made at the time of the original decision."

It also said it had been unable to reach an agreement on capital participation with AWA.

The deal was part of ANA's plans to expand its business internationally.

At the time, it would have been the first investment in a Myanmar-based commercial airline by a foreign airline.

AWA, which is based in Yangon, was launched in 2011 and operates domestic flights within Myanmar.

It also offers flights to Chiang Mai in Thailand and has plans to further expand its international service.

Since political reforms have led to the easing of international sanctions in Myanmar, many foreign firms have looked to the country for business opportunities.

After a 12-year hiatus, All Nippon Airways resumed its service between Japan and Myanmar in October 2012.

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New Khiri tour links two ancient kingdoms in Myanmar
 
Travel agencies This email address is being protected from spambots. You need JavaScript enabled to view it. - 30 July 2014, 06:33

A new six-day adventure trip between Bagan and Mrauk U is for travelers who are comfortable with no electricity or phones along the way.

image

Khiri Travel Myanmar has launched a unique trip that links the two ancient kingdoms of Bagan and Mrauk U in Myanmar. Khiri Travel is the first tour operator to bring travelers to the Mrauk U area via this challenging route to the far west of the country through the Chin and Arakan ranges.
 

For the first time in centuries it is possible to travel through this forgotten part of Myanmar where time seems to have stood still. The six-day trip offers fantastic scenery, remote Chin villages, plantations, jungle, boat rides, two days of reasonably strenuous hiking, and a glimpse into a rich living history that few people outside of Myanmar have seen.
 

Edwin Briels, Khiri Travel Myanmar General Manager, describes the facilities during much of the trip as "basic" – local houses with mosquito nets and blankets, and washing facilities either at the communal well or in the river. Food will be simple local dishes prepared by the guide.
 

After Bagan, highlights include a 4WD trip through dry mountain riverbeds where there are no bridges and a two-hour hike to the top of Mt. Kanpetlet (formerly Mt. Victoria) at over 3000 meters. Visitors can also swim in the seven-tiered waterfall at the source of the Lay Myo River amid impressive forested mountains.
 

Between Matupi and Amsway, visitors get to test their mettle further with a 22 km hike and an overnight in a local house, sleeping on bamboo mats.
 

Further on between Ma Du and Law Thu in a day with a 29km walk, visitors may see local women with their faces fully tattooed – an old habit said to make them look too bizarre to be abducted by kings of the former Bagan empire.
 

Like many other pioneering Asian adventure trips, the journey includes a boat ride, this one on the Lay Myo River all the way from Chin state to Rakhine state. The boat navigates from mildly turbulent white water down to the calmer waters of the valley where the river opens out into the fertile valley where the archaeological ruins of Mrauk U await inspection.
 

The area is rich in historic remains from the 14th to 18th centuries when Mrauk U was the capital of the Arakanese empire, which stretched from the Ganges to the Ayeyarwaddy (Irrawaddy).
 

Briels says of the trip: "The journey is the destination. We link Bagan to Mrauk U through incredibly beautiful, remote and unexplored areas where guests will most likely be among the first foreign travelers to set foot in the village."
 

He adds: "Both Bagan and Mrauk U each deserve an additional two or so days for detailed exploration."
 

From Mrauk U it is easy to take a boat to Sittwe for onward domestic flights in Myanmar or to go to the beaches of Ngapali for relaxation.

 

Photo caption: The fabled temples of Mrauk U
 

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Little hope for Burma’s Rohingya in refu­gee camps

Alittle girl balances a bag of donated rice on her head as she begs for her family of eight. Other children play in fetid, trash-clogged pools of water. And at a religious class at a makeshift mosque, more than a third of the children had not eaten that day. Or the day before.

The United Nations says that 135,000 ethnic Rohingya Muslims are still stuck in refugee camps on the western coast of Burma, two years after the government rounded them up in the wake of religious violence that left villages scorched, thousands homeless and more than 200 dead.

The Rohingya, a long-persecuted ethnic minority, have been forced to live as virtual prisoners in temporary huts, scraping by on donated bags of rice and chickpeas and whatever fish they can pull from the ocean. The situation is so dire that some 86,000 people have tried to flee by boat, and Human Rights Watch has accused the government of a campaign of “ethnic cleansing.” Yanghee Lee, the United Nations special rapporteur for human rights in Myanmar, said recently that the situation is “deplorable” and that restrictions on movement have had a severe impact on the Rohingya’s access to jobs, water and sanitation, health care and education.

“The Muslim community . . . continues to face systematic discrimination, which include restrictions in the freedom of movement, restrictions in access to land, food, water, education and health care, and restrictions on marriages and birth registration,” Lee said.

The humanitarian crisis worsened over the winter, after the Burmese government suspended operations of the aid group Doctors Without Borders in the area, leaving more than 700,000 people without proper medical care. The government said only late last week that the doctors could return. Violence forced other organizations to evacuate, then struggle to ramp up aid.

Now, children are starving. Aid workers say they have seen an alarming uptick in child malnutrition in recent months because for so long, local hostilities hindered their access to mothers and pregnant women and interrupted water, food and sanitation supplies.

“What we have observed from March to June is a dramatic increase in admissions for severe acute malnutrition. We saw the figures doubling,” said Bertrand Bainvel, Unicef’s representative in Burma. “We’re all still very concerned about the situation.”

‘Economic isolation’

The Rohingya camps are spread out over miles of the western state of Rakhine, some so remote they are reachable only by boat. With so much time having passed, life has established a rhythm of its own for the residents. In some camps, small markets have sprung up, with goods supplied by Rakhine traders on the outside, the same ethnic group the Rohingya have long clashed with.

Fish from the nearby ocean dries on long poles, and some residents have planted gardens next to their huts with donated seeds to augment the meager food supply. They are not allowed to leave for the most part, although the residents near the town of Sittwe can take trips in guarded trucks to the one remaining Muslim neighborhood across town.

The Rohingya are an ethnic minority in Burma, the predominantly Buddhist Southeast Asian nation of more than 55 million people. Tensions between the Rohingya and their ethnic Rakhine Buddhist neighbors existed long before the recent flare-up of violence.

During five decades of harsh military rule in Burma, the Rohingya were persecuted by the government, human rights experts say, forced to endure hard labor, relocations, rape and torture. Although Rohingya have lived in Burma for generations, a strict 1982 citizenship law rendered many of them stateless, and the government continues to consider them refugees from Bangladesh. This year, census workers refused to count those who identified themselves as Rohingya.

Ye Htut, the spokesman for the Burmese president, Thein Sein, bristled when the word “Rohingya” was used in an interview.

“I would like to point out that the government of Myanmar and Myanmar people didn’t accept the word Rohingya,” Ye Htut said. “We recognize there are Islamic Bengalis in our country.” But, he said, “We recognize there are tensions and challenges in our country, especially communal violence.”

Phil Robertson, the deputy director of Human Rights Watch in Asia, said that the government has engaged in a policy of “social and economic isolation of the Rohingya” for years, particularly since June 2012, when three Muslim men allegedly raped a Buddhist woman.

Since then, Robertson said, “It’s been a downward spiral in terms of humanitarian access and accountability. The situation is going badly downhill. You have about 140,000 people in displaced persons camps and another 40,000 locked in their villages without adequate access to food and medical services.”

Ye Htut said that the Rohingya are being kept in the camps for their own protection.

The crisis has given rise to widespread international outrage, and questions about whether the United States — which eased economic sanctions on Burma after the government began a process of democratic reform in 2011 — has painted a rosier picture of the emerging democracy than is warranted.

“No one is turning a blind eye to anything. In fact we’re working continually to help address problems on the ground,” said Derek J. Mitchell, the U.S. ambassador to Burma. “What we are doing out here is in anticipation of continued reform, although we need to remain patient as the country deals with increasingly difficult issues going forward.”

Doctors Without Borders said in a statement Friday that they were “cautiously optimistic” after the government’s surprise announcement that doctors could return to the area after they were expelled in February for treating victims of a January clash that left more than 40 Rohingya dead — a confrontation the government denies took place. Some, however, viewed the news with skepticism, arguing it could be a public relations ploy ahead of an expected visit by U.S. Secretary of State John F. Kerry in August.

The group was the main provider of medical care for more than 700,000 people in Rakhine state, and the ouster of the 600 staffers and the shuttering of clinics and traveling medical teams left huge gaps. The government compensated with a small mobile team that now numbers around 100.

The impact of the suspension has been profound. One recent humid day in the back of a makeshift pharmacy at a camp just outside Sittwe, dozens of Rohingya waited in line to receive a few tablets of donated medicine. A woman, Ommar Khulsom, 30, clutched her feverish newborn niece. The little girl’s mother had suffered from edema throughout her pregnancy and had been under the care of Doctors Without Borders, a local staffer who had worked with the aid group said. When they were forced out, however, her treatment stopped. The night she gave birth, the woman bled to death.

Looking for hope

Maung Hla Tin, 33, a carpenter and camp leader, said that about 50 people had died in his section, including more than a dozen babies, in the past two years. His area was without food for 15 days in April, and a nongovernmental organization stopped delivering soap, fresh water and other sanitary supplies, which gave rise to widespread diarrhea and other diseases, he said.

“We have no hope,” he said.

The government’s unexpected decision to allow Doctors Without Borders back into the camps followed a June meeting at which local leaders, U.N. officials, civil activists and others drew up an action plan to address the crisis. While that was viewed as a positive step, some feel little is being done to address the larger question of the Rohingya’s fate.

“In the long term, solutions must be found” for the displaced people and thousands of others living in isolated villages, said Pierre Peron, spokesman for the U.N. Office for the Coordination of Humanitarian Affairs in Rangoon.

Many Rohingya said they fear they may never resume normal lives.

“We’re suffering here. We want to go back to our homes,” said Thin Mg, 44, who had a small goods-trading business before the violence displaced his family. “One day is like one year.”

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Friday, August 01, 2014
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