Conclusion: human rights and the right to health

As in other developing nations, particularly in Africa, in Burma, a substantial proportion of government medications and preventive-health materials are sold on the black market. The theft of medical equipment, medicines and other products from international and UN organisations means these products can be purchased easily in Yangon’s main markets.

The transparency of aid delivery and the provision of materials from international donors are issues that continually confront in-country aid providers. The Australian medical practitioners currently working in Burma (Myanmar/Burma Update 2007) attest to the latent capacity and talent still evident among the Burmese medical fraternity, but the cost of health care, the continuing exodus of qualified medical personnel, the loss of much traditional knowledge since the colonial period and the existence of conflict zones within the country are all factors contributing to limit Burmese people’s access to health care. Taken as a whole, the possibility of affordable, accessible and evidence-based health care is extremely limited for the majority of Burma’s 54 million inhabitants. In this context, it is not surprising that Burmese people turn to folk and magical forms of medical practices, such as exorcists, alchemists and wizardry, when they have exhausted their financial resources and cannot find relief.

In the wake of the suppression of the so-called ‘Saffron Revolution’ in September–October 2007, it is perhaps timely to conclude with some thoughts about the long-term consequences of the lack of a right to health. There is indisputable photographic evidence of shootings and beatings administered to protestors during the attempted Saffron Revolution[16] and the former UN Special Rapporteur on Human Rights in Myanmar, Sergio Pinheiro, put the death toll at 31 with up to 4000 arrested and 1000 still detained as of 11 December 2007 (UNHRC 2008:4). In earlier work (Skidmore 2005, 2003), I described the long-term consequences of inculcating a state of fear and of perpetual vulnerability in the urban populace. Since September 2007, there has been a demonstrable increase in the efficiency by which terror, as distinct from fear, can be created among the population. In other countries in which violence has been perpetrated and witnessed, there are well-documented harvests of suicide, trauma and mental health problems. It is not possible to gather such health data in Burma, yet psychological health must surely be considered when describing Burma’s humanitarian and health crises. Paranoia, nightmares, confused and impaired thinking and psychological defences such as denial are also prevalent among the Burmese I have interviewed in the wake of the violence in Yangon (Skidmore 1998). Jail terms for monks and civilians who took part in the demonstrations, as well as reports of torture within prisons and harsh sentences to prison and labour camps, have together created a pathological psychological climate. In Yangon, the anger that Burmese Buddhists feel at the continuing barricading and closure of monasteries and the continuing arrests of monks is palpable. To seek health care for trauma and fear, however, is to risk charges of subversion and treason.

In making these comments about the mental health of the urban populace, the purpose is not to detract from the serious human rights issues that occur among forcibly displaced civilian populations in Burma’s civil war zone. In addition to the significant volume of core human rights abuses occurring in Burma, however, is a virtually undocumented and untreated epidemic of psychological trauma. This psychological trauma is a crucial aspect of a lack of a right to health and it is in part related to the subversion of medical ethics that is required of Burmese people who train and practice medicine in Burma today. There are precious few provisions for psychological, psychiatric or counselling help for those suffering from the long-term effects of living in a state of fear. At times of crisis such as during the September 2007 street protests against cost-of-living increases and military rule, anxiety, fear and paranoia can become acute, but medical personnel also live in fear of giving aid to people branded as enemies of the State or criminals during these moments of resistance.

The latter part of this chapter documents forms of health care offered by non-state providers, but also the forms of illness and disease that are not permitted to exist and therefore to be treated. It does so to emphasise not just the patent inadequacy of the current regime’s expenditure on health care, but to draw attention to the continuing denial of the fundamental right to health for the majority of the population.

[16] See, for example, the web pages of activist news organisations such as the Democratic Voice of Burma and the Irrawaddy Magazine.