Rohingya Dying from Lack of Health Care in Myanmar

Noor Jahan rocked slowly on the floor, trying to steady her weak body. Her chest heaved and her eyes closed with each raspy breath. She could no longer eat or speak, throwing up even spoonfuls of tea.

Two years ago, she would have left her upscale home - one of the nicest in the community - and gone to a hospital to get tests and medicine for her failing liver and kidneys. But that was before Buddhist mobs torched and pillaged her neighborhood, forcing thousands of ethnic Rohingya like herself to flee to a hot, desert-like patch of land on the outskirts of town.

She was then stuck in a dirt-floor bamboo hut about a quarter-mile from the sea. She and others from the Muslim minority group have been forced to live segregated behind security checkpoints and cannot leave, except for medical emergencies. Often not even then.

Living conditions in The' Chaung village and surrounding camps of Myanmar's northwestern state of Rakhine are desperate for the healthiest residents. For those who are sick, they are unbearable. The situation became even worse two weeks ago, when the aid group Doctors Without Borders was forced to stop working in Rakhine, where most Rohingya live.

The government considers all 1.3 million Rohingya to be illegal immigrants from neighboring Bangladesh, though many of them were born in Myanmar to families who have lived here for generations. Presidential spokesman Ye Htut accused Doctors Without Borders of unfairly providing more care to Muslims than Buddhists and inflaming communal tensions by hiring "Bengalis," the name the government uses to refer to the Rohingya.

Myanmar, a predominantly Buddhist nation of 60 million, emerged from a half-century of isolating military rule in 2011. Nascent democratic reforms have generated optimism in the international community - the World Bank recently pledged $2 billion in development aid - but waves of ethnic violence, mainly against the Rohingya, have raised concerns from the U.S. and others.

Before Doctors Without Borders was shut down, Rakhine Buddhists regularly protested the group in what Vickie Hawkins, its deputy head of mission in Myanmar, described as a slow strangulation. Staff members were intimidated. Landlords became too fearful to rent houses for their operation. Boat captains declined to ferry patients.

The situation intensified after the organization said it treated 22 Rohingya patients who were wounded and traumatized following an attack in January. The government has staunchly denied that a Buddhist mob rampaged through a village, killing women and children, but the United Nations concluded more than 40 people may have been killed.

Talks are still ongoing between the government and Doctors Without Borders over whether the group will be allowed to continue working in Rakhine state. Dr. Soe Lwin Nyein, the Health Ministry's deputy director general, said Wednesday that the government was continuing to accept HIV and tuberculosis drugs from the group for patients in Rakhine.

Many sick patients located in the camps outside of the state capital, Sittwe, prefer to visit Doctors Without Borders' small facility that sits among a tangle of flimsy thatch-roofed shacks. It is a trusted source of care, having worked in Rakhine state for two decades.

To see a doctor now, patients living in the camps must secure referrals from government physicians and frequently pay bribes to security guards to get past checkpoints. Treatment is then only permitted at one hospital, forcing some from remote areas to travel for hours.

Additionally, many fear violence outside their Muslim area. Aid workers said protesters once stormed a hospital in town, forcing officials to lock the doors while some Rohingya patients fled in terror.

Rohingya in Myanmar have faced decades of systematic discrimination that bars them from certain jobs and requires special permission for them to marry, among other restrictions. But their lives were far more peaceful before ethnic violence erupted in mid-2012. Up to 280 people have been killed in Rakhine and tens of thousands more have fled their homes, most of them Rohingya.

Before the clashes, Jahan's family lived comfortably in the heart of Sittwe. They were well-known among both Buddhists and Muslims, owned five houses and ran a construction supply business. When surrounding Muslim areas started burning nearly two years ago, they paid the police to guard their concrete home and believed they were protected. But mobs torched and looted it anyway.

The family fled their now-bulldozed house with some jewelry and around $5,000 in cash. They can no longer access additional money in their bank accounts because they left their identity cards behind.

The stress was especially hard on 48-year-old Jahan. Suffering from diabetes, liver and kidney disease, she started deteriorating about three months after being corralled into the Muslim area, when the family ran out of medicine and food became scarce.

She fell unconscious in December, and her husband, Mohamad Frukan, traveled with her to a nearby government clinic and waited for an emergency referral. Eventually, the Red Cross was able to take them to a Sittwe hospital since the clinic itself has no doctors.

Once in town, Frukan said, a security guard shouted ethnic slurs at them and a nurse tried to give them different drugs than the doctor had prescribed. The family was not able to leave the facility, and was forced to rely on guards to bring them food. He said some were helpful, while others were indifferent or downright mean.

Jahan was told she needed to see a specialist in the country's main city of Yangon, but Rohingya need special permission for such a trip -- a process that was too complicated and costly for the couple. Instead, after being treated for nine days, she was sent back to the dilapidated house made of bamboo slats and pieces of corrugated tin -- still one of the nicest homes in the neighborhood, when compared to the saggy huts surrounding it.

Jahan's condition soon worsened. She couldn't stand or lie down, so she sat, drawing one agonizing breath after another. The doctor asked that she return a week or two later for a checkup, but by then, Frukan said, security around the camp had tightened and there was no way for the family to leave.

Instead, he decided to pay $300 for a boat to take his wife to Bangladesh. He was prepared to carry her through chest-high water for 45 minutes to reach the vessel, but when he tried to arrange it, the boat captain took a look at her and simply shook his head. He wouldn't take the risk of her dying on the way.

There was little that Frukan could do but cry. The couple had traveled to Yangon for care just four years ago, and if the violence hadn't uprooted their lives, they could have done it again.

"Life is so miserable for us," Frukan said. "Sometimes I am out of my mind thinking about her, but she never knows that. Whenever I look at her, it just hurts so much, and it's so painful. I think my daughters might even die seeing their mother every day and night."

Lives have always been at greater risk in Rakhine, the second-poorest state of one of Asia's poorest countries. The situation is worse away from the Sittwe camps, in isolated and predominantly Muslim northern Rakhine state.

In 2011, before the violence erupted, the European Community Humanitarian Office reported that acute malnutrition rates in parts of northern Rakhine reached 23 percent, far above the 15 percent emergency level set by the World Health Organization. In one township, the number of deaths among children under 5 is nearly triple the national rate, according to the U.N.

Now the situation is even more dire, with families split and lives disrupted. An estimated 75,000 Rohingya have left the country by boat, including Jahan's son and son-in-law, though neighboring countries are reluctant to accept them.

In the camps, many suffer from diarrhea and respiratory illnesses, including tuberculosis, in cramped shelters with no ventilation. Agencies such as UNICEF highlight poor hygiene, sanitation and a lack of clean drinking water. It's a possible public health disaster in the making, especially during the rainy season, when the choking dust turns to gooey mud. Potential outbreaks such as measles and cholera remain a worry.

Pregnant women are particularly at risk. A quarter of Doctors Without Borders' emergency referrals involved complications during labor. One Rohingya woman, Asamatu, started bleeding four days before giving birth to a baby girl last month and died three days later in a camp filled with barefoot children and open sewage ditches.

"She was so weak at the end she couldn't stand," said sister Hasinara as she breast-fed her 15-day-old niece. "If we hadn't been here, the father would be working normally and earning money and she would have given birth in a better place."

The strain is hardest on the poor, who cannot even afford basic medication sold at small pharmacies along a road near several of the camps. An underground group has been smuggling everything from antibiotics to aspirin into the area using business channels, but it's far from enough.

And sometimes, money doesn't matter.

In early March, two months after his desperate efforts to get his wife to a doctor, Frukan walked along a dusty potholed road before sunset in a white skull cap and a crisp shirt. He had been praying for Jahan, whom he fell in love with and married 35 years ago. He would have handed over his entire fortune to save her.

"She died in the middle of nothing," he said. "We couldn't do anything in the middle of nothing."

Now all Frukan has left is his guilt and a mound of fresh dirt surrounding a large white concrete grave. The best he could give her.

"If I talk about her, I feel I will die," he said sitting in a shady courtyard outside the house. "I try to make myself comfortable by going to the mosque, but if I talk about what happened to her, I will die."