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Evaluation of Medical Services in Mae Ra Ma Luang With Respect to Burmese Refugees Laura T. Crankshaw The Zakat Foundation September 2004 Table of Contents Objective Methodology Introduction Background Control over Thai Border Forced Village Relocations Current Situation Mae Ra Ma Luang Observations Active NGOs (Health Sector) Organization Medical Staff Identified Needs (Health Sector) Conclusion Objective The Health Sector Evaluation was carried out in June, 2004. The main objective was to assess the conditions of the medical facilities in the Mae La Ma Luang refugee camp. The evaluation includes an inventory of pharmaceutical medicines, an assessment of the medical services available to the refugees, and a review of the impact of NGOs in the health sector. In addition to the evaluation, a three to four month supply of pharmaceutical medicine was delivered on behalf of the Zakat Foundation. Methodology During the evaluation, meetings were held with a BBC (Burmese Border Consortium) representative as well as with representatives of the refugee community such as the Karen Women Organization (KWO) and the medical staff in the main clinic. Introduction Country: Burmese-Thai Border Evaluated Refugee Camp: Mae La Ma Luang Province: Mae Hong Song Camp Population: Between 11,000 – 12,000 Focus of Evaluation: Health Sector NGOs Active in Health Sector: AMI (Aide Medicale Internationale, France); MHD (Malteser Hilfdienst, Germany) Background Control over Thai Border Prior to 1984, the Burmese-Thai border was predominantly under the control of the ethnic nationalities that had made the area their home for millennia. In 1984, the Burmese government launched a massive attack on the Karen National Union (KNU), severely weakening Karen defenses and sending roughly 10,000 refugees into Thailand. Over the next ten years, the Burmese Army launched annual attacks in which they obtained control of new areas, built supply routes and established new bases. By 1994, the number of refugees fleeing to Thailand had risen to 80,000. In January of 1995, the Burmese Army attacked and overran the KNU headquarters at Manerplaw, and soon took control of all other bases along the Moei River. Within three years, the Burmese army had effectively overrun the entire Thai border. The ethnic nationalities no longer had any control and were driven from their homes. By the end of 1995 the number of refugees had climbed to 115,000 (BBC source). Forced Village Relocations Once the Burmese army seized control, they began implementing a massive relocation plan aimed at strengthening their bases, bringing Burma under military control, and eliminating any ethnic opposition. According to a BBC report in October 2002, at least 2,500 ethnic villages have been destroyed, affecting a million people. More than 200,000 have fled to Thailand as refugees. BBC estimates that around 370,000 people have been forced to move to around 180 relocation sites, while another 270,000 Internally Displaced Persons are still in eastern Burma border areas in temporary shelters or fleeing. Meanwhile, the population of border refugee camps has increased to 152,000. Current Situation The Burmese military (SPDC) rules the country by force and repression, with no form of democracy, and with a blatant disregard for human rights. Ethnic minorities are considered supporters of rebel movements, and are the most vulnerable to violent repression and maltreatment by the Burmese military. Refugees arriving in the camps have fled to escape oppression, forced labor, and financial extortion. Many have witnessed the destruction of their houses, the burning of their crops, and confiscation of goods and personal belongings. Refugees seeking to obtain refugee status cross the border in small, inconspicuous groups so as not to attract the attention of the Thai authorities. Official refugees receive no aid from Thai government, are forbidden to work, and are supported only by officially authorized NGOs. Refugees risk imprisonment if they are caught leaving the camps, and cannot return to their place of origin. They are prohibited from any agricultural practices and denied any chance for economic independence. As a result, refugees have become dependent on humanitarian aid. Mae Ra Ma Luang Mae Ra Ma Luang was established in 1995, and since then has changed from what was a temporary emergency situation to a societal living arrangement that resembles a typical Thai-Karen village. At the time of my visit, it appeared that all essential services needed for normal living conditions have been wellestablished. There are a number of actors and NGOs currently involved in providing essential services to maintain and improve the conditions in the camp. There are several NGOs providing educational supplies and housing improvements (i.e. ICCO, BBC), and the main health activities are undertaken by AMI and MHD. AMI has been operating in the camp since 1995, and has introduced primary healthcare services and a referral system for severe or surgical cases. MHD is becoming increasingly more involved in the medical activities in the camp, and appears to gradually be taking over the bulk of the responsibilities. Observations Active NGOs in Health Sector AMI (Aide Medicale Internationale, France) MHD (Malteser Hilfdienst, Germany) AMI and MHD are partially funded by ECHO (European Community Humanitarian Office) to provide humanitarian assistance in the health sector to approximately 50,000 Karen refugees located in four camps along border. The objective of the ECHO-financed part of AMI and MHD operations is to provide basic healthcare and reduce aid-dependency, while preserving the refugees’ Karen culture and life-style. The ECHO-funded parts of AMI and MHD appear to be quite effective in realizing their objectives. Gradually, the assistance program has expanded from unstructured emergency responses to include preventative practices and educational and awareness programs. Organization In the camp (which is comprised of 7 sections), there is one In-patient Department (IPD) in section 4, one IPD in section 7A, and three Out-patient departments (OPDs) in section 4, 5A, 7A – all of which are currently run by AMI, but will soon be run by MHD, who currently operates an IPD and an OPD in section 7B. Medical Staff The medical staff is extremely limited, but there is a head medic on duty all of the time. He often makes “house-calls”, traveling hours at times to respond to an illness or injury. For serious medical or surgical cases, a referral system has been organized by the NGOs, using the medical facilities of Mae Sot, and also Chang Mai. AMI runs an office in Bangkok, as well as three of bases near the camps: Mae Sot, Umpahang and Mae Sariang, which are commonly used in serious medical injuries. Identification of Needs Medical conditions most often treated include low respiratory tract infections, diarrhea, malaria, vitamin B1 deficiency, and tuberculosis. The limited number of medical personnel, shortage of pharmaceutical medicines, and outdated equipment constricts the quality of medical services in the camp. During an interview with the chief medic in the camp (a Karen refugee), he expressed dissatisfaction with the medical practitioners from AMI. He complained that their participation was short term, and of limited value. In addition, the lack of guidance from AMI coordinators, combined with the inexperience of the refugee medical staff contributed to inefficient medical services. Conclusion Despite the shortcomings of some of the medical programs and limited resources, the development of a health sector infrastructure has severely lessened human suffering with respect to the refugees and continues to have a direct effect on the health of the community. The refugees currently have access to health services, medical treatment, and have the opportunity to be referred to Mae Sot, or even Thai hospitals at all times. Thanks to NGOs and medical training (limited as it may be), the camp has reached a level of self-reliance in terms of day-to-day medical organization and operations. Overall, there is a well structured society within the camp, and a sufficient organization of medical services.
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