Focus on health minority rights group international

State of the World’s Minorities and Indigenous Peoples 2013

Events of 2012

State of theWorld’s Minorities and Indigenous Peoples 20131 Events of 2012 Front cover: A Dalit woman who works as a Community Public Health Promoter in Nepal. Jane Beesley/Oxfam GB. Inside front cover: Indigenous patient and doctor at Klinik Kalvary, a community health clinic in Papua, Indonesia. Klinik Kalvary. Inside back cover: Roma child at a community centre in Slovakia. Bjoern Steinz/Panos

Acknowledgements Support our work Minority Rights Group International (MRG) Donate at www.minorityrights.org/donate gratefully acknowledges the support of all organizations MRG relies on the generous support of institutions and individuals who gave financial and other assistance and individuals to help us secure the rights of to this publication, including CAFOD, the European minorities and indigenous peoples around the Union and the Finnish Ministry of Foreign Affairs. world. All donations received contribute directly to our projects with minorities and indigenous peoples. © Minority Rights Group International, September 2013. All rights reserved. Subscribe to our publications at www.minorityrights.org/publications Material from this publication may be reproduced Another valuable way to support us is to subscribe for teaching or for other non-commercial purposes. to our publications, which offer a compelling No part of it may be reproduced in any form for analysis of minority and indigenous issues and commercial purposes without the prior express original research. We also offer specialist training permission of the copyright holders. materials and guides on international human rights instruments and accessing international bodies. For further information please contact MRG. A CIP catalogue record of this publication is available from Learn more about minority and indigenous the British Library. communities at www.minorityvoices.org Visit our online newsroom for stories and ISBN 978-1-907919-40-4 multimedia content from minorities and indigenous communities around the world. Published: September 2013 Production: Jasmin Qureshi Copy editing: Sophie Richmond Follow us: Design: Tom Carpenter, Texture Printed in the UK @minorityrights

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Minority Rights Group International 54 Commercial Street, London E1 6LT, This publication is funded by the United Kingdom. European Union. The content is Tel: +44 (0)20 7422 4200 the sole responsibility of Minority Fax: +44 (0)20 7422 4201 Rights Group International and can under no Email: [email protected] circumstances be regarded as reflecting the position Website: www.minorityrights.org of the European Union. Focus on health

State of theWorld’s Minorities and Indigenous Peoples 20131 Events of 2012 Edited by Beth Walker Minority Rights Group International Introduction

6 Foreword Paul Hunt, UN Special Rapporteur on the right to health (2002–2008)

Part 1 Thematic essays

10 Addressing health inequalities in the post- 2015 development framework Corinne Lennox

24 Improving indigenous maternal and child health Viviana Crivelli, Juan Hautecouer, Coll Hutchison, Ana Llamas, Carolyn Stephens

36 Minority women’s vulnerability to HIV/ AIDS in South East Asia Nicole Girard

46 Mental health care for survivors of torture and conflict David Gangsei, Erin Morgan, Paul Orieny, Ann Willhoite, Holly Ziemer

50 Litigating to realize the right to health for indigenous peoples Carla Clarke Part 2 Regional overviews 55 Africa Paige Jennings, Inga Thiemann, Laura A. Young

89 Americas Maurice Bryan

117 Asia and Oceania Jack Dentith, Emily Hong, Irwin Loy, Farah Mihlar, Daniel Openshaw, Jacqui Zalcberg

171 Europe Katalin Halász

191 Middle East and North Africa Said Shehata

Part 3 Reference

210 Peoples under Threat 2013, Mark Lattimer

228 Status of ratification of major international and regional instruments relevant to minority and indigenous rights

240 Who are minorities?

240 Selected abbreviations

241 Contributors

243 Acknowledgements Foreword Paul Hunt, UN Special Rapporteur on the right to health (2002–2008)

8 Foreword State of the World’s Minorities 2009 e live in a world of profound health compared to the rest of the population. inequalities, a world in which a More often than not, this ill-health and W person’s health and the quality of poor healthcare is a symptom of poverty and care they receive is determined by their ethnicity, discrimination. the language they speak or their religious and In sub-Saharan Africa, a young Samburu cultural beliefs. woman dies from complications during childbirth In almost every country in the world, because the government does not provide any minorities and indigenous peoples are among medical care in the area where she lives. In the poorest and most vulnerable groups, suffer Rwanda, a Batwa child suffers from debilitating greater ill-health and receive poorer quality of but easily treatable intestine worms because care than other segments of the population. of the dirty water he drinks. In India, health They die younger, suffer from higher rates of disease and struggle more to access health services Below: A Batwa child in Rwanda. Eric Lafforgue.

State of the World’s Minorities Foreword 9 and Indigenous Peoples 2013 workers refuse to visit a Dalit village because so on. I argued, for example, that reducing of untouchability practices. The suicide rate maternal mortality is not just an issue of among Yezidis living in Sinjar, Iraq, has development, but also an issue of human escalated because of their desperate situation. rights. But despite longstanding international The early mortality and greater morbidity commitments to reducing maternal mortality, faced by so many minorities and indigenous so far progress has been disappointing for peoples is a matter of pressing social justice many minority and indigenous women, for which governments and other actors must as numerous examples in this volume be held accountable. demonstrate. The right to health – the right to survive – Although the MDGs underscore the critical is the most basic human right; its fulfilment importance of health, government initiatives is both a precondition to, and a by-product often fail to reach those most in need. of, the enjoyment of all other rights. National-level targets allow governments But health is also a right in itself under and the international community to ignore international law and in the constitutions of persistent inequalities. Stretched resources many countries. lead governments and donors to focus on The international right to health – or the easy-to-reach population groups. Too often right of everyone to the highest attainable language barriers or different cultural and standard of physical and mental health – not religious practices are not taken into account only includes access to medical care, but also when designing health interventions. to the underlying determinants of health, New strategies are now needed to ensure such as safe water, adequate sanitation, decent the right to health for minorities and housing, healthy working conditions, a clean indigenous peoples in both the global North environment, health-related information and global South. (including on sexual and reproductive health) I welcome this edition of Minority Rights and freedom from discrimination. The right Group’s annual report, which will build has a pre-occupation with disadvantaged a better understanding among readers groups, participation and accountability. about the health issues facing minority and It demands that health-related services indigenous communities and what can be be evidence-based, respectful of cultural done to address their needs. difference and of good quality. Moreover, It not only provides us with a better it places a responsibility on high-income understanding of the state of health for countries to help other countries deliver minorities and indigenous peoples, it also the right to health to everyone within their raises neglected but important issues that borders. affect indigenous and minority health. These And so ensuring minority and indigenous include the link between land security, peoples can live healthy lives is not just a displacement and health; the social exclusion question of providing vaccines or treating and lack of political power that prevent particular diseases, it requires us to address groups from achieving better care; the the underlying causes of ill-health. need for culturally sensitive care; and the This is why as UN Special Rapporteur on importance of traditional medicine. the right to health I focused on two critical This volume also suggests constructive barriers to access to health and well-being: ways forward. It highlights the importance poverty and discrimination. Through a right- of collecting health data about specific to-health ‘lens’, I looked at a range of issues, ethnic, religious and linguistic groups to including access to medicines, water and ensure no one is left behind. It provides sanitation, mental health, the Millennium compelling evidence of the positive impact Development Goals (MDGs), sexual and of involving minorities and indigenous reproductive health, the work of international peoples in designing health interventions financial institutions, accountability, and and broader political processes. It also

10 Foreword State of the World’s Minorities and Indigenous Peoples 2013 provides examples of targeted measures to tackle discrimination – such as collecting evidence, supporting access to justice, training health professionals and providing culturally adapted health services. Many organizations do outstanding work to improve health outcomes for vulnerable people. In India, participatory women’s groups and community monitoring of health outcomes have radically reduced maternal deaths and newborn mortality among eastern India’s Adivasi communities. In eastern Europe, training Roma to act as health mediators has increased vaccination rates among Roma and helped community members access medical treatment. In Namibia, San have worked with non-governmental organizations to design mobile clinics to treat multi-drug resistant tuberculosis in nomadic communities. In Peru, traditional birthing practices have been integrated in the mainstream health system, encouraging indigenous women to give birth in hospitals, reducing preventable deaths. In the Mekong region of South East Asia, local radio dramas have raised awareness about HIV and available treatment among ethnic minority groups. All these examples show human rights for minorities and indigenous peoples, coupled with a human rights-based approach to development, can strengthen any new global development strategy – both in the global North and the global South. I strongly recommend this excellent book to governments, health professionals, human rights advocates, aid agencies, and minority and indigenous groups – and everyone committed to deepening social justice, health and human rights. ■

State of the World’s Minorities Foreword 11 and Indigenous Peoples 2013 Addressing health inequalities in the post-2015 development 1 framework Corinne Lennox n a village in Gujarat, India, most of the Above: A community health worker examines a Dalits seeking health services have to wait Dalit child, India. Dalit Freedom Network. I longer for their turn because the dominant caste people are given priority. Only where the has been shown to hamper poverty reduction doctor is also a Dalit are they given equal priority and growth strategies, to create tensions and in appointments. Health workers rarely visit the conflict between communities, and to undermine Dalit quarters of the village. In the health care democratic governance. centre, Dalits do not sit on the benches provided This increased focus on inequality has given and they drink water from separate vessels kept an important voice to minorities and indigenous for them. ‘Untouchability’ is widely practised peoples, who have long experienced the negative in the delivery of health services.2 Across India, effects of inequality. A major cause of this these realities have meant that Dalits have dispro- inequality is the violation of the human rights of portionately high rates of mortality and diseases minorities and indigenous peoples, and national compared with most of their fellow citizens. policies that do not reflect their own priorities or This is one picture of discrimination in perceptions of development. access to health that is faced by minorities and This chapter will show how specific attention indigenous peoples across the globe. There is to human rights for minorities and indigenous wide agreement that tackling inequality needs peoples, coupled with a human rights-based to be central to the post-2015 development approach to development, can strengthen any framework that will replace the Millennium new global development strategy on access to Development Goals (MDGs) in two years’ time. health. As the evidence will suggest, strategies for Not only is such an approach fair and just, it these groups are needed in both the global North also makes good development sense. Inequality and South.

State of the World’s Minorities Addressing health inequalities in the 13 and Indigenous Peoples 2013 post-2015 development framework Assessing the impact of the MDGs The MDGs framework had many deficiencies Over the past three years, a major consultation for minorities and indigenous peoples. The process has been under way to devise a new reliance on aggregate results and the lack of global development plan for the post-2015 era disaggregated data collection meant that very when the MDGs will conclude. This consultation few measurements were made on the progress has involved civil society, states and independent of these groups towards the goals. Stretched experts, principally guided by UN institutions. In resources and pressure to achieve the goals September 2013, the UN General Assembly will has prompted governments to focus on the meet to discuss the recommendations from this populations that are easiest to reach and those process and to begin planning a new framework whose levels of inequality were least costly to to follow the MDGs. address. Linguistic barriers or differences in Civil society groups have been involved cultural or religious practices were often not primarily in a series of thematic consultations taken into account when formulating national organized by the UN. This has been strategies on the MDGs. Thus, minorities and complemented by two other important processes: indigenous peoples now find themselves, in many the UN High-level Panel on the post-2015 cases, further from achieving the targets of the development agenda, co-chaired by Indonesia, goals than other populations that have benefited Liberia and the UK; and the inter-governmental from these interventions. Open Working Group on sustainable These trends are evident in some statistics development goals, which is tied to the Rio + 20 regarding the health MDGs. In India, child process. These consultations bring the need for a malnutrition is about 14–20 per cent higher for new development agenda together with the call Scheduled Castes and Scheduled Tribes and has from the Rio + 20 world conference to establish a been declining at a slower rate than for the rest set of sustainable development goals. of the population over the MDGs period.3 In Civil society groups have called for human Tanzania, the goal on reduction of HIV/AIDS rights and the principles of equality, non- was hampered for pastoralists in part because discrimination and participation to be the basis the national HIV/AIDS prevention campaigns of the post-2015 framework. were issued only in the dominant language of The recommendations published in May 2013 Swahili and antiretrovirals, although free, were by the UN High-level Panel fell short in this not easily accessible in several districts where regard; while some human rights are mentioned, pastoralists predominantly live.4 In Pakistan, such as non-discrimination against women, UNICEF reports that the maternal mortality property rights, due-process rights and freedom ratio for Baluchistan – largely inhabited by the of expression, there is no systematic integration Baluchi minority – stands at 758 per 100,000 of human rights in their proposal. The open live births, nearly three times the national working group on sustainable development average of 276 per 100,000, and a long way goals will submit its proposal to the UN off the MDG target of 140 per 100,000. The General Assembly in September 2013. Notably, prevalence of malaria is very low in large parts the document that came out of the Rio + 20 of Bangladesh but is especially high in the conference makes firm commitments to human Chittagong Hill Tracts, where the indigenous rights, including specifically the rights to health, Jumma peoples reside, and largely attributable to an adequate standard of living, to food and to to less investment in adequate living standards non-discrimination. and health services in this high-risk area. One component of the UN global civil society Chronic malnutrition among indigenous consultation process focused on addressing children in Guatemala is nearly twice the rate of inequalities, which offered minorities and non-indigenous children. indigenous peoples an important opportunity While governments may cite resource to participate in the creation of the post-2015 limitations or remote locations to explain these agenda. No equivalent opportunity was available inequalities, they cannot be justified from the when the MDGs were drafted. perspective of human rights.

14 Addressing health inequalities in the State of the World’s Minorities post-2015 development framework and Indigenous Peoples 2013 The right to health: some key (Article 12.2 (a)), through measures such international standards and principles as access to reproductive and sexual health Minorities, indigenous peoples and civil society services, emergency obstetrics, information organizations have all called for a human rights and resources to access these services. The foundation to the post-2015 agenda. It is Convention on the Elimination of all forms of therefore important to discuss the scope of the Discrimination Against Women (CEDAW) human right to the highest attainable standard has further provisions: states ‘shall ensure to of physical and mental health (International women appropriate services in connection with Covenant on Economic, Social and Cultural pregnancy, confinement and the postnatal period, Rights [ICESCR], Article 12). According to the granting free services where necessary, as well General Comment No. 14 of the UN Committee as adequate nutrition during pregnancy and on Economic, Social and Cultural Rights, which lactation’ (Article 12.2). oversees the core treaty that recognizes the right Specific rights to health for children are to health, this right: detailed in Article 24 of the Convention on the Rights of the Child. These include the obligation ‘is the right to the enjoyment of a variety of facilities, of states ‘to ensure that no child is deprived goods, services and conditions necessary for the of his or her right of access to … health care realization of the highest attainable standard of services’ (Article 24.1); to reduce infant and child health.… [The right includes both] timely and mortality (Article 24.2 (a)), to provide adequate appropriate health care … [and] the underlying nutrition and access to water and a clean determinants of health, including access to safe and environment (Article 24.2 (c)), and to ‘develop potable water, and adequate sanitation, an adequate preventive health care’ (Article 24.2 (f)). Health supply of safe food, nutrition and housing, healthy rights and special measures are also noted for occupational and environmental conditions, and children with disabilities (Article 23). access to health-related education and information, including on sexual and reproductive health.’ The right to health for minorities and indigenous peoples Thus, although the state cannot protect people Against the backdrop of these general human against ill health, the state can provide services rights provisions on the right to health we can and an environment that enable people to achieve sketch a framework that focuses on rights of the highest possible standards of health. particular concern to minorities and indigenous Regarding underlying determinants of health, peoples: the right to non-discrimination; the the ICESCR also recognizes rights to an adequate right to participation and the right to protection standard of living (Article 11), adequate housing of identity. (Article 11), food (Article 11), education (Article 13), and just and favourable conditions of work The right to non-discrimination (Article 7). The treaty also requires states to Everyone has the right to access health facilities, take steps for ‘the improvement of all aspects of goods and services without discrimination environmental and industrial hygiene’ (Article (ICESCR and International Convention on the 12.2 (b)); ‘the prevention, treatment and control Elimination of all forms of Racial Discrimination of epidemic, endemic, occupational and other [ICERD], Article 5.e.iv). This means non- diseases’ (Article 12.2 (c)); and the ‘creation of discrimination both in access to health care and conditions which would assure to all medical in enjoyment of the underlying determinants service and medical attention in the event of of health. States have obligations to prevent sickness’ (Article 12.2 (d)). discrimination both by state actors in the public Reproductive health rights for women are sphere and by non-state actors in the private also firmly recognized: ICESCR holds that sphere, including by private corporations. states should make ‘provision for the reduction Crucially, even where resources are scarce, states of the stillbirth-rate and of infant mortality cannot discriminate in the allocation of access to and for the healthy development of the child’ adequate health in the progressive realization of

State of the World’s Minorities Addressing health inequalities in the 15 and Indigenous Peoples 2013 post-2015 development framework this right (ICESCR, Article 2). consent before adopting and implementing Non-discrimination in access to the right to legislative or administrative measures that may health encompasses both positive and negative affect them’ (UNDRIP, Article 19). obligations of state actors. This requires more than the mere refraining from discrimination in The right to protection of identity providing access to and within health facilities, Identity factors, such as cultural or religious life, goods and services, but also taking positive can impact on the right to health for minorities measures, including through allocation of and indigenous peoples. Beliefs about health and resources, legislative change or policy reform to well-being, both individual and community, can ensure the fulfilment of this right. be deeply rooted in cultural practices or religious Discrimination can be both direct and indirect. beliefs that shape communities’ response to Direct discrimination results when a person is mainstream and strictly biomedical approaches to treated less favourably than another person in a health care and health. similar situation based on prohibited grounds of Minorities have the right to practise and to discrimination. Indirect discrimination refers to enjoy their own culture, to practise their own practices that may appear neutral but nevertheless religion, and to use their own language, in private have the effect of discriminating on prohibited and in public, freely and without interference or grounds. States have obligations to prevent both any form of discrimination (UNDM, Article 2.1; kinds of discrimination in access to health. International Covenant on Civil and Political Rights [ICCPR], Article 27). Indigenous peoples The right to participate have the right to exercise self-determination over Fulfilling the right to participate will be essential their cultural development (UNDRIP, Articles for the post-2015 framework. The Committee 3 and 11), to practise their traditional religions on Economic, Social and Cultural Rights holds (UNDRIP, Article 12), and not to be subjected to ‘the participation of the population in all health- forced assimilation or destruction of their culture related decision-making at the community, (UNDRIP, Article 8.1). Protection of indigenous national and international levels’ to be an land and resource rights is interdependent with important dimension of the right to health. these rights (UNDRIP, Article 26). Minorities have the right ‘to participate Regarding traditional forms of medicine, effectively in decisions on the national and, Article 24.1 of the UNDRIP states that where appropriate, regional level concerning the ‘Indigenous peoples have the right to their minority to which they belong or the regions in traditional medicines and to maintain their health which they live’ (UN Declaration on the Rights practices, including the conservation of their vital of Persons Belonging to National or Ethnic, medicinal plants, animals and minerals.’ Religious and Linguistic Minorities [UNDM], Cultural and religious practices can also be Article 2.3). Moreover, ‘[n]ational policies and harmful to health and some provisions have been programmes shall be planned and implemented made to overcome such harms; in the CRC, with due regard for the legitimate interests of for example, states are to take measures for persons belonging to minorities’ (UNDM, Article ‘abolishing traditional practices prejudicial to the 5.1). health of children’ (Article 24.3), which could Similarly, indigenous peoples enjoy the right include both community practice and entrenched to self-determination, including ‘the right to be and systemic forms of discrimination coming actively involved in developing and determining from outside. More generally, CEDAW Article health, housing and other economic and social 5(a) calls upon states to eliminate customary and programmes affecting them and, as far as other practices based on assumptions of female possible, to administer such programmes through superiority or inferiority, some of which can their own institutions’ (UN Declaration on the impact on health. Rights of Indigenous Peoples [UNDRIP], Article It is essential, however, that potential impact 23). Furthermore, states should obtain from on health from traditional harmful practices not indigenous peoples their ‘free, prior and informed be used as a justification to prohibit outright

16 Addressing health inequalities in the State of the World’s Minorities post-2015 development framework and Indigenous Peoples 2013 the cultural and religious beliefs of minorities Box 1 and indigenous peoples. Often what is needed is informed dialogue on how to reform certain specific practices without restricting or Delivering the denigrating a culture or religion as a whole. right to health Understanding inequalities and inequity in health The UN Committee on Economic, Social The poor MDGs results for minorities and and Cultural Rights has developed a indigenous peoples can be attributed to state framework to define many of the minimum failures to fulfil their obligations to these standards for delivering on the right to groups. More than mere inequality, minorities health in goods, facilities and services, and indigenous peoples also face inequity – including the underlying determinants distinguishable by the unfair and avoidable of health. This consists of: Availability, nature of the inequality witnessed. Inequity is Accessibility, Acceptability and Quality. therefore a better term to describe the unjust Availability. Health services should situation of minorities and indigenous peoples be readily available to all without and the unwillingness of states to remedy this discrimination. This includes sufficient situation. provision of hospitals, clinics, trained health professionals and essential medicines. Discrimination Services relating to the underlying Discrimination is one key cause of health determinants of health, such as safe drinking inequity. Discrimination can manifest in the water, sanitation facilities, adequate housing access to health facilities, in the delivery of health and public education on health, must also services and in exhibited inequalities in the be provided to an adequate level for all. underlying (social) determinants of health like Accessibility. Health services must be acces- access to safe water, sanitation, adequate housing sible to all without discrimination. Services and nutrition, having higher rates of illiteracy, or must be made affordable to all and must be working in more hazardous types of employment. located within safe and reasonable reach of Direct discrimination occurs, for example, everyone. Accessibility also includes the right when health practitioners give less quality care to to seek, receive and impart information on those discriminated against, evidenced by longer health, with due respect for confidentiality. waiting times, inadequate diagnosis, the provision Acceptability. Health services must be of less quality medication, patient segregation, or provided in a manner that is compatible neglect in patient hygiene or nutrition. Indirect with cultural and linguistic rights, for discrimination can manifest, for example, when example, by providing services in local access to information on health services and languages and sensitive to different cultural preventive practice is typically provided only practices. Health service delivery must also in dominant languages or in accordance with be responsive to gender and age differences. dominant cultural practices. Medical ethics must be adhered to in the Minorities and indigenous peoples are often delivery of health services. also poorer than other groups, making fee-based Quality. Health services must be culturally health services much harder for them to use. acceptable, scientifically and medically Both direct and indirect discrimination can be appropriate and of good quality. The compounding factors: in India, for example, provision of skilled medical personnel, although only about 1 per cent of disabled quality drugs, safe water and good sanitation persons receive help from the government for are among the minimum expected standards education the percentage of beneficiaries among of quality. ■ Dalits and Scheduled Tribes is about half that of the dominant caste group. This is likely

State of the World’s Minorities Addressing health inequalities in the 17 and Indigenous Peoples 2013 post-2015 development framework attributable both to direct discrimination and rheumatic heart disease than non-indigenous ‘untouchability’ practices, but also to higher rates Alaskans. of poverty among these groups.5 Displacement and land rights Culture and identity Displacement from land is a major underlying A second key factor is the different priorities cause: groups can be displaced from their land and perceptions of health that minorities and (to urban areas or to less fertile land), reducing indigenous peoples often hold. This can stem access to traditional food sources and production. from traditional cultural or religious beliefs Achievement of the MDGs has been used to about health and well-being, different customary justify such displacement, usually with net practices around health care, or living in distinct negative outcomes for communities. In Mexico, locations with unique health challenges. In order for example, an MDG ‘Sustainable Rural City’ in to achieve better equity in health outcomes, Chiapas displaced indigenous communities into these different viewpoints must be taken into prefab settlements with the aim of improving consideration in policy development and service access to health and other services. However, delivery. in the new houses, they could no longer grow their own food for consumption and income, Women’s reproductive rights nor cook their food staple, maize, thus putting Reproductive health rights warrant special pressure on incomes and food security; and while attention here. There is evidence from they were closer to health services, residents around the world to show that women from reported that the quality of such services was marginalized minorities and indigenous poor.7 The polluting effects of many extractive peoples have disproportionately high rates of industries encroaching on traditional lands have maternal mortality and often have less access to also severely harmed health outcomes for these reproductive health services. In some severe cases, groups. In the Ahwazi-Arab minority region of minority women can be coerced or intimidated Khuzestan in Iran, from where 90 per cent of into making involuntary decisions regarding the country’s oil revenues originate, minority their sexual and reproductive health, such as communities suffer ill health from the industry sterilization or (for or against) abortion.6 Both pollution of the Karoon River on which they rely. culturally based preferences and discrimination These and other factors need to be taken play a role in these outcomes. into consideration when shaping the post-2015 agenda if the aim of health equity is to be Poverty and social exclusion achieved. The underlying determinants of health can also be experienced differently by minorities and Post-2015 reforms: ‘Leave no one indigenous peoples. Disproportionately high behind’ rates of poverty and low rates of employment The High-level Panel’s final report published in (or underemployment) affect these groups. May sketches out a vision for post-2015 reforms. They are typically pushed into jobs with higher While this vision does not fulfil a human rights- occupational health risks as a result. Poverty based approach, there has been some important contributes also to inadequate housing and less recognition of discrimination and exclusion as food security. All of these factors also contribute barriers to sustainable development. The panel to higher rates of many non-communicable calls first and foremost to ‘leave no one behind’ and some communicable diseases for minorities in the post-2015 framework: and indigenous peoples. In Pakistan, UNICEF reports that rates of polio are highest among the ‘We should ensure that no person – regardless of minority Pashtun population, comprising 77 per ethnicity, gender, geography, disability, race or other cent of cases. In Alaska, the Non-Communicable status – is denied universal human rights and basic Diseases Alliance reports that indigenous economic opportunities. We should design goals that Alaskans have twice the mortality rate from focus on reaching excluded groups.’ 8

18 Addressing health inequalities in the State of the World’s Minorities post-2015 development framework and Indigenous Peoples 2013 Left: Māori mother and child, New Zealand. Jocelyn Carlin/Panos.

health through the new global development framework. A key tool for this is a national action plan to eliminate health inequity, including for minorities and indigenous peoples. National action plans, including the process by which they are devised, are considered by the UN Committee on Economic, Social and Cultural Rights to be a core obligation of ICESCR. National action plans should be elaborated with the full and effective participation of minorities and indigenous peoples, in accordance with their rights as outlined above. They should include clear indicators and benchmarks and be regularly monitored. National action plans must take a comprehensive approach to health inequity, rather than relying on isolated projects that cannot tackle underlying determinants of health. The new guidance note of the UN Secretary- General on Racial Discrimination and Protection of Minorities (2013) also offers some useful baseline recommendations for UN country teams to support these efforts. Several states have taken positive steps in this direction. In the USA, the Department of Health To achieve this, the panel recommends that states and Human Services has recently outlined its build ‘accountable public institutions’ and enable action plan to reduce racial and ethnic disparities. ‘inclusive growth’, and that indicators of new This plan is being implemented in collaboration goals be disaggregated by variables such as gender with existing Offices for Minority Health, which and ethnicity. The panel acknowledges that the have been established in all 50 states and work to ‘cost of delivering services in remote areas may be educate, monitor disparities, create community only 15 to 20 per cent higher than average’, and partnerships and develop targeted policies judges this to be ‘reasonable and affordable’ and and programmes on racial and ethnic health ‘the right thing to do’. inequalities. These suggestions can help to meet the In Ireland, the Traveller Health Strategy has rights of minorities and indigenous peoples. involved members of the Traveller communities Furthermore, the Rio + 20 outcome document in reviewing national and regional health emphasizes that policies for sustainable strategies to ensure that their interests and needs development and poverty eradication should: are reflected. The government has also launched ‘enhance the welfare of indigenous peoples and an All-Ireland Study of Travellers’ Health Status their communities, other local and traditional and Health Needs, an extensive census-style communities, and ethnic minorities, recognizing examination of all Travellers in Ireland and and supporting their identity, culture and Northern Ireland. interests and avoid endangering their cultural In New Zealand, a Māori Health Strategy heritage, practices and traditional knowledge’. and action plan have been adopted. This is In order to ‘leave no one behind’, states should supported by the Māori Health Business Unit, adopt specific targets that will ensure minorities which provides evidence-based research on health and indigenous peoples achieve the right to strategies and by Māori health providers who

State of the World’s Minorities Addressing health inequalities in the 19 and Indigenous Peoples 2013 post-2015 development framework give on-the-ground service delivery. This strategy p information on the facilities by location, such includes also an innovation fund, which supports as the number and type of hospitals and clinics positive Māori approaches that improve Māori and their user rates, including disaggregated health outcomes. In all three examples, there is a data on users; strong emphasis on target groups taking the lead p details on the health service workforce, in delivering these national strategies. including by location, and points such as An alternative approach is to mainstream patient–health worker ratios, and disaggregated attention to minorities and indigenous peoples data on staff recruitment and promotion levels; into general action plans on specific health p information on health levels of the population, sectors. In Brazil, for example, the National including prevalence of diseases, mortality rates Pact to Reduce Maternal Mortality included and access to reproductive health; specific objectives for ‘the inclusion of gender, p inventories on the equipment, types of facilities race and ethnicity considerations in all strategies and quality and affordability of drugs at health and measures’, and ‘the consideration of social services by location; and inequalities in decision-making processes’. p data related to underlying determinants, such Health targets can also be featured in any as access to clean water, sanitation, secure land national anti-racism action plans (mandated rights and adequate housing. under the UN Durban Declaration and Programme of Action from the 2001 World Baseline mapping needs to be accompanied Conference Against Racism). This was pursued by regular monitoring. Global datasets, health in Ecuador, where both indigenous peoples status statistics and access to universal health and people of African descent were targeted coverage should integrate disaggregated data on for culturally sensitive inclusion in health variables such as ethnicity, religion, language programmes. This was achieved through use and region, and intersect with data on sex, capacity-building and infrastructure development sexual orientation, gender identity, disability, age to ensure that medical services were culturally and other information relevant to marginalized appropriate to these communities. The groups. The UN Commission on Information programme was linked to MDGs targets and and Accountability for Women’s and Children’s included a specific project on culturally relevant Health is one initiative that has recognized the childbirth preferences. need for such data on a global scale. Monitoring There are several key areas these national should focus both on access to health services action plans could address. and inequalities in the underlying determinants of health. Non-discrimination in health access Data collection should be supplemented by and service delivery qualitative, participatory approaches. Service user Many practitioners have called for universal groups can be established to gather information health coverage in the post-2015 aims but this from minority and indigenous groups on their cannot be achieved without specific targets for experience of using health services. This can minorities and indigenous peoples and positive help to pinpoint particular problem areas, measures to tackle discrimination. whether it be direct or indirect discrimination, lack of cultural understanding or poor outreach Collecting evidence to affected communities. In British Columbia, Mapping access to health services by minorities Canada, an Aboriginal Maternal Health Forum and indigenous peoples is a useful baseline was convened to invite First Nations women, that can help to determine relevant national particularly those living in under-serviced rural targets. This should include an assessment of areas, to provide inputs on their perinatal health resource allocation to services in regions where support needs. As part of this initiative, 26 First these groups mainly live. Key quantitative and Nations women from two rural communities disaggregated indicators could include: were trained as doulas (midwives). Improving data collection capacities needs to

20 Addressing health inequalities in the State of the World’s Minorities post-2015 development framework and Indigenous Peoples 2013 be built into the post-2015 framework. In the mechanisms should be established and take a role UK, the London Health Observatory’s Ethnic in monitoring for non-discrimination in access Health Intelligence Overview provides an ethnic to health services. Patients should be instructed health database and data collection guidelines for on their rights in relation to health services health institutions across the city and nationally. and have support to access remedies in cases Among the resources they have developed is of violations of those rights. In South Africa, a toolkit to help the National Health Service a patients’ rights charter was developed to give analyse ethnic differences in health and health expression to the constitutional right to health. care.9 Listserves on specific topics in minority The charter is implemented through a number and ethnic health have also been established for of complementary complaints systems mandated practitioners to share data, research findings and by the 2003 South African National Health Act good practices. 61, with support from the South African Human Rights Commission. Targeted measures to tackle discrimination Such targeted measures have been Targeted measures for especially excluded recommended by UN treaty bodies. In the groups can also help tackle discrimination. Such case of Alyne da Silva Pimentel v. Brazil needs can be identified through mapping and (Communication No. 17/2008), the CEDAW developed in national action plans. Committee found that Ms da Silva Pimental, an Afro-Brazilian, faced discrimination on the p In Serbia, the Women’s Association in Kovil basis of her sex, her status as a woman of African provides weekly workshops for young Roma descent and her socio-economic background in women who are wary of mainstream health access to emergency obstetrics services, resulting services, and provides them with access to a in her death. Moreover, the committee found paediatrician, pregnancy counsellor and other that her family faced undue delay in access health information. to justice when seeking accountability for her p In the UK, the Black and Minority Ethnic death. The committee called upon Brazil to Health Forum has devised a targeted maternity ‘ensure access to effective remedies in cases where health programme. The programme works women’s reproductive health rights have been with community-based organizations to reach violated and provide training for the judiciary out to minority women and provide them and for law enforcement personnel’. The with information on maternal health services establishment of maternal mortality committees and how to raise their concerns with service at the local level was also recommended to providers and other relevant institutions. The monitor and investigate such incidents. These programme also supports network building committees can be charged with reviewing among minority women, who tend to be medical but also non-medical and system-related under-represented in mainstream maternal factors that may have impacted on mortality health networks. rates, including differences across ethnic or other p In Australia, an Indigenous Youth Health identity groups. Service has been established to target vulnerable Aboriginal and Torres Strait Training health professionals Islander youth who are experiencing or at risk Training and recruitment strategies need to of homelessness, substance abuse and unequal be reviewed to deliver on health equity post- access to sexual and reproductive health care, 2015. All staff responsible for delivering both providing both clinical and non-clinical public and private health services need to services. be trained on non-discrimination standards and expected practices.10 This includes Access to justice understanding and reforming their own Tackling discrimination also requires access prejudices and discriminatory behaviours, as well to justice and knowledge of rights. Health as understanding wider societal inequalities and Ombudspersons and other complaints injustice along these lines, and their interaction

State of the World’s Minorities Addressing health inequalities in the 21 and Indigenous Peoples 2013 post-2015 development framework with health. Recruitment should aim for a indigenous communities. Specific targets for the proportionate level of staff from minority or establishment of inter-cultural health schemes can indigenous communities, especially in regions be adopted. where the population of these groups is high. Health services designed to meet the post- Targeted training programmes or scholarships for 2015 aims should include specific provisions for health-related studies can be offered; Hungary, minorities and indigenous peoples. For example, for example, has created pre-training programmes this could mean making public health campaigns for Roma for health care careers. Given that available in minority languages and media language can be a significant barrier for members outlets. Those same campaigns could be adapted of minority and indigenous communities seeking to reflect different cultural practices or religious medical assistance, staff should be recruited who beliefs related to health issues, to ensure that speak relevant local languages, or should be information is better understood and responded trained to speak local languages. to. At another level, minorities and indigenous peoples may require distinct health policies Culturally adapted health services that depart from the mainstream post-2015 Cultural and religious variables were ignored framework. Such group-specific policies would in the one-size-fits-all approach of MDGs respond to significant differences that groups can but must figure in the post-2015 agenda express in terms of their worldview on health and for it to be effective. The health-related well-being. agenda needs to be adapted to the cultures, In Ethiopia, for example, Health Poverty religious beliefs and lifestyles of minority and Action has been working with pastoralist

22 Addressing health inequalities in the State of the World’s Minorities post-2015 development framework and Indigenous Peoples 2013 Left: A health mediator assists a Roma commu- Europe (Bulgaria, Romania, Slovakia, Serbia, nity in Bulgaria. Tzvetina Borisova/SETimes. Ukraine and Macedonia), there has been a similar widespread programme of Roma Health communities to create traditional birthing Mediators. They provide various services, huts where pastoralist women can give birth including referring clients to the appropriate safely and in accordance with customary health services, assisting in outreach with public beliefs but also be referred to equipped health health campaigns, and making legal referrals in facilities if complications arise.11 In Panama, cases of discrimination or abuse, as necessary. the government has created an ‘Office of The mediators have had success in increasing Traditional Medicine’ under the Medical Bureau vaccination rates among Roma, in enabling and a medical commission for the purpose of them to acquire necessary identification and ‘harmonizing and fusing western with traditional insurance documents, and have educated medicine’.12 communities on health and improved health More research is needed into culturally specific care provider knowledge and attitudes about practices and beliefs related to health. This Roma.14 Notably, some of the weaknesses of should include analysis of both positive and the programmes have been insufficient resource negative impacts on health of such practices and allocation, poor institutional support for the beliefs. In the UK, numerous studies have been mediators and continuing neglect of many done to highlight inequalities by ethnicity in underlying determinants of health for Roma by access to health services under the auspices of governments. The report recommends addressing the Better Health initiative. Better Health has these problems and also taking steps to ensure produced a briefing collection, providing studies mediators are better integrated into the health to help practitioners understand how minorities system, are collecting more detailed data on have differing experiences of health care in areas outcomes of interventions, and that there are like mental health, maternal health, certain more opportunities for health and social policy diseases such as cancer or diabetes, or people with officials to learn from mediator experiences.15 learning disabilities. For many indigenous communities, access to Addressing underlying determinants traditional medicine can supplement services of health from mainstream health facilities. The Ba’Aka Many agree that the World Health in Cameroon have poor access to health services Organization’s major review of social but have used their traditional medicine skills to determinants of health concluded in 2008 needs use forest resources to support their health; where to figure centrally in the post-2015 agenda. they are displaced from access to such resources, This is crucial for addressing health inequities of health levels decline. Specific rituals and taboos minorities and indigenous peoples, which often associated with childbirth also greatly impact on stem from differences in social determinants. uptake of mainstream services. For example, in The drive towards a ‘Health in All’ approach Bolivia, a micronutrients programme is failing to mainstreaming health considerations across to reach many pregnant women because it does multi-sectoral public policies similarly can help not take into account the traditional diet of to create a more comprehensive approach to indigenous groups, including taboos related to improving health in the post-2015 development certain foods during pregnancy.13 sectors. Training for all health services staff is needed on cultural impacts on health and use of health Poverty services. Specialized staff with expertise in Poverty reduction strategies targeted at minorities communities that experience discrimination can and indigenous peoples would tackle a key help to ensure better access to health services. underlying determinant of their health. Specific This strategy has been adopted in New Zealand targets on poverty reduction for minorities and with the creation of Māori Health Providers. indigenous peoples need to be adopted. As noted In at least six countries in central and eastern above, disproportionately high levels of poverty

State of the World’s Minorities Addressing health inequalities in the 23 and Indigenous Peoples 2013 post-2015 development framework for these groups are in evidence across the globe, UN funding to map their ancestral lands in an suggesting that poverty reduction efforts are effort to secure communal land tenure; this will not benefiting them equally. For example, cash hopefully help safeguard traditional ownership of transfer schemes have been shown to be effective land from encroachment by companies entering for many poor people but may be less effective indigenous territories. for minorities who can face discrimination in Protection of the environment will figure access to services, including in health. Poverty prominently in the post-2015 framework. may also increase other social problems in Rio+20 recognized that the right to health is an communities, such as abuse of alcohol or drugs, essential component of sustainable development. that impact greatly on health. Poverty also Many minorities and indigenous groups use pushes groups into more hazardous forms of natural resources sustainably and responsibly but employment, which can be better regulated they also face the polluting effects of industry on through safety measures and other monitoring their land and the harsh impact of climate change and legal protections. The post-2015 health on their local environment. agenda needs to take account of these distinct Access to justice and legal aid for marginalized forms and effects of exclusion. groups to hold actors to account for environmental harms should be one dimension of Land and natural resources post-2015 environmental reforms. Cooperation Land is a critical determinant of health, and with minorities and indigenous peoples in minorities and indigenous peoples typically have developing locally owned natural resources less legal protection for their land rights and less management schemes can also help deliver the access to quality land. They may also be more Rio aims in a way that does not force people off vulnerable to ‘land-grabbing’ or involuntary land, away from their resources and further into displacement from their land. The net effect is poverty. that minorities and indigenous peoples often lose livelihoods, food security, traditional forms Participation of housing and access to spiritual practices, Lack of political participation is another increasing poverty and lowering physical and determinant of health. The inability of mental health outcomes. minorities and indigenous peoples to secure fair The post-2015 framework needs to approach allocation of resources in national budgets is land rights and displacement differently, but one dimension. Targets for minorities and including by developing targets on access to land. indigenous peoples on greater representation Repeated cases show that forcibly displacing in political institutions at different levels can people to increase access to health services has be developed. Health Poverty Action has been actually had negative impacts on health for the working with indigenous women in Peru to build reasons outlined. Investment in local health their advocacy capacities to engage local and services for communities living more remotely is regional government in dialogue on their failure a more sustainable and cost-effective approach. to delivery adequate nutrition programmes. Making land security a top priority post-2015 The programme has also included institutional will have a strong multiplier effect on health capacity building for women’s organizations, for outcomes, underpinning key issues like poverty example on budgeting, as well as integrating men reduction, employment and food security. Any into discussions on traditionally gender-based targets on nutrition will have to consider the domains of work, thus helping to tackle gender link to land displacement. Where large-scale inequality. development of land is pursued, communities should give their consent to such processes and Conclusion legally enforced benefit-sharing agreements, and/ The bold experiment of the MDGs has yielded or just and equitable compensation for land and mixed results but it has taken the world closer resources, should be secured. In Cambodia, to the realization of human rights for all. For some indigenous communities are receiving the post-2015 framework, we need to be bolder

24 Addressing health inequalities in the State of the World’s Minorities post-2015 development framework and Indigenous Peoples 2013 3. Thorat, S. and Sabharwal, Physicians for Human and also smarter in how we tackle inequality. N.S., ‘Addressing the Rights, Ensuring Equality: Adopting specific and concrete targets and unequal burden of A Guide to Addressing and building capacities to include minorities and malnutrition’, India Health Eliminating Stigma and Beat, vol. 5, no. 5 (June Discrimination in the Health indigenous peoples in the new global agenda is a 2011), p. 1. Sector, Cambridge, MA, key piece of the puzzle for achieving sustainable Physicians for Human 4. Sikar, N.K. and Hodgson, Rights, January 2011. development for the 21st century in both the D.L., ‘In the shadow of the global North and South. MDGs: pastoralist women 11. See Health Poverty Action, and children in Tanzania’, ‘Improving health services ‘Health in All’ policy approaches are needed for Indigenous Affairs, vol. 1 for South Omo and Dollo a new cross-cutting strategy post-2015. The case (2006), pp. 34–6. Ado pastoralists’, retrieved July 2013, http://www. of minorities and indigenous peoples illustrates 5. Pal, G.C., Dalits with healthpovertyaction.org/ well how underlying determinants of health Disabilities: The Neglected where-we-work/africa/ Dimension of Social ethiopia/health-services-in- across many sectors, from land development to Exclusion, Working Paper south-omo-and-dollo-ado/ education and employment and environmental Series, New Delhi, Indian Institute of Dalit Studies, 12. Vasquez, J., Human Rights protection, impact on access to adequate health. 2010, p. 20. and Health: Indigenous The more holistic cultural and religious view of Peoples, Pan American health and well-being held by many minority 6. See, for example, Downing, Health Organization, 2008, R.A. et al., ‘Intersections retrieved July 2013, http:// and indigenous communities can also inform the of ethnicity and social www.who.int/hhr/activities/ mainstream approach to health care, moving us class in provider advice indigenous_peoples/ regarding reproductive IndigPeople_10069.pdf, p. all beyond narrow biomedical prescriptions. health’, American Journal 7. Strategies for building the capacity of of Public Health, vol. 97, no. 10, October 2007, 13. Vinding, D. (ed.), minorities and indigenous peoples to claim 1803–7; Maternity Alliance, Indigenous Peoples and the their right to health, and for governments to Experiences of Maternity Millennium Development Services: Muslim Women’s Goals: Perspectives from respect, protect and fulfil this right, should be Perspectives, London, Communities in Bolivia, included in post-2015 plans. Human rights- The Maternity Alliance, Cambodia, Cameroon, November 2004. Guatemala and Nepal, based approaches to health rooted in non- Geneva: International discrimination, participation and accountability 7. SIPAZ, ‘Sustainable rural Labour Organization, 2006, are needed. A key component of this is putting cities – “Violated rights, p. 11. campesinos forcibly in place adequate monitoring and accessible urbanized”’, SIPAZ Report, 14. Schaaf, M., Roma Health accountability mechanisms to counter vol. 17, no. 2, May 2012, Mediators: Successes and retrieved July 2013, Challenges, New York, discrimination. Such mechanisms should be http://www.sipaz.org/ Roma Health Project, sensitive to and respectful of the differing cultural en/reports/107-informe- Open Society Public Health sipaz-vol-xvii-no-2-mayo- Program, Open Society and religious views of groups that influence their de-2012.html Foundations, October priorities and activities in development. Ensuring 2011. 8. United Nations, A New the participation and leadership of minority Global Partnership: Eradicate 15. Ibid, pp. 59-64. and indigenous groups in the elaboration of Poverty and Transform Economies through policy and programme responses is also essential Sustainable Development; for creating interventions that will work better The Report of the High Level Panel of Eminent Persons on in reaching our common goals for sustainable the Post-2015 Sustainable development. ■ Development Agenda, New York, United Nations, 2013, Executive Summary. Endnotes 9. Aspinall, P.J. and Jacobson, 1. Parts of this chapter have 2. Excerpt taken from B., How to Analyse Ethnic been reproduced with Acharya, S.S., Access to Differences in Health, Health permission of the Indian Health Care and Patterns of Care and the Workforce: Institute of Dalit Studies Discrimination: A Study of A Toolkit for the NHS, from a working paper Dalit Children in Selected London, London Health prepared by the author on Villages of Gujarat and Observatory, 2006, retrieved Good Practice in Combating Rajasthan, Working Papers July 2013, http://www. Discrimination in Access Series, New Delhi, Indian lho.org.uk/viewResource. to Education and Health: Institute of Dalit Studies aspx?id=10625. International Norms and and UNICEF, 2010, p. 26. Local Strategies (July 2012). 10. For some useful strategies on staff training, see

State of the World’s Minorities Addressing health inequalities in the 25 and Indigenous Peoples 2013 post-2015 development framework Improving indigenous maternal and child health Viviana Crivelli, Juan Hautecouer, Coll Hutchison, Ana Llamas, Carolyn Stephens n the public hospital in Otavalo in the population, and often culturally diverse in Ecuador, indigenous women have seen a terms of both the majority population and other I major change in their maternal and child minorities, with very different ways of looking health services and this has increased their trust at health and their own health systems. For in the system. In the past, discrimination was a example, according to the 2000 Census, China major problem, and women were not allowed has 55 different indigenous populations, totalling to use their traditional birth practices or bring 104.49 million people, but comprising only their traditional birth attendants (TBAs) with 8.1 per cent of the country’s total population. them. They were not able to explain all the fac- Each of these groups has their own language and tors that they felt important for their children’s culture, highly different from each other and health. Now since the introduction of a national from the majority culture. Vertical Birth Policy – many indigenous women traditionally give birth standing up – a Universal Health Care Policy, and the introduction of TBAs into the hospital system, indigenous women feel less discriminated against (see Box 1). Box 1 Discrimination towards indigenous peoples and minorities is a global problem, and indigenous populations internationally experience One indigenous extreme marginalization and poor health. woman’s perspective Indigenous women are particularly disadvantaged during pregnancy and children during infancy. on discrimination in But before we look in detail at health in indigenous women and children it is important the health system to describe briefly the historical and cultural context of indigenous health worldwide. When I started to work in this organization we used to attend talks about our rights, The context for indigenous maternal about pregnant women’s rights, about the and child health rights that the state guarantees and the The current marginalization of indigenous right to health, that nobody can tell us off peoples has a long history. Five hundred years or discriminate against us … Before, I ago in Latin America, millions of people were didn’t know we had rights, you even felt displaced, killed or lost their lives to introduced bad for being indigenous because there was diseases in the course of the Spanish and discrimination everywhere, in education, Portuguese invasions. In Asia, Africa and the in health … in the street they used to call Middle East the situation of minorities and us ‘indians, longas’ [pejorative terms used indigenous peoples is linked to their historical to insult indigenous people]. We used to relationship with majority ethnic or religious say nothing but after those talks [in the groups. For example, in India indigenous groups, organization] and the self-identification as known as tribal peoples, are often seen by indigenous you start seeing things more clearly scientists and policy-makers from the majority and you can defend yourself. If anyone tells culture as backward and their health problems are me off without justification I can answer blamed on their culture and bad habits. back. So I wanted to deliver in hospital To an extent, the policy support and attention because we needed it for my husband’s indigenous peoples receive in their countries [paternity leave] and because I wanted to relates to the size of their populations. In some help others, because there is so much injustice. countries, for example Bolivia, indigenous peoples are the majority population, and there Indigenous woman, aged 30, Otavalo is an indigenous president. However, in most Public Hospital, Ecuador, 20121 ■ countries indigenous peoples are a minority of

State of the World’s Minorities Improving indigenous maternal 27 and Indigenous Peoples 2013 and child health It is important to realize that for many statistics. This is important for understanding indigenous communities ‘health’ is a concept indigenous health problems. There is no linked to the community, not the individual; it universally accepted definition of ‘indigenous’ has an important spiritual element and relates and countries may use very different ways of strongly to the well-being of the ecosystem and identifying the indigenous population and planet. This has important implications for of registering this status in health data. For how we measure and treat health in indigenous example, census and population surveys often peoples. Allopathic medical models, often termed base their statistics on indigenous populations on ‘western’ medicine, tend to treat symptoms of surveys that use a measure of self-identification individuals, and measure ‘health’ with statistics as indigenous by respondents. Problems regarding individual illness and mortality. This emerge where indigenous peoples experience chapter uses some of these statistics but also discrimination, and they often do not want to reports from indigenous community members self-identify as indigenous as it is stigmatizing. As about their own perspectives on health. policies change and discrimination decreases, the If we look at what we know globally from indigenous population may seem to increase, but scientific studies and government reports, this is simply because more indigenous people are indigenous health data is better documented in willing to self-identify as indigenous. Australia, North America and New Zealand, In some regions, it is the government that does where approximately 1.1 per cent of the world’s not wish to recognize the concept of ‘indigenous’. indigenous populations live. The health of This is most pronounced in Africa, where there indigenous peoples in lower-income regions – are an estimated 14.2 million self-identifying including Latin America, South Asia and Africa – indigenous people, including hunter-gatherers, has received significantly less scientific and policy such as Batwa in central Africa and San in attention. A Lancet series2 on global indigenous Botswana; and pastoralists such as Maasai in health identified several key themes: Kenya and Tanzania, and Tuaregs in west and p Lack of data: indigenous identity is not northern Africa. Almost all these communities face recognized by some national governments, and discrimination, displacement and conflict with where indigenous peoples are recognized, data national governments and majority populations. are rarely routinely collected or disaggregated. Health data may be even more problematic p Where data exist, evidence suggests that, in all than population data – people’s ethnic status settings, indigenous peoples suffer extreme ill- is rarely measured in health statistics and health and many population groups are at risk data are rarely disaggregated. If you add of demographic extinction. these statistical problems together with the p Indigenous peoples’ concepts of health differ demographic reality that indigenous peoples may from western biomedical models. Rarely be a small proportion of national population focusing on individual well-being, indigenous in most countries, indigenous peoples can be people see their personal health as intimately rendered invisible. Women and children can be linked to that of the wider community and particularly voiceless, and their needs overlooked. ecosystem in which they live. Keeping this background context in mind, p Socio-political factors linked to marginalization we can start to look at the evidence of the and colonialism, and relationships with the health situation faced by indigenous women land and environment, are seen as fundamental and children. Gender inequities exist in almost determinants of indigenous health. all settings – girl children are disadvantaged in infancy, women are disadvantaged in health Concluding the series, The Lancet editor Richard terms, access to education, employment Horton commented: ‘perhaps the most urgent and social services. In almost every country, call of all is to remove the cloak of invisibility indigenous and minority women and children from the shoulders of indigenous peoples’.3 The have worse health indicators than non-indigenous problem is that in many countries, indigenous and non-minority women and children.4 peoples are not visible within census or routine The context of indigenous poverty and

28 Improving indigenous maternal State of the World’s Minorities and child health and Indigenous Peoples 2013 inequity underlies the health profile of While health problems are common across indigenous women and children. But this is not the world, the scale of the health problems, the only problem: indigenous peoples often live and of inequities between indigenous and in remote inaccessible areas, which are often non-indigenous groups, varies widely between home to natural resources that are important to countries. For example a study in China found majority populations in their countries. that infant mortality rates (IMR) for indigenous Many communities may not have access to groups in Yunnan Province were 77.75 per basic services such as clean water, sanitation, 1,000, compared to a national IMR of 26.9 education and health, but as importantly, they per 1,000, and an IMR of 53.64 per 1,000 for are often displaced from their homes through non-indigenous populations of Yunnan.7 In deforestation, resource extraction and conflict. Mexico, municipalities with a high proportion In urban areas, indigenous peoples often end of indigenous peoples in their population had up in low-income settlements in the worst an IMR of 55.1 compared to a national IMR environmental and social conditions. And of 34.8 per 1,000. This study also showed even when services are available to indigenous that there are important inequalities between communities they are often not adapted to the indigenous groups – the highest IMRs were in needs of culturally distinct indigenous peoples. the indigenous regions with the worst socio- economic conditions.8 Indigenous child health Figure 1 shows the IMRs in Yunnan compared International studies show that indigenous with the national data in China, as well as in three children have worse health indicators than non- other countries.9 It is based on different studies indigenous children in almost every context.5 from different periods but it does allow us to see They have higher rates of infant mortality, and the striking differentials in between indigenous and higher rates of illness, including respiratory and non-indigenous populations and countries with diarrhoeal disease. In the Republic of Congo, different regions and socio-economic conditions. It mortality from measles has been estimated to also highlights the differences between countries. be five times higher in Ba’Aka children than Indigenous child health indicators can be neighbouring Bantu communities.6 equally poor. Indigenous children often suffer

Figure 1 Infant mortality for indigenous and non-indigenous children in four countries

80 National Non-Indigenous 70 Indigenous

60

50

40

30 Infant mortality / 1,000 20

10

0 Yunnan & National National National National, China Mexico Australia Canada

State of the World’s Minorities Improving indigenous maternal 29 and Indigenous Peoples 2013 and child health malnutrition and childhood diseases at rates higher than non-indigenous children. Indigenous Box 2 children also often have poorer nutrition indicators, with both under-nutrition and malnutrition, and have higher intestinal parasite Indigenous loads, than non-indigenous children in their settings. In Misiones in Argentina, there are a maternal health – remaining 78 Mbyá Guaraní communities with 4,083 members. Studies indicate that 57 per a perspective from cent of Guaraní children under five years were undernourished and 43 per cent suffered chronic Ecuador under-nutrition.10 As they grow into adolescence, particularly if they are exposed to so-called western lifestyles, ‘With my first child, the doctors told me that they are vulnerable to drug and alcohol I would deliver around 3 p.m. and that if I addictions, with young girls also vulnerable to needed anything before that I should ring the sexual abuse and prostitution. Young girls are bell. I was left alone [in the labour ward]; I particularly vulnerable when major infrastructure rang the bell many times because I needed to projects move into their remote regions, bringing go to the toilet. I rang the bell for half an hour outside workers who look to the young girls for and nobody came. Then, a doctor in a suit who sex work.11 was not on duty turned up by chance. I told Mental health problems and suicide him I wanted to go the toilet, I had been calling rates among indigenous young people for help and nobody was coming. ‘Are you in can also be higher than those in the non- labour?’ the doctor asked. ‘Yes, and I can’t cope indigenous population. This is often linked to any more!’ I said. He checked me with one of ‘acculturation’, particularly if the indigenous those machines you put in the tummy and he community has been forced into urban settings, said ‘This baby is about to die!’ And the doctor where urban indigenous children and their gave a cut to deliver. It turns out that the doctor families often experience the worst situations who was on duty had gone to the park with a of urban marginalization, discrimination and friend and didn’t come back on time; so the poverty. doctor in the suit delivered me. My daughter Some evidence suggests that maternal health was born very, very blue and with a very big plays an important role in protecting young head. That’s why I didn’t want to go back to indigenous people from mental health problems, hospital because [health care workers] say it’s even in extreme circumstances of displacement.12 not time [for delivery] yet and they leave.’ ‘Graci’ – a pseudonym Indigenous maternal health Indigenous women are most often the key carers After this first experience Graci wanted a of children in their communities. TBAs are a very homebirth for her second child. However, important health resource in the community, and she delivered her second child in hospital too many traditional healers are women. In many because, as she explained, her feet swelled up indigenous cultures in Latin America, an elderly and she felt a strong burning sensation all over indigenous woman in the community is chosen her body. Her husband and her sister said each year to become the Pachamama (or Earth this was not normal and, although she did Mother), advising the whole community and not want to go to the hospital, eventually her guiding them towards a caring relationship with husband and sister persuaded her. According the environment. to Graci, her second experience was very In interviews with Doña Celia Andrade, different. Research data showed that at that Pachamama of the Calchaqui Valleys of time, the hospital had implemented the Tucumán in northern Argentina, she told us:

30 Improving indigenous maternal State of the World’s Minorities and child health and Indigenous Peoples 2013 Vertical Birth and the Universal Health Care said “It’s a boy!”’ ‘Graci’ Policy. Graci’s sister, Marta, who also happened to ‘I think the second time care was good because the be pregnant, was due to deliver a few months doctor and the indigenous TBA were [on the labour after Graci. As Marta stated, initially she ward]. The TBA is employed there and they are wanted a homebirth but she delivered in with the patient. The same for doctors and nurses, hospital because she felt strong cramps during they are there with the patient; now they don’t leave labour and felt she would not be able to you alone … What is also very good is that now a deliver at home. She was encouraged by her relative can stay with the patient … My sister was sister Graci to go to the hospital because ‘care with me [during labour] and she told me I could in the hospital is good now’.13 ■ [deliver], because I thought I couldn’t cope. When I was about to deliver my sister told me I had to push Below: An indigenous woman feeds one and that I could do it and then the baby came out. of her children in a river, Ecuador. James My sister told me “It’s a boy!” and the doctors also Morgan/Panos.

State of the World’s Minorities Improving indigenous maternal 31 and Indigenous Peoples 2013 and child health ‘When I was young and a mother, I cured my children with our medicines, with herbs, with Box 3 good food. Now that I am Pachamama I see young mothers who do not have such good food for their children, who do not have time to cook for their The MDGs children. These children are our future and we have to care for them with good food and health, and with our knowledge of our medicines and our love p Goal 1 Eradicate extreme poverty and for our planet.’ hunger p Goal 2 Achieve universal primary Despite their cultural importance and knowledge, education indigenous women are often highly marginalized p Goal 3 Promote gender equality and in their national and local contexts. They are empower women generally the key holders of traditional food p Goal 4 Reduce child mortality and medical practice, but may speak only p Goal 5 Improve maternal health their native languages, and are often unused to p Goal 6 Combat HIV/AIDS, malaria and communicating with people outside of their other diseases community. As a result indigenous women often p Goal 7 Ensure environmental sustainability experience extreme prejudice in their contact p Goal 8 Develop a global partnership for with the outside world, particularly in health and development social services. Pregnancy can be a particularly difficult time: the official health system of most countries is not based on cultural sensitivity towards indigenous women may also have health behaviours that put women, and they are often treated with disrespect them at risk, such as smoking during pregnancy, and prohibited from following their traditional and they may delay attending health services until birth practices. As a consequence, indigenous the last stages of an emergency, giving health staff women in many settings do not access the formal very little time to help them. health system, or access it only in emergencies, Gender inequities within the household also often too late. play a significant role in indigenous maternal Box 2 (on p. 28) shows the experience of one health: one study in Mexico among indigenous indigenous women and her sister during two women in Chiapas found that decision-making pregnancies in Otavalo Hospital in Ecuador was dominated by husbands and their families, talking about their feelings about care during and that 98 per cent of indigenous women only pregnancy and delivery. spoke their own indigenous language and did not The experience of indigenous women in access outside services. Western maternal health Ecuador is very similar to that of indigenous services were not used at all: 49 per cent of all women across the world. Indigenous women obstetric cases were assisted by TBAs, 45 per cent rarely receive culturally appropriate care by relatives and 6 per cent by their partner.15 within a western health care system and this is particularly problematic during pregnancy. Risks The Millennium Development Goals to maternal health are often the same as for any and indigenous maternal and child pregnant woman, and include complications health during pregnancy and in delivery. Data can be Box 3 shows the Millennium Development Goals incomplete as indigenous women often distrust (MDGs), adopted initially in 2001. Since their the health systems and do not access services, but introduction, indigenous peoples’ organizations, studies show that indigenous women have higher international non-governmental organizations rates of maternal mortality than non-indigenous (NGOs) and UN bodies have expressed concerns women.14 about the MDGs process, particularly in relation From a health service perspective, indigenous to measurements of indigenous well-being.

32 Improving indigenous maternal State of the World’s Minorities and child health and Indigenous Peoples 2013 Above: Aboriginal children at a health clinic in and child health outcomes. We cannot answer the Ramingining, Australia. Penny Tweedie/Panos. questions: Who are our indigenous peoples? What is their current standard of health and how does it Concerns relate principally to the issues of compare to other members of the population? Why is measurement of indigenous population, along their health so poor and how can opportunities for with economic, social and health statistics better health care and health outcomes be supported mentioned earlier in this chapter. For example, and increased?’16 Jane Freemantle, writing for the UN Chronicle, reports that, even in Australia, it is estimated that The key solution to the problems of the MDGs only 59 per cent of Aboriginal and Torres Strait and indigenous well-being is in the development Islander children (under 15 years) are included in of disaggregated MDG indicators for indigenous national infant and childhood mortality statistics peoples within countries. For example, Goal 4 due to incomplete and inaccurate identification is to reduce child mortality. The specific target in some states and territories. Freemantle of MDG 4 is to reduce the under-five mortality comments: rate by two-thirds, between 1990 and 2015. The indicators for MDG 4 are under-five and IMRs, ‘Without accurate identification of indigenous and the proportion of one-year-old children persons in health datasets, we cannot accurately immunized against measles. These indicators describe and monitor indigenous births, deaths, could be disaggregated in order to measure rates

State of the World’s Minorities Improving indigenous maternal 33 and Indigenous Peoples 2013 and child health within indigenous populations – this would allow us to know if indigenous peoples were being left Box 4 behind in the overall MDG race. This is a key civil society policy recommendation for any post- MDG framework. Health-related Policy responses Articles of the Despite the continued problems of indigenous maternal and child health, significant progress UN Declaration has been made at both the international level and within countries. In terms of data collection and on Rights of documentation of indigenous health issues, UN agencies, NGOs and indigenous organizations Indigenous have been pushing for disaggregated data for indigenous peoples for some years. Peoples, 2007 Some countries, such as Argentina, Bolivia, Brazil and Ecuador, now include census questions that allow the population to self-identify as Article 24 indigenous if they wish. This helps to identify the 1. Indigenous peoples have the right to their size of the indigenous population but needs to be traditional medicines and to maintain their combined with indicators of indigeneity within health practices, including the conservation data collected by health, education and other of their vital medicinal plants, animals and government agencies. minerals. Indigenous individuals also have the In 2007 the UN Declaration on Rights of right to access, without any discrimination, to Indigenous Peoples was ratified. It emphasizes all social and health services. indigenous peoples’ rights to health and to their 2. Indigenous individuals have an equal right to own definitions of health and well-being. The the enjoyment of the highest attainable standard declaration also emphasizes indigenous rights to of physical and mental health. States shall take the conservation of medicinal plants, animals and the necessary steps with a view to achieving minerals – an important element linked to the progressively the full realization of this right. natural resources that indigenous peoples rely on. At national level, indigenous peoples have Article 31 been supported by a number of governments. 1. Indigenous peoples have the right to Health services have been adapted and training maintain, control, protect and develop their of medical professionals has been made more cultural heritage, traditional knowledge and culturally sensitive. In several states, governments traditional cultural expressions, as well as the have trained indigenous peoples to become health manifestations of their sciences, technologies workers and developed inter-cultural health and cultures, including human and genetic services. resources, seeds, medicines, knowledge of the Some of the most interesting examples of properties of fauna and flora, oral traditions, initiatives are found at the local level. For literatures, designs, sports and traditional games example, the implementation of the Vertical and visual and performing arts. They also have Birth Policy in Ecuador was principally driven by the right to maintain, control, protect and indigenous groups both within and outside the develop their intellectual property over such Ecuadorian government. This has not been easy cultural heritage, traditional knowledge and but has gradually changed the face of the health traditional cultural expressions. system for indigenous women and their families. 2. In conjunction with indigenous peoples, In other contexts, indigenous women have States shall take effective measures to recog- been involved in the development of research nize and protect the exercise of these rights. into maternal mortality and maternal health

34 Improving indigenous maternal State of the World’s Minorities and child health and Indigenous Peoples 2013 policies. For example, indigenous women in Above: Medical students from the high Andean Australia were involved in the development of valleys of Salta, Tucumán and Catamarca, vaccine policy and antenatal care.17 As a result, Argentina. Carolyn Stephens. previously autonomous indigenous health providers were incorporated into a community- also incorporated indigenous perspectives and based, collaborative Mums and Babies indigenous practitioners into medical schools. programme for indigenous women in Townsville. The photo above shows young medical students A subsequent study found that the number of from the high Andean valleys of Salta, Tucumán indigenous women who entered the programme and Catamarca celebrating the first programme and gave birth at Townsville Hospital trebled in of social inclusion in medical education initiated three years to 61 per cent. by the National University of Tucumán in A major step forward for indigenous health Argentina. These students are the first group from generally has been the development of education their communities to be trained as doctors, with programmes to incorporate indigenous young a concurrent programme of indigenous health people into medical and nursing training, often training introduced into the medical faculty in with concurrent development of inter-cultural 2013. health education in medical schools. One particularly successful programme in Australia Conclusion explored what indigenous communities in There is a long way still to go to bring northern Queensland want from their medical indigenous maternal and child health up to the doctors. This included culturally appropriate standards of their right to ‘the highest attainable knowledge and communication. The programme standard of physical and mental health’. Making

State of the World’s Minorities Improving indigenous maternal 35 and Indigenous Peoples 2013 and child health vol. 32, no. 3, 2008, pp. ‘Maternal deaths high for visible the current situation is one important step 216–23. Indigenous women’, Women forward. If governments internationally make a Birth, vol. 21, no. 4, 2008, commitment to routinely disaggregate data on 8. Fernandez Ham, P., ‘Infant pp. 175–6. mortality in the indigenous indigenous populations, their health and their population: backwardness 15. Herrera Torres Mdel, social and economic situation, this would be and contrasts’ (in Spanish), C., Cruz Burguete, J.L., Demos, vol. 6, 1993, pp. Robledo Hernandez, G.P. another important step forward. The MDGs 12–13. and Montoya Gomez, G., are an important initiative that governments ‘The household economy: 9. Ibid.; Alessandri, L.M., a determinant of maternal internationally have signed up to, but they have Chambers, H.M., Blair, death among indigenous not yet acknowledged formally the need to have E.M. and Read, A.W., women in Chiapas, Mexico’ ‘Perinatal and postneonatal (in Spanish), Revista indicators disaggregated for indigenous health. mortality among Indigenous Panamericana de Salud Finally, we need to recognize that indigenous and non-Indigenous Publica, vol. 19, no. 2, infants born in Western 2006, pp. 69–78. peoples are an important representation of Australia, 1980–1998’, human cultural and linguistic diversity. They Medical Journal of Australia, 16. Freemantle, J., ‘Indigenous vol. 175, no. 4, 2001, children – their human are often the guardians of the most critical pp. 185–9; Smylie, J. rights, mortality, and the natural resources of the planet and have a unique and Adomako, P. (eds), Millenium Development understanding of these environments. They Indigenous Children’s Health Goals’, UN Chronicle, Report: Health Assessment in 2010, retrieved June 2013, have a key contribution to make to medicine Action, Toronto, Keenan http://www.un.org:80/ internationally and to the health of all peoples. Research Centre, University wcm/content/site/chronicle/ of Toronto, Centre for home/archive/issues2010/ The health of indigenous mothers and children Research on Inner City achieving_global_health/ is vital for the survival of indigenous populations Health, 2009, http://www. indigenouschildre crich.ca . Variances depend nhumanrights internationally. And the survival of indigenous on availability of data. peoples is linked intimately to the survival of the 17. Panaretto, K.S., Lee, H.M., ■ 10. Agencia Dyn, ‘Misiones: Mitchell, M.R., Larkins, planet and all of us. mas de la mitad de los niños S.L., Manessis, V., Buettner, indigenas estan desnutridos’, P.G. et al., ‘Impact of Endnotes Diario la Voz del Interior, a collaborative shared Cordoba, Argentina, 2005, antenatal care program for p. 17. urban Indigenous women: 1. Llamas Montoya, A., Heaman, M., Smylie, J., a prospective cohort study’, ‘Delivering maternal health Martens, P.J., McHugh, 11. Napolitano, D. and Medical Journal of Australia, in Ecuador: the right N.G. et al., ‘Birth outcomes Stephens, C., ‘La salud de vol. 182, no. 10, 2005, pp. to health of indigenous and infant mortality among los pueblos indigenas y el 514–19. women’, unpublished PhD First Nations Inuit, and Proyecto de Gas de Camisea Informe para la AIDESEP’, thesis data, London School non-Indigenous women by London, London School of Hygiene and Tropical northern versus southern of Hygiene & Tropical Medicine, 2013. residence, Quebec’, Medicine/Shinai Serjali, Journal of Epidemiology 2003. 2. Stephens, C., Porter, J., & Community Health Nettleton, C. and Willis, vol. 66, no. 4, 2012, pp. 12. Nettleton, C., Napolitano, R., ‘Disappearing, displaced, 328–33; UNICEF, Ensuring D. and Stephens, C., and undervalued: a call to the Rights of Indigenous An Overview of Current action for Indigenous health Children, Innocenti Digest Knowledge of the Social worldwide’, The Lancet, vol. 11, Florence, UNICEF Determinants of Indigenous 367, no. 9527, 2006, pp. Innocenti Research Centre, Health, Geneva, World 2019–28. 2004. Health Organization (Commission on Social 3. Horton, R., ‘Indigenous 6. Ohenjo, N., Willis, R., Determinants of Health, peoples: time to act now Jackson, D., Nettleton, C., Working Paper), 2007. for equity and health’, The Good, K. and Mugarura, Lancet, vol. 367, no. 9524, B., ‘Health of Indigenous 13. Llamas Montoya, op. cit. 2006, pp. 1705–7. people in Africa’, The Lancet, vol. 367, no. 9526, 14. Barnett, S., Nair, N., 4. Stephens, C., Nettleton, 2006, pp. 1937–46. Tripathy, P., Borghi, J., C., Porter, J., Willis, R. Rath, S. and Costello, A., ‘A and Clark, S., ‘Indigenous 7. Li, J., Luo, C. and de prospective key informant peoples’ health – why are Klerk, N., ‘Trends in surveillance system to they behind everyone, infant/child mortality measure maternal mortality everywhere?’, The Lancet and life expectancy in – findings from indigenous vol. 366, no. 9479, 2005, Indigenous populations in populations in Jharkhand pp. 10–13. Yunnan Province, China’, and Orissa, India’, BMC Australian and New Zealand Pregnancy Childbirth, vol. 5. Luo, Z.C., Wilkins, R., Journal of Public Health, 8, no. 6, 2008; Kildea, S.,

36 Improving indigenous maternal State of the World’s Minorities and child health and Indigenous Peoples 2013 State of the World’s Minorities Improving indigenous maternal 37 and Indigenous Peoples 2013 and child health Minority women’s vulnerability to HIV/AIDS in South East Asia Nicole Girard ar Yee first learned she had been have been increasing, as opposed to the general infected with HIV in 2005. Pregnant population. Female partners of men who use M and away from her home in Karen sex workers or intravenous drugs are also an State, Burma, Mar Yee had few health care options. increasingly acknowledged at-risk group. But In Burma, health care infrastructure is extremely the focus on these specific at-risk groups can poor, lacking even basic facilities and equipment, ignore those who are vulnerable to contracting strained after years of civil war in many areas of the HIV or are denied access to services because of country that are home to ethnic minority popula- systemic discrimination along ethnic, religious tions. Mar Yee, like many others from her Karen and linguistic lines. ethnic group, fled to Thailand in search of the And there is reason to be concerned. Although opportunities and stability that she simply couldn’t UNAIDS states that ‘no country in the region find at home. By her early 20s, she was living with a has a generalized epidemic’ (when HIV man who gave her enough money to support herself prevalence is 1 per cent or more in the general in return for sexual favours. It was this man, she population), in some areas where minority and suspects, who gave her HIV. After she grew tired of indigenous populations reside, HIV prevalence the lack of any emotional bond, she dated another has reached a generalized epidemic. For example, man, with whom she eventually got pregnant. As an in the highland provinces of Papua, Indonesia,1 undocumented migrant in Thailand, there were no HIV is spread mainly through heterosexual public health options available to Mar Yee. She, like transmission. Gender-based disparities mean that thousands of other women who find themselves in married women often have little say with regard the margins between Thailand and Burma, had to to condom use; the epidemic therefore threatens depend on an NGO clinic for antenatal care, where to disproportionately affect indigenous women HIV testing is part of their services. living in those areas. In South East Asia, many women from The cases from Thailand and Burma, Vietnam minority and indigenous communities have and Papua described below show that some similar stories to tell. But that does not mean minority and indigenous women in South East their stories have been included in the official Asia have a higher risk of contracting HIV/ accounts of women living with HIV in South AIDs and are not receiving the treatment they East Asia. In fact, in a region that has the need. These women are particularly vulnerable second highest HIV rate after Africa, as well as for a range of factors: gender inequality, ethnic the highest numbers of indigenous peoples (an discrimination, unequal access to health care and estimated two-thirds of the world’s indigenous education, conflict and associated human rights population lives in Asia), the struggle of abuses in the areas they live, and poverty and indigenous and minority women and their right lack of opportunities. Although there is little data to health remains largely invisible. on HIV prevalence rates among minorities and UNAIDs estimates that there are about 1.2 indigenous peoples generally, and minority and million people living with HIV/AIDS in South indigenous women in particular, international East Asia, 37 per cent of whom are women. The organizations, government and health care countries with the highest number of people professionals must be more aware of the issues living with HIV/AIDS are Burma and Cambodia, affecting women from minority and indigenous Indonesia and Thailand. Unfortunately, the communities, and how to address their particular experiences and vulnerabilities of women needs. belonging to minority and indigenous groups are lost in these numbers; there are no official Papua, Indonesia figures for HIV rates for minority and indigenous ‘A lot happens in society, where women who don’t women or men. know anything in the end contract HIV/AIDS HIV interventions in South East Asia have because of their husbands’ “snacks” outside [the largely focused on groups considered high-risk, home]. They get cash from Special Autonomy funds, including sex workers, men who have sex with then in a matter of days use it up paying prostitutes men, and people who inject drugs, whose rates and buying liquor.’ 2

State of the World’s Minorities Minority women’s vulnerability to 39 and Indigenous Peoples 2013 HIV/AIDS in South East Asia in Papua is Mimika, home to the giant Grasberg Papua was forcibly incorporated into the copper and gold mine. In 2012 alone, there were Indonesian state in 1969 and since then its people 367 new cases recorded in Mimika, reaching have struggled to realize their rights in the face a total of 3,190 cases since the first HIV cases of militarization and conflict, mass in-migration were identified in 1996. HIV infection rates are of Indonesians from other areas of the country, particularly high around mining sites, military and development projects that leave little money bases, ports and other transport hubs, where in the hands of Papua’s indigenous people. The men come for work and thousands of female sex 2001 Special Autonomy law was intended to workers, both Papuan and non-Papuan, have give the province more fiscal and administrative followed. autonomy, but many of its provisions remain Many Papuan women live a transient unimplemented. existence, which can make them more vulnerable HIV infection rates in Papua are 15 times the to infection. According to Jenny Munroe, a national average, but since the government does researcher at the department of community health not collect data disaggregated by ethnicity, this sciences at the University of Calgary: figure obscures how hard indigenous Papuans are hit. In 2008, UNAIDS estimated that the ‘Men and women get together young … and the HIV prevalence rate was 2.4 per cent among the woman is taking care of the household and the general population, but reached 3.4 per cent in children while he is off getting higher education or the indigenous Papuan populated highlands.3 working. They move around, so many women are Some experts estimate that prevalence rates in some in-between place, not where they are from, are as high as 7 per cent to 10 per cent in the and yet not always with their husband either, as he highlands.4 The epidemic is driven largely by moves from place to place pursuing opportunities, heterosexual transmission. Over 50 per cent of and starting new sexual/marital relationships in new the Papuan population have not heard of HIV places. Gender expectations, marital norms and new or AIDs and 65 per cent do not know that a mobilities are certainly posing challenges for young condom can prevent its transmission, according women in terms of HIV exposure.’ to government data from 2007.5 The area with the fastest-growing HIV rates Married women are most at risk for contracting

40 Minority women’s vulnerability to State of the World’s Minorities HIV/AIDS in South East Asia and Indigenous Peoples 2013 Left: An indigenous Mooi woman, Papua, women did not visit the clinic because of ‘shyness’ Indonesia. James Morgan/Panos. and their communities’ overly ‘strong’ traditions. Other researchers suggest Papuan women do not HIV in Papua, according to official data. Papuan know about the services offered or about HIV in women experience a high level of domestic general and feel intimidated by using a clinic run violence. The number of cases of violence against by non-Papuans. women in Papua was the highest in Indonesia, according to a 2006 national survey.6 Papuan Fear of stigma and discrimination women’s groups reported an increase in domestic Papuans living with HIV face huge stigma violence after the implementation of the Special and discrimination from members of their Autonomy law of 2001, a provision of which community; as a result many are afraid to be disburses central government funds directly to tested for HIV or get treatment. In highland households. Many Papuan women report their communities, people commonly respond to husbands taking the money and spending it on illness by retreating to the forest to suffer the alcohol and sex workers. Women do not feel in a illness alone without access to care; this reinforces position to demand fidelity or ask their husbands the idea that social withdrawal is an appropriate to use condoms, even if they know their partner is action. Self-stigma or a sense of shame is also infected with HIV. common. Women take great care not to disclose Papuan women who engage in sex work are their HIV status for fear it will threaten their at an even higher risk of HIV infection. The relations with their family, especially as their industry is stratified by ethnicity; migrants from physical well-being decreases. other parts of Indonesia are the highest paid and Many women also do not access the care they work in the relative safety of bars and brothels, need because they are afraid to disclose their Papuans are paid the least and work in the street, status and have feelings of self-stigma. As one increasing the risk to their personal safety. Papuan Papuan women noted: women sex workers are also less likely to use a condom. In one rural area, an NGO study found ‘I’m shy, I’m afraid if anyone knows my status. I that less than 5 per cent of Papuan sex workers heard on the radio that if you have HIV then you used a condom. In comparison, Indonesian sex will die. So I don’t want to tell anyone, I’m afraid. workers working in larger brothels outside the So I pretty much stay home, if anyone sees me they capital reportedly convinced 70 per cent of their will suspect I have HIV.’ clients to wear a condom. Such low condom use and knowledge about Many women feel judged by non-indigenous HIV is a result of poorly targeted HIV education health care workers. A survey of health care campaigns. For example, 100 per cent condom workers in the highlands of Papua showed that use campaigns have targeted brothels and bars, some agreed with discriminatory statements such where mainly non-Papuans work, but have as that people living with HIV/AIDS are dirty overlooked Papuans working outside these and should be shunned; and most assumed that establishments. people living with HIV/AIDS will feel ashamed There are also serious barriers for Papuan of their status. women to access health care. In Merauke, a town with one of the region’s highest number of HIV Vietnam cases, a government clinic provides free monthly The Vietnamese government collects some health medical check-ups for sex workers. In September data disaggregated by ethnicity, but only for the 2001, 172 women used the clinic’s services. But five largest minority groups, and not for HIV/ even though there are around 400 active female AIDS prevalence, which is only collected on the Papuan sex workers in the area, only one Papuan basis of provincial prevalence rates. Vietnam’s woman visited the clinic over a year. Reflecting a ethnic minorities comprise about 14.3 per cent widespread tendency to blame Papuan indigenous of the population. The northern province of culture, the clinic director argued that Papuan Dien Bien is home to 21 ethnic groups and the

State of the World’s Minorities Minority women’s vulnerability to 41 and Indigenous Peoples 2013 HIV/AIDS in South East Asia majority Kinh here only make up 19 per cent Right: A Burmese woman in a safe house for of the population. In 2009 the province had the women with HIV, Thailand. Nic Dunlop/Panos. third highest HIV prevalence rate in the country, nearly three times higher than the national Ethnic minority women are less likely to average.7 receive treatment for HIV. This is reflected by As in the rest of the country, HIV is their low utilization of antenatal care and health concentrated among men who inject drugs, but facility delivery services, and lack of knowledge in Dien Bien the HIV prevalence rate among about HIV and its transmission, compared to men who inject drugs is twice the national their Kinh counterparts. According to the World average, reaching 43 per cent. Female sex Health Organization (WHO), the disparities workers, many of whom are local minorities, have in access to health services for marginalized an HIV prevalence rate of 20 per cent, which is minority women and the social majority actually the highest in the whole country. Further, HIV grew over the period of 2006 to 2010. Ethnic rates among women accessing antenatal care minority women are more likely to give birth at services in rural Dien Bien were 10 times higher home and maternal mortality among minorities than the national average, at 2.25 per cent. is four times higher than among the majority People who inject drugs in Dien Bien, all of Kinh. Low use of health services makes it whom were male, had a significantly greater extremely difficult to prevent mother-to-child knowledge of how HIV is transmitted than the HIV transmission. female sex workers, according to a report by the Furthermore, HIV tests are only available Asian Development Bank (ADB) and Vietnam at district- or provincial-level health facilities. and Laos government research organizations. Many minority women receive antenatal care at The researchers attribute this to HIV campaigns community health centres, which do not offer that focus heavily on male drug users and HIV testing. Of those minority women who which have perpetuated the notion that HIV accessed antenatal services at district- or provincial- is mostly the problem of injecting drug users. level clinics where HIV testing was available, only This tendency has led to what some are calling one-third were actually tested for HIV. a ‘hidden HIV epidemic’ among the women of Geographical remoteness is often cited Vietnam, as many wives of drug users have not as the reason why minority women do not been accounted for, especially among minority access health care, but health practices that groups. Most HIV-positive pregnant women and do not consider the realities of minorities are mothers in Vietnam have contracted it through also a significant barrier. For example, health their PWID (people who inject drugs) husbands care staff insist that minority women give and learned of their husband’s status only after birth lying down, rather than in a traditional they were married. squatting position, common for many Economic reforms in the 1990s increased minorities. Husbands are not allowed into cross-border trade while also indirectly facilitating the birthing room, as is customary for Black heroin trafficking routes. Many minority groups Thais and Hmong. Health attendants are often in Vietnam have a history of traditional opium Kinh and so language poses difficulties for smoking among older men that, since the late minority women, including for HIV voluntary 1990s, has turned into injecting heroin among counselling in provincial hospitals where few younger men. Wives of men who inject drugs are staff speak minority languages. Stigma in the at an increased risk of HIV, which is especially health care system also prevents HIV-positive true of minority groups where high numbers of ethnic minority women from accessing services: people inject drugs. In studies conducted in three Black Thai communities in Dien Bien, almost ‘We have to wait for all “normal” patients to be half of all women reported at least one male examined and receive then our turns, all remaining family member had used or was using heroin; a as people living with HIV and AIDS, to receive quarter reported at least one male family member services. Doctors and nurses often treated us with dying from drug use. bad-mannered behaviours.’

42 Minority women’s vulnerability to State of the World’s Minorities HIV/AIDS in South East Asia and Indigenous Peoples 2013 Borders of Burma and Thailand researcher with Johns Hopkins Bloomberg School The health situations facing ethnic minority and of Public Health working on HIV with border indigenous women from Burma and Thailand minority communities, the situation for Burma’s have many similarities, stemming from systematic minorities may actually be getting worse: human rights abuses, sporadic or non-existent access to health care, low education levels and few ‘Sadly, and ironically, the changes in Burma employment opportunities. Women from Burma have resulted in more displacement and even migrate to Thailand in search of work and better multiple displacements, increasingly as a result of lives, but migration leaves them vulnerable to a “development” projects that push people off their wide range of human rights violations; many are land. Ceasefires with ethnic-based armies have not undocumented migrants, which leaves them at resulted yet in a durable peace on the ground, and increased risk of sexual violence and exploitation. humanitarian groups still do not have full access to Many of Thailand’s indigenous peoples still remain populations most severely affected’ . without access to citizenship documentation, barring them from access to Thailand’s public Decades of conflict, government mismanagement health and education programmes. and serious under-spending on health Burma is experiencing a whole host of infrastructure have left Burma’s minorities with transformations as it makes moves away from some of the country’s worst health outcomes. a military-run administration, but according to The Mae Tao Clinic, a health facility on the many working in the ethnic minority areas, these Thai–Burma border serving people from Burma changes have not been seen on the ground. and its migrating communities, has seen a According to Dr Voravit Suwanvanichkij, a definitive increase in the rates of HIV in the last

State of the World’s Minorities Minority women’s vulnerability to 43 and Indigenous Peoples 2013 HIV/AIDS in South East Asia 10 years, from around 1 to 2 per cent prevalence for long periods of time under the law and rate. eventually deported. Many are returned to areas There are no clear statistics on HIV rates plagued by conflict, areas known for abuses among minorities from Burma or Thailand. and systemic rape by Burma government forces Estimates coming from Burma are likely to against minority women. be skewed, as HIV projections are based on Minority women from Burma and Thailand very limited data, mostly taken from cities. are at acute risk of HIV infection because of their Very serious problems have been reported on engagement in low-end sex work with men who the borders of Kachin and Shan states, where refuse to wear condoms, because Thai-language ethnic armies have been in open conflict with HIV campaigns do not reach them and because the military for decades. Sentinel HIV testing of they have no access to health care and fear of groups on the Thai–Burma border in the early seeking out health care services. Further, anti- 2000s has found an HIV prevalence rate among retroviral (ARV) medication is hard to access: ethnic Shan to be 3 per cent for women and 9 ‘In Thailand, for Thai women, there is universal per cent for men. In 1999, Shan migrant workers health care and ARV,’ an Empower staff member in Chiang Mai area had prevalence rates of 3.8 notes, ‘but for undocumented migrants from per cent for women, and 5.7 for men – double Burma, they have no right to the health care. Thai rates at that time. Shan migrants’ rights are And they can’t go home to receive treatment particularly at risk as they are not recognized by either. You can’t carry your bed home …’ the Thai government as refugees, as opposed to their Karen and Karrenni counterparts, who have ‘The most marginalized are invisible. access to refugee camps on the borders. We don’t see them’, Dr Voravit According to Empower Foundation, a Looking at the situations of minority and Thailand-based sex workers’ rights organization, indigenous women in Papua, Indonesia, Vietnam for many women from Burma’s ethnic minority and Burma, there is a clear set of risks that make groups in bordering states, it is not a question these women particularly vulnerable to HIV of if they will migrate to Thailand, but when. and, without access to health care, vulnerable to Migration is unsafe: many lack identity developing AIDS. But minority and indigenous documents from Burma, as travelling the long women are largely overlooked by HIV prevention distance to the capital Yangoon makes little and care efforts because of their marginalized sense. Many rely on human smugglers to try to position. They are economically disadvantaged, ensure their safe passage, as women under 25 are with low education levels, low ability in the not allowed to travel unaccompanied in border language of the majority, and face discrimination areas in Burma, and immigration and police on as women within their communities and the Thai side of the border pose threats to their discrimination from the wider society because of passage. their minority or indigenous status. Once women find work they are paid less With prevalence rates in some minority and in the informal sector under poor working indigenous areas reaching generalized epidemics, conditions – most often in agriculture, fisheries states and international agencies can no longer processing, construction and restaurants – with ignore the issues and must address the needs little freedom of movement. Thailand does of these communities. What follows are some have a migrant worker registration programme, examples of initiatives that have successfully which should give opportunities for health care, reached out to minority and indigenous but many employers do not register employees, populations, including women, for HIV or women are not covered by the programme, prevention and treatment. as is the case for sex workers. Anti-trafficking legislation has only served to pose problems for Klinik Kalvary: Indigenous-led sex workers as many were not actually trafficked: community health clinic in Papua, most of the women interviewed by Empower Indonesia consented to their work. Women are imprisoned Klinik Kalvary, a community health clinic started

44 Minority women’s vulnerability to State of the World’s Minorities HIV/AIDS in South East Asia and Indigenous Peoples 2013 by an American doctor, works in Wamena, The Sunflower Network: Papua Indonesia. It is a grassroots organization, Peer support for ethnic minority and all of its 20 staff are indigenous Papuans. women in Vietnam When it first opened in 2006, they were overrun The Sunflower Network started as a small group by indigenous clients wanting to get tested of HIV-positive women in Hanoi in 2004. It for HIV who had been too afraid to go to the has since grown into a countrywide network of hospital or other voluntary counselling and peer support groups, covering seven provinces testing sites. with over 2,500 members. The network was According to Marcel Kooijmans, who works initially supported by the Medical Committee at the clinic, the indigenous staff make all Netherlands-Vietnam (MCNV). In 2009, the decisions and are in charge of all of the groups were established in rural areas with high programmes: numbers of ethnic minorities, such as Dien Bien, recognizing the need for peer support among ‘They know the culture and also speak the local ethnic minority women. languages. We use contextualized examples to explain The Sunflower Network’s main objective is to diseases such as HIV/AIDS. Women are still difficult improve the quality of life of pregnant women to reach, so we are now developing programmes to and mothers living with HIV, their children specifically reach the women.’ and families, by improving access to HIV treatment and providing information about HIV The services of the clinic are available to and its treatment to women, especially young everyone, but most of the patients are indigenous women. The groups also work with national-, Papuans. provincial- and district-level agencies to improve The clinic specializes in sexually transmitted their understanding of the illness, and address diseases, tuberculosis, malaria and HIV/AIDS. stigma attached to people living with HIV/AIDS It also researches ways to make services more and the specific issues faced by women. Mobile accessible to Papuans, and advocates for a better voluntary counselling and testing clinics for health care system throughout Papua. pregnant women in rural minority areas has also While the clinic offers free HIV testing and been a key part of the network’s work. ARV treatment, it still faces funding shortages. MCNV project manager Ian Brommage ‘We work together with NGOs who teach the reflected on the project: local community,’ Marcel explained: ‘The aim of this work is to help empower these ‘We go out with a testing team to places in the women to advocate for their rights, ensure they inlands [highlands]. Before we go, the people are have access to services and are able to live in their taught about HIV and we always take counsellors communities free from stigma and discrimination.’ with us. Before testing in and outside the clinic people get information about the test and HIV. In Dien Bien the Sunflower Network has Patients come back every month for check up and established three project sites, with 212 members, more information.’ many from the Black Thai community. As a result communities have seen improvements in The clinic also trains indigenous nurses for one mental health, improved access to services and year, who then go to work or open other clinics. knowledge of sexual and reproductive health. They train people to live in the villages and A recent evaluation concluded that stigma and directly care for and monitor those affected with discrimination against minority women with HIV, and bring them to the Klinik for further HIV/AIDs had decreased in health care and help if needed. education, as well as from within their families and communities. This has been brought about ‘In everything we do we connect with the indigenous through support to individual minority women people. The local people know that our staff is local with HIV/AIDs suffering stigma, as well as by too and that is one of the reasons they like to come.’ organizing community events, which have helped

State of the World’s Minorities Minority women’s vulnerability to 45 and Indigenous Peoples 2013 HIV/AIDS in South East Asia to strengthen their self-esteem and increase or English to double-check the accuracy of the awareness more generally. health information. Programmes were then tried The Sunflower Network continues as a positive out with the local community to receive their example of women peer support groups, and has feedback. resulted in spin-off groups, such as the Cactus- UNESCO’s project is the only one of its kind Blossom group for female injecting drug users. that has addressed the issue from a regional perspective, understanding that the issue of HIV Community radio drama spreads is very much a cross-border problem, particularly public health information in the in the GMS. In total, the project covered 13 Mekong region minority languages, and two were turned into ‘While good information does not guarantee good television dramas. choices, no information virtually guarantees bad ‘Women from minority groups are less likely choices.’ David Feingold, former UNESCO to have good control of the national language, so project manager this was one of the best ways to specifically engage minority women,’ Feingold concluded. The key problem in providing effective HIV prevention among minority communities Recommendations in South East Asia is that minorities receive International organizations and all levels of virtually no HIV prevention information government must: in their own language, according to David p acknowledge that women from indigenous Feingold, former UNESCO programme and minority communities are vulnerable manager. Between 2001 and 2011, UNESCO, to contracting HIV/AIDS and experience with support from the ADB, undertook significant barriers to receiving effective health a project to disseminate HIV prevention care; information in minority languages throughout p collect data disaggregated by ethnicity and the Greater Mekong Subregion (GMS), which gender to target health initiatives toward the covers Cambodia, China, Laos and Thailand. most vulnerable groups; UNESCO developed radio dramas to broadcast p acknowledge and remedy inequalities in access culturally appropriate information about HIV to health care, and incorporate a broader prevention in minority languages on local view of the multiple forms of discrimination stations. In China, for example, the little HIV faced by indigenous and minority women, prevention material that was available in local and consider the role of men in preventing languages had previously been directly translated transmission among their partners and from materials developed in Beijing. Characters children; were set in an urban context, using words p incorporate indigenous and minority women’s and sayings relevant to a Han Chinese target voices, values and ideas into policy-making audience; the cultural cues and signs inherent in and programmes for HIV prevention and the message were lost on minority populations. treatment; In contrast, UNESCO developed a way p support grassroots initiatives that address the of using storytelling to disseminate HIV needs of minority and indigenous women; information. Episodes were based on research p develop culturally appropriate material to raise undertaken in the communities, to develop awareness about HIV prevention in minority believable storylines. Often storylines were languages that is gender sensitive and targeted written by a team of story writers from the toward women; and minority community, or, when this was not p prioritize education and training for indigenous possible, authors who were native speakers of the and minority women health care workers, minority language. Dramas were then written fostering full participation in health care in the minority language, rather than translated administration and policy development. ■ from Mandarin. After that, the minority language script was translated into the majority language

46 Minority women’s vulnerability to State of the World’s Minorities HIV/AIDS in South East Asia and Indigenous Peoples 2013 Endnotes

1. Munro, J. and Butt, L. (2012) ‘Compelling evidence: research methods, HIV/AIDS, and politics in Papua, Indonesia’, Asia Pacific Journal of Anthropology, vol. 13, no. 4, 2012, pp. 334–51, retrieved June 2013, http://dx.doi.org /10.1080/14442213.2012. 694467. Papua here refers to both Papua and West Papua, Indonesia.

2. Excerpt from Documentation Working Group, Enough Is Enough! Testimonies of Papuan Women Victims of Violence and Human Rights Violations 1963–2009, retrieved June 2013, http://ictj.org/sites/ default/files/ICTJ-IDN- Enough-Women_Papua- Report-2010.pdf

3. Simonin, A., ‘Social, cultural and political factors in the design of HIV programmes with Papuan highland communities’, Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, vol. 13, suppl. 2, 2011.

4. See: Butt, L. et al., Stigma and HIV/AIDS in Highlands Papua, retrieved July 2013, http://www.papuaweb.org/ dlib/tema/hiv-aids/butt- morin-etal-2010-stigma- HIV.pdf

5. Simonin, op. cit.

6. Documentation Working Group, op. cit.

7. ADB and Greater Mekong Sub-region Communicable Diseases Control Project, HIV Transmission in Vietnam–Laos Border Areas: Current Status and Solutions, Joint Study Report, retrieved July 2013, http://www.aidsdatahub. org/dmdocuments/HIV_ transmission_in_Vietnam_ Laos_border_areas.pdf

State of the World’s Minorities Minority women’s vulnerability to 47 and Indigenous Peoples 2013 HIV/AIDS in South East Asia Mental health care for survivors of torture and conflict David Gangsei, Erin Morgan, Paul Orieny, Ann Willhoite, Holly Ziemer t is estimated that between 5 and 35 per possible – learning alongside professional cent of today’s refugees are survivors of psychotherapists with survivors in individual and I torture. Research by the Center for Victims group settings. of Torture (CVT) has found that rates are much Peer counsellors undergo an intensive training higher in some specific refugee populations: 69 period and then receive monthly formal trainings per cent of men and 37 per cent of women from and ongoing feedback. CVT always aims to build Oromo refugees resettled in Minnesota in the US sustainable healing services for torture survivors. have been tortured; 37 per cent of women and 25 Therefore, training for counsellors is lengthy, per cent of men in the Somali refugee community hands-on and intensive. have experienced torture.1 At the community level, CVT conducts While each conflict has its own story of large-group activities to raise awareness of the origin, the violence is distressingly familiar: prevalence and effects of torture. Staff work forced recruitment of children and adults as together with teachers, religious figures and other soldiers; arbitrary arrests, detention and torture; community leaders to identify how they can help sexual crimes against men, women and children; others, address community-level conflicts, form barbaric rape of women and girls leaving a supportive community for healing and identify some with extreme and irreparable mutilation; individuals who might benefit from care. witnessing killings or being forced to kill; CVT’s collaboration with the community kidnapping and human trafficking. and training of paraprofessional psychosocial Many survivors rebuild their lives with counsellors also aim to carefully incorporate supportive families and communities. But a positive cultural systems and rituals into significant number will face serious, ongoing evidence-based mental health interventions. symptoms as a result of their torture and war experience. Survivors can live with constant fear, Dadaab, Kenya debilitating depression, terrifying nightmares, In 2011, CVT began to use this model for care crippling anxiety and thoughts of suicide. These and training to provide mental health services in symptoms can be incapacitating, leaving survivors one of the refugee camps located outside Dadaab, unable to care for themselves or their families the Kenya. way they could before. The Dadaab refugee complex in north-east The Center for Victims of Torture (CVT) is an Kenya is the world’s largest refugee site. The area international non-profit organization dedicated to is dry and dusty, with temperatures usually above healing survivors of torture and war. It provides 40 degrees Celsius. The sprawling camps are direct care to survivors at its healing centre in notorious for overcrowding. Designed to house Minnesota and at healing initiatives in Africa and 90,000, they are home to over 460,000 refugees. the Middle East. In Dadaab the organization provides care While CVT is one of the largest torture for a population of refugees who are primarily rehabilitation centres in the world, its ability to from Somalia. Although some humanitarian provide mental health care in a refugee camp or groups were attempting to address mental health post-conflict nation is overwhelmed by the scale needs, CVT was the first mental health-focused of violence and numbers of survivors. In response organization to work in the camp since it was to this overwhelming global need, CVT has built in 1991. developed community mental health programmes Experience in Dadaab shows that torture and to provide direct services to those most deeply violence among civilian populations in Somalia affected and to develop the capacity of local was widespread and indiscriminate. Many communities to meet their own mental health survivors have withstood a number of different needs. traumatic events, including persecution of The heart of CVT’s international mental minority clans by majority clans, and violence by health initiatives is training. The training is the armed Islamist organization al-Shabaab and experiential, with paraprofessional counsellors the government. – recruited from affected communities where CVT bears witness within the Dadaab camps

State of the World’s Minorities Mental health care for survivors 49 and Indigenous Peoples 2013 of torture and conflict to discrimination, harassment and even assault they were not allowed to fetch water or to queue towards minority populations. Most refugees in at water points. Efforts are made to prevent the camps are from the Somali majority but there women from gathering firewood in the town, so are Somali minority groups including Bantu, that majority groups can sell the wood for profit. Benadiri and occupational groups. There is also In 2013, a woman from a minority community a small number of refugees from other African was raped and there was suspicion that it countries, including Burundi, the Democratic was an attempt to intimidate her community Republic of Congo, Eritrea, Ethiopia, Rwanda and discourage them from taking jobs from and Sudan. the majority. Rape in the Dadaab camps is a The stigma assigned to people with mental common occurrence, with women and children and physical illness is staggering. In some cases, being the most vulnerable to this violence. survivors the camps serve have been ridiculed, Others report that individuals from the harassed and even stoned for having a physical majority communities are more likely to be or mental disorder related to their traumatic offered employment, and that minority group experiences. Members of minorities who also members are provided with fewer food rations suffer mental and physical illness face double at distribution centres where majority groups are discrimination. employed and responsible for handing out the Women and girls from minority groups are rations. particularly vulnerable in the camps. They are Language is another significant barrier. Since harassed when they go to the market if they are most translators in the camps are from majority not dressed as the majority group. No female groups, this prevents minority groups from can expect to wear skirts, trousers or uncovered interacting and claiming their rights within the hair without attracting verbal and often physical camps. This happens when shelter, resettlement harassment. Other women have reported that or other materials are offered by humanitarian

50 Mental health care for survivors State of the World’s Minorities of torture and wars and Indigenous Peoples 2013 Left: The Ifo Extension refugee camp in and other organizations focusing on mental Dadaab, near the Kenya-Somalia border. health are able to provide care to only a fraction REUTERS/Thomas Mukoya. of the survivors in need. Integrating mental health services along groups and the UN refugee agency. with capacity building is one way to scale up The tenuous security situation in the camps care for survivors after conflict and political compounds the difficulties of vulnerable groups. violence. The paraprofessional psychosocial One paraprofessional counsellor who had a counsellors employed by CVT gain several physical disability was able to work at CVT years of education, training and direct clinical because a CVT vehicle could transport her work. They are ready to serve, but there are no to the counselling compound. After attacks complementary mechanisms in place to support on refugee leaders and the kidnapping of aid their long-term development to continue this workers, organizations could not enter the camps work. except for their own compounds. Unable to get The well-being of traumatized individuals transportation or to walk 5 km, the counsellor and communities requires both access to mental was not able to continue working. health services and building of local capacity to Cultural norms also prevent the camps provide those services. Counsellors representing from hiring as diverse a staff as they intend. minority groups should be an integral part of the In Dadaab, it has been difficult for the camps process. With experience and training, they can to hire the number of women counsellors they continue to provide care in culturally appropriate would like to, since the majority culture puts the ways to members of their community, act responsibility of care for the family and children as educators about the effects of trauma and above work outside the home. participate in the development of community- At times, not finding translators means based approaches to addressing the needs of the survivors seeking our services need to wait before community, including pursuit of basic human they can receive counselling. While we make rights, health and education. every effort to find and train interpreters, limited It is understandable that humanitarian aid access to the camps combined with extremely during and after conflict is focused on basic limited resources mean there can be a waiting needs: food, clean water, shelter and medical care. period. It is also essential to integrate mental health care Minorities who received supportive mental in support of refugees and during post-conflict health services from CVT report that they have rebuilding. When political violence intentionally found a refuge where they can gather strength destroys a community, the society itself must heal and courage to withstand the prejudice they before peace and civil society can grow. ■ cannot escape in the camps. Survivors receiving services from CVT in Dadaab consistently Endnotes report significant decreases in mental health 1. Jaranson, J.M., Butcher, J., symptoms such as anxiety and depression, as well Halcon, L., Johnson, D.R., as decreases in somatic symptoms. They report Robertson, C., Savik, K. et al., ‘Somali and Oromo increased hope, better coping skills and improved refugees: correlates of relationships. torture and trauma history’, American Journal of Public Health, vol. 94, no. 4, 2004, Rehabilitative care for pp. 591–8. Retrieved June 2013, http://www.ncbi. minority groups nlm.nih.gov/pmc/articles/ For minority groups, equal access to mental PMC1448304/ health care is necessary to rebuild lives and community, and to establish a voice that can advocate for their own rights among the majority population. Unfortunately, the need for mental health care far exceeds available services. CVT

State of the World’s Minorities Mental health care for survivors 51 and Indigenous Peoples 2013 of torture and wars Litigating the right to health for indigenous peoples Carla Clarke he Xakmok Kasek indigenous com- was to be provided to the community; (2) given munity lives in the Chaco region of the difficulty of members of the community in T Paraguay. Over a lengthy period they accessing health clinics, a permanent health clinic had been restricted to occupying an ever dimin- was to be established where they were currently ishing area of their traditional lands and even settled, and with the necessary medicines and then it was at the whim of the private ranch supplies; and (3) a system of communication owners, who forbade them to hunt, keep live- was to be established between the community’s stock or cultivate their own crops. Having failed settlement and competent health care authorities to secure recognition of their land rights through for emergency cases, and, if necessary, transport the national process during the 1990s, the com- was to be provided by the state for such munity started legal proceedings at the regional cases. Once the community resettled on their level in 2001 and in 2010, the Inter-American traditional lands, both the medical centre and the Court of Human Rights (IACtHR) found in communication system were to be moved there. their favour and ordered that Paraguay return The IACtHR also attributed a number of deaths their lands to them. The Xakmok Kasek thus of members of the community (predominantly joined with a growing number of other commun- children) from such preventable illnesses as ities, including the Awas Tingni of Nicaragua pneumonia, tetanus, anaemia and dehydration and the Yakye Axa and Sawhoyamaxa indigenous to the state due to the lack of medical attention communities, also from the Paraguayan Chaco, provided. in invoking the right to property to secure rec- Given the fundamental relationship of ognition of their rights to their traditional lands indigenous peoples to their lands and resources, (even if implementation of such favourable deci- and that many indigenous communities either sions often remains wanting). find themselves already displaced from those As well as the right to property, in the case of lands or in situations where their lands are being the Xakmok Kasek community, the IACtHR was encroached upon without their consent by asked to examine the issue of provision of basic third parties (e.g. for logging, oil exploitation or services, including health services, with respect the establishment of wildlife reserves), it is not to the obligation on the state to protect the surprising that where indigenous communities right to life (interpreted as the right to a decent have been able to overcome the numerous existence). Given that in 2009 the government obstacles to accessing justice it is primarily in of Paraguay had itself declared a local state of order to claim their right to their traditional emergency on account of the community’s lands. Even in cases where violations of their precarious and vulnerable situation due in right to health are not directly pleaded in part to the absence of medical care, it is not addition to their right to property (as in Xakmok surprising that the IACtHR found a violation Yasek but also in Yakye Axa and Sawhoyamaxa), of this right. Specifically, the IACtHR found it can be argued that in securing recognition of that the state had not guaranteed physical or their rights to their traditional lands they are also geographical access to health care establishments securing recognition of the principal underlying for the community (the nearest health care determinants included in their right to health. centre was 75 km away, poorly run and had no This interplay between health and secure rights vehicle that could reach the community, while over indigenous traditional lands has been the nearest hospital was over 400 km away and recognized at the international level.1 the public bus fare there was out of the reach of There have been some cases brought by the members of the community). Similarly, the indigenous peoples where health has been the Court found that the state had not taken any primary focus, but where their submissions measures to ensure that the medical care and have emphasized the negative impact on health supplies would be acceptable, taking into account through spoliation of traditional lands. Such traditional practices. The Court therefore went cases include Mapuche Paynemil and Kaxipayiñ on to order that until their traditional lands Communities v. Argentina before the Inter- were returned: (1) immediate medical attention American Commission on Human Rights

State of the World’s Minorities Litigating the right to health for 53 and Indigenous Peoples 2013 indigenous peoples (IACHR) concerning contamination of water a property connection is that of María Mamérita on indigenous land with lead and mercury Mestanza Chávez v. Peru before the IAHCR. affecting community health, particularly that Rather than being about the failure of the state of the children; and The Social and Economic to provide accessible and adequate health care, Rights Action Centre and the Centre for Economic the case concerned the provision of unwanted and Social Rights v. Nigeria before the African health services, namely the forced sterilization Commission on Human and Peoples’ Rights of generally poor, rural and indigenous women concerning the Ogoni and the negative health as part of a government policy to change the and environmental impacts of oil exploration reproductive behaviour of the population. in Ogoniland. At the national level, the case While the focus on litigating over indigenous brought by the San of the Central Kalahari Game peoples’ property rights is understandable, the Reserve challenged a decision of the Botswana dearth of litigation on the right to health, absent government to terminate essential services such a territorial connection, both at regional and as the provision of mobile health clinics in what national level, calls for further examination, was an attempt to force them off their traditional given that report after report, study after study lands. shows that indigenous peoples suffer from One of the few cases concerning the right to higher mortality and morbidity rates than non- health of an indigenous people in the absence of indigenous populations. For example, while

54 Litigating the right to health State of the World’s Minorities for indigenous peoples and Indigenous Peoples 2013 Left: Bodo community villagers point to an obstetric care, it was alleged that access to quality oil spillage site in a river in the Ogoni region medical care during pregnancy was a systematic of the Niger Delta, Nigeria. REUTERS/ problem. In finding against Brazil, including Akintunde Akinleye. finding that the woman had been discriminated against because of her ethnic status, CEDAW Guatemala has already surpassed the MDG 4 recommended that Brazil ensure affordable access target of reducing childhood mortality by two- for all women to adequate emergency obstetric thirds in relation to non-indigenous children, care (Alyne da Silva Pimentel v. Brazil, 2011). it has yet to reach it in relation to indigenous Litigation may not be a complete panacea but, children. The gap between the mortality rates on current trends, without judicial intervention it of indigenous and non-indigenous children has is difficult to see substantial progress being made remained more or less constant since the base in realizing the right to health for indigenous year of 1987. Even in Brazil, where a specific communities. ■ Indigenous Health Subsystem has existed since 1999, early improvements in indigenous health Endnotes indicators have since stalled such that, despite 1. See the UN Committee significant expenditure, they continue to have on Economic, Social and the worst health status of any group. (See the Cultural Rights’ General regional chapters for other examples.) Comment no.14, para. 27. The situation also calls for further examination given the fact that, in a region such as Latin America, activism among indigenous peoples is arguably more organized and their rights, at least in theory, are better protected (e.g. under Paraguay domestic legislation, indigenous people are entitled to free medical services) than in other regions. One key regional trend has been the exponential growth in the last two decades of the right to health litigation among the non- indigenous population, with a high rate of both success and implementation. However, not only have indigenous people not benefited from this growth, they are arguably further prejudiced by it as finite health care budgets are used on providing the medications ordered by the courts, since the litigation is, by and large, around access to (often costly) medication. An increasing number of commentators call into question the individual nature of the increase in the right to health litigation. The time appears ripe for a case to be brought which is about structural access to health care and systematic provision of essential services so that the right to health of the most vulnerable becomes a reality. In this regard, hope can perhaps be taken from action by treaty monitoring bodies. In a relatively recent case before the UN Committee on the Elimination of Discrimination Against Women (CEDAW) concerning an Afro-Brazilian woman who died due to lack of adequate emergency

State of the World’s Minorities Litigating the right to health 55 and Indigenous Peoples 2013 for indigenous peoples TUNISIA MOROCCO

ALGERIA LIBYA Western EGYPT Sahara

MAURITANIA MALI NIGER ERITREA SENEGAL THE GAMBI A CHAD SUDAN GUINEA-BISSAU BURKINA DJIBOUTI FASO GUINEA BENIN NIGERIA SIERRA TOGO ETHIOPIA LEONE CÔTE CENTRAL D’IVOIRE GHANA SOUTH SUDAN LIBERIA AFRICAN REP.

CAMEROON SOMALIA

UGANDA SAO TOME EQUAT. AND PRINCIPE GUINEA REP. OF KENYA GABON THE CONGO RWANDA DEM. REP. BURUNDI OF THE CONGO INDIAN TANZANIA OCEAN

ANGOLA MALAWI ATL ANTIC ZAMBIA

OCEAN MOZAMBIQUE ZIMBABWE MADAGASCAR

NAMIBIA BOTSWANA

SWAZILAND

LESOTHO

SOUTH AFRICA

AfricaPaige Jennings, Inga Thiemann, Laura A. Young water and sanitation. The limited number of health institutions, disparity between rural and East urban areas and severe under-funding of the health sector all make access to health services very difficult. It is estimated that more than half Africa of Ethiopia’s population lives more than 10 km from the nearest health facility, often in regions Laura A. Young with poor transportation infrastructure. Another major issue in the Ethiopian health sector is gainst a background of famine and brain drain – there currently are more Ethiopian conflict in 2011, the year 2012 brought doctors working in Chicago, USA than in A new hope for increased stability and Ethiopia according to some experts.1 regional coordination in East Africa. The region emerged from a devastating drought, which had created health and humanitarian emergencies in several countries. Regional intervention in Somalia reached a peak in 2012, as Ethiopia, Benishangul- Gumuz Gambella

Kenya and Uganda all sent troops to the country. Average

From a health perspective, these changes brought Addis Ababa a new opportunity for progress. Across East 15.6% 15.7% 12.3% Africa there have been strong gains in maternal 7% and child health – fewer mothers are dying in childbirth and more children are surviving Under-five mortality rate in Ethiopia beyond infancy. For instance, Ethiopia’s rate of maternal mortality has steadily declined over the past 20 years. But for minority and indigenous peoples, these gains have been unequally realized because of ongoing marginalization. Lack of transportation infrastructure to access health Afar Gambella Benishangul- Gumuz centres, poverty that makes paying for care Average almost impossible, and discrimination related Addis Ababa to the provision of health services often prevent 27% 20% 30% 17% minority groups from benefiting from general 4.3% gains at the national level. Also, disaggregated health data on minority groups is often Teenage girls between 15 and 19 years of unavailable or difficult to access, making targeted age who have been pregnant in Ethiopia intervention and planning a challenge. But for many minorities and indigenous peoples Ethiopia in Ethiopia, health concerns are exacerbated. Ethiopia has made positive gains in health care Although health data in Ethiopia is rarely indicators over the past decades, consistent disaggregated by ethnicity, regional data provides with the trend in East Africa generally. Both some insights, given the residency patterns maternal and child mortality have reduced, of minority groups. Reports indicate that and the government has been lauded for its many negative health indicators are above the commitment to training community health national average in federal regions populated workers, especially women, to assist with basic predominantly by minority groups, such health needs. However, substantial challenges as Gambella, Afar, Oromia, Somali region, remain, including maternal mortality, malaria, Benishangul-Gumuz, and the Southern Nations, tuberculosis and HIV/AIDS, compounded by Nationalities and Peoples (SNNP) region. For acute malnutrition and lack of access to clean instance, while the under-five mortality rate

58 Africa State of the World’s Minorities and Indigenous Peoples 2013 in Addis Ababa is 72 per 1,000, the rates in remains a nation of centralized decision-making Benishangul-Gumuz and Gambella are 156 and and minimal democratic space. After Meles’ 157 per 1,000 respectively; the national average death, his deputy, Hailemariam Desalegn was is 123 per 1,000.2 The percentage of teenage girls quickly elevated to acting head of government. between 15 and 19 years of age who have been Desalegn is not expected to preside over pregnant is 4.3 per cent in Addis Ababa, but is any substantial change in Meles’ policies. For 20 per cent in Afar, 27 per cent in Benishangul- example, controversial villagization schemes Gumuz and 30 per cent in Gambella – the continued in five regions of Ethiopia in 2012. national average is 17 per cent.3 Early pregnancy The villagization programme, resulting in forced is a major risk factor for other health problems, resettlement of tens of thousands of people, has including obstetric fistula (see case study on p. had serious negative impacts on minorities and 68). Distribution of health care infrastructure indigenous peoples in Ethiopia. Although the is also uneven. According to the Ministry of asserted purpose of the villagization process is Health, Addis Ababa has 33 hospitals for a to provide enhanced public services, including population of 3.1 million, whereas Afar region health care, relocated Ethiopians report that has two hospitals for a population of 1.5 million, the promised services have not materialized. Somali region has eight hospitals for a population Severe negative health consequences, including of 4.5 million, and SNNP region has 20 hospitals starvation and malnutrition, have resulted from for a population of almost 16 million. the lack of arable land, and those who resist A substantial proportion of minority groups relocation report beatings, arbitrary detention and indigenous peoples in Ethiopia are and even killings as a result of their resistance. pastoralists. Pastoralism brings unique health In Ethiopia’s Gambella region, the indigenous challenges, especially for women. As reflected in Anuak community was so negatively affected the statistics above, pastoralists who live in rural, by the programme that in 2012 it brought a low population density areas often must travel complaint to the World Bank’s Inspection Panel, long distances to access health services. claiming that the US$1.4 billion that the World Gender disparity in health indicators also is Bank had provided to the Ethiopian government heightened – for instance, men outlive women in support of the programme was contributing to in pastoralist areas, the inverse of national data. massive human rights abuses. This disparity may be a result of the intensive household work burdens put on pastoralist Kenya women as well as clear boy-child preferences Preparations and campaigning for the 2013 in pastoralist communities. Harmful practices elections dominated life in Kenya for much such as female genital mutilation (FGM) and of the year 2012. During the first political early marriage, as well as chronic malnutrition, campaigns since the adoption of a new also contribute to lower health status among Constitution in 2010, Kenyan minorities and pastoralist women. indigenous peoples struggled to find their voice On 20 August 2012 the government in the new political landscape. The delineation announced that Prime Minister Meles Zenawi of electoral boundaries was contested by many had died after governing for 21 years. Under communities in Kenya, including minorities Meles, Ethiopia became one of Africa’s largest and indigenous groups. The multiple petitions recipients of foreign donor aid, including health were consolidated in a single, large case that was aid, receiving more than US$3 billion total aid in decided by the Kenyan courts in 2012. In many 2010 for example. Despite this, the health system cases, the court took account of minority interests remained chronically underfunded. in addressing boundaries and redrew electoral Ethiopia’s progressive Constitution is units to afford minority groups a chance to have protective of minority rights, with a system of a member of their community elected either at ethnic federalism that protects the right to self- the local or parliamentary level. However, civic determination. However, under Meles the system education to ensure that minority and indigenous was never truly implemented. Instead, Ethiopia communities understood new political structures

State of the World’s Minorities Africa 59 and Indigenous Peoples 2013 and were well-prepared to vote in the election are often told to return another day. In early remained a concern in 2012. Smaller indigenous 2012, thousands of health workers in government communities, and indigenous women in health facilities around the country went on particular, reported a low level of understanding strike over pay and benefits. The strike left of the new Constitution, despite important patients unattended and some died as a result provisions in the Constitution that protect the of lack of care. The government threatened to rights of minorities and indigenous peoples. fire 25,000 of the strikers after they ignored The presidential campaign was dominated demands to return to work. Ultimately, the strike by candidates from the two largest ethnic was resolved when Prime Minister Raila Odinga communities in Kenya. Ultimately Uhuru finally agreed to meet the strikers’ representatives Kenyatta, son of Kenya’s first President and and address some of their demands. The a member of the Kikuyu ethnic community, end of the strike, however, did not resolve was declared the winner. Ethnically aligned the underlying challenges in Kenya’s health politicking and the formation of political sector. For minority groups, marginalization, alliances based on large ethnic blocks left less poverty and displacement all contribute to an room for minority groups, especially very small inability to realize the right to health. Decades communities, to wield influence at this level. of marginalization in many areas have left Candidates from minority and indigenous groups roads non-existent or impassable during rains. did, however, emerge in many areas to contest for Government-run health centres remain under- elective office. In particular, the constitutionally staffed and often without essential supplies and reserved women’s parliamentary seats opened medicines. Kenya’s constitutionally mandated opportunities for women from minority and Equalization Fund is designed to help remedy indigenous communities to contest for office. these disparities, specifically to raise the level of MRG documented women candidates from the basic service provision – including water, roads, El Molo, Maasai, Pokot, Rendille and Somali health facilities and electricity – in marginalized communities, among others, contesting for areas. However, legislation to implement ‘women representative’ seats in their respective the fund has not yet been drafted and initial regions. MRG partner organizations nevertheless government proposals on how ‘marginalized reported that at least some minority and areas’ would be defined for the purposes of the indigenous communities saw their representation fund would leave many minority and indigenous decrease at the local and national levels. communities without any access to equalization The right to health is protected in Kenya’s resources. Land loss and displacement has 2010 Constitution and provides that all Kenyans also deepened poverty in many minority have the right to the highest attainable standard communities, to the extent that the financial of health, including health care services. Despite cost of health care can be a major burden. For this guarantee, minorities and indigenous peoples instance, Sanye community members, who in Kenya face substantial challenges, including reside in the interior coastal regions of Lamu lack of physical and financial access to care as County, report that no one in the community well as discrimination. has sufficient resources to pay the fees charged by A major complaint from many in Kenya, health centres, so they use traditional medicine especially those in marginalized areas, is that or someone outside the community must pay for health personnel are only rarely present in health health care costs. centres. Community members report arriving Another serious, yet under-analysed, health at health centres with serious, urgent conditions concern in minority communities is the effect of only to have to wait for days because no health violence – including deaths, serious injury, long- care staff are available. For example, a human term disability and reduced quality of life, as well rights monitor in the Ogiek community, which as psychological trauma. Kenya’s Coast region, lives in remote regions in and around the Mau home to several ethnic minority and indigenous Forest, reported that community members who communities as well as many members of can find transport to the nearest health centre Kenya’s minority Muslim community, was a

60 Africa State of the World’s Minorities and Indigenous Peoples 2013 particular flashpoint in 2012. In August 2012, case in a Kenyan court in 2012 to stop the port a well-known Muslim cleric was executed in project. The port is anticipated to have severe Mombasa leading to deadly and destructive negative environmental impacts for the Aweri, rioting; five people were killed and churches were Bajuni, Orma, Sanye and other communities attacked. In the Tana River region, hundreds of through loss of fishing grounds and traditional Kenyans including civilians and members of the lands. security forces were killed in a series of massacres The Endorois community continued to and revenge raids that pitted ethnic Pokomo advocate for implementation of a 2010 decision agriculturalists against Orma pastoralists. In of the African Commission on Human and December 2012, simmering conflict between Peoples’ Rights (ACHPR) that recommended Turkana and Samburu pastoralists resulted in the that the government compensate them for killing of 42 Kenyan police officers, who were in eviction and loss of access to their ancestral the midst of an operation to recover cattle, in the lands; however there had been no significant Baragoi region. The government’s response to the steps towards implementation by the government attack on the police led to the displacement of before the end of 2012. The Ogiek land rights hundreds of families from the area. While deaths case was referred by the ACHPR to the African are the most often reported tragic outcome of this Court on Human and Peoples’ Rights in 2012; it violence, many communities live with permanent will be the first case on indigenous peoples’ rights scars, both physical and emotional. Often the to be considered by the court (see case study on long-term trauma is disproportionately borne by p. 61). women. The director of the Consortium for the Empowerment and Development of Marginalized Somalia Communities (CEDMAC) identified the health Somalia emerged into a new political era in 2012, and psychological consequences of violence as the with substantial hope for improvement in the top issue facing minority and indigenous women lives of Somalis, including the health status of in Kenya. the population. Military intervention, including Finally, minority and indigenous communities African Union peacekeepers (AMISOM), continued to confront threats to access and Kenyan forces and Ethiopian troops, continued control over their land and natural resources. in 2012 and succeeded in pushing al-Shabaab Land loss and displacement have negative health out of several key areas, including Kismayo consequences through entrenching poverty and and Mogadishu. As the military operation reducing communities’ ability to gather and use moved forward, the process of designing a new traditional healing products. In many instances, constitution and new institutions of governance displacement is for the purpose of development, continued on a parallel track. The first formal which in Kenya has often led to environmental Somali parliament was sworn in in August degradation and resulting food insecurity. In 2012 and the parliament voted in September to March 2012, the Kenyan government announced elect Hassan Sheikh Mohamud as president. As the discovery of oil in Turkana County. The new governance arrangements were concluded, discovery of oil has led to extensive exploration however, concerns remained that minority groups around Lake Turkana, a major environmental such as Bajuni, lower caste Midgan and Somali asset for Turkana and other minority groups such Bantus, as well as women were not sufficiently as the Rendille and El Molo, who fish and hunt represented in the arrangements, a problem animals that live near the lake. Communities in that has undermined previous governments. the region fear environmental changes for Lake The perpetuation of marginalization into the Turkana as a result of oil exploration in Kenya new dispensation in Somalia raises concerns for and the Gibe III dam project in Ethiopia. On the minority rights in general in Somalia, including Kenyan coast, multiple minority and indigenous the right to health. groups continued to oppose the construction of Although data on minority and indigenous the Lamu Port, which was officially launched in communities in Somalia are difficult to obtain, March 2012. The Save Lamu Coalition filed a in general, minorities experience more challenges

State of the World’s Minorities Africa 61 and Indigenous Peoples 2013 in accessing health care and thus experience more Above: A Bantu family home in Somalia. negative health consequences. A UN OCHA Petternik Wiggers/Panos. (Office for the Coordination of Humanitarian Affairs) study identified several challenges related first time in four years, inoculating more than to access to health for minorities in Somalia: 383,000 children under the age of five against p Conflict and insecurity makes it difficult for polio and almost 80,000 against measles. Another aid agencies to access vulnerable communities. campaign to provide health and nutrition services, p There is a lack of adequate information including vaccines, reached about 275,000 regarding the health status of minority groups. children and 394,000 women in 26 districts in p There is a lack of adequate transport December. Despite this, cholera outbreaks in infrastructure, including land routes and 2012 demonstrate the challenging health situation water routes. in many parts of Somalia. The World Health p There are insufficient numbers of health centres, Organization (WHO) estimates that there are including mother and child health services and about 215,000 children who remain malnourished tuberculosis clinics, in minority areas. and at risk of complications from malnutrition. p Minorities in urban areas observe that their In the past, minority groups in Somalia have concerns are not given much consideration faced substantial health challenges – they have when establishing health centres. They say been among the most vulnerable of groups that local authority staff do not report serious because of their isolation and because of an health conditions in Dami and Gaan Libah, inability to depend on the extended clan support where many minorities reside. system that is a critical feature of social protection in Somalia. Unless the new Somali government Despite the positive political developments and dedicates specific resources to addressing the enhanced security, many of these problems health care needs of minority groups, they could remain for minority communities. be left behind in the new Somalia. However, there also are positive indicators in Somalia’s health sector. The drought-induced South Sudan famine in Somalia was officially declared at an South Sudan is home to an estimated 56 ethnic end by the UN in February 2012. The ending of groups and almost 600 sub-groups. After the al-Shabaab occupation in many areas has enabled excitement of South Sudan’s independence the government and its international partners to in 2011, the year 2012 was characterized by enhance health services. New health centres have continuing conflict with its northern neighbour opened and are offering service to approximately as well as internal ethnic divisions that regularly 1 million Somalis. Vaccination campaigns were erupted into conflict. Health status and the conducted in 14 districts of southern and central ability to access care were often directly related Somalia between November and January for the to the political and inter-ethnic crises still

62 Africa State of the World’s Minorities and Indigenous Peoples 2013 health insurance, so already-impoverished Case study by Chelsea Purvis families are left to bear the costs of caring for people with disabilities or major illnesses on their own. Families are forced to take out Ogiek in Kenya loans to pay for medical care, leaving them deep in debt. Major surgeries can cost up to 140,000 Kenyan shillings (£1,100), while the The plight of the Ogiek community average family in Western Mau earns only highlights the impact of land-grabbing, 2,000 Ksh (£16 per month). displacement and discrimination on health. Separated from the forest, the Ogiek cannot The Ogiek are an indigenous group of easily access traditional medicines such as about 20,000 people in Kenya. The Kenyan kapukeriet, to treat respiratory illness, and the government has repeatedly and forcibly African wild olive, to treat malaria. Poverty evicted the Ogiek from their ancestral land is so severe in some communities that Ogiek in the Mau Forest and around Mount experience chronic hunger. The Kenyan Elgon. This has left entire communities of government provides only occasional food Ogiek homeless or without proper housing, relief, which is insufficient to prevent hunger. in some cases for generations. During Ogiek women and girls are also particularly evictions, police have burned homes and vulnerable. Women and girls living in food stores – exposing the Ogiek to hunger informal settlements are at risk of violence due and homelessness – and assaulted Ogiek to insecurity from overcrowding, exposure to individuals. Injured Ogiek, fearing the roads and neighbouring communities, and a government, are unable to seek medical lack of toilet and bathing facilities. attention from government hospitals. In one community, there have been Many Ogiek are completely landless reports of rape and sexual abuse of girls and live without proper shelter and food, by people from outside the community, safe water and sanitation. Ogiek of the in some cases leading to child pregnancy. Serengonik area, for example, live in an The local government has done nothing to informal settlement along the edge of a investigate the crimes or help the girls. When public road. Large families crowd into one- community members reported the crimes to room shacks. The sick and elderly must sleep a journalist, local officials finally visited the on the bare ground. It becomes very cold community – but only to publicly criticize in hilly Serengonik, but the community has little clothing and few blankets. As a result, Below: An Ogiek family in Kenya. children die from diseases like pneumonia Ishbel Matheson/MRG. and from exposure. The community has no place even to bury its dead. Ogiek communities have been pushed into deep poverty. They are cut off from the forest, where the Ogiek traditionally hunt and gather their food, and they are discriminated against in government employment. This leaves Ogiek with no choice but to engage in low-paid agricultural wage labour. Ogiek struggle to pay medical fees and the cost of transportation to hospitals, which may be many kilometres away. Ogiek with disabilities or major illnesses are particularly vulnerable. Kenya has no national

State of the World’s Minorities Africa 63 and Indigenous Peoples 2013 Case study continued the complainants and the victims, calling them troublemakers and liars. Early marriage and transactional sex are serious problems among adolescent Ogiek girls. Evictions have broken families apart, leaving girls and young women to fend for themselves. Moreover, Ogiek girls lack educational and work opportunities. Secondary school is expensive, and Ogiek report that local governments discriminate against Ogiek in awarding financial-based scholarships. Seeking income and food, girls are thus pushed to engage in transactional sex with adult men or to marry before they turn 18. Girls who engage in transactional sex or marry early are vulnerable to high-risk pregnancies, sexually transmitted infections including HIV/AIDS and abuse. Adolescent pregnancy is a major health issue for Ogiek girls. Pregnant girls often hide their pregnancies, preventing them from obtaining appropriate prenatal care. Sometimes communities are not aware that girls are pregnant until they are in labour, when it is too late to take girls to distant hospitals. This means that girls must deliver in unsafe conditions. Ogiek girls drop out of school when they become pregnant and the government provides little assistance to reintegrate them. This locks Ogiek families ongoing in the country. Moreover, access to into a cycle of poverty. Mothers of all ages health services for minorities and indigenous struggle to obtain pre- and postnatal care peoples in South Sudan is hampered by lack of because of long distances to hospitals and the infrastructure to facilitate travel to a clinic or high cost of treatment. hospital, poverty and the resulting inability to The plight of the Ogiek community pay for health services, as well as discrimination. highlights the impact of land-grabbing, Conflicts between South Sudan and Sudan displacement and discrimination on health. over oil revenues continued throughout 2012. The government of Kenya should cease In January 2012, South Sudan shut off oil evicting Ogiek and provide them with secure production entirely, citing the high price ownership of their traditional land. The Sudan was demanding to use its pipeline. The government should also end discrimination in government of South Sudan obtains 98 per cent employment and distribution of school funds. of its revenue from oil production.4 As a result, To protect women and girls, the government the reduction in government funds had a direct should ensure that girls remain in school; impact on the provision of health services. South investigate and prosecute gender-based Sudan has the highest maternal mortality (2,050 violence; and provide reproductive health deaths per 100,000 live births) and under-five care. ■ mortality rates in the world. Of the 17 neglected tropical diseases recognized by the WHO, all

64 Africa State of the World’s Minorities and Indigenous Peoples 2013 are present, and endemic, in South Sudan. Above: A Murle woman in Pibor, South Sudan. More than half of South Sudan’s 10.5 million PA Images. people live more than a three-mile walk from any basic primary health facility. There are only conflict resolution through engagement with 37 hospitals in the country. Plans for enhancing community leaders and local politicians, the cycle South Sudan’s health sector and transferring of violence has continued. more responsibility away from donors and to the For those caught up in the Jonglei fighting, government stalled when oil production was shut the nearest medical facility equipped to down for nine months of 2012. address the resulting serious injuries was a Inter-ethnic conflict also has a severe impact on five-hour boat ride away. Even in the absence health status and access to services, particularly of conflict, minorities in Jonglei report that for minority groups. In Jonglei State, in the they are often afraid to seek health services south-eastern part of the country, conflict because of discrimination – they fear that between Lou Nuer and Murle communities medical service providers from the dominant continued in 2012. The year began with a community will not provide effective massacre in Pibor town. Revenge attacks and treatment or might even harm them if they counter-raids continued. Despite the presence of seek care. Whether justified or not, these fears UN troops in the state, government disarmament have a direct impact on the health of minority campaigns, as well as numerous attempts at groups.

State of the World’s Minorities Africa 65 and Indigenous Peoples 2013 factions in the region and the Khartoum Case study government. By 2012, thousands from Nuba communities, as well as other communities perceived to be anti-government, were under Conflict in the attack via an intensive government bombing campaign. Nuba mountains The conflict has created a health and humanitarian crisis. Fear of bombings has drives famine displaced thousands into mountain caves and prevented the planting of food crops. Bomb- and disease related injuries have intensified the strain on an already limited health care system. Delivering humanitarian aid to the region In 2012, one of the world’s most devastating has become extremely challenging – because humanitarian crises was unfolding along the of the active conflict as well as the refusal of border between Sudan and South Sudan in the government to allow much assistance – the Nuba mountains. The people of Nuba leading to terrible conditions for those living include a number of different ethno-linguistic in Nuba. Because it has not been possible to communities, as well as different religious groups, move vaccination to the region, outbreaks living side by side. They have been marginalized of measles and other preventable childhood for decades by the Sudanese government in diseases are a serious concern. Khartoum, and the region has now become a Thousands of refugees have fled to South conflict hotspot. As a result of marginalization Sudan, but conditions in the camps there and large-scale government land acquisitions in were also described as desperate in 2012, the region, Nuba leaders supported the Sudan with rampant disease and malnutrition. Some Peoples’ Liberation Army (SPLA) in its war have likened the tactics of the Khartoum against the government in Khartoum. When government to those used in the Darfur negotiations led to South Sudan’s secession, the region, with indiscriminate attacks on civilians fate of the Nuba region was left unresolved. and use of food as a weapon of war. ■ In 2011, conflict erupted between militia

South Sudan is also hosting hundreds of reports ranked Uganda’s health sector as the thousands of refugees and internally displaced most corrupt in the East African region, citing people as a result of continuing conflict with extensive problems with bribery and health Sudan and within South Sudan. Refugee flows care worker absenteeism as major contributors. throughout 2012 have led to dire conditions in Uganda also saw worrying reversals in its the remote camps on the border between South generally successful HIV/AIDS prevention Sudan and Sudan, with rampant disease and programme, as well as outbreaks of several rare malnutrition leading to thousands of preventable diseases, including nodding disease, Ebola virus deaths. Minority communities and indigenous and Marburg haemorrhagic fever. The Ugandan peoples, who often make up a substantial parliament threatened to block the entire national proportion of refugee flows and who are often budget unless there was an increase in funding for found in the most remote areas, are particularly the health sector, which the WHO had described negatively affected by the dire state of health as having a severe health worker shortage. For services. minorities and indigenous peoples, who generally have less access to health services than the general Uganda The health sector in Uganda faced multiple Right: Batwa woman and child, Uganda. challenges in 2012. At the end of the year, Michael Pitt.

66 Africa State of the World’s Minorities and Indigenous Peoples 2013 State of the World’s Minorities Africa 67 and Indigenous Peoples 2013 population as a result of marginalization and poverty, these nationwide health sector challenges Case study can have an disproportionate impact. In a shadow report to the UN Universal Periodic Review process for Uganda, a coalition Batwa – sexual of minority and indigenous rights groups highlighted concerns about health status and violence and lack access to services. Major challenges included (1) loss of access to traditional medicinal herbs of health care because of environmental degradation and land loss, as well as reduced transmission of knowledge spreads HIV/ on traditional methods of healing; (2) failures of the Ugandan health system to account for AIDS minority and indigenous peoples’ needs in their policy and planning processes; and (3) lack of culturally appropriate health service provision, Displacement and loss of access to ances- especially in the area of reproductive health. tral territory has had devastating effects on The coalition reported statistics that highlight indigenous peoples, including on their health disparities in health status: status. Arguably, those most severely affected have been the Batwa communities of East ‘[A]mong the Batwa women of Kisoro, there are and Central Africa. With recent news about two still births out of every dozen live births (with increases in HIV infection rates in Uganda, an infant mortality rate of 17 per cent) and only MRG interviewed Faith Tushabe, Executive five out of 10 children reach their first birthday. Director of African International Christian Further, out of those five children, few reach their Ministry, an NGO that works closely with fifteenth birthday. These figures are far worse than Batwa communities on the impact of HIV/ the national averages, i.e. an 11 per cent infant AIDS and other health concerns for Batwa mortality rate, and an 18 per cent chance of dying in Uganda. before the first birthday’. MRG: What are the major health issues for HIV/AIDS also often has a disproportionate Batwa communities you work with? impact on minorities and indigenous peoples, FT: For Batwa, health concerns are directly so increasing rates in 2012 are a concern. For linked to their displacement from the forest, many years there were substantial drops in to social discrimination and to their extreme HIV infection rates in Uganda, attributed to a poverty. Traditionally, Batwa depended high-profile public-awareness campaign, testing on forest products to provide medicines programmes, treatment provision, and substantial and food products for the community. In donor support. From 1992 to 2000, HIV addition, their isolation inside the forest prevalence rates dropped from 18.5 per cent to reduced their exposure to many illnesses. 5 per cent,5 but data released in 2012 indicated Today, as a result of their eviction, they that this trend is reversing, with a prevalence have lost access to many traditional rate of 7.3 per cent. Rates are increasing across forest products that contributed to their the population, in urban and rural areas, and in health. They also have difficulty accessing particular among adult married couples. health services provided by the Ugandan Loss of access to and control over land and natural resources are also related to health status for minorities in Uganda. In mid-2012, Uganda district, inhabited by the Bagungu indigenous announced that oil reserves initially discovered fishing community, has been a major centre for in 2010 were even larger than reported, oil exploration, which has led to community amounting to 3.5 billion barrels. The Buliisa concerns about possible environmental damage

68 Africa State of the World’s Minorities and Indigenous Peoples 2013 government. For example, in order to access MRG: Does HIV/AIDS affect Batwa men antiretroviral treatment and other care and and women differently? How? support services for men and women living with FT: Batwa women are affected differently HIV, Batwa have to walk approximately five from men for a number of reasons. Some kilometres. Batwa women have been subjected to rape Batwa resettlement never provided sufficient and also are coerced into sexual relationships land to ensure food security, so, particularly for in exchange for basic goods, which because those living with HIV/AIDS, the inability to of poverty they cannot afford. Sexual provide sufficient food has a negative impact on assaults and sex for goods/money is generally their health status. Discrimination also hinders as a result of interactions with other Batwas’ ability to access health services, as many neighbouring ethnic communities. Other health workers perceive them negatively. ethnic communities have discriminatory Shelter and sanitation is another major health perceptions about Batwa women, believing concern. Poverty and lack of land makes it that having sex with a Mutwa will cure extremely difficult for Batwa families to build diseases such as backache or HIV. Also, sufficient shelter with adequate sanitation. As Batwa women often are believed to be HIV- a result, babies and young children are at high free, which paradoxically has led to the risk of pneumonia during cold seasons and spread of HIV. hygiene-related diseases spread easily through the community. MRG: What health services in general are available in areas where Batwa are MRG: What is the prevalence of HIV/AIDS in currently living? Batwa communities? FT: Batwa reside in eight centres in the four FT: The high level of stigma and discrimination sub-counties of Muko, Ikumba, Bufundi and has affected access to HIV/AIDS services, Butanda in the Kabale District. Primary care, reducing the number of Batwa men and women reproductive health, HIV/AIDS care, water who go for counselling, testing and other care and sanitation services are generally available services. This has affected the data analysis on from the regional hospital and other local the prevalence rates, so it is difficult to know health centres. However, fees for service are the actual rate of HIV in the community. a major barrier for Batwa accessing care. Also Despite the difficulty in gathering data, it is Batwa sometimes have negative perceptions clear that HIV is having negative effects in the of the health care system, as they often community, including decreases in productivity experience discrimination, which reduces because of illness and an increase in orphans the likelihood that they will seek out health and vulnerable children because of the death of services. ■ parents as a result of HIV. Couples’ counselling and testing have also been hard to conduct, which has led to high risk of HIV infection and other sexually transmitted infections like syphilis. There are very limited HIV/AIDS services, including basic education information, as well as care and support, in the Batwa resident centres.

and the spillage of toxic material in the area, (yet to open), sponsored male circumcision which could have negative impacts on health campaigns to reduce the risk of HIV infection, status. The oil company operating in the region and has also trained peer health educators in local has funded the construction of a local hospital villages.

State of the World’s Minorities Africa 69 and Indigenous Peoples 2013 Girls who become pregnant before age 19 are Case study at higher risk for fistula because their bodies are not yet fully developed for childbirth. We see a higher rate of these practices in minority Obstetric fistula – and marginalized communities in Kenya and across East Africa. For example, many of our a preventable but cases come from Pokot, where rates of FGM and early marriage are high. We have begun seeing deadly condition an increase in cases from Samburu and Maasai communities recently, as those groups have begun for mothers in sub- to learn about our services. Poverty also is a risk factor, as poverty can lead to girls being married at Saharan Africa an earlier age and then have higher risk for fistula.

MRG: How does fistula affect women in their Girls who marry young or suffer genital families and communities? mutilation are at highest risk from obstetric JM: The stigma associated with fistula is terrible. fistula, a hole in the birth canal caused by Because the condition leads to a constant smell prolonged or obstructed pregnancy. The of urine, many women are pushed away from condition is easy to treat – the difficulty is their families and communities. For example, getting women the medical care they need. just the transport for a woman to come to the Obstetric fistula generally occurs as a hospital can be a difficult experience. Here in complication of pregnancy during which Kenya we use matatus (minibuses that seat 14 labour becomes obstructed – it is often a result people in close quarters) and people may refuse of women labouring for many hours or days to travel with a woman who has fistula because without access to medical care. Obstructed labour of the smell. How can you get to the hospital if leads to the development of internal tears and no one will bring you? We have women here who leaves women with chronic incontinence. In most have been dealing with the condition for many cases the baby is stillborn. Left untreated, fistula years. The victims are so poor and have limited can lead to chronic medical problems. communication with the world outside their While fistula is rare in parts of the globe where community so they may remain with fistula for emergency obstetric care is available, in sub- more than 50 years in some cases. The treatment Saharan Africa fistula remains a serious health women have experienced often is so bad that problem. The East, Central and Southern African after the surgery some of them do not want to go Health Community (ECSA-HC) estimates that home. We continue to try to find ways to work there are approximately 3,000 new fistula cases on community reintegration for survivors. every year in both Kenya and Tanzania, and that an estimated 250,000 women in Ethiopia are MRG: What services does Gynocare’s living with fistula. programme provide for women and girls who MRG talked with Jared Momanyi, the project have fistula? manager at Gynocare Fistula Centre in Eldoret, JM: Gynocare clinic was started by Dr Hillary Kenya, to learn more about the impact of fistula Mabeya in 2010. Since then we have conducted and how the problem can be addressed. more than 850 fistula repairs, but we have 300 women on our waiting list. We provide women MRG: Why is fistula an issue for minority and and girls with surgical repair, post-operative indigenous communities? recovery and counselling. The psychosocial JM: Female genital mutilation (FGM) and early impacts on women are very severe and, for marriage are major risk factors for fistula because many, coming to the clinic is very frightening, they increase the risk of obstructed delivery. so our counsellors provide a critical service

70 Africa State of the World’s Minorities and Indigenous Peoples 2013 to help women feel comfortable. While women are in recovery they stay here with us and we provide their food and Southern housing. The services are free of charge and we receive donor funding to support our work, in particular from Direct Africa Relief International and One By One Fistula Foundation. We have also started Inga Thiemann a programme in which survivors become community educators. After they have Enjoyment of the right to health is not a matter successfully recovered, interested women of course in Southern Africa. High numbers are trained to spread the word about fistula of HIV, tuberculosis and malaria cases are a and to help identify women who are in problem across the region, while health care need of our services. We also have some facilities are often hard to reach. Public health cases of young girls who come to our clinic. care facilities are regularly under-stocked and If we find that they might be in danger if under-staffed, while private health care is usually they return to their community or if they unattainable for the majority of the population, wish to stay in school, we try to support including most indigenous and minority groups. them financially to do so. Indigenous and minority communities living We actually have been receiving patients in remote areas often have no access to health from other East African countries, including care facilities and life-saving medicine, and Uganda, Tanzania and even South Sudan. public health information is not available in their Although there are fistula services in those own languages. Equally, they are often the last countries, often it is easier for women living ones to be reached by educational campaigns in border areas to reach our services. ■ regarding HIV, tuberculosis and malaria prevention, putting their lives at an even higher risk compared to the general population. This is further aggravated by the double marginalization HIV-positive members of minority and indigenous groups face. HIV/AIDS is a major concern for San communities in Botswana. While the government of Botswana provides free antiretroviral medication, treatment is not always as accessible for San in remote areas. San leaders from central Botswana say that many San do not understand the disease fully and therefore do not access treatment until it is too late. For them, as well as for other indigenous communities in remote areas, early intervention needs to be promoted.

Namibia Minority and indigenous rights remain difficult issues in Namibia due to the legacy of apartheid. Despite some government efforts to improve their situation, indigenous peoples still have not benefited from independence as much as other groups. In a visit to the country in October 2012, James Anaya, the UN Special Rapporteur on the rights of indigenous peoples, expressed

State of the World’s Minorities Africa 71 and Indigenous Peoples 2013 concern about the lack of a coherent government policy that assigns a positive value to the distinct Case study identities and practices of indigenous people and promotes their cultural survival. In January 2012, 36 traditional Himba leaders, Innovative mobile one of the country’s most marginalized groups, issued a statement to the UN describing their tuberculosis grievances. They claimed the government has refused to recognize 33 of them as traditional treatment reaches leaders, despite winning their case in the high court in 2001. Himba leaders also challenged Namibia’s the 2002 Communal Land Reform Act, which allows others to buy land traditionally owned by nomadic San Himba. The leaders called for the government to remove mining companies from Himba territories community or involve the Himba in the decision-making about mining permits and mining revenue. Himba children do not have access to San are the only ethnic group in Namibia education and funding has decreased for mobile whose health and economic status have schools for their children. Himbas’ semi-nomadic declined since independence. San life lifestyle means their children are unable to expectancy is 22 per cent below the national attend mainstream schools. Both Himba and San average. Namibia has one of the highest children face discrimination at school; they are tuberculosis rates in the world. In parts of not allowed to wear traditional clothes and are Tsumkwe where San live, rates of more than not taught in their mother tongue, which affects 1,500 tuberculosis cases per 100,000 people their quality of education and knowledge about health issues. Himba leaders also demanded better health care and more hospitals in their areas. Access to health facilities remains one of the main obstacles to medical treatment for all nomadic and pastoral minorities in Namibia. Indigenous groups are also more vulnerable to HIV infection, because of their comparatively low access to sexual and reproductive health services and information. Namibia has an adult HIV prevalence rate of 13.4 per cent,6 but indigenous groups do not always know about the risks. A 2009 study revealed that 80 per cent of women in a San community in Tsumkwe did not know if HIV/AIDS was a problem in their community and 85 per cent responded ‘do not know’ when asked about their risk of infection. There are no public health campaigns in San languages. Maternal mortality rates have doubled since the early 1990s, mainly due to HIV. This is despite an increased number of women with access to skilled birth attendants (81 per cent) and receiving antenatal care (70 per cent), according to the latest UN Development Programme (UNDP) Millennium Development

72 Africa State of the World’s Minorities and Indigenous Peoples 2013 were recorded in 2004, which is almost 50 Goals (MDG) report. However, indigenous per cent higher than the national prevalence communities in remote locations are less likely rate for the same period.7 to benefit from antenatal care and skilled birth The San region of Tsumkwe has high attendants, and while their exact maternal and levels of multi-drug-resistant tuberculosis infant mortality rates are not fully documented, because they live in remote places and often experts believe them to be extremely high. move their homes and go on long hunting expeditions, which means they do not South Africa finish courses of medicine. Unwittingly, The ‘Rainbow Nation’ continues to be affected they therefore contribute to one of the chief by its colonial and apartheid legacy. Land rights causes of drug-resistant illnesses. However, and distribution of wealth remain contested the San, with the help of two NGOs, issues in South Africa. Per capita personal income devised a health programme that takes into among white South Africans is nearly eight times account their lifestyle. Family members higher than that of the country’s black citizens, are trained to administer drugs and a according to the South African Institute of Race community-based education programme Relations. The redistribution of farmland from taught San about tuberculosis, required white owners to black citizens has progressed drugs, how to read and record treatment slowly, hindered by government mismanagement. cards and how to collect medical samples. Economic competition between small-scale black- As a result, recent data indicates a decrease owned farms and large-scale factory farms owned in multi-drug-resistant tuberculosis cases in by whites exacerbates the problem by leading to Tsumkwe.8 ■ economic failure and buy-backs by white farmers. Frustrations about the process have also led to Below: San children playing a traditional an outbreak of violent farm invasions, leading game, Namibia. Paul Weinberg/Panos. to casualties among white South Africans in 2012. The outbreak in violence is linked to calls by Julius Malema, the former president of the African National Congress (ANC) Youth League, for whites to give up their land without compensation or face violence by angry black youths ‘flooding their farms’. Malema was charged with hate speech in 2010 and 2011 and was expelled from the ANC in April 2012. One of the incidents of hate speech included singing the song ‘Shoot the Boer’ (a South African term simultaneously used for white farmers and descendants of Dutch-speaking white settlers). In January 2012, President Jacob Zuma also sang ‘Shoot the Boer’ at the ANC centenary celebration. He claimed that this was not intended as hate speech, but to commemorate the struggle against apartheid. However, his actions may contribute to an increase in ethnic tension. Land rights continue to be an issue for the Khoisan indigenous community, who feel disadvantaged by the provisions in the 2011 land reform green paper. The reform does not take into account dispossession of land before 1913, which, according to the Khoisan group Sapco, excludes most Khoisan claims. However, Khoisan

State of the World’s Minorities Africa 73 and Indigenous Peoples 2013 can apply for land under the government’s the Swati- and Zulu-speaking Mpumalanga region, redistribution programme, according to with 15.4 per cent (compared to the national aver- academics. Nonetheless, Sapco representatives, age of 10.9 per cent and 3.8 per cent in the Western as well as some Dutch-speaking Afrikaner groups, Cape). Women are significantly more likely to be argue that the current land reform policy will HIV-positive. The overall HIV prevalence in South benefit the black majority but not minorities or Africa is slowly decreasing, but at the same time the indigenous communities. HIV prevalence among young pregnant women South Africa took a big step towards improving has increased from 22.8 per cent in 1994 to 29.3 general health care in the country in 2012 by per cent in 2010. If current trends continue, South introducing the first stage of a universal health Africa is unlikely to achieve all its MDGs on HIV. care plan. The national health insurance, first The highest HIV prevalence rates among introduced in 10 selected districts, is intended women attending antenatal clinics are in eventually to provide essential health care to KwaZulu-Natal (39.5 per cent) and in all citizens and legal residents. This will greatly Mpumalanga region (35.1 per cent), according to benefit the black majority and minority groups a 2010 study by the South African Department that suffer from a rudimentary public health of Health. care system, which provides services for 80 per In some Zulu communities misinformation cent of the population, and a lack of doctors in about HIV puts female babies and young girls public health care. A rich white minority tends to at a particularly high risk. The so-called ‘virgin benefit from private health care providers. cleansing myth’, according to which an HIV- The introduction of universal health care positive person can be healed through intercourse could also benefit the highly marginalized San with a virgin, is held responsible for higher communities. New health care facilities in remote numbers of sexual assaults against female minors. San regions will facilitate their access to health Tuberculosis remains the main cause of care services and medicine. death in South Africa. It is linked to the high The South African government has also taken prevalence of HIV. South Africa accounts for 28 steps to formalize the role of traditional healers. In per cent of the world’s people living with both February the government inaugurated the Council HIV and tuberculosis. People whose immune for Traditional Health Practitioners to regulate the systems have been weakened by HIV are much quality of services delivered by diviners, healers, more likely to be infected with tuberculosis. traditional birth attendants and herbalists, and to protect the public from bogus practitioners. Zimbabwe Traditional healers play an important role in Political reform in Zimbabwe has been slow and South African health care, since they are often insufficient, despite a new draft constitution more likely to be contacted than western doctors, and the implementation of the Global Political especially by the Zulu and Xhosa communities. Agreement (GPA), which was signed in 2008. The 42 deaths and hundreds of injuries of There has been no end to political violence Xhosa boys from botched circumcisions in the and discrimination, including against the first six months of 2012 highlighted the need for white minority and gay rights activists. The stronger regulations for traditional healers. Most Zimbabwean government was also accused of deaths and injuries in the ritual have occurred in reintroducing youth militias to create fear among the Mpondoland region of Eastern Cape. The political opponents prior to the 2013 elections. Eastern Cape House of Traditional Leaders insists In February 2012, the governor of Mazvingo it is taking the problem seriously and running a province suspended 29 NGOs providing services campaign for safety at initiation schools. ranging from food aid to assisting people with South Africa has the highest number of people disabilities, for failing to register with his office. living with HIV/AIDS in the world, but there are While the governor lacked the legal authority to large differences between communities.9 The mainly do this, his action caused fears of a crackdown on Zulu minority region KwaZulu-Natal has the high- NGOs similar to the one that preceded elections est HIV prevalence, with 15.8 per cent, followed by in 2008.

74 Africa State of the World’s Minorities and Indigenous Peoples 2013 Health places by flooding. This led to poor harvests, Meanwhile, a combination of unpredictable food shortages and rising food costs amongst rainfall and limited access to seeds and fertilizers chronically vulnerable populations. caused the number of people in need of food The impact was compounded in some areas aid to rise by 60 per cent, making more people by conflict and displacement. By year’s end 18.7 vulnerable to illness due to malnutrition. million people faced food insecurity in the Sahel, Zimbabwe is expected to fall short of most with over 1 million children at risk of dying from of its health-related MDGs. The number of acute malnutrition. maternal deaths has more than doubled since The year 2012 also saw the most serious 1990, and the under-five mortality rate increased outbreak of cholera in years in Guinea, Liberia from 79 per 1,000 in 1990 to 94 per 1,000 in and Sierra Leone, as well as along the Congo 2009. River in the Republic of Congo, the Democratic However, Zimbabwe has reduced its HIV/ Republic of Congo (DRC) and western Niger. AIDS prevalence rate from 23.7 per cent in 2001 Ten years on from the end of a brutal civil to 14.3 per cent in 2010 and is likely to reach war, fuelled in part by regional interests seeking this MDG target. While the government has to control the country’s lucrative diamond fields run significant awareness campaigns, including by exploiting domestic tensions, former Liberian an event in June 2012 when 44 members of president Charles Taylor was convicted by the the Zimbabwean parliament were circumcised, Special Court for Sierra Leone of war crimes and gender inequality still hinders the effectiveness of crimes against humanity. HIV campaigns. To aid recovery, in 2010 Sierra Leone opened Globally, the country ranks 17 out of 22 high- a programme to provide free health care to burden tuberculosis countries. The incident rate pregnant women, breastfeeding mothers and rose from 97 per 100,000 people in 2000 to 782 children under five. Since then, use of health per 100,000 in 2007. According to government services has reportedly increased by 60 per cent, statistics, more people from Matabeleland are with, for example, five times as many children dying from tuberculosis than in any other area receiving the recommended malaria treatment of Zimbabwe. Matabeleland is the homeland of as in 2008. In other positive developments, the Ndebele minority and has been particularly in November Sierra Leone held peaceful affected by drought. Up to 18 per cent of presidential, legislative and local elections. patients in Matabeleland North province and Despite some electoral violence, Senegal 14 per cent in Matabeleland South province die continued its process of democratic transition while on tuberculosis treatment. when the incumbent conceded defeat in March polls and handed power peacefully to the opposition. In August the UN Committee on the Elimination of Racial Discrimination (CERD) West and expressed concern at renewed violence between the army and separatists in the Casamance region, which is populated largely by the Central minority Diola ethnic group. In December Senegal and the African Union (AU) set up a special tribunal to try Chad’s Africa former dictator Hissène Habré for human rights violations committed during his eight years in Paige Jennings power, ending in 1990. Victims included his political opponents and members of ethnic The Sahel region, including parts of Burkina groups he believed opposed him. Faso, Cameroon, Chad, Mali, Mauritania, The year 2012 saw an upsurge in attacks by Niger, Nigeria, Senegal and Sudan, suffered the armed Islamist group Boko Haram in Nigeria the worst drought in decades, followed in (see country section below). Security forces,

State of the World’s Minorities Africa 75 and Indigenous Peoples 2013 Christians and Muslims suspected of opposing Right: Mbororo children in Cameroon. Emma the group appeared to be the primary targets; Eastwood/MRG. violence centered on the predominantly Muslim north, though attacks occurred elsewhere as well. food, Olivier de Schutter, visiting Cameroon in For their part, security forces were accused of July, expressed grave concern at food insecurity numerous human rights violations, including there. Cameroon’s progress against Millennium during raids on communities that had previously Development Goals (MDGs) health indicators been attacked by Boko Haram. remained weak; for example, its infant mortality In Mali, a Tuareg-led uprising followed by rate declined by only 1.2 per cent between 1990 a coup ended a 20-year stretch of democratic and 2010. Cameroon, one of UNAIDS’ (UN transition (see below), while in Guinea Bissau, and AIDS) 22 priority countries, achieved a the first round of presidential elections was moderate decline in new HIV infections among followed by a military coup in April. children between 2009 and 2011 (MDG 6). In March, the Central African Republic In January, the UN Committee on Economic, (CAR), DRC, South Sudan and Uganda Social and Cultural Rights (UNESCR) urged announced a 5,000-strong UN- and AU-backed Cameroon to protect indigenous peoples’ rights joint military task force to combat the notorious to their ancestral lands and any natural resources Lord’s Resistance Army (LRA). there. By year’s end the LRA had carried out at least For his part, the Special Rapporteur noted 180 attacks in the CAR and DRC, including that the enjoyment of the right to adequate food against minority ethnic groups, forcing some was particularly threatened among indigenous 443,000 people to flee their homes. peoples. He called for the government to consider Following the 2011 adoption by the Republic a stricter tax regime for the (primarily foreign- of Congo of Africa’s first law on indigenous owned) companies that draw on Cameroon’s rights, CERD raised concerns about reports of resources and to ensure a greater voice for discrimination against indigenous peoples there. indigenous groups in allocating the proceeds. For its part, the UN Committee for the Elimination of Discrimination against Forest-dwelling groups Women (CEDAW) expressed concern about The Special Rapporteur expressed fears that the vulnerability of the Republic of Congo’s large-scale agroforestry and agriculture on their indigenous women and girls to sexual violence, lands would deepen the marginalization of forest- and about ongoing reports of discrimination dwellers. against them by health workers. The culture and livelihoods of the indigenous The World Heritage Committee, the body BaGyeli people were reportedly threatened considering the nomination of the Tri-National by international palm oil companies’ plans, de la Sangha protected area, including parts of developed without consultation, to clear their Cameroon, CAR and the Republic of Congo, forest for cultivation. as a UNESCO World Heritage Site, raised A July NGO report found that allocation of concerns in 2011 about lack of consultation traditional lands to agriculture, agroforestry or with local indigenous populations. Some logging put the culture and livelihood of the consultations were held in early 2012, but civil formerly nomadic Ba’Aka similarly at risk. society groups reported that the process was It pointed to high child mortality and low life flawed. The application was resubmitted in 2012 expectancy rates among the Ba’Aka, who had by the concerned authorities, and the area was poor access to health care due to discrimination, inscribed or declared a World Heritage Site by cost and lack of identity documents; those who the Committee at its July session. managed to maintain access to the forest were The Sahel drought sharpened endemic hunger said to have a higher standard of health in some and malnutrition, leading the government to respects due to their skills in traditional medicine. declare a state of emergency in the north. Contrary to international standards, the 1994 The UN Special Rapporteur on the right to Forest Code does not recognize indigenous

76 Africa State of the World’s Minorities and Indigenous Peoples 2013 rights to traditional lands and resources. In 2012 addressed challenges such as increasing the law was under revision; in its Concluding landlessness due to privatization, the effects of Observations in January, the UNESCR urged population growth and climate change, and the Cameroon to speed up the reform process and impact of creating national parks and protected to guarantee indigenous rights. However, civil areas on indigenous peoples. society groups raised doubts about the content At a workshop in November on voter of draft reform proposals, the tight timetable of sensitization and registration in the run-up to the review process and its failure to fully respect 2013 elections, Mbororo activists called for the indigenous groups’ right to consultation. adoption of a Pastoral Code governing farmer– grazer relations. Other key issues raised included Nomadic pastoralist groups access to the identification documents needed In November, the Mbororo Social and Cultural for voting, and the interconnection between Development Association (MBOSCUDA) education and meaningful political participation representing the minority Mbororo cattle- – including for girls. herding community from different provinces of Cameroon, and the International Land Côte d’Ivoire Coalition (ILC) Africa, a global coalition of Despite 2011’s return to constitutional order, organizations focusing on land access issues for Côte d’Ivoire remained unstable in the face of a rural people, organized a conference on ‘Securing wave of attacks generally attributed to supporters the land rights of indigenous people and rural of former President Laurent Gbagbo. While communities’, with 95 participants from 22 in power, and in particular during the 2010 countries. The resulting Yaoundé Declaration electoral campaign, Gbagbo’s use of xenophobic

State of the World’s Minorities Africa 77 and Indigenous Peoples 2013 language and manipulation of ethnicity and concern that the ICC’s decision to ‘sequence’ its citizenship exacerbated tensions between the enquiry into events in Côte d’Ivoire, investigating south and the largely Muslim north. Gbagbo and his camp first rather than addressing Following his refusal to concede defeat at the abuses by both sides simultaneously, was being polls, his supporters were accused of widespread used domestically to justify the pursuit of one- human rights violations against those of his sided justice in the national courts. opponent Alassane Ouattara. By the time of Gbagbo’s departure in 2011, serious violations Health based on perceived ethnicity or political The drought in neighbouring Sahel countries affiliation had been attributed to both sides. increased hardship by raising food prices; In 2012 security was unstable, with internal ongoing insecurity further disrupted livelihoods. as well as cross-border attacks from Liberia Ouattara had set up nationwide free health care and Ghana. In June, seven UN peacekeepers, in 2011 to aid recovery from the earlier violence; patrolling in response to reports of an attack on in March the programme was scaled back to civilians the night before, were killed, reportedly pregnant women, children under age five and by pro-Gbagbo militias, in an ambush outside of malaria patients. the town of Tai. As one of UNAIDS’ 22 priority countries, In July soldiers, pro-Ouattara militias and Côte d’Ivoire achieved a moderate decline in new ethnic Malinké civilians attacked the Nahibly HIV infections among children between 2009 camp for internally displaced people, leaving and 2011 (MDG 6). It made some progress in at least 11 dead and several score injured and child and maternal mortality, though reportedly forcing thousands more to flee. Many of the not enough to reach the 2015 MDGs. camp’s inhabitants were ethnic Guérés and had At its 52nd session, held in Côte d’Ivoire in supported Gbagbo; it was said to have been October, the African Commission on Human attacked in retaliation for deaths during an armed and Peoples’ Rights (ACHPR) reviewed robbery in nearby Duékoué that the attackers Côte d’Ivoire’s periodic country report. In its believed had been carried out by camp residents. Concluding Observations, it recognized positive In October staff of the International measures such as the establishment of a ministry Federation for Human Rights and two of its for combating HIV, but expressed concern at member organizations in Côte d’Ivoire reported lack of access to basic health services, particularly being present at the discovery of a mass grave for women and girls. that they believed to be of a further six victims of The Concluding Observations also expressed the July attack on the camp. concern at the failure to implement a 1998 law From August, police and security forces were banning female genital mutilation (FGM) and increasingly targeted by Gbagbo supporters. sexual harassment. In the first application of that In response they cracked down on Gbagbo law, in July, nine women in the northern town of supporters and those from his ethnic group, Katiola were convicted of carrying out FGM. reportedly committing violations such as arbitrary According to government and UN statistics, arrest, ill-treatment and torture. the practice is most prevalent in the north and At year’s end, Gbagbo and his wife Simone west of the country, its frequency varying across faced charges before the International Criminal religious and ethnic groups; it is also practised Court (ICC), and scores of their supporters had by immigrants from neighbouring countries been brought before domestic courts on charges with high FGM rates. According to UNICEF, of committing abuses against Ouattara loyalists nearly 88 per cent of women are affected in during the conflict. No judicial proceedings had northern Côte d’Ivoire, and 73 per cent are been instigated against Ouattara supporters, affected in the west. however, despite the fact that the report of the National Commission of Inquiry into the electoral Mali violence referred to cases of serious human rights The year 2012 was one of unprecedented crisis abuses by both sides. Some observers expressed in Mali, which has a tradition of moderate Islam

78 Africa State of the World’s Minorities and Indigenous Peoples 2013 and a 20-year democratic history. On top of the and religious sites, including mausoleums and Sahel food emergency, the country was wracked shrines, and committed abuses while carrying by fall-out from an armed rebellion. Northern out punishments under a strict interpretation of Mali is home to the Tuareg and Maure (Moor) Sharia law. ethnic groups, both traditionally nomadic. In July Mali’s Minister of Justice asked the The Tuareg had been in low-level conflict with ICC to investigate crimes committed since the colonial and post-colonial authorities for decades. beginning of the January uprising. In December Tuareg separatists protesting at marginalization, the UN Security Council authorized deployment lack of development and neglect of the north, of an African-led force to support Mali’s army in including during times of devastating drought regaining control of the north. in their communities, had carried out repeated Analysts raised concerns that military rebellions in the hope of establishing a separate intervention could trigger further ethnic conflict, Tuareg state, Azawad. particularly in the form of acts of collective In addition, in recent years the weak state punishment against Tuaregs. presence had allowed armed Islamist groups and organized crime to operate and gain significant Health influence in the north. The armed conflict added to the burdens of a The January rebellion, led by Tuareg population already confronting food insecurity. combatants recently returned from Libya after the Conflict interrupted basic services and destroyed fall of Muammar Gaddafi in late 2011, spread health infrastructure, weakening responses to through the northern Sahara region. The secular, outbreaks of cholera and malaria. separatist Tuareg group National Movement Reports indicated that the strict imposition for the Liberation of Azawad (MNLA) acted of Sharia law further impeded health services, alongside Islamist groups, which also included with armed men at times disrupting services to some Tuaregs among their combatants. verify that female patients and staff were covered, The ensuing violence led to the internal or banning radio-based health campaigns on displacement of roughly 204,000 people, while religious grounds. As the year progressed, aid more than 200,000 fled into neighbouring workers reported that child malnutrition in Mali countries. The rebels were accused of violating was reaching emergency levels. In January 2013 humanitarian law by executing captured soldiers, an estimated 585,000 people were suffering from and of widespread abuses against civilians, food insecurity, with a further 1.2 million at including use of child soldiers and widespread, at risk, out of a total population of 1.8 million in times ethnically oriented, rape. northern Mali. For its part, Mali’s army was accused of indiscriminate bombing, of targeting Tuareg Nigeria civilians in reprisal attacks, and of failing to Nigeria more than doubled its per capita income protect Tuaregs and other minorities, including between 1990 and 2010; but progress towards Arabs and Mauritanians living in the capital, the MDGs has been inconsistent and hampered from revenge attacks, including by self-defence by sharp social inequalities. militias of other ethnic groups. While the country has achieved significant In March, army officers, frustrated by lack of declines in HIV infections, and in 2010 government support for their fight against the reported good potential for meeting MDG 6 on rebels, staged a coup. The rebels took advantage combating infectious diseases, child and maternal of the upheaval to further expand their area health indicators continued to reflect inequalities of control, declaring an independent state of between the poor, predominantly Muslim north Azawad on 6 April. and the oil-rich south. However, the MNLA was driven out by the In a particularly worrying development, in Islamist groups, including Ansar Dine and northern Zamfara state, labour-intensive artisanal al-Qaeda in the Islamic Maghreb (AQIM). gold mining has left widespread lead poisoning, These groups destroyed very important cultural especially among children, killing more than 400

State of the World’s Minorities Africa 79 and Indigenous Peoples 2013 of them since 2010. Around 2,500 others have groundbreaking report on oil pollution in the received treatment, but thousands more have not. Ogoniland region of the Niger Delta, home to This is because environmental remediation, or the minority Ogoni people. The report found decontamination, has not been undertaken, with that, given that oil exploitation began in the the result that the children’s exposure continues late 1950s in the area, most residents had lived and any therapy would be ineffective. with chronic oil pollution throughout their lives, In December an Economic Community of with grave impact on the traditional livelihoods West African States (ECOWAS) court ordered of farming and fishing. It called for emergency the Nigerian federal government to enforce action in response to high levels of contaminants, regulations on six oil companies responsible for including benzene, a known carcinogen, in oil spills, ensuring that they carry out adequate communities’ drinking water, and detailed the clean-up, fully compensate affected residents and impact of oil pollution on soil, groundwater, take steps to avoid future pollution. surface water and vegetation. In 2011 the United Nations Environment In 2012 northern Nigeria suffered the effects of Programme (UNEP) had published a the Sahel drought and, in some areas, of internal

80 Africa State of the World’s Minorities and Indigenous Peoples 2013 Left: Members of Church of Christ in Nigeria are checked by a security man for guns before entering the church building in Jos. In recent years attacks have become more frequent between Christian and Muslim communities in the city. George Osodi/Panos.

is a sin’ in the Hausa language) increased its violence in the largely Muslim north, with additional attacks elsewhere in the country. The group is primarily targeting members of the Christian community, although it has carried out bomb attacks across the country. Security forces and Muslims suspected of opposing the group appeared to be other primary targets. Security forces were also accused of numerous human rights violations, including during raids on communities that had been attacked by Boko Haram. More than 250 people were killed by Boko Haram in January alone, 185 of them in one day of attacks on security force installations the northern city of Kano. The group appeared to be widening its range of targets, with attacks on churches, unoccupied schools and media outlets. Mourners at funerals of some victims were attacked, prompting further inter-ethnic retaliatory violence. On 31 December 2011 President Goodluck Jonathan declared a six- month state of emergency in the affected region. Boko Haram responded with a three-day ultimatum to southern Nigerians, most of whom are Christian, to leave the North. In the following six months, Boko Haram reportedly carried out more attacks and killed armed conflict. These factors have disrupted more people than during all of 2010 and 2011 livelihoods, increasing residents’ vulnerability to together. The security forces, granted emergency hunger and disease, including polio. Nigeria is powers in April, were accused of extra-judicial one of only three countries in the world where killings, torture and arbitrary detention against polio is endemic, and the only one in Africa. suspected militants and members of the public at For a polio immunization campaign to be large during raids in communities where attacks effective, it must be universal; however in have occurred. the north in particular, the vaccination drive The NGO Human Rights Watch (HRW) is reportedly hampered by mistrust of the reported in October that abuses by Boko Haram, initiative among the population and disrupted could constitute crimes against humanity, while by insecurity caused by the armed Islamist group at the same time pointing out that the state Boko Haram. security forces were implicated in very serious human rights violations, including extra-judicial Boko Haram killings, which also need to be investigated In 2012 Boko Haram (‘western education and prosecuted.

State of the World’s Minorities Africa 81 and Indigenous Peoples 2013 per cent of Mauritania’s population. They are Case study reported to be the most marginalized of the country’s ethnicities; malnutrition, poverty and illiteracy are reportedly higher among them Mauritania – why than among other groups. However, as health information is not disaggregated by ethnicity do Haratine in Mauritania, the disparity is not easily quantifiable. women still live Boubacar Ould Massaoud, president of Mauritanian NGO SOS Esclaves, reported that in slavery? roughly 80 per cent of Haratines are believed to live in poverty, and that Haratines make up the majority of the country’s poor. The government must step up efforts to Despite a 2007 law criminalizing slavery, 10–20 eradicate all forms of slavery and provide per cent of Mauritania’s population is estimated health care for its most vulnerable citizens. to live in slavery today; the vast majority of them Though facing serious obstacles Mauritania, 155th of 187 countries on the UN Development Programme’s (UNDP’s) Human Development Index, has been taking steps towards meeting the MDGs. In 2010 it was reported to be very close to halving extreme poverty, and had made slight progress against infant mortality, reducing it by 6.3 per cent between 1990 and 2010. International analysts drew particular attention to Mauritania’s progress in the area of women’s participation in politics, the greatest on the African continent in 2010 following a July 2006 law that mandated a minimum of 20 per cent women’s representation in municipal and legislative bodies. In 1992 there were no women parliamentarians, for example, while in 2007 they occupied 18 per cent of posts. In municipal elections in 2007, nearly 30 per cent of seats were won by women. While its efforts to meet internationally agreed indicators have been recognized, Mauritania continues to confront a particular problem remaining from its past: slavery and its scars. The dominant ethnic group in Mauritania is the White Maures, or Berber-Arabs. Historically they raided, captured and enslaved members of sedentary black ethnic groups, who are known today as the ‘Haratines’. The term ‘Haratine’ is used today to refer to slaves and persons of slave descent. The Haratines make up between 30 and 40

82 Africa State of the World’s Minorities and Indigenous Peoples 2013 Below right: A Haratine woman in Mauritania. a social contract for all Mauritanians, Shobha Das/MRG. and for the establishment of a structural mechanism, with a budget and a public are thought to be Haratines. reporting function, responsible for the The March 2013 annual report of Mauritania’s effective eradication of slavery. It also National Human Rights Commission (CNDH) urges progressive movement towards drew attention to the persistence of slavery-like universal health insurance, and for a quota practices; at the same time, it pointed to efforts of 40 per cent Haratine representation in under the government’s Strategic Framework for constitutional and administrative bodies. the Struggle against Poverty to reach descendants Anti-slavery activists came under of slaves living in poor areas and facilitate their particular pressure in 2012 when seven access to health and education services. members of the anti-slavery organization Slavery is reported to be most prevalent in IRA Mauritania were arrested with their the Hodh el Gharbi, Hodh ech Chargui and leader after he burned religious texts at a Trarza regions, where poverty, lack of education protest. and adherence to a hierarchical tradition create At least one demonstrator for their release conditions in which people continue to be died in June, reportedly due to the effects enslaved, working in their masters’ households or of tear gas used by the police. The activists tending their herds. were provisionally released in September; While there is little data on the conditions of however, they reportedly continued to slavery, information received indicates that slaves receive threats. often receive inadequate food and care; enslaved The international analysts who women and girls are particularly vulnerable to highlighted Mauritania’s advances in sexual violence. electing women to posts of authority have Dozens of slaves have escaped or been freed noted that cultural barriers can still make since the 2007 law was passed, with most cases it difficult for them to speak out, advocate against their former masters being resolved outside for change or make decisions publicly – all of the courts or dropped due to pressure on the essential steps in truly empowering women. plaintiffs. In the face of this situation, in 2012 In November 2011 the first conviction MRG began implementing a three-year was handed down, in a case involving the project on behalf of Haratine women, enslavement of two young boys. The accused working with civil society organizations was given a two-year sentence and ordered to to improve understanding of the rights pay compensation to the children; their lawyer of women and the multiple forms of appealed on the grounds that the judgment was discrimination against them to help ensure too lenient. The owner was released on bail after that their work addresses the specific needs four months’ detention. of Haratine women. The project also aims SOS Esclaves, founded in 1995, was deeply to improve the leadership skills of Haratine involved in the struggle to criminalize slavery women through projects and grants. The in law in Mauritania. The organization now trainees will then be supported in outreach provides practical support and at times legal work in their wider community, to assistance to those escaping slavery, and works challenge gender stereotypes and foster girls’ to combat the discrimination and social and women’s leadership at the grassroots prejudices that underpin it. level. On 29 April 2013 the ‘Manifesto for It is hoped that efforts such as this will the political, social and economic rights contribute to much-needed change at the of Haratines’ was launched by civil society grassroots level in Mauritania. ■ organizations and Haratine community leaders. It calls for a nationwide effort to develop

State of the World’s Minorities Africa 83 and Indigenous Peoples 2013 Central Africa members of the security forces and persons Burundi affiliated with the youth league of the CNDD- While 2012 reportedly saw fewer killings than FDD. And journalists and civil society the preceding year, ongoing political violence organizations continued to feel pressure, between the dominant party, the National with draft legislation curbing press freedoms Council for the Defense of Democracy-Forces being proposed in the Burundi parliament in for the Defense of Democracy (CNDD- October. FDD) and opponents continued to threaten After Tanzania revoked their refugee status Burundi’s stability. Widespread impunity and announced plans to close their camp remained a critical issue, especially concerning by the end of the year, more than 34,000

84 Africa State of the World’s Minorities and Indigenous Peoples 2013 Left: Batwa man in Burundi. Ben Rodkin. Central African Republic In the CAR, political divisions, tensions among Burundese refugees returned home in late ethnic groups and spillover conflict from 2012. Upon arrival they faced a Ministry of neighbouring Chad, Sudan, the DRC and Health-declared national disaster: a cholera Republic of Congo have contributed to chronic outbreak, which was particularly severe in instability. returnee areas. In 2012 several discrete conflicts caused The situation of Burundi’s Batwa people internal displacement and hampered was one focus of the Universal Periodic Review humanitarian assistance to those affected. (UPR) of Burundi’s compliance with human In the west and north-central areas, farmers rights standards by the UN Human Rights clashed with nomadic pastoralists in search Council in 2012. Burundi’s report stressed that of grazing land for their livestock. In the its Constitution mandates respect for ethnic north, the Chadian Front Populaire pour le diversity, that the rights of all citizens are Redressement (FPR) rebel movement operated protected equally, and that it was implementing despite joint efforts by both armies, raising non-discrimination measures in favour of Batwa tensions between Muslims, particularly those of children, for instance by funding their secondary Chadian descent, and other citizens. education. LRA attacks, which had abated over previous During the review a number of UN agencies months, resumed in January. By year’s end, expressed concern about discrimination against the UN signalled an increased LRA presence Batwa with regard to access to land, education in south-eastern CAR, with nearly 50 separate and employment. attacks causing scores of deaths and abductions. Further issues were raised during the UPR Some of the LRA leaders wanted by the ICC process. Several NGOs drew attention to the fact on charges of crimes against humanity were that poverty remained more prevalent among believed to be operating from the CAR, and Batwa than among other groups. the threat of LRA attack seriously curtailed Other issues of concern during the review movement, disrupting farming, hunting and included the level of malnutrition among Batwa trade and exacerbating poverty. children, their lack of access to full medical In May the UN Secretary-General expressed treatment due to their families’ poverty, and the particular concern about the vulnerability of inability of Batwa women to access maternity the CAR’s Mbororo, cattle-herding nomads, care due to lack of identity documents. not only to LRA abductions for ransom but For its part, the United Nations Integrated also to stigmatization by other ethnic groups Management Team in Burundi (UNIMT) who suspected them of being associated with expressed concern that medicines for chronic the LRA because of their nomadic way of life. illnesses were not affordable for Batwa, among Mbororo have also reportedly been attacked by others.With regard to MDG 4, on reducing child security forces and others mistaking them for mortality, and MDG 5, on reducing maternal Chadian rebels. mortality, Burundi had by 2010 made some In December, an alliance (‘Seleka’) of dissident progress; however it reported that it was not elements from three former rebel groups made likely to meet the 2015 targets. With regard rapid gains, securing key towns and threatening to MDG 6 on reducing infectious diseases, it the capital Bangui; they accused the government reported that stopping the spread of HIV was of failing to honour promises made during improbable, but achieving goals in reducing earlier peace deals. President François Bozizé malaria and other infectious diseases, on the was overthrown in March 2013, after the rebels other hand, was possible. seized key government buildings including the One of UNAIDS’ 22 priority countries, presidential palace. A deal had been signed Burundi achieved a moderate decline in new between Bozizé and the rebels in January 2013, HIV infections among children between 2009 but the rebels quickly began accusing the former and 2011 (MDG 6). president of reneging on key aspects.

State of the World’s Minorities Africa 85 and Indigenous Peoples 2013 Health Conflict and displacement make access to health Case study care, already exceedingly poor in the CAR, even more difficult. Experts reported that the CAR faced a perpetual health crisis, with little international Community support. In 2011 the CAR had the second-lowest life expectancy in the world, at 48 years. health care A survey by medical NGO Médecins sans Frontières (MSF) indicated that, alarmingly, succeeds for Batwa children under the age of five accounted for almost half of all reported deaths in parts of the As Rwandans enjoy rising life expectancy country. An update on progress towards the and falling disease burdens, marginalized MDGs in Africa indicated that the CAR was Batwa remain excluded from mainstream one of the four countries in the region – all in or health care. But now a community project post-conflict – with the highest infant mortality is beginning to change attitudes. rates; and one of the eight countries – again all In recent years, Rwanda has made in or post-conflict – with the highest maternal impressive progress in combating poverty mortality rates. It was one of only seven African and inequality through inclusive economic countries where immunization coverage declined growth. It has established universal health between 1990 and 2010. insurance and recorded a 40 per cent With the region’s highest rate of HIV reduction in the infant mortality rate. infection, the country faces what The Lancet At the same time, Rwanda has taken steps described as an ‘escalating HIV epidemic’. at a policy level to address the inter-ethnic According to its 2010 MDG report, the issues that led to the 1994 genocide. The government judged it impossible to meet the 2015 Constitution rejects ethnic classifications; it target reductions in child and maternal mortality commits itself to ‘fighting the ideology of (MDGs 4 and 5). With regard to MDG 6, it genocide’ and to ‘the eradication of ethnic, reported that while stopping the spread of HIV was regional and other divisions and promotion impossible, reducing malaria was possible. of national unity’. New laws have prohibited ‘divisiveness’ Democratic Republic of Congo along ethnic lines. Experts have expressed The year 2012 saw an upsurge in fighting in concern that the non-recognition of ethnicity eastern DRC; in November the UN reported contravenes the individual’s right to identify an increase from 1.7 to 2.24 million internally with a specific ethnic group, and ignores such displaced people over the year. An additional groups’ specific needs and situations. 70,000 people fled into Rwanda or Uganda. The Rwandan state has recognized Despite vast wealth in resources, the DRC the particular challenges facing what it ranks last out of 187 countries under the UNDP terms ‘historically marginalized peoples’, Human Development Index. The root cause namely, roughly 33,000 indigenous Batwa. of its misery is ongoing conflict and the state Traditionally forest-dwelling hunters and of humanitarian crisis it creates. This results in gatherers, over past decades they have been the highest rate of malnutrition in central and expelled from their ancestral lands without west Africa, affecting 43 per cent of children compensation to make way for agriculture or under five according to UNICEF. Treatable conservation. infectious diseases such as malaria, diarrhoea and Through discrimination and difficulties in acute respiratory ailments have become the most accessing services, Batwa communities have common causes of death for this age group. largely missed out on Rwanda’s progress, A regional MDG update indicated that the with the result that they have higher infant DRC was one of the four African countries – mortality rates, shorter average lifespans and all in or post-conflict – with the highest infant

86 Africa State of the World’s Minorities and Indigenous Peoples 2013 Above: A Batwa woman in Rwanda. Eric Batwa. Over two years, it reached about Lafforgue. 52,500 people through community, market and street performances. higher rates of disease and malnutrition than While preparing the theatre production, their neighbours. actors and staff spent time living in a In 2011, the Young Women’s Christian Batwa community. This, explained YWCA Association of Rwanda (YWCA), a non- Programme Officer Archimede Sekamana, governmental, non-profit grassroots was an eye-opening experience for the organization, developed a street theatre development workers, who saw straight away project as a way of challenging stereotypes that the community ‘needed more support and discriminatory attitudes against the than just changing the mindset … you see

State of the World’s Minorities Africa 87 and Indigenous Peoples 2013 Case study continued mortality rates; and one of the eight in the region – again all in or post-conflict – with the highest young 16-year-old girls with babies, you see maternal mortality rates. It was one of only seven the needs, and you think “How can I help African countries where immunization coverage them?”’ declined between 1990 and 2010. YWCA staff began to search for ways to The year 2012 saw health emergencies such as respond. In January 2013, a pilot Young an outbreak of Ebola fever in Orientale province Women’s Action Club was set up in a Batwa and an ongoing cholera epidemic. community in Gitarama. Eighteen young HIV is also a serious issue, in part due to the Batwa women have received training in high incidence of sexual violence in conflict reproductive health and family planning, with areas. The DRC, one of UNAIDS’ 22 priority the aim of carrying out outreach work among countries, was reported to have achieved ‘slow other young women in the community. or no decline’ in new HIV infections among Batwa women have also been included children between 2009 and 2011 (MDG 6). in the YWCA’s programme for HIV- In October, Dr Denis Mukwege, founder positive women. Sekamana, describing the of Panzi Hospital in Bukavu, South Kivu, was initial outreach effort, said, ‘in the Batwa temporarily forced into exile after narrowly community, we asked them how many knew escaping an attack by armed men outside his about their (HIV) status. We realized that home. Dr Mukwege has become an international none had been to clinic or hospital to get spokesperson against conflict in the DRC over tested … we were looking for 50 women and the course of a career treating tens of thousands found 200.’ YWCA is now working on HIV of women victims of sexual violence. prevention education. Indigenous groups such as Batwa faced Fifty Batwa women have been incorporated difficulties with regard to health care; as conflict into a project helping them develop skills spread, discrimination and marginalization in handicrafts or small businesses. The made it particularly difficult for them to access programme was initially set up to support emergency humanitarian aid. children who had been orphaned in the genocide or whose parents were in prison on Upsurge in conflict genocide charges. Batwa children, without an In April members of the armed group authority figure to advocate for them, were National Council for the Defence of the often left out. Now the project is trying to People (CNDP), which had integrated into recruit young heads of households among the national army after a 2009 peace deal, Batwa families, such as those orphaned by mutinied. Some of them were led by Bosco HIV/AIDS. Ntaganda, against whom the ICC issued International donors have cut some of the arrest warrants in 2006 and 2012 for alleged aid that makes up 40 per cent of Rwanda’s crimes against humanity and war crimes. The budget in response to reports that the mutineers subsequently formed themselves into government is supporting the notorious M23 the armed group M23. rebels in neighbouring DRC, reports that In November M23 took the city of Goma Rwanda vehemently denies. in North Kivu, withdrawing in December to Meanwhile, quietly, groups like the begin negotiations with the DRC government in YWCA, which have shown an impressive Uganda. willingness to challenge their own mindsets as During the course of the year’s confrontations, well as those of their beneficiaries, continue both M23 rebels and army soldiers reportedly to make a genuine difference in the lives of committed mass violations and war crimes, extremely vulnerable people. ■ including summary execution and rape, against the civilian population. According to the UN and other sources, the M23 is directly backed by the Rwandan and

88 Africa State of the World’s Minorities and Indigenous Peoples 2013 Ugandan governments, although both reject these discrimination-and-a-lack- 9. Avert, ‘South Africa allegations. of-creativity-prevent-the- HIV and AIDS statistics’, eradication-of-tuberculosis/; retrieved June 2013, http:// In the security vacuum formed in eastern DRC Health Poverty Action, www.avert.org/south-africa- as some soldiers and police deserted to join the ‘The San people raise hiv-aids-statistics.htm; awareness of tuberculosis UNAIDS, South Africa M23 and the remainder focused on fighting ahead of World TB Day’, Country Progress Report the new threat, existing armed groups have 25 March 2013, retrieved 2012, retrieved June 2013, June 2013, http://www. http://www.unaids.org/en/ gained ground, at times carrying out ethnically healthpovertyaction.org/ Regionscountries/ motivated attacks in areas newly under their news/the-san-people-raise- Countries/SouthAfrica/ awareness-of-tuberculosis- control. ahead-of-world-tb-day/ The UN reported that at least 264 civilians were killed in more than 75 attacks on villages in Masisi, North Kivu between April and September. The attacks were said to have been committed along real or perceived ethnic lines, with the Democratic Forces for the Liberation of Rwanda (FDLR) and Mayi-Mayi Nyatura militia targeting civilians they considered to support the rival Mayi- Mayi Raia Mutomboki group, and the latter targeting ethnic Hutus they suspected of sympathizing with the FDLR. ■

Endnotes

1. Roeder, A., ‘Transforming Global Aids Response Ethiopia’s health care Progress Reporting 2012, system from the ground up’, Ministry of Health and Harvard School of Public Social Services, retrieved Health News, 29 August June 2013, http://www. 2012, retrieved June 2013: unaids.org/en/dataanalysis/ http://www.hsph.harvard. knowyourresponse/countr edu/news/features/ethiopia- yprogressreports/2012cou primary-care-health- ntries/ce_NA_Narrative_ conference-html/ Report[1].pdf

2. Ibid. 7. Open Society Foundation and Equitas, ‘Health and 3. Macro International, human rights in minority Ethiopia Atlas of Key communities: the Roma Demographic and Health and San’, in Health and Indicators, 2005, Calverton, Human Rights: A Resource MD, 2008, retrieved July Guide, retrieved June 2013: 2013, http://pdf.usaid.gov/ http://equalpartners.info/ pdf_docs/PNADM636.pdf Chapter6/ch6_TOC. html; see also Trading 4 Downie, T., The State of Economics, ‘Incidence of Public Heatlh in South tuberculosis in Namibia’, Sudan, Washington, DC, retrieved June 2013: http:// CSIS, 2012, p. 2. www.tradingeconomics. com/namibia/incidence-of- 5. Uganda AIDS Commission, tuberculosis-per-100-000- Global AIDS Response people-wb-data.html Progress Report – Uganda, April 2012, retrieved 8. Thomson Reuters June 2013, http://www. Foundation, ‘We must unaids.org/en/dataanalysis/ not let discrimination knowyourresponse/countr and a lack of creativity yprogressreports/2012cou prevent the eradication of ntries/ce_UG_Narrative_ TB’, 19 October 2012, Report[1].pdf retrieved June 2013: http:// www.trust.org/alertnet/ 6. Republic of Namibia, news/we-must-not-let-

State of the World’s Minorities Africa 89 and Indigenous Peoples 2013 Alaska (US)

CANADA

NORTH UNITED STATES PACIFIC

ATL ANTIC

OCEAN

CUBA Hawaiian Islands (US) MEXICO DOMINICAN REP. HAITI Puerto Rico (US) BELIZE JAMAICA GUATEMALA HONDURAS EL SALVADOR NICARAGUA

COSTA RICA VENEZUELA PANAMA GUYANA COLOMBIA Guyane (Fr.) SURINAM

ECUADOR

PERU BRAZIL

BOLIVIA

PARAGUAY

SOUTH CHILE URUGUAY PACIFIC ARGENTINA Americas Maurice Bryan he immense and socially diverse Right: A girl stands in a classroom in San Americas region has large populations Miguel, an African descendant community in T of mixed ethnicity. These include immi- Ecuador. Ivan Kashinsky/Panos. grants from European, Asian-Pacific and Middle Eastern countries. There are tens of millions of the survival chances of earlier generations of distinct indigenous and African descendant indigenous peoples across the hemisphere. peoples, some constituting more than 40 per cent of the total population of their countries. Regional health concerns It is the region with the world’s greatest A general lack of socio-economic and general income disparity. According to the Economic data disaggregated by both ethnicity and gender Commission for Latin America and the in most of the countries of the Americas, makes Caribbean (ECLAC) over 35 per cent of the total it difficult to draw really precise conclusions. population region-wide lived in poverty during Nonetheless, important similarities between 2011, with the ratio being considerably higher in indigenous peoples across the countries of Latin some countries. In 2012, indigenous and African America do exist, especially in the health sector. descendant populations continued to represent a In 2012, among the major basic health disproportionate number of the poorest people concerns for African descendant minorities and to experience the negative consequences and indigenous peoples – especially in Central of that reality on their overall well-being and and South American states – were continuing especially with regard to their health. high infant and maternal mortality numbers, According to the World Health Organization inadequate nutrition, a high incidence of (WHO) at least 125 million people region-wide diarrhoeal and respiratory diseases, as well as do not have access to health services. The very vector-borne diseases such as dengue fever and large population of indigenous peoples and malaria. African descendants in many states, however, In addition, during 2012 the effects of suggests that their health concerns should rank changing diet and life patterns among indigenous among the main national priorities. and African descendant people remained a source Nevertheless as a group, indigenous peoples in of concern for community leaders and public the Americas often have the worst health profiles. officials in both rural and urban areas of the This includes the highest rates of morbidity and continent.1 mortality, and the least access to health services This is with special reference to the rise in the compared to the rest of the population. Along incidence of non-communicable chronic diseases with African descendants they continue to be the such as diabetes, hypertension, cardiovascular most institutionally under-served. dysfunction and cancers (breast, colon and lung) During 2012, land loss, national population in these populations. Hitherto, these have tended growth, as well as the continued extension of to be associated with non-traditional mainstream agricultural, mining and energy generation urban industrial mass-consumption living initiatives – in Argentina, Bolivia, Brazil, Chile, patterns. However, health officials note that both Guatemala, Honduras, Mexico, Panama, Peru – the prevalence of diabetes and mortality are rising continued to represent serious threats to health higher in minority populations – in Mexico and and well-being, and in some cases even continued the USA – particularly among those who are less community survival. physically active, less educated and with lower This was very evident among groups living in income levels. remote areas and forest zones, including those Along with changing consumption patterns, in voluntary isolation in the Amazon rainforest. part of the disease rate rise (especially cancers) In addition to losing their traditional means of can also be attributed to increased exposure – livelihood, the voluntary isolationists remain both as residents and as workers – to toxins in particularly vulnerable to incoming diseases, mineral resource extraction and agro-industry to which they lack resistance. Historically such zones. situations have had notably negative effects on Factors such as inadequate working conditions,

92 Americas State of the World’s Minorities and Indigenous Peoples 2013 pesticide and toxic materials run-off, mining and a general reliance on subsistence economies effluent, diversion of water sources and pollution that are closely tied to natural cycles and weather of groundwater were all causes for concern patterns. among both community residents and health officials from Alaska to Argentina. Traditional remedies One result of historical and current Climate change marginalization has been the need and also the Adding to health and well-being challenges desire of these populations to retain a degree of during 2012 were environmental factors self-sufficiency in the area of health, through increasingly attributed to climate change. continued use of traditional methods of healing Unprecedented floods, droughts, and the melting and medication. In recent years the effectiveness of glaciers and Arctic perma-frost threatened and sound underlying curative principles of physical safety and food and nutrition security some traditional methods have been increasingly – and, by extension, overall health (in Bolivia, recognized by state health authorities across the Canada, Costa Rica, El Salvador, Guatemala, region. Honduras, Mexico, Peru, the United States). Apart from Cuba, Honduras and Venezuela Often this was linked to the remote, marginal – which make no legal allowances – most and rural locations of the vulnerable populations, regional states have taken steps to formally

State of the World’s Minorities Americas 93 and Indigenous Peoples 2013 recognize, validate and incorporate indigenous Organization’s Health of the Indigenous Peoples traditional medicine into mainstream health Initiative 16 years ago, mental health services services. This includes providing training designed for indigenous peoples’ special needs courses in traditional medicine to health have yet to be created.2 professionals and incorporating female In 2012 however, mental health issues within traditional birth attendants into the formal vulnerable African descendant and indigenous health system. communities continued to be of particular concern region-wide. This is especially as they Security issues relate to alcohol and substance abuse, chronic Of special concern also from a health perspective depression, intra-family violence, and the during 2012 was the ongoing high level of high suicide rates among young people in the public insecurity (Brazil, El Salvador, Guatemala, marginalized indigenous communities of Canada, Honduras, Mexico) as well as protracted armed the United States and the Mato Grosso region of confrontations (Colombia, Mexico). All too Brazil. frequently the zones affected are inhabited by indigenous and African descendant populations. Bolivia These conflicts continued to result in high In Bolivia, according to the national census some homicide and disappearance rates, as well as 71 per cent of the population is considered to firearm injuries – especially among young males. be indigenous. During 2012, resource extraction None of this was lessened by the continued and continued to be a major factor in national life, arguably still growing influence of human and affecting the economy and also the general health narcotics trafficking and other organized criminal of the population. activity on state institutions, sometimes affecting The US$2.642 billion Bolivia earned from judicial impartiality and other functions of state mining products in 2010 represented about 22 apparatus. per cent of the overall national GDP. However, When combined with extra-judicial killings according to the ECLAC the state spent just of rights defenders and journalists (Honduras, 4.8 per cent of GDP on health, one of the very Mexico) as well as corporate harassment lowest expenditures in the Americas region. The of peasant farmers and environmentalists limited expenditure means that some areas – (Colombia, Guatemala, Honduras, Mexico) the especially rural and indigenous – have no health threats these all pose to physical and especially clinics or access to doctors or nurses. mental health can be significant. Nevertheless, Bolivia’s historically marginalized This is true of rural areas as well as indigenous population makes up the bulk of the overcrowded low-income urban zones where approximately 79,000 employed – both formally marginalized indigenous and African descendant and informally – in the mining sector. Their populations tend to gravitate and sometimes health and well-being, therefore, are closely tied be predominant, and which are very prone to to these activities. exploitation by armed criminal gangs. Mining sector health is not related solely The constant feelings of public insecurity to extraction issues. It can also be influenced can contribute to high stress levels, anxiety and by social and political factors like the ongoing trauma. When combined with the range of socio- mine nationalization that began in 1952. In economic challenges it all can take a significant January 2011, the Bolivia government reported – and sometimes institutionally overlooked – toll 29 unresolved – and sometimes violent – on the mental health of these vulnerable groups. conflicts involving cooperative and unionized mining workers. According to BBC reports, Mental health one such dispute over ore access rights at the There is a notable lack of research on the mental recently nationalized Colquiri mine caused health of indigenous peoples; consequently injuries and death during 2012. Rival groups of statistics are virtually unavailable. Despite miners signed a deal that ended the clashes in the launching of the Pan-American Health September.

94 Americas State of the World’s Minorities and Indigenous Peoples 2013 Mining and community health male miners, these are also worked by indigenous In addition to unionized miners directly women and by adolescents and children. employed by the state-owned mining corporation, According to UNICEF, under-age miners COMIBOL, there are about 650 private constitute some 10 per cent of the total Bolivian cooperative mining groups nationwide, employing artisanal mining workforce. 75,000 people. In 2012 they helped make Bolivia Thousands of indigenous women and under- the world’s sixth largest producer of tin. age artisan miners work up to 14 hours a day With global tin prices at an all-time high, there on mountainsides and deep underground in is a boom in places such as Potosi and Huanuni extremes of heat and cold. Consequently, like in the department of Oruro. Critics claim the male miners, women and children in Bolivia tin rush is extracting a heavy toll on the health are also exposed to mining-related health risks, and social fabric of the community. Local sources especially silicosis. indicate that the population of Huanuni has now Women in the Bolivian mining areas are more than doubled from the 15,500 of just a sometimes doubly affected, by both health risks few years ago. This has prompted many changes as miners and the social consequences of any in the overall social and environmental health town becoming a mining boom town. situation – with special consequences to those Members of a local women’s support network local women who are dependent on wage-earning in Huanuni were especially concerned during males. The severe air pollution from mining and 2012 about the social effects of the boom on tin smelting can cause watery eyes and running indigenous women, particularly with respect noses after just three hours of exposure. The tin to the relationship between over-indulgence extraction tailings continue to be discharged into in alcohol and violence (physical, sexual, the nearby river, turning the waters black. psychological) against women. Given the long history of tin mining in the Government legal services do exist for victims Bolivian altiplano, a particular indigenous health of domestic violence and neither Bolivian law concern across many generations has been the nor authentic traditional indigenous culture effect of free crystalline silica. It is the most tolerate such behaviour. However, violence abundant compound in the earth’s crust and the against women is endemic. According to the most common element in the dust that Bolivian female doctors at the Huanuni health centre, mine workers inhale. around six cases of domestic violence are treated According to the International Labour each weekend – some with injuries that require Organization (ILO), prolonged silica exposure hospital attention. Sexually transmitted diseases, can produce silicosis. This is a respiratory ailment cervical cancer and AIDS are also evident among that can cause shortness of breath, coughs and the town’s indigenous female population. fevers within months, and significant impairment In a country where, according to the ECLAC, or death within a few years. Silica exposure is the maternal mortality rate is 190 per 100,000 also associated with an increased risk of fluid live births, the doctors are also concerned in the lungs, tuberculosis, lung cancer and about the health consequences of high teenage some autoimmune diseases such as rheumatoid pregnancy rates in the boom town. About half arthritis. The mining-related population spike occur among those under 15 years of age, with in Huanuni has not only increased the overall some 19-year-olds on their third pregnancy. spread risk of communicable pathogens such as According to the NGO Development and tuberculosis but also of socially related diseases Peace, during 2012, local environmental such as HIV and hepatitis (B and E). The rapid organizations succeeded in having the population boom has also created environmental government declare Huanuni an environmental health risks arising out of a surplus of rubbish, emergency zone. The government indicated which ends up in the local river. that it will promote plans, programmes and As well as large mining operations, there are projects to address the negative aspects – for the many small indigenous family-run zinc, silver and environment and the population – of the mining tin mines in the altiplano region. In addition to upsurge in the Huanuni area.

State of the World’s Minorities Americas 95 and Indigenous Peoples 2013 called Machai Juyai, known only to Kallawayas, Case study which is thought to date from the Inca era. Like other traditional healers from Andean region countries such as Ecuador and Peru, the Bolivia: Traditional Bolivian Kallawayas share a common worldview which is based on respect for Mother Earth healers and climate (Pachamama) and the need for humans to live in harmony with their environment. change Another manifestation of the overall Andean cosmovision, and one of the main tenets of the Kallawaya practice, is the ethic of ‘reciprocity’ As elsewhere in the indigenous Americas, there is or mutual exchange. This is considered to be a very significant distrust of formal mainstream equally applicable to people, communities and the medicine among Bolivia’s largely indigenous environment as a whole. Preventative measures population and a particularly strong preference and health maintenance are therefore based on the for traditional medicine. National surveys by idea that humanity must remain in balance with the Ministry of Health indicate that 60 per cent the environment. of Bolivians turn to natural prescriptions before Consequently, Kallawayas use various medicines going to a modern physician. This occurs even in and rituals to restore equilibrium to the person zones with some access to formal health services, and their environment, and thereby ensure such as southern Cochabamba, where over 55 per harmony between the two. cent of the population continues to prefer to use Bolivia’s Kallawayas traditionally live in the traditional medicine. province of Bautista Saavedra, north-east of During 2012, efforts continued to integrate the world’s highest lake – Lake Titicaca. This the practices of modern health professionals with region has a unique ecosystem situated at the those of traditional healers. interface between the high peaks of the Cordillera There are three main categories of traditional Apolobamba and the lowland semi-tropical healers: Hechiceros, yatiris and curanderos. climate of the Yungas. Hechiceros and yatiris deal primarily with mental The villages of the Cordillera Apolobamba disease and the environmental, psychological, constitute the heartland and home base of the social and cultural causes of disease. The centuries-old Kallawaya healing tradition and the hechiceros cure by joining the patients in a distinctive geography plays an important role in special ritual with members of their family and this. their community. Curanderos are the medical The mountains are considered to be the home practitioners who deal with physical disease and of spirits that protect those living near them. The specialize in herbal curing. communities are often located on the steep sides Of all traditional health care providers, the of the mountains and are usually divided into most renowned are kola-waya (‘he who carries three altitudes, each one growing certain crops medicines in his shoulders’). These travelling using terrace-style agriculture. healers are more commonly known as Kallawayas While the communities depend on the various and they journey extensively on foot all over agricultural zones for food and medicine, they also Bolivia as well as throughout Argentina, Chile, symbolize the structure of the human body. The Ecuador and Peru, reaching as far north as higher levels are thought to represent the head of Panama during the canal-building era of the early the human body, with the central and low levels 1900s. representing the trunk and legs respectively. This Villagers across the Andean area have a deep division governs daily life in the communities respect for their knowledge and skills. These and also underscores the complex interconnection are usually passed down through successive between the land, the communities and the people generations using a special esoteric language that live there – including the Kallawayas.

96 Americas State of the World’s Minorities and Indigenous Peoples 2013 Climate change have great symbolic meaning as well as practical However, ongoing changes in climate are now consequences for the lower-lying communities threatening the survival of traditional indigenous that make up the three levels of the human/ communities throughout the Andean region, cosmic body. and by extension the continuation of the art of Since Kallawaya healers see people as inherently Kallawaya healing. linked to the land, the rapid disappearance of the Many of the glaciers in the high Andes are now glaciers (located at the head) does not bode well rapidly melting, and many of these are located for the future of the body. in this Bautista Saavedra region. The changes are causing great concern to Kallawaya healers both Return and revitalization from a practical physical as well as metaphysical Although the Kallawaya healers are known to perspective. The melting high glaciers – once visit places as far distant as Panama, they regard considered a permanent part of the landscape – the villages around the Cordillera Apolobamba as their physical as well as spiritual home base. After their extensive travels it is important for them to return to Bautista Saavedra in order to maintain their farms and to ‘recharge their spiritual batteries’. However, the changes in climate are unprecedented in the thousand-year experience and legacy of the Kallawaya tradition. They claim the dry season is now longer and dryer, which makes the wet season much shorter. The river that runs past the villages is now almost dry. For Kallawaya healers, who depend on agricultural and herding activities, the dried- out river and the seasonal changes are especially threatening, both in terms of physical survival and of spiritual sustenance. In accordance with the integrated nature of the Kallawaya cosmovision, the decline of the environment is directly linked to a weakening of the physical and spiritual well-being of the communities that live there, including the crops they grow. They claim that the unpredictable and shorter seasons directly affect the quality of local agricultural products, which in turn has an impact on the art of healing since balance is central to sustaining overall spiritual and physical health and well- being. Local healers point out that in recent years the all-important potato harvests have been coming in earlier, and other crops are also being affected. Moreover, while the food may look and taste the same to those unconnected with the healing

Left: Kallawaya healer from Bolivia holds up a curative plant. REUTERS/David Mercado DM/VP.

State of the World’s Minorities Americas 97 and Indigenous Peoples 2013 Case study continued Brazil During 2012, violent disputes continued on tradition, Kallawayas are concerned that the ancestral lands claimed by indigenous peoples in environmental imbalance is causing a loss the state of Mato Grosso do Sul in south-west of key vital forces, thereby diminishing the Brazil. It is home to some 44,000 Guaraní- spiritual content of the food itself. These Kaiowá, the second largest indigenous group in vital forces they hold to be important in Brazil. maintaining the spiritual energy of their According to local media, having grown weary communities and, by extension, their own of being encamped along the roadsides waiting personal spiritual vitality. for the Brazilian government to demarcate their There are other social factors that ancestral territory, the indigenous Guaraní- Kallawaya view as being detrimental to the Kaiowá community of Pyelito Kue/Mbarakay overall equation. The crop cycle changes occupied a small part of their lands, which and overall environmental degradation had been taken over by large-scale farmers and have added to the contemporary lure ranchers. When ordered by the court to leave of urbanization that is causing many in October, the Guaraní publicly threatened to young people to abandon the hillside engage in mass suicide to protest their continuing communities to seek education and work dispossession. in the cities. Houses are left to crumble The threat attracted global attention and and the thousand-year-old mountain highlighted the worsening conflicts over the terraces in the high Andes left untended, ongoing invasion and occupation of indigenous further diminishing the chances of cultural territories in Brazil. For over a decade expanding continuity. cattle ranches and the agro-industrial cultivation The overall reduction of human and of Brazil’s two major biofuel-related export crops environmental energy on which the have pitted indigenous groups against landholders Kallawayas depend for the effectiveness of in the Matto Grosso region on the Brazil– their healing rituals and ceremonies means Paraguay border. the ability to carry on their work is also Indigenous efforts to regain their dispossessed at risk. This is threatening the legacy of territories include occupations and there have healing knowledge and practices as well been armed confrontations with landholders. The as the ancient and vital art of Kallawaya continuing armed attacks by local landowners, healing itself – which in 2008 was included coupled with the October 2012 court ordered by UNESCO as a Representative of the eviction, prompted 30 Pyelito Kue Kaiowá Intangible Cultural Heritage of Humanity. community families to announce their ‘collective Such a disappearance would mark the loss death’ if they were driven off the land. not only of a very important and cherished For over a week between late October cultural tradition but also the curtailment and early November 2012, activists in Brazil of a highly regarded source of health care mobilized protests in support of Guaraní- for thousands of indigenous people all Kaiowá resistance in several of the main cities. across the countries of the Andean region Street demonstrations were also mobilized who continue to depend on the travelling internationally, including protests in Germany, Kallawaya healers for their physical and Portugal and the United States. spiritual health and well-being. ■ Faced with the growing and very public local and international clamour, the Brazilian government ordered the court ruling revoked. This allowed the Pyelito Kue Kaiowá families to stay where they were until the demarcation process is completed. The Brazilian government has recognized indigenous rights to 9,317 hectares of

98 Americas State of the World’s Minorities and Indigenous Peoples 2013 Guaraní-Kaiowá community territory since Boycotts 2005, however actual possession has been delayed In an effort to stop transnational corporations by litigation and negotiations on landholder from purchasing commodities from estates compensation. Since 1991, only eight reserves illegally located on disputed indigenous lands, have been formally approved. the Brazilian NGO Repórter Brasil launched The ongoing delay has left the way open for an international boycott campaign. However, takeovers by those seeking to enlarge their landed evidence suggests that companies will continue estates. Moreover, the state government has buying these products as long as they think estate strongly supported agribusiness. This has only holders are not legally compelled to relinquish served to sharpen the conflict. the occupied lands. According to a study by the Brazilian NGO During 2012, the federal government promised Repórter Brasil, the expansion is partly fuelled by to speed up the demarcation process; however rising international commodity prices for crops farmers and ranchers continue to demand such as soy beans or sugarcane. This is prompting economic compensation for having to vacate an increase in demand for arable land, which indigenous territory. then leads to more communities being forced off their territories. Belo Monte During 2012, protests continued in efforts Land and health to halt construction of the controversial Belo Given the importance of land to indigenous Monte dam, which is the largest in a number cultural survival and mental health, the ongoing of contested energy expansion projects on dispossession is taking a heavy toll. According indigenous territory in Brazil. Actions included to the Catholic Indigenous Missionary Council a 21-day occupation of the site in late June and (CIMI), the rates of malnutrition, suicide and in July. Indigenous activists detained and later violence in Guaraní-Kaiowá communities are released three of the building engineers. extremely high. Of enormous significance to Belo Monte The Kaiowá are a nomadic people who have protesters and critics was the unanimous legal traditionally migrated in search of ‘the land decision to cease all project construction issued without evil’ and there is a significant history by Brazil’s federal regional tribunal of the first of suicide, particularly among young people, in region (TRF-1) on 14 August 2012. Judges cited Kaiowá and other Guaraní groups. A total of 555 the lack of prior consultation with indigenous suicides between 2003 and 2010 in Mato Grosso peoples affected by the massive hydroelectric indicates a suicide rate of nearly 80 a year (out of project. The August ruling upheld an earlier a population of 44,000 Guaraní-Kaiowá in the 2005 court decision. region). Nevertheless in late August 2012, in response Additional health concerns are directly to a complaint filed by the government, the connected to the large-scale agro-industry, Chief Justice of the Brazilian Supreme Court including the intensive use of pesticides in overturned the suspension, arguing that stopping the Guaraní-Kaiowá areas. This aggravates construction of the dam would cause social and the destruction of rivers and forests that have economic chaos, including the dismissal of some traditionally represented indigenous hunting and 14,000 workers. Construction resumed almost fishing food survival sources. immediately. The Federal Public Prosecutor’s Although the working conditions on large Office appealed the decision and demanded estates or in sugarcane ethanol biofuel plants a review by the Supreme Court. A further are less than ideal, the increasing move towards large-scale occupation took place in October, agricultural mechanization in Brazil and the temporarily halting construction. In November, use of toxic chemicals is reducing even these the Brazilian National Development Bank employment opportunities for indigenous peoples. (BNDES) announced a loan of approximately For many, dependence on government assistance US$11 billion towards the construction project; is the only other available income option. a first disbursement was made in January 2013,

State of the World’s Minorities Americas 99 and Indigenous Peoples 2013 despite the ongoing legal process. and agribusiness expansion, the latest round of Indigenous groups have protested the giant displacement and rights violations is linked to Belo Monte dam project on the Xingu River, the rapid expansion of the mining sector in the claiming that it would pose a great risk to their Colombian economy – including illegal gold health and well-being. In addition to being a mining. source of their livelihood and sustenance they regard the Xingu River as a living entity. Mining fever Colombia is now a major international producer Colombia of coal, nickel and gold. According to the In an effort to end the long-running internal Ministry of Mines and Energy, about 4 per cent conflict, at the end of 2012 the Revolutionary of the national territory has been leased out for Armed Forces of Colombia (FARC) began mining concessions. Moreover there is a pending formal peace negotiations with the Colombian backlog of 20,000 unprocessed title requests that government in Cuba. This is to be followed by cover approximately 20 per cent of Colombia’s talks between the government and another major overall land area. Many of the sought-after insurgents’ group, the National Liberation Army concessions affect indigenous and Afro- (ELN). descendant lands, which combined constitute a Nevertheless, indigenous and Afro-Colombian total of 91 million acres (or 37 million hectares). activists report that while military combat may According to ECLAC data, the mining and have lessened, Colombia’s various far-right petroleum sectors provided almost 50 per cent paramilitary ‘gangs’ continued to operate and of the country’s total exports (US$8 billion) in expand in their regions, even while the presence 2010. However, this sector, with its multiple of other armed groups was diminishing. social and environmental questions, contributed During 2012, Afro-Colombians and just 6 per cent to the total GDP in a country that indigenous peoples continued to be removed spends 7.6 per cent of its GDP on health. and dispossessed of their ancestral lands by The Colombian NGO Dejusticia argues that these paramilitary entities. Instead of conflict the country is undertaking mining with very little

100 Americas State of the World’s Minorities and Indigenous Peoples 2013 Left: An indigenous man participates in a pro- pits of contaminated water. These areas contain test against the construction of the Belo Monte highly toxic chemicals such as mercury. hydroelectric plant in Brazil. REUTERS/ In addition to land conflicts between armed Ueslei Marcelino. entities and the respective communities, during 2012 the limited state presence in remote regard for the enormous social and environmental areas also encouraged violent disputes among costs to the nation, and especially to indigenous the various paramilitary factions themselves, and Afro-descendant communities. as well as between private investors, guerrillas, The UN refugee agency UNHCR has narcotics producers and the military, who are all cautioned that the rapid expansion of mining increasingly interested in gold speculation. directly threatens the territorial rights, overall According to local MRG partner health and economic well-being of indigenous CIMARRON (the Movimiento Nacional por and Afro-Colombian communities, who make up los Derechos Humanos de las Communidades over 30 per cent of the national population. Afrocolombianos ), community members are Mining in proximity to their lands has greatly often threatened with expulsion and violence increased the risk of related health hazards. These if they resist encroachment. Moreover there is range from environmental problems to deaths frequently an overlap of areas where displacement and injuries due to title disputes and forced has occurred and where mining licences have displacement by encroachers. been applied for or granted. At issue is the fact that although some As well as gold exploitation the increase of territories in question may be legally titled to open-pit coal mining in Colombia also had an the respective communities, under Colombia’s effect on the well-being and health of Afro- 1991 Constitution the state retains the sub-soil Colombian and indigenous communities. rights for mineral and petroleum resources, which In February 2012 a protest over pollution officials can allocate as they choose. caused by the massive coal mining in the north- In May 2011 a newly introduced Mining eastern Colombian zone of El Cesar blocked the Code (Law 1382) was challenged by Colombia’s railroad used to carry trainloads of coal to the Constitutional Court. It had excluded the port of Santa Marta. constitutionally guaranteed right to prior and El Cesar sub-soil coal mining required the informed consent regarding any activities removal and relocation of the Afro-Colombian occurring on indigenous and Afro-Colombian population from their ancestral territory to other territories. The government then proposed areas. This included an obligation to provide amendments before re-tabling the legislation. new housing and public services – including The new draft favoured large – mostly foreign – schools. The residents complained there had mining companies and allowed already protected been no prior consultations on the mining environmental and ethnic territories to be used initiative, and coal mining had destroyed vast for strategic mining projects. areas of productive land as well as the region’s About half of the gold produced in Colombia Calenturitas River. Moreover, the companies is extracted by small-scale and artisan miners had not fulfilled the obligations to relocate their and increasingly also by illegal prospectors. populations and provide basic amenities. During 2012 incursions onto ancestral areas by Likewise in La Guajira, the indigenous Wayúu individuals bent on illicit gold mining generated community protested during 2012 over large- tensions in the Amazon as well as the southern scale coal mining occurring at the giant open-pit Pacific coast region near the border with facility at El Cerrejón, which exports over 30 Ecuador. million tonnes of coal annually. Indigenous and Afro-Colombian communities Apart from not having consented to mining complain that illegal miners ravage the jungle on their territory, the main reason for the El earth to get at the gold. Then they move on, Cerrejón protests is the resulting poor air quality, leaving behind a series of polluted wastelands the which causes respiratory health problems. They size of football fields, littered with slag heaps and also claim that the groundwater in their springs

State of the World’s Minorities Americas 101 and Indigenous Peoples 2013 and wells is now contaminated, and that there Right: Q’eqchi’ Maya girl holding her baby have been soil and forest losses. This is partly sister, Guatemala. Sean Sprague/Panos. connected to the reality that mining 1 tonne of coal leaves behind 10 tonnes of slag and waste the state acknowledge, respect and promote the materials that continue to leach into rivers and development of traditional medicine, monitor its the ground. application and legally control the operation of traditional medical practitioners. Ecuador This includes the right to the protection of Although health services continue to improve, ritual and sacred places, plants, animals, minerals the access to mainstream health care by and ecosystems of interest from the point of view Ecuador’s indigenous populations still presents of traditional medicine. challenges – especially for rural populations Unlike other Andean countries, there are in the Andean and the Amazon regions. This no specific programmes in Ecuador linking includes lack of available health centres in or near traditional with formal mainstream medicine. indigenous communities, and inadequate access Nevertheless, the state has been focusing to medication. According to the Pan-American more attention on official linkages including Health Organization (PAHO), Ecuador’s health conducting courses for indigenous traditional services are concentrated in urban centres while birth attendants. indigenous and Afro-Ecuadorian communities are often isolated and sometimes only accessible Amazon headache by boat or forest and mountain footpaths. This In Ecuador, health issues that affect indigenous makes emergency care almost impossible. peoples can sometimes be linked directly to the economic sector. This is no more evident than in Traditional medicine zones with resource extraction in the Ecuadorian Some indigenous Ecuadorians are unwilling Amazon and in the long-running legal drama to make use of the services that actually exist. connected with the giant Chevron-Texaco oil According to researchers, indigenous Ecuadorians spill. in the Andean region regard health in the After 19 years of litigation, in October 2012, context of harmony between body, mind and the US Supreme Court rejected a bid by Chevron environment. Under these circumstances they to reverse a negative appeals court decision earlier are much more likely to place greater confidence in the year. In January, the 2nd US Circuit in their communities’ own traditional medical Court of Appeals in New York had overturned practitioners and use them as their first option.3 an earlier ban on enforcement of an Ecuadorian According to WHO studies, during such decision against the company. Meanwhile, consultations the traditional healer will usually damages in the case were increased to US$19 determine whether the illness requires therapy by billion by the Ecuadorian judiciary. The suit was rituals and ceremony and traditional medicines or originally filed nearly two decades ago on behalf a visit to the ‘hospital doctor’. of 30,000 indigenous and mestizo plaintiffs from Traditional medicine practitioners in Ecuador some 80 Amazon communities. are unregistered and there is no licensing Substantial evidence – including thousands of procedure; however associations of indigenous contamination samples taken by the company – practitioners exist at regional and local levels. prove that Texaco (which Chevron absorbed in According to the WHO, up to the early 2001) was responsible for significant pollution 1990s, Ecuadorian law limited the practice of and environmental devastation in the rainforest medicine only to persons holding qualifications of north-eastern Ecuador (see SWM 2012 for from the University of Ecuador. Under the more details of the case). new more culturally inclusive Constitution, From the human perspective, this seriously however, recognition and regulation of affected the economic and cultural base of the traditional indigenous medicine came into force local indigenous communities, and especially in August 1998. Included are stipulations that their immediate and long-term well-being and

102 Americas State of the World’s Minorities and Indigenous Peoples 2013 health. The levels of hydrocarbon concentrations US$600 million for clean-up of groundwater. in some streams was as much as 280 times higher By year’s end, the plaintiffs were seeking than European Union permitted levels. enforcement in jurisdictions where Chevron does According to sworn statements filed by the business. plaintiffs, some residents contracted skin rashes Meanwhile, with the case still not settled and while others experienced vomiting and fainting. the health problems ongoing, Amazon indigenous They also claim children have died from communities continued to see multinational unknowingly drinking contaminated river water. hydrocarbon prospectors cut through their Studies have detailed the impact of oil ancestral lands in search of the vast petroleum development on the health of people in the resources. Ecuadorian Amazon. There is a higher risk of In December 2012, the Ecuadorian health problems developing among residents who government launched an international bidding live near oil fields. Based on national population process for large-scale oil exploitation in characteristics, higher than expected cancer rates Ecuador’s south-east Amazon region. According have been found in the oil-producing village of to indigenous leaders, most of this lies within San Carlos. ancestral territories of Achuar, Shuar, Huaorani, In another study published in the International Kichwa, Shiwiar and Záparo indigenous Journal of Occupational and Environmental communities. Health, a connection was found between higher spontaneous abortion rates and living in the Guatemala proximity of hydrocarbon-contaminated water Guatemala has an overall population of 15 streams. million, of which close to 40 per cent identify as In the original decision, the Ecuadorian judge indigenous according to official statistics. This allocated nearly US$1.4 billion for health care. includes Maya, Garifuna and Xinca peoples. In addition, US$800 million is to be used for However, indigenous rights activists put the establishing a long-term health fund, US$5.4 indigenous figure closer to 61 per cent – a billion is to be used for soil restoration and majority. Seventy-five per cent of indigenous

State of the World’s Minorities Americas 103 and Indigenous Peoples 2013 Guatemalans live in rural areas, and studies point infection among indigenous women. This is to a close relationship between location, poverty, partly because most indigenous women still ethnicity and poor health. cook and heat with firewood rather than gas or Fifty-four per cent of Guatemala’s population electricity. Most houses lack adequate ventilation lives in poverty and 13 per cent in extreme systems. Only 4 out of every 100 indigenous poverty. According to the ECLAC, the per capita houses had electricity in 2010 compared to 94 GDP in 2011 was US$2,303.90. Of that, the per cent of all urban households. Like the hauling state spent 6.9 per cent on health. In real terms of water, having to carry heavy bundles of fuel this puts Guatemala among the countries with wood over long distances also contributes to the very lowest expenditure on health in the muscle strains and back problems. Americas. Moreover, health resources remain concentrated in urban centres even though 60 Health and income per cent of the total national population lives in The issues of poverty and health have strong rural departments. links to income levels. In Guatemala, half of Studies by the PAHO, have found that the the indigenous population (nearly 5 million) rural departments with the highest concentrations continues to be employed in low wage- of indigenous peoples display the greatest poverty agriculture. and extreme poverty indicators, and the poorest In 2012, Maya K’iche’ activist groups such as health figures. According to the 2011 national Waxaquib Noj indicated that, along with poor survey of living conditions, the overall Guatemala pay, the working conditions endured by rural health profile is among the very worst in the indigenous people continued to leave much to western hemisphere. be desired. During the export-oriented coffee or cane harvests, workers live in rough shacks or Painful realities sheds and sleep crowded together on the floor. In 2012, many indigenous communities still These crowded living conditions aid the spread lacked access to clean water, adequate sewerage of communicable diseases, particularly respiratory systems, electricity and paved roads. According to infections such as the often lethal tuberculosis. the PAHO, less than six per cent of indigenous Many rural indigenous people survive communities had access to drinkable water.4 tenuously on subsistence farming. Rural To compound the problem, according to the indigenous women are usually responsible for ECLAC in 2010 only 15.4 per cent of mostly farming communal holdings. indigenous rural households had a sewerage A historical pattern of – sometimes forcible – connections compared to 68.4 per cent of mostly land dispossession for agro-industry is a major non-indigenous urban households. According to factor in the continuing disparity between INCAP, 79 per cent of indigenous people still the indigenous population and the rest of used outdoor toilets.5 Guatemalan society. It is clearly reflected in the Health professionals conclude that the high area of food sovereignty and health. incidence of diarrhoea and other intestinal During 2012, the Guatemalan Coordinating problems among Guatemala’s indigenous Committee of NGOs and Cooperatives majority is directly related to the poor quality (CONGCOOP) pointed out that over the last of water supply and sanitation in indigenous 22 years, the expansion of officially promoted communities. export-oriented monoculture agro-industry The PAHO indicates that among multiple and extractive enterprises have forced many implications of this for female health is that rural families to sell their plots of land, leaving carrying heavy loads of water over long distances them hemmed in on all sides by African palm places strains on women’s musculo-skeletal plantations and polluted water sources. systems. In addition, unsafe water means their The National Institute for Agrarian and Rural families are more prone to intestinal and bacteria- Studies in Guatemala City estimates that between borne diseases. 2005 and 2010 the area of Guatemala given over There is also a high incidence of respiratory to palm oil plantations increased by 146 per

104 Americas State of the World’s Minorities and Indigenous Peoples 2013 cent. As reported in SWM 2012, much of the between the majority indigenous Maya land acquisition was conducted under arguably population and the rest of the society – questionable circumstances. including in the area of health – is racism and Studies by the PAHO indicate that the discrimination. According to the Guatemala limited access to land for indigenous female- Times, a November 2012 study conducted by headed households in Guatemala – coupled in a government commission and a local NGO recent years with unprecedented droughts and on workplace discrimination and racism found floods – is largely responsible for a significant that more than half of the business owners malnutrition problem among Guatemala’s interviewed admitted paying indigenous people indigenous Maya children and women, leaving less for their services. them more vulnerable to illness. In the various types of urban work where According to the PAHO the prevalence of indigenous Maya women are employed they chronic malnutrition among indigenous Maya often suffer physical and sexual abuse while children aged five and under was 58.6 per cent in receiving just 43 per cent of men’s wages. 2008–2009, almost twice the 30.6 per cent rate Indigenous women’s long working hours, of non-indigenous children. combined with their multiple tasks in relation to domestic responsibilities, can result in chronic Reforms fail fatigue, high stress levels, headaches and frequent Despite earlier government assurances of change, colds, as well as other symptoms. in late November 2012 an ‘integral rural development law’ to promote access to land, clean Unhealthy trends water, soil conservation, food security, financial While indigenous people in urban areas may services, employment and other rights for small have better access to health services the opposite rural farmers was once again defeated in Congress. holds in rural zones where indigenous Maya According to IPS News, the bill was defeated due populations numerically predominate. to fierce opposition from large landholders and At the primary level of care indigenous their Chamber of Agriculture, who see it as an people must depend on rural health personnel. unwelcome attempt at land reform. Travelling physician visits are infrequent. In Eighty per cent of Guatemala’s fertile land these rural departments most indigenous Maya now lies in the hands of barely 5 per cent of the communities are remotely located and lack population, according to the United Nations transport services. Getting to a clinic from an Development Programme (UNDP). Meanwhile isolated village can sometimes entail a sun-baked 80 per cent of the overwhelmingly indigenous four-hour walk. Mayan rural dwellers who represent some 61 per Even when indigenous people do have access cent of the total population remain poor and to health centres the service is less than ideal. landless. Among the main problems – besides poverty – are ethnic and class discrimination. This Urban indigenous health especially affects indigenous women, many of In urban areas the majority of indigenous people whom steadfastly continue to wear traditional are either self-employed in the informal sector Mayan clothing.6 or run small businesses. Large numbers of In a society that favours a mainstream Latino indigenous peoples are employed by the export- culture, activists point out that many indigenous processing factories known as maquilas, where Maya women complain about poor treatment women make up 80–90 per cent of the labour by health personnel and/or of not being force, with 54 per cent being between the ages understood. Indigenous women cite language of 15 and 25. Most of this urban employment is barriers as a primary problem. Forty per cent of low income, demands long working hours and Guatemala’s indigenous population speaks one does not provide access to any health insurance, of 20 Mayan languages and many patients do social security or legislative protection. not speak Spanish. The majority of state health A significant factor in the issue of disparity workers do not speak or understand indigenous

State of the World’s Minorities Americas 105 and Indigenous Peoples 2013 Mayan languages. the PAHO about 75 per cent of births in rural This means some indigenous Maya women areas occur in the home, often in poor hygienic are often unable to adequately describe their conditions with women preferring the services of symptoms or understand medical instructions traditional midwives (comadronas). Unlike purely from health staff. The researchers point out clinical approaches, traditional birth attendants that this creates barriers and ill will between the incorporate traditional beliefs and medicinal indigenous community and the health centre, plants (e.g. sedative grasses) in their work. This preventing other indigenous people from seeking preserves a connection with the natural and clinical health care in the future. supernatural worlds and even the patient’s own According to the WHO, one notable standing in the community. complaint by indigenous patients is that most This is one reason why indigenous Maya western-oriented services ignore the spiritual women in Guatemala – as in other indigenous and mental side of physical ailments and general communities of Latin America – tend to health care. Consequently indigenous Maya exhaust all traditional therapies before seeking communities continue to use traditional ancestral conventional treatment. Nevertheless, some medicines and health specialists to meet most of traditional midwives lack the training needed their health care needs. to deal with complicated pregnancies and their methods may risk endangering women’s lives. Cultural disconnects ECLAC data indicates that the Guatemala National Ministry of Public Health surveys maternal mortality rate of 280 deaths per have revealed that some symptoms attached 100,000 live births (in 2010) is nearly 300 to illnesses have no explanation within the per cent higher than the regional norm of 81. concepts of conventional mainstream medicine. Moreover, within indigenous communities, the However, they are a functional part of the PAHO estimates the rate to be even higher. In Mayan indigenous health system of Räxk´aslemal 2000, the main causes of maternal death were (fullness of life). This is characterized by a search haemorrhage (53.3 per cent), infection (14.4 per for harmonization and balance and includes cent) and hypertension (12.1 per cent). perceptions of life and death that may differ from There have been officially noted concerns over western philosophical traditions. traditional midwife practices and their links to Many indigenous women who have given high levels of maternal mortality in rural areas. birth in hospitals have complained about the However, perhaps even more important is the poor institutional care they have received. This very close link to poor nutrition and poor pre- includes feeling abandoned. Women prefer giving natal care. According to the PAHO, about 65 birth at home where they have a higher chance per cent of Guatemalan women do not have of obtaining family and community psychosocial prenatal check-ups. The lack of medical care support. during pregnancy and birth has permanent health consequences for undernourished indigenous Guatemalan traditional medicine women including anaemia, and otherwise The principal traditional medicine specialists, preventable genital and urinary infections. On such as bonesetters, herbalists and massage the other hand, indigenous women also claim therapists, use a variety of medicinal plants, that health personnel treat both traditional flowers, roots and tree barks, and also make birth attendants and their patients as inferiors, use of animal fats, bones, skins and oils. As and often do not provide the comadronas with elsewhere in the Americas, traditional Mayan sufficient equipment or training. The sum total medicine is learned through apprenticeships, is that most cases seen by modern doctors are practice, observation, psychological readings and already in advanced stages of complication, often intuition. The collected knowledge and wisdom beyond prevention and frequently incurable. is transmitted orally across several generations Traditional medicine is recognized by usually within families. Guatemala’s Constitution as well as by the Birth attendants are crucial. According to Acuerdos de Paz (Peace accords) that followed

106 Americas State of the World’s Minorities and Indigenous Peoples 2013 the intensely violent (and arguably genocidal) economic and political marginalization of the 1978–85 civil war. It guaranteed compliance with respective populations. the UN ILO Convention No. 169 on indigenous In addition, access to formal health services peoples’ rights.7 and institutions by the majority of the rural Since 1996, the Ministry of Health has been indigenous population in Panama is limited. training midwives in safe birthing techniques. This is partly due to the dispersed nature of Courses in traditional medicine are also available the population and the distance between their for non-indigenous health professionals through communities and the nearest medical services. the Public Health Ministry. In some areas, indigenous people need to walk between three and five days to get to a health Panama centre and there is no guarantee there will be According to the ECLAC, 68.7 per cent of personnel or medicines on hand. Language is Panama’s population are urban dwellers. With a also a significant factor. Many poor indigenous per capita GDP of US$7,265 in 2011, of which families are headed by monolingual non-Spanish- 8.1 per cent was spent on health, Panama ranks speaking parents who are also non-literate. among the most developed societies in Latin America. Health care initiative However, Panama’s wealth is concentrated in In September 2011 Panama received a loan of the main urban areas. The urban poverty rate about US$50 million from the Inter-American in 2011 was 15.5 per cent with 4.7 per cent in Development Bank (IDB) to reorganize its extreme poverty. In contrast, the rural poverty primary health care system and improve figure was 43.6 per cent with 26.8 per cent in maternal, neonatal and chronic disease care. an extreme condition. The majority of Panama’s The loan is aimed at improving services in indigenous people live in the under-served nutrition, reproductive health and dental care. peripheral rural zones of the country. It is intended to help reduce maternal and infant mortality rates as well as the prevalence Indigenous groups of chronic malnutrition among children The three main indigenous groups are Ngöbe- under the age of 5. It remains to be seen what Buglé (sometimes called Guaymís), Kuna and effect this investment will eventually have in Embera-Wounan (Darienitas or Chocós). Of improving health conditions of rural indigenous these Ngöbe-Buglé account for almost two-thirds communities. of the 200,000 indigenous population, with Kuna being the second largest group. Privatization moves Half of all indigenous children suffer from In an effort to raise revenue to repay international malnutrition, while only 10 per cent of non- debts and stimulate development, during the indigenous children are undernourished, past two decades Panama has been engaged in according to the PAHO. Infant mortality among an aggressive programme of privatizations. In Panama’s indigenous population is approximately October 2012, the government put into effect 40 to 50 children for every 1,000 live births. In a plan to sell off state-owned lands in the Free stark contrast the national average is 19, which Trade Zone of Colón, which has a large Afro- is considered a very positive ratio for Latin Panamanian population. American countries. The huge difference is Free Trade Zone businesses are a major source another expression both of income concentration of employment in the otherwise depressed area, and the public policy towards the country’s and during 2012 Colón residents picketed and indigenous population. street-marched for months to protest the planned Housing problems and lack of basic services sale. They argued that the land sale in the biggest such as potable water and sanitation promote duty-free zone in Latin America would cost jobs, diseases including diarrhoea, typhus and other cut incomes and deconstruct the largely Afro- health problems. These affect mostly indigenous Panamanian community. children, and are directly connected to the social, The actual passage of the new law in October

State of the World’s Minorities Americas 107 and Indigenous Peoples 2013 led to a sharp escalation of marches, and street many detained. blockages. Security forces answered with tear gas, Finally, in March 2012, elected Ngöbe-Buglé bird shot and rubber bullets. According to local leaders and Panama government officials reached media sources, three people were killed in the a new agreement. All mining was banned in clashes. Ngöbe-Buglé territory. The agreement also Protesters argued that the land sale was an requires community consent for any hydro- inadequate solution to raising additional revenue electric projects via referendum vote. to pay for large national projects whose economic Nevertheless, a dissenting group of Ngöbe- benefits largely bypass Colón’s economically Buglé resumed street protests in opposition to depressed and marginalized Afro-Panamanian the agreement, particularly regarding permits for and indigenous populations. hydroelectric projects. According to AFP wire Among residents’ complaints during the service, the Ngöbe-Buglé General Congress, protest were that some Colón communities had which represents the traditional indigenous not had access to water facilities for months, leadership, does not recognize indigenous leaders thereby raising the risk of gastrointestinal formally elected under government rules. Ngöbe- and other infections. Following the adverse Buglé traditionalists continue to reject all hydro- international publicity and the protesters’ refusal electric projects in their territory for economic to enter a dialogue unless the new legislation and cultural as well as health reasons. was repealed, in October Panama’s President They argue that the Barro Blanco hydro- Ricardo Martinelli said he would scrap the land electric dam, when completed, will flood Ngöbé sale plans. Instead, according to BBC News, communities along the Tabasara River. Places commercial rents would be increased and the at risk include schools, cemeteries, cultural sites money reinvested in the area, as protesters had and rich fertile farmlands. They also cite health been demanding. risks. The president of the Indigenous M-10 The protest and deaths in Colón were just one (Movimento 10 de Abril) protest movement in a string of incidents across Panama during especially argues the project will change the 2012 where police were accused of using excessive currently fast-flowing fish-filled Tabasara River force to disperse demonstrations over social and into an expanse of still water ideal for breeding economic policies that have a potentially negative disease-carrying mosquitoes in a country long effect on the health and well-being of minority noted for a high incidence of malaria and yellow and indigenous communities. fever and in an area with inadequate health Over the past year and a half, indigenous services. Ngöbe-Buglé have also relentlessly fought for According to a UN report, some of the sites to their right to free, prior and informed consent be flooded are of significant cultural and religious concerning the growing number of mining and value. This includes ancient boulders carved hydroelectric projects on their lands. They too with petroglyphs that were the key to recreating have been met with serious force from the police. the Buglé written language, and led to a revival Opposition to governments plans first of indigenous culture in the area. Indigenous prompted blockades of the Pan-American activists across the Americas argue that such Highway during February 2012. These cost religious and cultural disruptions, which have several lives, but forced an agreement that now continued for several generations, are among prohibited mining and hydroelectric power the main contributors to the ongoing mental projects in their territory (comarca) located on the health issues that continue to affect aboriginal north-west coast, bordering Costa Rica. communities from Alaska to Argentina. However – in what critics see as a familiar pattern – the government backtracked and in Peru February 2012 the Ngöbe-Buglé community Despite steady economic growth during recent resumed their protests to again force the years, health investment in Peru remains among government to negotiate. Two people were the lowest in Latin America. According to killed by security forces, dozens injured and the ECLAC, Peru had a per capita GDP of

108 Americas State of the World’s Minorities and Indigenous Peoples 2013 according to Garifuna community health care Case study pioneer Dr Luther Castillo, it opened the way for some young Garifuna to also become health professionals. Given the low per capita Honduras: income and a national history of ethno-racial discrimination a career in medicine had always first Garifuna seemed too remote a possibility. Although founded in 1847, the School community of Medicine of the National Autonomous University of Honduras (Universidad Nacional hospital offers Autónoma de Honduras, UNAH) did not graduate the first Garifuna doctor until 1962. alternative model Since then, high costs, social marginalization and the difficulty in gaining admission had ensured for community- that the dream of pursuing a medical career would continue to elude the majority of Garifuna based health care high school graduates. delivery Latin American School of Medicine The chance for change came with the 1998 establishment in Cuba of the Latin American The approximately 700,000 African- School of Medicine (Escuela Latinoamericana de descendant Garifuna community in Medicina, ELAM). ELAM then also initiated a Honduras represents nearly 10 per cent of the scholarship programme to train several thousand country’s total population. doctors from Latin America, Africa and Asia. As According to ECLAC, the per capita a result, by 2012 11 Garifuna medical students GDP in Honduras was US$1,519 in 2011. had become doctors This is more than had ever Consequently, the 6.8 per cent of GDP the graduated in the entire 115-year history of the state allocated for health care was not likely UNAH, and new classes were being trained at the to go very far. The limited expenditure ELAM during 2012. meant that during 2012 Garifuna medical professionals needed to continue their Student work brigades efforts to develop and finance their own Among the earliest graduates was Garifuna community-based health care delivery system. community health pioneer Dr Luther Castillo, Their initiative has links with the who was in the very first ELAM graduating class devastating Hurricane Mitch of 1999 in 2005. which destroyed more than 50 per cent of While still in medical school, Garifuna Honduran infrastructure; the predominantly students began looking for ways to immediately rural indigenous Miskito and Garifuna start contributing to community health communities were completely cut off. improvement. The result was the creation of Nevertheless, this ill wind ended up blowing Garifuna Medical Student Work Brigades. All some good in the form of a revolutionary Garifuna students since then donate 15 days of change in Garifuna health care options. their annual vacation from medical school to The disaster produced an immediate work alongside the Cuban and Garifuna doctors response from the international community. in various Garifuna communities. This included a medical contingent from From 2001 onwards, the student work brigades Cuba that reached some of the most have helped run the permanent clinics established remote and hardest hit Garifuna villages. in at least 12 of the 46 widely separated Garifuna Besides providing urgent immediate help, communities along the Honduran coast.

State of the World’s Minorities Americas 109 and Indigenous Peoples 2013 Case study continued grabbers and international corporations that have established extensive palm oil plantations In 2005, three Garifuna doctors set out to in the Baja Aguan region. According to MRG build the first clinics for communities that had partner in Honduras OFRANEH (National no prior access to health care. They also worked Fraternal Organization of Black Hondurans), to develop a comprehensive system of preventive armed paramilitaries are used to crush indigenous health care and patient education that focused community protests, and there are also instances on Garifuna community cultural realities. They of verbal harassment by the rifle-toting company organized a broadly based community volunteer ‘guards’. The latter park on public access roads structure to assist with all aspects of fund- and are prone to showing displeasure at the raising, construction, service development and presence of the young ‘rights-defending’ Garifuna sustainability. doctors and nurses in the area. As the first phase, they decided to develop a free community hospital. They established a First Garifuna hospital camp at the proposed site and began treating the The modest two-floor hospital was inaugurated first patients even though construction was still in 2007 by the left-leaning President Manuel under way. It helped to generate interest and Zelaya – who was subsequently unseated in June hope. 2009. By 2012, there were well-equipped rooms They also created alliances between faith for delivery, a pharmacy, ultrasound department, groups, women’s organizations, students and a small laboratory and a dental room. Electrical workers. The organizers used online social power was supplied by solar panels. networks to link their efforts with similar health The hospital directly serves the more than care delivery models. This included international 30,000 residents in the Ciriboya zone and, if the research institutions, universities, international surrounding area is included, regularly reaches medical volunteer teams, health care NGOs and a total of 60,000. According to the staff, who social movements. essentially work as volunteers, the hospital has According to the organizers, acquiring the provided almost half a million free consultations support of Garifuna women was crucial. In since 2007. addition to spearheading the mobilization In addition, using the free hospital and clinics process, they worked alongside community as a base, the far-ranging bilingual Garifuna carpenters and bricklayers in getting the building health team and brigades provide medical finished and played a key role in the overall consultations and medicine without cost to success of the project. the more than 500,000 Garifuna living in the Following a substantial effort at fund-raising isolated Garifuna communities on Honduras’ and community mobilization, the group of Caribbean coast. young doctors headed by Dr Luther Castillo Organizers claim that to date over 240,000 gradually completed the first Garifuna hospital in free medical treatments have been administered. Honduras. Based on local rates, this totals about 144 million The hospital is located in the community of Honduran Lempiras (US$7.2 million). It is Ciriboya, Colón, in the north-east of the country. money that the Afro-Honduran population – It is a very remote marginalized area with few marginalized and discriminated against – did not roads – all unpaved – no electrical connections have to find in order to take care of their own and no government health services. Patients need health needs. to walk for many miles along the beach with the sick suspended in hammocks in order to receive Comprehensive care strategy any medical attention. Part of the health strategy also involves This is also an area where both Garifuna and encouraging community projects that aid mental other indigenous peoples continue to lose their and physical well-being. Health system founder ancestral lands and ocean fishing rights to land Dr Luther Castillo describes it as ‘inter-culturally

110 Americas State of the World’s Minorities and Indigenous Peoples 2013 oriented medicine’. It takes a broad-based including within North American migrant inclusive approach. Garifuna communities. While using modern medicines, it matches the Assistance also comes in conducting scientific cultural modes, practices and material needs of studies in conjunction with US-based academic the community and its traditions. and other institutions. They conduct medical This means that a female patient with back research on chronic illnesses that particularly pain from carrying heavy bundles of fuel wood affect Garifuna communities. These include will be treated for the physical ailment, and also diabetes, high blood pressure, kidney failure, the underlying causes. In addition to prescribing sickle cell anaemia and venomous snake bites. rest and medication, efforts will be made to In addition to providing patient care, the provide the patient with a community-built solar hospital also runs a two-year nurses’ training stove to reduce firewood needs. programme for local women and works with The health teams have been able to provide international NGOs to help train Garifuna health education to more than 200,000 youth. women to be midwives. They have also organized interventions in schools Given the training costs and other aspects of on topics ranging from intestinal parasites to hospital and system maintenance, the organizers alcoholism, sexually transmitted diseases to need to expend substantial time and effort in self-esteem. This includes setting up health- local and international fund-raising. promoting soccer fields and volleyball courts. Unhealthy relations International solidarity While efforts at international linkage and fund- Since the hospital and the community health raising have borne fruit, the Garifuna health system receive no support from the Honduran system organizers have been much less successful government, the support they get from voluntary in getting the model incorporated into the official service networks at the national and international Honduras health structure. level is very important, say the organizers. In November 2008, a commission for the The hospital receives help from an average improvement of the health sector (Proyecto de of 30 international medical brigades that visit the community annually from North America. Below: Garifuna doctor consults visiting Almost all of the material used in the medical patients at a community health clinic, work comes from donations and fund-raising, Honduras. Garifuna Hospital Photo Archives.

State of the World’s Minorities Americas 111 and Indigenous Peoples 2013 Case study continued US$5,378.50 in 2010, but spent just 5.1 per cent of that on health. This lack of investment Reforma del Sector Salud, PRSS) examined is especially felt in the poorer areas, where the hospital in relationship to the state. indigenous and Afro-Peruvian populations are An agreement was signed in April 2009 predominant. These include the marginalized between the Department of Health and urban colonias around Lima and the rural the Association of Honduran Garifuna communities along the Pacific coast, in the Andes Municipalities (MAMUGAH). It was due mountains and in the Amazon rainforest. In these to be renewed in July of that year making rural zones the ECLAC indicates that 56 per cent the hospital an official part of the Honduran of the population is classified as poor, versus 18 Department of Health. Then a coup per cent in urban areas. happened. Following the June 2009 presidential Biases in services ouster, the new administration proposed a According to MRG partner CEDET (Centro significantly modified new agreement. The de Desarrollo Étnico), a study carried out by original model had focused strongly on Peruvian human rights organizations in 2005 preventive health care and direct Garifuna revealed that the government spends more than community involvement in management and twice as much per person in service delivery to control using the Garifuna native language. the more prosperous regions than in the poorer It favoured the training and employment of departments. The ECLAC data indicates that, in local community health workers. It took into 2010, some 84.6 per cent of urban households account modern medical practices, as well as had sewerage services versus 44 per cent in rural socio-economic and geographical conditions, areas. Also in urban areas, 88.8 per cent had and indigenous Garifuna preventive care, piped water compared to 38.4 per cent of rural healing methods and medicines. It was all homes, and electricity reached 92.1 per cent based on the free, prior and informed consent of urban homes but just 28.2 per cent in rural principle. zones. After the coup, the Department of Health Inequality in health service access is reflected proposed changes that centralized all aspects, in the contrast between the maternal and including staff appointments. This meant that infant mortality rates of the richer urban areas, an agreement could not be reached, and the compared to those with majority indigenous Garifuna health system has remained outside and Afro-Peruvian populations. According to of the national framework. the ECLAC, the maternal mortality rate in Peru According to the programme’s director during 2010 was 67 per 100,000 live births Dr Luther Castillo, health investment in with infant mortality being 18 per 1,000 live Honduras is already low, plus people of births. Although these represent a considerable African descent feel they are still treated improvement compared to previous years, the as ‘folkloric objects’, and exposed to racist positive change has mostly been limited to ridicule, belittling media images and urban groups with higher incomes. According to xenophobia. Therefore, Garifuna communities CEDET, the rates of infant and child mortality consider it important to maintain control of continue to be especially high in indigenous their health delivery process. and Afro-Peruvian communities where CEDET ‘We were expecting official recognition and research indicates that 92 per cent of African respect for our cost-effective community-based descendants live below the poverty threshold. system, but the Department of Health was Critics argue that in general there is a lack of a unwilling to change the long-held attitudes to clear policy, appropriate financing and adequate our communities. So we just have to find ways service delivery to these populations, especially to keep going and expanding the services on given their culturally specific health needs. The our own,’ Castillo said. ■ official focus is curative more than preventive, with an emphasis on reproductive health that

112 Americas State of the World’s Minorities and Indigenous Peoples 2013 ignores the non-reproductive and preventable to provide live-birth verification to indigenous illnesses that also affect women, including babies born at home or whose parents have hypertension and diabetes. not been able to pay a punitive fine for not CEDET further argues that adding to the submitting to official prenatal control. Without economic challenges that impede access to proper this document, the child cannot receive the health services for indigenous and Afro-Peruvian official birth certificate, which is needed to obtain communities are the racism and discrimination national identity documents. connected to their cultural and ethnic identity. Peruvians without identity documents are The perception of many indigenous women is deprived of a range of rights, among them – that they are treated with contempt bordering ironically – the right to join the national health on abuse in some health centres because they insurance programme (introduced in 2002), are poor and also come from indigenous which is mandated to provide free attention to all communities. They complain that among the Peruvians who cannot afford to pay. factors affecting treatment quality are that both In recent years according to the PAHO, rural and urban health staff do not bear in mind progressive medical trainers in Peru have been their beliefs and cultural practices. stressing the importance of cultural awareness, For example, indigenous women in Andean and paying more attention to the positive aspects communities have traditionally held that the of traditional medicine such as the extensive best orientation for delivering babies is in the accumulated knowledge of herbal treatments. vertical position, or kneeling down, which they feel aids the functioning of abdominal muscles. United States of America Nonetheless, CEDET points out that the vertical US elections childbirthing of indigenous Andean women is During early November 2012, the first African routinely viewed with scepticism – and even American president in US history, Barack ridiculed – by local health professionals, all Obama, was re-elected to a second four-year term of whom have been trained to follow western in office. The Democratic president convincingly medical modalities. triumphed in the number of states required As in other countries in the Americas, the for victory; however the popular vote was split situation is complicated by language. In Peru roughly in half, with the win reflecting a slim 2 health professionals very rarely speak the per cent margin. languages of the indigenous communities they The re-elected administration will also have serve. Therefore, it is often impossible to explain to face a House of Representatives that remains the prescribed treatment or to obtain informed under the control of the Republicans who oppose consent. This in turn promotes more anxiety many of the policies endorsed by minority and and mistrust. indigenous Native American voters. Analysts attributed the result partly to Traditional cures changing US demographics, with the Republican For these reasons indigenous women prefer to use opponent Mitt Romney failing to convince a traditional medicine and to give birth at home. sufficient number of minorities, women and According to the PAHO almost 50 per cent of youth voters that he would do better than the deliveries in Peru are conducted at home, mostly Obama campaign promised in areas such as the by traditional midwives or by family members. economy, immigration reform and health care Of these some 83 per cent occur in rural areas. coverage. According to exit poll analysis by the The PAHO studies also indicate indigenous Pew Research Center, non-white voters now women particularly prefer traditional midwives make up 28 per cent of the nation’s electorate, because they feel understood and respected by compared to 26 per cent in the 2008 election. them. Latinos (or Hispanics) are the fastest-growing According to CEDET, this indigenous cultural demographic in the country and the US Census preference can produce added bureaucratic Bureau estimates that Latinos will comprise one- challenges. Some health centre personnel refuse third of the US population by 2050. Already

State of the World’s Minorities Americas 113 and Indigenous Peoples 2013 in California and Texas nearly 40 per cent of with insufficient social investment, including the population is Latino. According to exit poll inadequate housing, rent and mortgage analysis, Latinos voted for President Barack challenges, and constrained educational Obama over Republican Mitt Romney by 71 per opportunities. cent to 27 per cent. Unemployment levels are high and sustained In addition, national media reported that employment is infrequent and mostly low wage. Obama received almost 96 per cent of all African The US Census Bureau’s Surveys of Income American votes. While over the past two decades and Program Participation (SIPP) indicate that some educated African Americans have achieved hardship conditions such as food insecurity and better income levels, a disproportionate number unmet health needs were virtually the same for still remain on the lower rungs of the US socio- poor able-bodied African American families with economic ladder. children, regardless of whether most of their income derived from employment (48 per cent) African Americans or not (47 per cent). According to the Economic Policy Institute, These under-serviced urban communities African Americans are as residentially isolated also have a high ratio of under-educated school from Euro-Americans as they were in 1950, and drop-outs, alienated youth and youth-related more isolated than in 1940. A significant number gun violence, resulting in a significant risk of nationwide remain concentrated in marginalized, firearm injuries and homicides. According to the distressed low-income urban neighbourhoods US Centers for Disease Control and Prevention,

114 Americas State of the World’s Minorities and Indigenous Peoples 2013 Left: Native American Chugach man hangs cent are from Mexico and 22 per cent from other smoked salmon in Alaska. Catherine Karnow/ Latin American countries, primarily Central Corbis Images. America and the Caribbean. In a nation with sharply divided views on the subject, the Obama homicide is the leading cause of death for the administration was unable to implement any majority of young African Americans between the immigration reforms during its first term. ages of 10 and 24 years old. During the 2012 election campaign, most African American children in low-income Republican candidates continued to call for urban families frequently suffer from health tough immigration measures. By year’s end, problems that lead to school absences and the US Congress had been unable to agree on educational disruptions. The ongoing individual an amnesty programme for undocumented and environmental stress affect personal as well immigrants. According to US Immigration as collective well-being, promoting further social and Customs Enforcement, nearly 397,000 and cultural disintegration, self-destructive undocumented aliens were deported in 2011, behaviour and a range of other mental health returning to already economically challenged problems. Latin American countries. Despite the Congressional gridlock, polls by Immigrant minorities Pew Research also indicated that among all US As with other US minorities, factors such as voters, 65 per cent think immigrants should be unemployment, youth violence, inadequate offered a chance to apply for legal status. education, and economic and health care challenges also negatively affect Latino Native Americans and indigenous Alaskans communities. In December 2012, hundreds of tribal leaders Latinos are disproportionately affected by attended the fourth White House Tribal poverty, food insecurity and unemployment. Nations Conference at the US Department of Homicide is the second-leading cause of death the Interior. During the encounter tribal leaders among young Latinos between the ages of 10 and had the opportunity to discuss and highlight 24 years old, according to the US Centers for issues such as self-determination, culture, and the Disease Control and Prevention. economic challenges faced by their communities. The Census Bureau’s SIPP indicated that In addition to specific historically related nearly 31 per cent of Latino citizen families Native American concerns such as land loss, with children experienced overcrowded resource control and prior and informed consent, housing, food insecurity or unmet medical there are other emerging issues. These include needs. For non-citizen Latino families it was pollution of the Arctic, which is home to Alaska’s 47 per cent. According to the NGO Feeding indigenous populations. This region continued America, more than 25 per cent of Latino to have the highest levels of ‘persistent organic households are considered ‘food insecure’ and pollutants’ (POPs) on earth. are disproportionately represented among those POPs are artificially created organic receiving emergency food aid. compounds that resist natural breakdown and However for Latino voters, besides these can persist for many years. These highly tenacious factors, of major community concern was the and toxic health-threatening substances are need for immigration reform, especially in light transported for thousands of kilometres by rivers, of undocumented immigrant profiling policies and by ocean and air currents from warmer parts and the banning of ethno-cultural studies in of the globe to the colder polar regions. They some states such as Arizona. accumulate in the fatty tissue of seals and whales that traditionally play a key role in the Arctic Undocumented immigrants indigenous diet and can be passed directly to The US government estimates that there are 11 infants through maternal breast milk, causing million undocumented immigrants in the US. disruption of the hormone and immune systems, According to the Pew Hispanic Center, 56 per and affecting postnatal growth.

State of the World’s Minorities Americas 115 and Indigenous Peoples 2013 Like other minorities in the US therefore – land dispossession, marginalization, language loss, and perhaps to an even greater extent – Native cultural disintegration, exclusion and more. Americans and indigenous Alaskans continue On some reservations, Native American to face many challenges in the areas of housing, unemployment is over 80 per cent. There are few education, employment and especially health. Not full- or even part-time jobs available in a national least among these is the issue of mental health. economy constrained by the severe economic slowdown. Many Native Americans live below Native American youth suicide emergency the federal poverty line. During 2012, Native American leaders and Among the socio-economic factors driving the activists continued to be greatly alarmed at high suicide rates therefore are extreme poverty, what they describe as a youth suicide epidemic hunger, alcoholism, domestic violence (physical sweeping US Native American communities. and psychological) and substance abuse. According to reports by the US Surgeon General, In addition, Native American women suicides among young Native Americans between experience high rates of rape, as well as the ages of 15 and 24 are 3.5 times higher than unintended and teenage pregnancies. Victims the national average and rising. Moreover, 40 per complain that attempts to obtain justice are cent of Native American suicides occur within sometimes met with prejudicial and even this age group. violent treatment by law enforcement and other Suicide figures vary by community with the public officials, or trivialization and a lack of most troubling numbers being in the Northern understanding of their situations. Plains, parts of the south-west and Alaska. US indigenous communities face a range of According to the Alaska Native Tribal Health other health challenges which also contribute Consortium, the suicide rate for young Native to the overall problem. According to the US Alaskan males (Inuits) is about nine times that Department of Health and Human Services these of all young males in the country. The White include higher than average mortality rates from Mountain Apache Tribe has mandated the tuberculosis, chronic liver disease and cirrhosis, reporting of all suicides and attempted suicides and motor-vehicle accidents compared to other on their Arizona reservation, and discovered that minority communities. Asthma rates in some between 2001 and 2006, Apache youth ended areas are twice the national average. their lives at 13 times the national rate. The diabetes rate among Native Americans is Although Native American communities have at an all-time high and often remains untreated. experience of suicide, according to fronterasdesk. At 16.5 per cent, it is higher in the indigenous org, a media organization in the south-west, it is population than in any other major US ethnic culturally regarded as taboo on some reservations, group. so there is no native language word for ‘suicide’. All such issues end up weighing heavily on Consequently, suicides often go unreported or get the minds of native youngsters, which, activists classified by police as accidents. Given the growing argue, produces feelings of hopelessness. Mental crisis some tribes have now declared states of illness such as depression is therefore common. emergency and set up crisis-intervention teams. Behind trans-generational alcoholism and depression, there are also long-lasting memories in Historical trauma some families of sexual abuse by religious clergy. Activists argue that one of the principal factors Lawsuits have detailed a history of sexual, physical driving the high suicide rates in Native American and emotional abuse by parish priests as well as by communities is what they call a collective staff at traumatizing, culture-erasing, faith-based community-wide historical trauma that has boarding schools that Native American children a strong connection to cultural breakdown. were forced to attend until the 1970s. Researchers in 2011 reported that – even more often than Native American adults – as many Seeking solutions in indigenous culture as 20 per cent of Native American adolescents There is a consensus among both Native thought daily about issues stemming from native American and non-Native health professionals

116 Americas State of the World’s Minorities and Indigenous Peoples 2013 that tradition and cultural healing are key Proposed legislation to prevent Native elements in countering the deeply embedded American suicides suicide risk factors. In April 2012, Democratic Representative Joe According to Indian Country Today Media Baca of California introduced a Congressional Network (ICTM), studies by US and Canadian bill entitled the Native American Suicide researchers conclude that traditional ties and Prevention Act of 2012. It requires states or cultural connectedness provide important state-sponsored organizations to consult with psychological and practical physical benefits federally recognized Native American tribes and antidotes. Family and clan relationships, and their organizations as well as urban Native reverence for elders and a deeply held spiritual American organizations in the development life are among the key protective factors. and implementation of state-wide suicide early Supporting these culturally based positives intervention and prevention strategies. makes Native youth feel valued and able to However, the bill died in Congress from lack seek help. of support. An indigenous NGO, Native Cry Outreach Financial support Alliance, which provides services in the area A number of US federal agencies and foundations of youth suicide prevention and depression, provide grants and services to programmes that took up the challenge of trying to obtain new try to address the suicide problem. However, Congressional support for the bill. This included many programmes struggle to continue in a time seeking a Representative to commit towards of shrinking budgets. reintroducing the bill to the newly elected 113th During 2012, the US Indian Health Congress during the 2013 sessions. At the end of Service (IHS), which serves the 566 federally the year, indications were positive that this would recognized tribes, included 10 more tribes or occur. ■ tribal organizations in a batch of youth suicide prevention grants. That brings to 43 the number Endnotes of indigenous groups that have received this form of IHS funding. Most will receive nearly US$ 1. Bliss, K., Health in Latin 4. Hughes, J., Gender, Equity 500,000 annually for three years. America and the Caribbean, and Indigenous women’s However, leaders, such as former North Washington, DC, CSIS Health in the Americas, Global Health Policy Washington, DC, PAHO, Dakota Senator Byron Dorgan, who chaired Center, 2009, retrieved June 2004, retrieved June the Senate Committee on Indian Affairs for 2013, http://csis.org/files/ 2013, http://new.paho.org/ media/csis/pubs/090422_ hq/dmdocuments/2011/ four years, argue that, given the extent of the bliss_healthlatinamer_web. GDR-Gender-Equity-and- emergency, the IHS is inadequately funded pdf Indigenous-Women-Health- to provide the needed level of mental health Americas.pdf 2. See Incayawar, M. and services. Maldonado-Bouchard, 5. See: http://estadisticas. According to the Pan-American Regional M., ‘The forsaken mental cepal.org/cepalstat/ health of the Indigenous WEB_CEPALSTAT/ Office of the World Health Organization, only Peoples – a moral case PublicacionesEstadisticas. indigenous peoples living on or near their US of outrageous exclusion asp?idioma=i in Latin America’, BMC reservations are eligible to receive IHS clinic and International Health and 6. Montenegro, R.A. and hospital care. It is estimated that only one-third Human Rights, vol. 9, 2009, Stephens, C., ‘Indigenous retrieved June 2013, http:// health in Latin America and of Native Americans live permanently on or www.biomedicalcentral. the Caribbean’, The Lancet near reservations. Another third reside in urban com/1472-698X/9/27 vol., 367, no. 9525, 2006, areas. The remaining third moves back and forth pp. 1859–69. 3. WHO, Legal Status of between the two. Traditional Medicine and 7. Piox, L.X., ‘La medicina Given that only 2 per cent of IHS funding Complementary/Alternative tradicional en los sistemas Medicine: A Worldwide de salud pública: una serves urban communities, this means that at Review, retrieved June Mirada desde Guatemala’, least half of Native Americans are not reached by 2013: http://apps.who. retrieved June 2013, http:// int/medicine docs/en/d/ hdrnet.org/606/1/65-485-1- IHS programmes. Jh2943e/5.2html PB.pdf

State of the World’s Minorities Americas 117 and Indigenous Peoples 2013 ARCTIC OCEAN

RUSSIA

JAPAN KAZAKHSTAN NORTH MONGOLIA KOREA UZBEKISTAN SOUTH TURKMENISTAN KOREA KYRGYZSTAN TAJIKISTAN PACIFIC Jammu and AFGHANIS- Kashmir CHINA TAN OCEAN

PAKISTAN TIBET Taiwan NEPAL BHUTAN BANGLADESH Hong Kong INDIA BURMA LAOS PHILIPPINES THAILAND VIETNAM CAMBODIA Andaman and Nicobar BRUNEI SRI LANKA Islands Bougainville PAPUA NEW MALAYSIA SOLOMON ISLANDS MALDIVES GUINEA SINGAPORE Borneo Sulawesi Wallis and Futuna (FR.) Sumatra INDONESIA TIMOR-LESTE FIJI ISLANDS French Polynesia (FR.) Java New Caledonia (FR.) INDIAN

OCEAN AUSTRALIA

NEW ZEALAND Asia and Oceania Jack Dentith, Emily Hong, Irwin Loy, Farah Mihlar, Daniel Openshaw, Jacqui Zalcberg Right: Uighurs in Kazakhstan picking fruit from Central a tree. Carolyn Drake/Panos. which affects the health of the most vulnerable people living in the region. In March, the Asian Asia Development Bank (ADB) reported that the shrinking of the Aral Sea and drying up of two Daniel Openshaw major rivers, the Amu Darya and Syr Darya, would particularly affect Karakalpakstan – an inority groups live in some of the autonomous region of Uzbekistan, home to the poorest regions of Central Asia; majority of the country’s Karakalpak population, M Pamiris in Gorno-Badakhshan as highlighted in MRG’s 2012 State of the World’s Autonomous Province in Tajikistan; Uzbeks Minorities and Indigenous Peoples. in South Kazakhstan province; Karakalpaks in In an already poor region, climate change Uzbekistan’s Karakalpakstan region; and high is especially significantly affecting the most numbers of Uzbeks and Tajiks in Kyrgyzstan’s vulnerable. Most people in Karakalpakstan Ferghana Valley. Poverty has a direct impact depend on agriculture, so water shortages have on their health. The right to free health care is reduced farmers’ income and resulted in food enshrined in the constitutions of four of the five shortages and poor health through malnutrition. Central Asia states; Turkmenistan abolished free Overuse of pesticides has also polluted water health care in 2004. However, the reality is not supplies and caused health problems, such as as straightforward as reports are commonplace of kidney and liver disease, tuberculosis and cancer. bribes being necessary to gain access to Many people want to migrate due to poor health care. environmental conditions. Official health data – disaggregated by either Climate change and mismanagement of water ethnicity or gender – is not widely available in resources have also led to water shortages in the region, but some information is available southern Kyrgyzstan, home to many minorities, from international organizations. For example, a particularly Uzbeks, according to a 2012 report 2008 World Health Organization (WHO) report by the ADB. The ADB report highlights other found that inequity of access to mental health environmental problems in the region: glacier services was an issue for minorities in Kyrgyzstan melt in Tajikistan – the poorest country in the that should be addressed. region – which will reduce access to water, and The rate of new HIV infections continues to desertification in Kazakhstan. rise across Central Asia according to UNAIDS; in Kyrgyzstan and Kazakhstan new infections Kazakhstan rose by 25 per cent between 2001 and 2011. Incumbent president Nursultan Nazarbaev and Drug resistant tuberculosis and malaria also his Nur Otan party won parliamentary elections disproportionately affect people living in in January with 80 per cent of the vote. The poverty or social exclusion, including minorities, Organization for Security and Cooperation according to the United Nations Development in Europe (OSCE) criticized the elections for Programme (UNDP). failing to meet democratic standards yet again. Prisoners are another population at risk of Two other political parties considered loyal contracting HIV and tuberculosis, or suffering to Nazarbaev also gained seats in parliament. from mental health problems and other problems Women continue to be under-represented in associated with drug use. This particularly affects government, with 27 of 77 seats in the lower minorities, given the high numbers of ethnic and house of parliament and 2 of 47 in the upper religious minorities among prison populations in house. Kyrgyzstan, Uzbekistan and Kazakhstan. There are still very few ethnic minority Climate change is exacerbating the effects of representatives in senior government, which long-term mismanagement of water resources, could in part be because of language barriers.

120 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Although knowledge of Kazakh is not required sound more Kazakh. While offering substantial for government and civil service positions – positive rewards and glory for successful except for presidential candidates – non-Kazakh competitors, this practice reportedly led to speakers complain that Kazakh speakers are resentment towards ‘plastic’ Kazakhs, which favoured for government positions. could contribute to discrimination. Nazarbaev’s victory is seen to reflect a growing The situation for religious minorities Kazakh nationalism in the country. Under his deteriorated in 2012, following the adoption of a leadership, the creation of Kazakh-language new Religion Law in late 2011. The law compels schools and the conversion of some Russian- public organizations and religious groups to language schools to Kazakh reduced the overall register with the Ministry of Justice and regional number of Russian-only language schools. In authorities, and has been enforced through March, Nazarbaev called for fewer home-grown fines and imprisonment. For example, in East films to be made in non-Kazakh languages and to Kazakhstan members of an unregistered Baptist show the country in a more positive light. group were fined almost 18 months’ wages each. At the most elite end of public health Registration processes have been described promotion, home-grown nationalism was less as complex, arbitrary and expensive. The 2013 of an issue for the government as naturalized or United States Commission on International so-called ‘plastic’ Kazakhs made up over half of Religious Freedom (USCIRF) report documented Kazakhstan’s delegation to the London 2012 cases of corruption involving the re-registration Olympics. The athletes included several Russians process. and three Chinese-born weightlifters, who took During 2012, numerous groups were not Kazakh nationality and changed their names to allowed to re-register. For example, members

State of the World’s Minorities Asia and Oceania 121 and Indigenous Peoples 2013 of the Grace Protestant Church in Karaturyk, legal documents. with a mainly Kazakh and Uighur membership, Increasing numbers of Kyrgyz women are were pressured to remove their names from moving to Kazakhstan in search of work where registration documents to prevent the church they are vulnerable to exploitation. There were from registering. Some congregations of the reports in 2012 that some migrant Kyrgyz Russian Orthodox Church Abroad were also women face mistreatment and exploitation. Poor affected. The government raided numerous places female migrants are vulnerable to becoming of worship and confiscated religious material, forced sex workers, drug mules or victims of affecting Pentecostal Christian, Methodist, Hare human trafficking to other countries, especially Krishna and Jehovah’s Witness groups. Russia. Their situation risks being compounded Muslim groups have also been affected. Only by medical problems, lack of access to proper groups that are part of the state-backed Sunni health care and unwanted pregnancies caused by Muslim Board can register and in November rape or forced prostitution. some independent mosques belonging to This trend sparked debate in Kyrgyzstan in Shi’a and Ahmadi Muslim communities were April when a female member of parliament refused legal status. As a result the Ahmadiyya proposed that women under the age of 23 community in Almaty has nowhere to legally should be banned from leaving the country for worship. Other mosques have also been work in order to protect them from mental and threatened with demolition if their communities physical abuse. However, this proposition is don’t register with the authorities. an inappropriate attempt to control women’s Human rights activists report that prison freedom of movement. administrators do not allow prisoners to practise their religion. If members of unregistered groups Kyrgyzstan were incarcerated they would face a prison system Ethnic minorities are under-represented in that has been criticized for providing insufficient the Kyrgyz government; non-Kyrgyz citizens access to medical care and having inadequate constitute 35 per cent of the population but only numbers of medical personnel, including 12 per cent of members of parliament. Women infectious disease doctors, not monitoring are also under-represented. Non-Kyrgyz speakers antiretroviral treatment of HIV-infected complain of a glass ceiling within the civil service, prisoners, having shortages in medication, and even though the law provides for the preservation having inadequate heating and ventilation and free development of minority languages systems. alongside Kyrgyz as the state language and In September, Uzbek Pentecostal pastor, Russian as an official language. Makset Djabbarbergenov, was arrested in More positively, in December 2012 President Kazakshtan at the request of the Uzbek Almazbek Atambaev refused to sign a bill that government for conducting religious activity. He would introduce fines for public officials who do was not extradited, partly due to international not have sufficient knowledge of Kyrgyz language. pressure, but he was held in detention for In January Kamchybek Tashiev, leader of three months. Upon his release in December, the nationalistic Ata-Jurt party, which holds Djabbarbergenov and his family left the region; seats in parliament, called for the then prime he is banned from returning to Kazakhstan minister, Ormunbek Babanov, to resign because before 2017. Djabbarbergenov had previously his mother was not from Kyrgyzstan. Tashiev been recognized as a refugee by the UN refugee said: ‘I should say openly, and let people not be agency, UNHCR. offended, that the head of government should The plight of Kyrgyz migrant workers also be a pure-blooded Kyrgyz, who will actually be made the news in 2012 when three Kyrgyz who rooting for the interests of the country.’ The had suffered de facto slavery in Kazakhstan statement sparked debate and media attention, for about a decade were found and released in as well as reportedly an investigation by the State Almaty. Rights groups say that migrant workers’ Security Service. rights are often violated due to their lack of Ata-Jurt also supported nationalistic protests

122 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 in Osh in the run-up to council elections. The ‘biased attitude’ and that it review their poll led to a strengthened position for nationalist guilty verdicts. However, Uzbeks continue to mayor Melisbek Myrzakmatov, with his supporters report police harassment, and continue to be almost achieving a majority in the city council. disproportionately prosecuted and incarcerated. This is a sign of growing Kyrgyz nationalism Throughout 2012 crowds of courtroom in the city. The election results prompted the spectators, including family members of victims, International Crisis Group (ICG) to warn that disrupted trials of ethnic Uzbeks charged with Uzbeks are being pushed to breaking point by the crimes related to the 2010 violence, threatening discrimination and anger directed towards them, the security and the safety of defendants, and that Myrzakmatov is largely to blame for this. attorneys and judges. Too little has been done in the way of inter-ethnic The strength of inter-ethnic feeling can be seen reconciliation, according to ICG. in an incident in September; Kyrgyz residents in June 2012 marked the second anniversary of Ala-Buka, Jalalabad (another site of violence in the ethnic clashes between Uzbeks and Kyrgyz in 2010), beat up a judge following the exoneration Osh and the neighbouring region of Jalalabad, of a local ethnic Uzbek who was found not guilty in which more than 400 people were killed and of assaulting a local Kyrgyz citizen. thousands more displaced. In the run-up to the In prisons, a disproportionate number of ethnic anniversary, authorities tightened security and minority prisoners serve life sentences and so carried out passport checks expecting trouble. face numerous health risks, including high levels A National Remembrance Day – 10 June – was of drug use. UN Special Rapporteur on torture instituted and marked by the opening of the Juan Mendez noted poor prison conditions, country’s biggest mosque in Osh city in a bid to including the use of torture, on his visit to the instil some unity. However, a bell dedicated to country in December 2011. In January 2012, those who lost their lives during the violence was prisoners organized a nationwide hunger strike also unveiled in Osh in the summer with ‘Peace by sewing their mouths shut in protest against all over the world’ written in Kyrgyz, Russian and poor conditions. The protests, led by an ethnic English – but not Uzbek. Uzbek, also aimed to highlight the corruption and Ethnic tensions remain high. In June an Uzbek criminality rife in the prison system. rap song about regional leaders in Osh province Ethnic Uzbek citizens in Osh and Jalalabad offensive to Kyrgyz people started circulating face discrimination when looking for work, online, where the song had been said to spark particularly within public services, according several minor ethnicity-based incidents and was to the 2012 US State Department report on promptly banned by the provincial court for human rights in the country. There have also inciting ethnic hatred. been multiple reports of seizure of ethnic Uzbek The US State Department 2012 human rights businesses and property. report states that trials of ethnic Uzbeks for crimes As 2015 approaches, assessment of how committed during the 2010 violence continue, countries have lived up to the Millennium with some cases of previously lenient sentences Development Goals has begun. In 2012, being overturned in favour of harsh ones. Human research published in The Lancet medical journal Rights Watch questioned the fairness of trials for showed that Kyrgyzstan and Uzbekistan were non-Kyrgyz citizens after one ethnic Uzbek and the two most equitable countries out of 54 one ethnic Russian were sentenced to death in studied in terms of mother and child health October for crimes committed during the inter- interventions. This is not to say that interventions ethnic violence. were necessarily good, but that access was not In April 2013, the UN Committee on determined according to wealth.1 Elimination of Racial Discrimination reported In terms of HIV, 70 new cases in children – 10 that Uzbeks were the main victims of the June in Jalalabad and 60 in Osh, both with large Uzbek 2010 events but were also the most prosecuted populations – were announced in June 2013 and and condemned. The committee recommended attributed to accidental transmissions in regional that the government investigate the courts’ hospitals. This follows an incident in 2010 when

State of the World’s Minorities Asia and Oceania 123 and Indigenous Peoples 2013 a large number of women in Osh were infected for remarks he made about Islamic mullahs in a with HIV. Even though it was accidental, reports radio interview, but he denied trying to stir up following the aftermath of this incident cite a religious hatred and says he is being targeted for debilitating stigma – within and outside the health his Tengristic beliefs. The case drew attention service – attached to those with HIV. They also to Tengrism, which is an ancient Central Asian highlight a wider problem of client confidentiality religion incorporating elements of shamanism, not being observed by health care professionals, as animism, totemism and ancestor worship. the identities of the women became widely known Although largely tolerated in Kyrgyzstan, some among their relatives and neighbours. clerics claim that Tengrism proselytizes against The Kyrgyzstan government, despite promises, Islam. has not reviewed the restrictive 2009 Religion Law, which among other things requires religious Tajikistan groups to undergo a laborious registration Ethnic minorities and women are politically process. The government has consulted with under-represented in Tajikistan. There are no external bodies to discuss measures, such as a female or minority ministers; and out of the ban on sending students abroad for religious 96 seats in the upper and lower chambers of education without state permission, a ban on parliament, only two are occupied by ethnic foreigners carrying out religious practices without minorities and 17 by women. a state licence and amending registration criteria In May Salim Shamsiddinov, an Uzbek that would require groups to have 200 founders community leader in southern Tajikistan’s within the same locality; all of which would Khatlon region, was seriously assaulted after he further restrict religious assembly and freedom. publicly claimed the government was pursuing By early 2012, only 135 Muslim communities nationalist policies. He has since gone missing and three Russian Orthodox parishes had in what Amnesty International suggest was a been registered, leaving hundreds of mosques, political abduction. Elsewhere in 2012, the US Protestant churches, Jehovah’s Witnesses State Department reported occasional harassment and Hare Krishna communities unregistered, of Afghans and Uzbeks by law enforcement according to the USCIRF 2013 report. Ahmadi officials. Muslims are also affected. In February the South In Tajikistan 7,500 children under the age Korean-based Unification Church was banned. of five die every year of undernourishment Uzbek imam Khabibullo Sulaimanov faced according to a 2012 report by the World extradition to Uzbekistan at the beginning of Bank and UNICEF. A third of children have 2013 after his arrest for illegally crossing the stunted growth and there is high prevalence of border in 2012. In March 2013 the courts anaemia and other health impacts from lack of decided not to extradite him, partly due to food, according to the report. This was found international pressure over the ill-treatment he to be most prevalent in rural Khatlon, with would probably face in Uzbekistan. However, he a significant Uzbek population, and Gorno- is still incarcerated. Badakhshan Autonomous Province, where The authorities continued to target religious ethnic Pamiris mainly live. President Emomalii minority groups for ‘inciting racial hatred’, Rahmon’s lack of connection with his people – particularly the banned Islamist group Hizb- especially minorities in these rural areas – was ut-Tahrir. The group calls for the peaceful shown when he criticized his citizens’ unhealthy establishment of an Islamic caliphate, but is seen eating habits and lack of exercise, which he as a terrorist organization by the government. thinks leads to high levels of obesity. In August, a Hizb-ut-Tahrir leader was arrested Violence erupted in Gorno-Badakhshan in Jalalabad, allegedly for planning to overthrow Autonomous Province in July, after a local the government. Another imam was arrested in state security official government official was October for suspected membership of the group. murdered. The government sent 3,000 troops In January charges of inciting religious and to the autonomous Pamiri region to arrest ethnic hatred were also used against a Tengrist Tolib Ayombekov, an opposition leader from

124 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 the 1990s Tajik civil war who was blamed for women are particularly repressed since a fatwa or the assassination. The violence led to numerous religious decree issued in 2004 banning women deaths and injuries, including among civilians, from praying in Tajik mosques remains in effect. according to HRW. A majority of the region’s Women are also banned from wearing the hijab population belongs to the Ismaili sect of Islam; in schools and government offices. representatives of the movement’s spiritual leader, In 2012, the Tajik government arrested citizens the Aga Khan, were involved in negotiation for belonging to alleged extremist groups such efforts to diffuse the situation. as Hizb-ut-Tahrir and Jamaat-i Tabligh (Society Tensions continued through August, however, for Spreading the Faith), which has been banned as local Pamiris protested after the murder of since 2006. Members dispute claims that these another former opposition leader, Imomnazar groups have connections to terrorism and say Imomnazarov. The government conceded that they belong to peaceful organizations. In May, they would withdraw at the end of August but several alleged members of the Islamic Movement sporadic killings and skirmishes continued into of Uzbekistan were arrested and tried behind September. closed doors. The Tajik government further tightened restrictions on religious freedoms in 2012, Uzbekistan introducing new penalties for those receiving Only 11 members of the 150-seat strong lower religious education abroad, preaching and chamber of government and 11 of 100 seats teaching religious doctrines, and establishing in the lower chamber are occupied by ethnic connections with foreign religious organizations. minorities. Furthermore, officials reserve senior This move led to Tajikistan joining government positions for ethnic Uzbeks despite Turkmenistan and Uzbekistan as a ‘country of laws prohibiting employment discrimination particular concern’, according to the USCIRF based on ethnicity or national origin. 2013 report. The US State Department 2012 human rights The report notes that restrictions and abuses report cites widespread restrictions on religious primarily affect the majority Muslim population, freedoms, including harassment of religious but also Seventh-day Adventists, Baptists, Baha’is, minority groups. The report also highlighted a Protestants, Jehovah’s Witnesses and Hare government crackdown on international NGO Krishnas. activity and further suspicion of unregulated A repressive 2009 Religion Law prohibits all Islamic and minority religious groups. For religious activity independent of state control. example, in March security cameras were installed Those who participate in unregistered religious in more than 30 mosques in the religiously activity face up to two years’ imprisonment. conservative Ferghana Valley. Authorities claimed The 2011 Parental Responsibility Law stipulates that cameras were installed in order to prevent that parents must prevent their children from theft, but locals argue it is to ensure preachers toe participating in religious activity, outside state- the party line. approved religious education. Uzbekistan remained a ‘country of particular According to the Tajik State Department, as concern’ according to the USCIRF 2013 report. mentioned in the USCIRF 2012 report, only Persecution of unregistered Christian groups was 74 of the 4,000 registered religious are non- commonplace throughout 2012. For example, in Muslim, including Ismaili groups. Minority December a group of Protestants were charged Muslim groups continue to face persecution; the for discussing their faith and singing Christian Islamic Renaissance Party claims that numerous songs; they also had their songbooks confiscated unregistered mosques have been demolished; and fingerprints taken. In November, leaders the Salafi Muslim group has been banned since of some registered Protestant churches were 2009; and in February it was reported that gathered in Tashkent and instructed to re-register in December 2011 a mosque was raided for within one month. They were also warned observing a Shi’a Muslim holiday when only against missionary activity. Baptist congregations Hanafi Sunni rituals should be observed. Muslim have made similar reports.

State of the World’s Minorities Asia and Oceania 125 and Indigenous Peoples 2013 The state-run media encouraged intolerant being in prison in Uzbekistan is detrimental to views towards Protestants, Jehovah’s Witnesses prisoners’ health. The WHO has launched a and other groups, sometimes equating their prevention and treatment programme in prisons practices with extremism. to stop the spread of tuberculosis as well as In the autonomous republic of Karakalpakstan HIV/AIDS. – with a mainly Karakalpak population – only The Uzbek government claims that conditions Muslim and Russian Orthodox religious in the jail are improving. However, a letter communities have been registered, making the from an inmate – published by French human activity of more than 20 Protestant and Jehovah’s rights group Association for Human Rights in Witness congregations ‘illegal’. Most churches are Central Asia (AHRCA) – tells of being beaten for now closed and there have been reports of Hare something as minor as not showing interest in Krishna and Protestant students being expelled nationalist books written by President Karimov. from university. Members of the South Korean- based Unification Church have been told that Sokh enclave they cannot contact members in other countries. Sokh is a small pocket of Uzbek territory almost Many citizens arrested for alleged religious completely surrounded by Kyrgyzstan’s Batken extremism continue to end up in prison. In July province in the Ferghana Valley. It is home to an 2012 ethnic Kazakh Ermek Qosmaghambetov estimated 60,000 people, with the vast majority was charged with attempting to smuggle ‘materials ethnic Tajik and other minorities. propagating religious extremism’ into Uzbekistan Ethnic tensions have simmered in the small on his laptop. Most arrests for extremism affect region amid border disputes since the dissolution members of banned religious groups Hizb- of the Soviet Union. Both Uzbekistan and ut-Tahrir and Nur (a movement founded by Kyrgyzstan have a strong security presence and theologian Said Nursi, who died in 1960), whose strict border checks. members comprise the majority of political Territorial disputes have hampered local prisoners in Uzbekistan. Pressure to break up development and the region remains one of the ‘extremist’ cells has led to police and security poorest areas in Kyrgyzstan. The Sokh enclave services to use measures such as detention and has been targeted by the Uzbek authorities as a mistreatment of accused persons’ family members suspected breeding ground for Islamic extremism. and attaining confessions through torture. As a result large numbers of residents have Trials rarely meet international standards emigrated, particularly to Russia. and once they are incarcerated prisoners In January 2013 ethnic violence erupted as report religious discrimination. The US State Sokh residents attacked Kyrgyz guards erecting Department 2012 report highlights the case of an electricity poles in disputed territory. The ensuing imprisoned Jehovah’s Witness reaching the end riots, which spilled over into Kyrgyz territory, led of his term and being told to renounce his beliefs to the destruction of Kyrgyz property – mainly or face trial once again. Also, despite periodic vehicles – and almost 40 Kyrgyz were taken presidential amnesties to mark public holidays, hostage, among them women and children. political and religious prisoners remain ineligible. The enclave border was sealed and barbed Large numbers of prisoners are sent to the wire fences erected along some borders. The infamous Jaslyk Prison in the autonomous republic residents, mainly ethnic Tajiks, were cut off from of Karakalpakstan. The institution is colloquially the rest of Uzbekistan. Aid agencies were initially known as the ‘House of Torture’ or ‘Place of No prevented from entering the enclave although Return’. It became a destination for those charged restrictions were relaxed by the end of January. with religious extremism after bombings in 1999 Talks between the governments of Kyrgyzstan that were blamed on Islamist groups. HRW now and Uzbekistan to solve the crisis quickly broke places the number of inmates at between 5,000 down, although Uzbekistan did agree to pay and 7,000. It is well known for housing prominent compensation in some instances to Kyrgyz citizens dissidents and political prisoners. for damage to their property. Tajikistan also has As in other Central Asian states, simply long-standing territorial claims in the region.

126 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 likely to have HIV or other sexually transmitted Case study diseases. In Kazakhstan, child marriage is more common among ethnic minorities who follow Islam and Child marriage live in rural areas. Women in such communities often occupy a subordinate position within their in Kazakhstan families and this is a contributing factor to the prevalence of the practice. Many families are also poor, and seek to marry their daughters off ‘There were problems both during pregnancy early in order to obtain kalym or bride price. and after the birth, but my mother-in-law Many child brides do not want to enter into the thought it was nothing to worry about: it marriages chosen for them. happens to many women and that’s how it Child marriage is rarer in Kazakhstan than in should be. My mother-in-law said I should put other Central Asian states, but 2012 statistics still up with all the pain.’ Child spouse, member suggest that 1 per cent of girls are married by of an ethnic minority.2 the age of 15 and 7 per cent by 18. Data from the Republic of Kazakhstan Agency for Statistics If you are a married child in Kazakhstan then shows that child marriage is most prevalent you are likely to both be a girl and belong to among Kurds with 6 per cent of all married an ethnic minority. Child spouses are those women being under 18, followed by ethnic Turks who enter marriage under the age of 18, (4.3 per cent), Azerbaijanis (3.5 per cent) and which the UN Committee on the Rights of lesser numbers of Dungan (2.5 per cent) and the Child considers to be the minimum age Uighurs (1.5 per cent). By contrast, only 0.64 per for marriage. In Kazakhstan, research by the cent of married Kazakh women are under age. UN Population Fund (UNFPA) has found In some of these communities, child marriage this to be particularly prevalent amongst is an out-of-date tradition that is still the norm: Kurdish, Turkish and Azerbaijani minorities. Child marriage in many cases is quickly ‘Early marriage is typical for the Uighur population. followed by pregnancy, which has the They believe that a girl who doesn’t marry before potential to cause physical and mental health the age of 18 has failed.’ Child spouse, member of problems to both the mother and infant. an ethnic minority.3 Girls’ bodies are less ready than those of adult women for childbearing, leading to Child marriage in Kazakhstan is illegal. The complications during both pregnancy and legal age to enter into marriage is 18 for both childbirth. men and women except in certain circumstances, UNICEF global figures suggest 70,000 such as pregnancy, where the age can be reduced maternal deaths of girls and young women to 16 but only with the consent of both parties. aged 15–19 occur annually as a result of However, in the communities identified, many these complications. An infant born to a child marriages are performed by imams and mother aged under 18 is 60 per cent more remain both unofficial and unregistered, giving likely to die before his or her first birthday the girls involved few legal rights. than an infant born to a mother aged over A lack of education in general is one social 18. And if the infant survives he or she consequence of child marriage, but access is more susceptible to a range of health to sexual health education and sexual health problems, including low birth weight, a lack services are also particularly restricted. Under of nutrition and late physical and cognitive Kazakh law, if a 16-year-old girl seeks medical development. assistance, a doctor does not have the right to Child brides often marry older men, who conduct a full medical exam without informing because of their age are statistically more the girl’s parents or guardians. Often child

State of the World’s Minorities Asia and Oceania 127 and Indigenous Peoples 2013 Case study continued brides are accompanied by their husband or South mother-in-law when they go to the doctor. This restricts their personal decisions about contraceptive use or treatment for sexually Asia transmitted infections. The UNFPA research found that most girls interviewed did not Jack Dentith and Farah Mihlar know what contraception was. A preference for sons over daughters within communities Afghanistan where child marriage is prevalent also leads to While the US and the governments involved in pressure to become pregnant as many times as the NATO-led International Security Assistance it takes to have a boy, before family planning Force (ISAF) are gradually withdrawing their is an option. troops from Afghanistan, serious concerns Further physical and mental health regarding human rights violations and the issues arise from the unequal nature of the protection of minorities remain. At the marriage, which puts child brides at risk same time, there were some overall positive of domestic violence, sexual abuse and developments during 2012. Civilian deaths exploitation by both their husband and dropped for the first time in 2012 by 12 per husband’s family; many girls recount bullying cent compared with the previous year, to 2,754, from their mothers-in-law. Child brides are according to the United Nations Assistance also at risk of becoming isolated from Mission in Afghanistan (UNAMA). Over 80 per family, friends and their communities. cent were killed by armed groups. Kazakhstan has ratified both the UN The Taliban continue to control large areas Convention on the Rights of the Child of Afghanistan, particularly in the south and the (CRC) and CEDAW but failure to prevent east, where the situation for religious minorities child marriage puts the state in contravention along with dissenting Muslims is insecure. In of Article 24 of the CRC that states all territory controlled by the Afghan government, children have the right to health and to too, there have been incidents of violations of access to health services; and protection from religious freedom. In July, the case of Baljit harmful traditional practices. And Article Singh, a Sikh, raised concerns about attitudes 16.1(b) of CEDAW states that women towards religious minorities. Singh was held should have the right to freely choose a in detention in Afghanistan and later released spouse and enter into marriage only with over allegedly ‘false claims’ of being an Afghan their free and full consent. ■ national after having been deported from the UK, where he had unsuccessfully sought asylum. Singh described how he had been abused by Afghan security personnel and other prison inmates, and forced to convert to Islam. Singh was detained for 18 months but was never formally charged with any crime. The case shone a spotlight on both the Afghan criminal justice system and the Afghan Sikh community, which has gone from several thousand families to merely a few hundred in the last decades. Ethnic tensions between Hazaras and Tajiks, reported for many years by MRG, remain a key issue in Afghanistan. In September 2012, a number of people were killed as violence broke out in Kabul between members of the

128 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 two communities on the day that otherwise Above: A Hazara labourer returns home from commemorates the death of Tajik military work in Kabul, Afghanistan. REUTERS/ leader Ahmad Shah Massoud, who was killed Adnan Abidi. by two Tunisian men posing as journalists in 2001. A convoy of Tajiks from the Panjshir the traditional Ashura festival. Approximately Valley passed through the largely Hazara 80 people died during the attack on the 2011 neighbourhood of Pol-e-Sokhta; a cyclist was procession. injured by one of the vehicles. When the Despite extensive development and police failed to act, violence erupted. The final humanitarian assistance efforts, continued unrest number of casualties from the incident was has meant that the benefits of international aid not confirmed. Known as the ‘Lion of the have been unevenly distributed. Conflict has Panjshir Valley’, Massoud is officially regarded had a negative impact on the health of Afghans, as a national hero; however Hazaras recall and the health care infrastructure throughout a devastating attack on their community in the country is poor – with a particularly negative western Kabul by his forces in the early 1990s. impact on marginalized groups. Bamyan province, There was a reminder during 2012 of a large- for example, has a large Hazara minority scale attack against the Shi’a community that had population and has faced discrimination on the occurred during the previous year. In November, part of central governments in the past. According the Afghan police announced that they had to the United Nations Development Programme arrested two persons planning a suicide bombing (UNDP), there are hardly any services available against Shi’a Muslims gathering in Kabul for in the region. This has resulted in low vaccination

State of the World’s Minorities Asia and Oceania 129 and Indigenous Peoples 2013 rates, widespread waterborne diseases, and high ethnicity has been shown to increase the risk of levels of maternal and infant mortality. human rights violations for women at a drug There have been mixed results from attempts abuse treatment centre. Recent studies suggest to open the region up to mining in order to that Afghan women continue to face cultural, exploit its deposits of ores and coal. While the religious and social barriers to accessing health closure of unlicensed mines may have protected care.4 Issues include limited autonomy for children from dangerous and unhealthy work, the women, preventing them from visiting clinics Chinese firm that won the tender for mining in for check-ups, as well as a lack of emphasis the region had reportedly not replaced the jobs on the importance of regular antenatal care. with new ones. Reports emerged in 2012 that the Patients also reported that the attitudes and lack of opportunities may have pushed people behaviour of public health staff deterred women into the employment of the Taliban, which the from using medical facilities, with abusive and government has vigorously denied. disrespectful practices being reported, along with Independent human rights monitoring discrimination and charging for free services or remained in question throughout 2012, adding medication. to the general climate of impunity that helps to Concerns about the mental health status of keep minorities vulnerable. Posts remained vacant women and children in Afghanistan continue. on the Afghan Independent Human Rights With diminished rule of law and increased Commission (AIHRC) during 2012, including economic hardship, practices such as selling or after one member was killed by a suicide bomber exchanging girls have become more common, in early 2011 and three more were removed and domestic violence continues to be a source by President Hamid Karzai at the end of that of distress. Establishing the social and medical year. A fifth commissioner was also dismissed. A structures to prevent abuse and treat women landmark AIHRC study of war crimes remains who have suffered violence remains a significant unpublished, despite having been completed two challenge in Afghanistan. years ago. Bangladesh Women’s rights Religious minorities in Bangladesh, including The situation for women in Afghanistan Hindus and Buddhists, faced a spate of showed little improvement in 2012. Despite violent attacks in the middle of the year that constitutional provisions on women’s rights, earned the country national and international grave incidents of violence against women condemnation. In September, dozens of Buddhist continue to be reported from the country. temples, at least one Hindu temple and homes According to HRW, in early 2012 there were and shops belonging to these communities were 400 women and girls in detention centres for set alight in Cox’s Bazar and Chittagong, in one ‘moral crimes’, which usually involved attempts of the biggest targeted attacks against places of to escape forced marriage or domestic violence. worship in recent years. According to media The antipathy of the Taliban towards reports, at least 20 people were injured in the international aid organizations and government attacks. Amnesty International quoted police as agencies makes it difficult to assess the health saying they had arrested around 300 people, but of communities living in areas under Taliban according to media reports tens of thousands of control, particularly the health of women who Muslims were involved in the attacks, sparked have suffered in the past under the Taliban. In by the posting of a derogatory image of the 2012, Afghan intelligence officials accused the Qur’an on Facebook. The government did little Taliban of poisoning schoolgirls in Bamiyan to protect the targeted communities. While province, although the accusation was denied. the government condemned the attacks, they Similar poisoning incidents were reported in unhelpfully politicized them by blaming Islamic other provinces as well. radicals and opposition party members. Even in urban areas under government control, MRG has documented continuous incidents of vulnerable women still face big health risks, and violence and human rights violations, including

130 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 extra-judicial killings, rape and destruction of harm; and the manner of refoulement, by push property against indigenous Jumma peoples in backs into dangerous waters, including in unsafe the Chittagong Hill Tracts (CHT). MRG has vessels are matters of serious concern.’ also reported in previous State of the World’s Minorities reports that these communities are In July, Bangladesh ordered charities to stop also attacked, harassed and face land grabs from giving aid to Rohingya refugees, exacerbating Bengali settlers in the area. In September 2012, the already precarious health situation of these at least 20 people were injured when Bengali groups. Acute malnutrition rates were already settlers attacked Jumma shops and homes in critically high in the camps for registered Rangamati. According to some reports, the figure Rohingya refugees – approximately 24,000 of the was as high as 60 injured. The incident was estimated 200,000 population in Bangladesh – sparked by an altercation on board a college bus. while rates of malnutrition for the unregistered Security personnel reportedly did little to stop Rohingya were reported as being even higher. the violence. The Bangladeshi government refuses to recognize Bangladesh’s Ahmadiyya community also and register the vast majority of Rohingya who continues to face harsh treatment and threats. have escaped to Bangladesh from persecution In October, in Kisamat Menanagar, a group of in Burma. Registered Rohingya are served by Islamic extremists obstructed the construction inadequate health facilities in their camps, while work of an Ahmadiyya mosque. The local unregistered Rohingya are essentially reliant authorities subsequently called for construction on what they can find for themselves. The lack to be suspended. On 25 October, the group of aid money has meant health assessments conducted a procession in the area abusing have been impossible since the crackdown, but and threatening the Ahmadiyya community. reports suggest that the situation of unregistered In early November, they made public calls for Rohingya is growing increasingly desperate. the community to renounce their religion. On 7 November, the makeshift mosque and two Health adjoining houses, one of which was used for As in many South Asian countries, there is a prayer, were burned down. Fifteen people were general lack of official health data disaggregated injured in the incident. The community had by ethnicity or religion in Bangladesh. on several occasions reportedly sought police Nevertheless, studies from UNICEF and other intervention and protection but had not received international organizations help to build a partial any. There is a history in Bangladesh of Ahmadis picture of health problems faced by marginalized being attacked and persecuted. minority and indigenous groups. In June, Bangladesh’s Foreign Minister Approximately 600,000 indigenous Jumma declared that the government would not be peoples live mainly in the CHT, one of the opening the country’s borders, preventing the country’s most deprived areas, and suffer entry of thousands of the Muslim minority particularly extreme rates of ill health. The Rohingya people who were fleeing brutal attacks CHT has the highest incidence of underweight in Burma. This was in response to a request by newborn babies – a strong indicator of poor the UN refugee agency UN High Commissioner infant health. The amount of unmet need for for Refugees to keep the border open. family planning services (i.e. married women who Referring to a widely held principle of want but do not have access to contraception) international law forbidding forced return to in Chittagong (at 21 per cent) is also the highest situations of persecution, MRG and a group of in Bangladesh (for which the average is 14 per international non-governmental organizations cent), and contraceptive use, at 51.4 per cent, is issued a joint statement in July saying: considerably lower than the national average of 61.2 per cent. ‘The refoulement of these refugees by Bangladesh to The prevalence of malaria in Bangladesh Myanmar, where they face a very immediate threat reflects the geographic distribution of Adivasis to life and freedom, and a danger of irreparable (the term used generally for indigenous peoples).

State of the World’s Minorities Asia and Oceania 131 and Indigenous Peoples 2013 This is largely attributable to less investment in strong effects on the chances of having malaria in proper housing and health services in these high- Rajasthali. risk areas. Marginalized communities, such as the Adivasis often live in remote areas where access Marma tribe of Rajasthali for example, are at risk to mosquito nets and health care is limited, and, of the disease. One study found that members on the other hand, their higher rates of poverty of the Marma community had higher prevalence mean they often cannot afford health care. The of malaria, and that both the amount of forest remote location of Adivasi communities like the cover and the elevation of a person’s home had Mro make accessing health services much more

132 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Left: Dalit woman in Bangladesh. Livia minorities would be put on hold until the Saccardi/MRG. elections ended. The quota proposal suffered a further blow difficult than for their Bengali counterparts. when in May a high court in Andhra Pradesh The most recent national demographic health rejected the government order to implement the survey showed that the CHT region, home to quota, saying it was designed purely on religious the Jumma peoples, had the second lowest rate of grounds and had no empirical data to justify the basic vaccinations in the country, at 81.8 per cent necessity for it. The central government’s efforts – the national average was 86 per cent. to override the high court through the country’s A 2009 UNICEF study showed that Christians Supreme Court also failed, when the court and Adivasi groups have higher prevalence of refused a stay order against the Andhra Pradesh diarrhoea than other religious or ethnic groups, decision. which is attributable to higher levels of poverty In February, Justice Rajinder Sachar, who and lower levels of education. The incidence for headed the panel that produced a landmark Christian households was 9 per cent, whereas report on Muslim education in 2006, said in for Buddhist households it was 5.6 per cent; an interview with the Deccan Herald that the among Saontals, an ethnic group who live government was ‘fooling’ minorities by promising mostly in the Himalayan foothills, it was 12 per reservations during elections when the greater cent in comparison to 6 per cent for Marmas need was to strengthen the education system to of Rajasthali. Poverty and a lack of education support minorities. are shown in the UNICEF study to increase Reports of Muslims being targeted under the prevalence of diarrhoea, and Christians in national security laws for arrest and detention Bangladesh have higher rates of both. continued. According to media reports, in May, The lack of adequate sanitation facilities at a special meeting, Muslim leaders under the in CHT and other remote areas where many banner of All India Muslim Majlis-e-Mushawarat Bangladeshi ethnic minorities and indigenous expressed concerns about the growing trend peoples live also impacts strongly on these of Muslim youth being arrested by police on differences. suspicion of being involved in terrorist groups. Bangladesh’s rush to lift itself out of poverty The meeting took place against the backdrop of through a boom in manufacturing has also reports that three young men – one from Bihar affected Bangladeshi health, with the tragic and two from Kashmir – had been arrested by collapse of a garment factory in Dhaka in April police that month. In November, the Students 2013 reminding the world that it still has a Islamic Organisation of India organized a protest long way to go in ensuring the health and safety march in Delhi, demanding an end to the arrests. of its workers. The leather industry also faced Also in November, several Muslim leaders signed criticism in 2012 for flushing untreated waste a letter to India’s Home Affairs Minister making water containing chemicals and animal flesh the same call. into the city’s main river, as well as exposing February marked ten years since the Gujarat children to hazardous work conditions. Minority riots, when some 254 Hindus and close to 800 communities, including Dalits, who often live Muslims were killed during communal violence on the margins of communities, are particularly in 2002 that in some areas was sanctioned and vulnerable to the effects of such contamination. supported by Hindu extremists and politicians. The government has taken little action towards India achieving justice and accountability. The state of Elections that took place in five states in India Gujarat has not properly compensated victims in the early part of the year had some significant and has been very slow to bring perpetrators impact on minority issues. First, the country’s of crimes to justice. In August, however, in a election commissioner announced that a much significant turn of events, a court convicted 32 awaited implementation of a 4.5 per cent quota people, including senior politicians from India’s for jobs and seats in the education sector for Bharatiya Janata Party for their involvement in

State of the World’s Minorities Asia and Oceania 133 and Indigenous Peoples 2013 the rioting and attacks in Gujarat. The charges between the government of India and Maoists were for a variety of crimes ranging from murder for decades. The Communist Party of India, to arson. Maya Kodnani, an ex-minister, received minorities and indigenous peoples have been 28 years in jail for her role, while 30 others targeted for attack and human rights violations were given life sentences. Although the verdict by both parties to the conflict. Violence in caused some embarrassment to Gujarat’s Hindu the state reportedly significantly decreased in nationalist chief minister Narendra Modi, who 2012, according to the Institute of Conflict held the post during the riots, he managed to win Management in Delhi. However, targeted back his seat in December 2012 and remains in violations against minorities continued. The power. Asian Human Rights Commission (AHRC) has In November, Mohamed Ajmal Amir Qassab, reported at least five prominent cases in 2012 the only surviving gunman of the Mumbai 2008 of torture in police custody, some from West attacks, was executed in a prison in Pune. In Bengal. One was a member of the indigenous September, the Supreme Court upheld his death community and one was a Muslim. sentence but the execution happened without In July ethnic violence in the north-east warning and Qassab’s family was only notified between indigenous Bodo people and Muslim later. The news of the execution sparked mass settlers saw an upsurge, leaving at least 78 people celebrations on the streets in parts of India, killed and more than 300,000 displaced. HRW but human rights activists in the country and issued a statement calling on the government internationally were critical of the execution and to rescind ‘shoot on sight’ orders issued to the the manner in which it was conducted, adding police to quell the violence and asked that police that it was politically motivated. action be taken according to international law. Arrests and detention of persons belonging to Violence between these two communities has minorities and indigenous peoples under national been ongoing and is mainly over land and natural security laws continued to take place in West resources. The failure of Assam local government Bengal. The region has been plagued by conflict officials to manage the conflict has exacerbated

134 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Left: Muslim boys from the Chowduli commu- as Uttar Pradesh and Nagaland, which have nity catch fish in India. Sanjit Das/Panos. relatively large populations of SCs/STs, are consistently poorer than for other regions such the violence. as Goa. In August, nationwide panic swept the country Infant mortality rates are 25 per cent higher based on rumours of reprisal attacks by Muslims for SCs/STs than for non-SCs/STs, according to against people from north-east India. Ethnic and a 2007 study by the UNDP. More recent studies tribal community people living and working in in Andhra Pradesh show that infant mortality India’s big cities boarded trains in their millions rates among SCs are double the national average and fled to their places of origin in fear of being and maternal mortality rates are 50 per cent attacked. higher than average. In May, India faced its Universal Periodic According to a 2007 UNDP study, a higher Review (UPR) by members of the UN Human number of SCs/STs have no access to public Rights Council. In September, the Council made health services compared to other groups; a series of recommendations to India to improve furthermore, since 1990, in some regions, the its human rights record on issues including number of people with access to health services torture in police custody; repealing the Armed had actually declined. Forces Special Powers Act; religious freedom; and Problems with lack of health services are the rights of minorities and Dalits. compounded by broader socio-economic Many international organizations campaigned problems faced by communities. Examples for Dalit rights issues ahead of India’s UPR. include malnutrition caused by poverty, and the Dalits, who make up a little over 16 per cent of inability to take time off work to travel to health the population, suffer consistent and continuous facilities or see a health worker. It was calculated grave human rights violations by members of by UNDP that, in 2000, 23 per cent more SC higher castes and have virtually no access to children, and 27 per cent more ST children, justice. In December 2012, the brutal gang rape were undernourished than their non-SC/ST and killing of a girl in Delhi sparked a national counterparts nationwide. outcry as hundreds of thousands of women For many groups living in remote or forested took to the streets to mourn her death and areas, who have never had access to health protest against violations of women’s rights in care services, medicinal plants and traditional the country. MRG and its partner organizations healing practices are a crucial resource for their receive reports of many similar incidents of gang health. Yet many communities, such as the rape on Dalit women that go unreported and Sartang in the Monpa area and the Baiga of unnoticed. Attempts by victims to seek justice are northern Chhattisgarh, face threats from the often very difficult, as they face further violations unsustainable exploitation of forest resources and attacks by the law enforcement authorities by outsiders who gather valuable plants like they complain to. ginseng for trade. Forest peoples in India face a number of threats to their cultures and Health livelihoods, through biodiversity loss and urban In India, discrepancies in health outcomes migration. The unsustainable harvesting of occur on the basis of region, gender and social medicinal plants simultaneously threatens the group. Although there is a lack of health data well-being of communities while withholding any for minority and indigenous groups, the wide compensation for resources taken from their land. discrepancies between regional provisions of Discrimination suffered by marginalized services and health outcomes in India is telling. groups also affects their health. In 2012, for The majority of India’s Scheduled Castes (SCs) example, the AHRC reported that an Ahirwar and Scheduled Tribes (STs) live in rural areas, Dalit community in Maregoan village, Madhya where there is worse health care provision and Pradesh was being deprived access to water and worse health outcomes than in urban areas. food following their refusal to carry animal Similarly, health indicators for regions such carcasses; the local shopkeeper had been

State of the World’s Minorities Asia and Oceania 135 and Indigenous Peoples 2013 intimidated into refusing to provide rations to company Vedanta Resources and its Indian the Ahirwar by the dominant caste, and the subsidiary’s plans to open a mine on land held local water pump and communal water tank sacred by the local community had a positive were fenced in. The AHRC similarly noted in moment in April 2013, however, with India’s 2012 that the dominant caste preventing access Supreme Court ruling that the indigenous of Dalits, tribal and minority communities communities will have the final decision on any to government welfare schemes is a common bauxite mine plans practice in Madhya Pradesh, Uttar Pradesh, Bihar The ongoing unrest in Jammu and Kashmir and Orissa. has also had drastic health consequences for This kind of discrimination and exclusion the population there. Violence or the threat of makes minority groups much more vulnerable physical violence continue to have significant to disease, and dramatically increases the risks effects on mental health, with a number of of malnourishment. It also directly affects their studies in recent years identifying high prevalence ability to access treatment from health services. of mental health problems, from post-traumatic In 2000, Action Aid found that in 21 per cent of stress disorder and bipolar disorder to high levels 555 villages sampled from 11 states in India, SCs of generalized anxiety, panic and phobia. were denied access to health centres. The same The increased presence of the military also study found that 48 per cent of villages denied makes it difficult for some people to access health SCs access to public water or drinking places. care. Nomads like the Gujjars, who traditionally A 2010 study by Navsarjan, a grassroots Dalit live in higher altitudes, have been left unable rights organization, and the Robert F. Kennedy to access facilities, or unable to sustain their Center for Justice and Human Rights, found that livelihoods due to restrictions on movement doctors in 10 per cent of villages would refuse and access to land. One study, published in to treat Dalit patients. A follow-up study in 2012, revealed that 39 per cent of the Gujjar 2012 found that three times more Dalit children community had relinquished their migratory were unvaccinated against polio than non-Dalit tradition during the past two decades of conflict. children. Minority and indigenous groups in India also Nepal face discrimination in the way in which their The deadline to agree on a new constitution land is appropriated and their voices ignored expired in May as members of the country’s in the drive to capitalize on India’s natural Constituent Assembly failed to come to an resources, in particular through the mining agreement. Then Prime Minister Baburam industry. The effects of mining on health are Bhattarai, member of the Maoist Party, went on twofold. First, removing a population from the to dissolve the Assembly, but elections were not land on which they depend without adequate held in 2012. The Assembly had also served as compensation results in impoverishment and the country’s parliament. ensuing indirect health effects. And, second, there One of the major areas of disagreement for are the direct impacts on health from pollution members of the Constituent Assembly was resulting from the mining. The first kind of on the issue of creating federal units based on deprivation was shown in 2008, when hundreds ethnicity. This is a major demand for some of displaced villagers from Jagatsinghpur minority communities that want greater self- district in Odisha protested against inadequate rule in their areas. However, the large numbers compensation from Paradeep Phosphate Ltd. of different ethnic groups in Nepal and their The second kind has been demonstrated across geographical dispersion has complicated the issue. India, from reproductive health problems due to The failure to reach agreement on this issue and uranium mining in Jharkhand to skin disorders the subsequent dissolving of the Constituent associated with bauxite mines and refineries in Assembly has left Nepal in political deadlock. Orissa and Andhra Pradesh. The country effectively spent much of the year The well-publicized case of the indigenous without a legislature. More concerning is that the Dongria Kondh’s battle with the UK mining constitution-making process linked to

136 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 indigenous communities have yet to reap the Case study by Dr Audrey Prost, Dr Prasanta social and economic benefits of mining-related Tripathy and Soumendra Sarangi development. In eastern India, competing claims over existing natural resources are increasing the risk of conflict. Power of Amidst this charged political backdrop, Adivasis remain the poorest socio-economic participation: group in India, with low literacy and the highest maternal and child mortality rates women’s groups in the country. The risk of an Adivasi child dying before the age of five is 25 per cent dramatically higher than that of a non-tribal child, and the maternal mortality ratio (MMR) in tribal areas improve health for of Jharkhand and Odisha is three times the national MMR. Adivasi mothers Although access to quality health services is critical to saving mothers and infants, in and newborns in tribal areas of Jharkhand and Odisha around half of women still deliver at home, and fewer eastern India than 20 per cent access postnatal care. This is because of the remoteness of tribal villages, concerns about the costs of health care and fear Involving Adivasi women in the of discrimination at the hands of non-Adivasi planning and evaluating of health care professionals. There is also a lack of information has significantly reduced deaths and about simple prevention strategies and care for empowered women among India’s Adivasi common problems during pregnancy, childbirth communities in Jharkhand and Odisha. and the postnatal period. Over 84 million Adivasis (original Fortunately, in some areas this is beginning inhabitants) from more than 500 tribal to change through processes led by Adivasi groups live in western, central, eastern women themselves. Since 2005, the civil and north-eastern India. Today a quarter society organization, Ekjut (meaning ‘coming of all Adivasis reside in the central and together’), has worked with women’s groups eastern states of Jharkhand, Odisha to improve maternal and newborn health in and Chhattisgarh. Traditional Adivasi remote tribal areas of Jharkhand and Odisha. livelihoods revolved around the use of forest Building on a methodology first developed with products and cultivation (both shifting the indigenous Aymara community of Bolivia, and upland). Laws imposed under the Ekjut selected local female facilitators to support British administration led to the widespread 244 women’s groups to meet every month nationalization of forests and subsequently as part of a participatory learning and action large forest areas were contracted to process. During these sessions women identified private companies. Adivasi ownership of common problems they faced in pregnancy land and resources has yet to be addressed and after giving birth. They also found feasible through government legislation, such as strategies to address these problems and evaluate the recently enacted Forest Act. Because of the results. The facilitators were not health this, and large infrastructure projects such workers but local women whom others could as the construction of dams, Adivasis now trust and relate to. They were given training in constitute over half of India’s displaced participatory communication techniques and people. Adivasi homelands also span some basic knowledge about maternal and newborn of the world’s largest mineral reserves, but health. The women’s groups discussed common

State of the World’s Minorities Asia and Oceania 137 and Indigenous Peoples 2013 Case study continued are implementing the participation learning and action cycle with self-help groups in Bihar problems using role plays, picture cards and and Odisha. storytelling, followed by reflection and analysis. There are a number of lessons from this The groups also organized large community work. First, women can be catalysts for meetings to share their priority problems and change. Many organizations and governments enlist the support of other community members endorse the right to participate in the to implement their chosen strategies. These planning of health care, but methods to ensure activities were meant to improve individual this are rarely evaluated, and tribal women and community knowledge of maternal and are seldom in control of the process. Using newborn health, but also foster reflection and participatory methods to involve Adivasi the confidence to change existing practices. women in planning and decision-making The intervention had hugely positive results. resulted in substantial reduction in mortality The impact of the women’s groups was and a significant sense of empowerment evaluated using a cluster-randomized controlled among women. In the first local elections held trial, published in a leading medical journal. An in the areas where Ekjut implemented the indigenous demographic surveillance system programme, several facilitators of the women’s was used, in which local women reported births groups won seats as people’s representatives, and deaths among women of reproductive age testifying to women’s increased confidence. in their communities. A data collection team Second, good evaluation pays off. Many interviewed women who had recently delivered organizations do outstanding work to improve to find out about events around the time of health among indigenous communities but birth. The women’s groups led to a 32 per cent low-cost surveillance systems and evaluation reduction in neonatal mortality (deaths in the methods lend credibility to demands for first 28 days of life), significant improvements scaling up. Finally, scaling up interventions in hygienic practices at the time of delivery and is often not – and need not be – a linear increases in exclusive breastfeeding. process: change happens in many ways, and At the end of the trial, Ekjut decided to so efforts to scale up interventions require introduce the women’s group intervention long-term commitment and flexibility. Today, into control areas for ethical reasons. Neonatal combined with increased government efforts mortality fell sharply in the control areas, and to strengthen health services and a national an estimated 500 newborn infants have been conditional cash transfer scheme to increase saved through these interventions since 2005. the uptake of institutional deliveries (Janani Further analyses also showed that the groups had Surakjsha Yojana), women’s groups from succeeded in attracting the poorest mothers and Jharkhand and Odisha are paving the way to mortality reduction has been greatest among the a better future for Adivasi mothers and their poorest. newborn babies. ■ After these early successes, Ekjut is also adapting the participatory learning and action Endnotes method to address other pressing health issues, including the prevention of childhood illnesses 1. F. Gonzales, E. Arteaga group led community and under-nutrition, and carrying out new and L. Howard-Graham, mobilisation intervention evaluations. Ekjut have also supported a scaling ‘Scaling up the Warmi on maternal and newborn project: lessons learned’, Save health outcomes: the Ekjut up of the intervention through their own the Children Federation, trial process evaluation’, facilitators and other actors. The government of retrieved July 2013, http:// BMC International Health www.eldis.org/vfile/ and Human Rights 2010, India’s flagship National Rural Health Mission upload/1/document/0708/ retrieved July 2013, http:// programme now supports women’s groups DOC15246.pdf www.biomedcentral. 2. S. Rath et al., ‘Explaining com/1472-698X/10/25 facilitated by accredited social health activists in the impact of a women’s several areas of Jharkhand, and other agencies

138 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 peace-building has been stalled, which does not celebrations of Tibetan holidays. In March, augur well for a country that has been out of for example, the authorities arrested 100 conflict for a relatively short period. Furthermore, Tibetans who were protesting to mark the 53rd the continuum between the old Constituent anniversary of the Tibetan uprising. These Assembly and the new process is unclear, leaving restrictions appear to have been imposed at the in doubt the impact of the groundwork done by behest of the Chinese government. minority and indigenous members of the former Constituent Assembly and civil society groups on Health minority rights promotion and protection. Although Nepal’s 2012 demographic health A further pressing issue is lack of survey did not provide data about inequalities accountability. While in August the Council of across caste or ethnic groups, previous population Ministers proposed a Commission of Inquiry on surveys have indicated serious disparities between Disappeared Persons, Truth and Reconciliation, the health of minority populations and that of the Commission was reportedly granted powers the population at large.5 The life expectancy of a to recommend amnesties but not prosecutions. Hill Brahmin was 68 years, while for a Hill Dalit The situation was exacerbated by a number of it was only 61 in 2009, according to UNDP. In high-profile appointments of persons alleged to 2001, UNDP found that upper-caste Brahmins have committed serious human rights violations. and Newars live, on average, between 11 and 12 Amnesty International noted that this climate of years longer than Dalits and Muslims. impunity was a particular problem in the Terai Disadvantaged minority groups face difficulty region, where it reported abuses by the security in accessing health services in Nepal, due to forces, police and armed groups. Fear of reprisals geographical remoteness, social stigma, or prevented victims from coming forward. refugee status. Marginalized groups, including Human rights protection in the country Dalits and indigenous Janajatis, face barriers to was further affected when, in March 2012, the accessing family planning services due to their Office of the High Commissioner for Human illiteracy (which may prevent them filling in Rights (OHCHR) field presence was formally required forms), poverty (which may prevent shut down after the Nepali government refused them from paying for services), or their low to extend its mandate. They also refused to social status (as a result of discrimination on the allow an OHCHR staff member to be housed part of health workers). The very distribution in the country’s UNDP office. This removal of of health workers is, in the first place, highly the UN human rights office has left a vacuum unequal across regions. in international human rights monitoring and A number of factors that contribute to health reporting. outcomes, such as sanitation, nutrition and Caste-based, ethnic and religious access to health care, are marked by significant discrimination continued to be reported. In disparities between rural and urban populations October, Bhim Bahadur, a Dalit from Dailekh that recent Nepalese surveys have captured. These district, sustained severe injuries after having factors disproportionately affect ethnic minorities, been attacked for touching the front door of a who make up a higher portion of the population house belonging to a person of a dominant caste. of Nepal’s rural regions. Dalits experienced restrictions on their religious A number of sources suggest that insecure freedom; Hindu priests and villagers prevented access to food and water is especially pronounced Dalits from entering temple precincts and for indigenous groups, especially in mountainous participating in Hindu festivals. Christian groups regions, as well as for Dalits in Nepal. As a reported receiving threats from Hindu extremists; result, disadvantaged minority groups are more these were usually linked to extortion. vulnerable to disease and malnutrition. The rights of Tibetan exiles and Nepalis Maternal mortality for Muslims, Terai of Tibetan origin continued to be curtailed, Madhesi and Dalit groups is higher than for particularly with regard to public assembly and other social groups. These rates are linked to the

State of the World’s Minorities Asia and Oceania 139 and Indigenous Peoples 2013 comparative lack of access to pre- and post-natal 2012, HRW reported that 320 members of the care for marginalized groups. Shi’a community had been killed during the The latest figures from Nepal’s Demographic year, noting that this was an escalation of the Health Survey, in showing sharp disparities in violence against the minority. Most of the attacks child mortality between the far-western and in the largely Sunni country were targeted ones eastern regions, strongly suggest that these trends by militant groups such as the banned Lashkar-e have continued to create health differences Jhangvi. In one of the attacks in August, gunmen between ethnic groups. Similarly, under-five ambushed a bus, searched ID cards, singled out mortality rates among Dalits are higher than Shi’as and shot them dead, HRW said. Violent among any other group, and well above the attacks against Shi’as increased again towards the national average (95 out of 1,000 Dalit children latter part of the year, as the community marked do not survive to their fifth birthday, while for its major religious festival, Ashura. In the run- Newar children the figure is 43). up to the event at least 30 people were killed Although a 2012 Samata Foundation study and over a hundred injured in a series of bomb in Sapatri district found that health workers do attacks in Rawalpindi and Dera Ismail Khan. not in general discriminate against low-caste Seven children were killed in one attack on 24 members at the point of service delivery, there is November. believed to be more widespread discrimination Many of the attacks on Shi’as were targeted in terms of access to information about health against ethnic Hazara living in the conflict- care that Dalits in Nepal have, as well as health affected Baluchistan province. According to workers requiring increased interest rates or fees media reports over 100 Hazara were killed for services. in Baluchistan in 2012. The Human Rights Dalits also suffer discrimination in accessing Commission of Pakistan (HRCP) reported that water due to their untouchable status. The there were 213 incidents of sectarian-related AHRC reported in 2012 an instance where attacks in 2012, which killed 583 people and the non-Dalit community in Koteli village, injured 853. Dadeldhura district prevented the water from Intolerance towards other religious minorities flowing to Dalit households. The affected in Pakistan continued to be reported throughout villagers, particularly women, have to walk five 2012. In August 2012 the AHRC reported on hours to fetch water – back-breaking work that a rise in emigration of Hindus from Pakistan’s causes stress as well as physical problems, and Sindh Province to India. The AHRC noted that takes time away from crop cultivation. large numbers were fleeing the country due to For refugees in Nepal, the situation in terms the increase in incidents of religious intolerance. of accessing health resources remains precarious. The exodus was believed to have been prompted One study of Pakistani and Somali refugees by the abduction and forced conversion of a noted that, given the lack of attention to or 14-year-old Hindu girl to Islam in Jacobabad, in budget for mental health care for the population Sindh. Earlier in the year, in Mirpur Mathelo, a at large, provision for refugees was negligible. For 17-year-old Hindu girl was allegedly abducted, Tibetan refugees, the Nepali government’s recent forcibly married and forcibly converted. The rejection of a plea to grant them identification AHRC reported that the case was brought before papers represents a major obstacle to their ability a civil court, where the girl, Rinkle Kumari, to secure livelihoods and access essential services. was slapped and abused, and, despite her pleas that she wanted to return to her parents, the Pakistan girl was converted to Islam. Her family was Pakistan has become one of the deadliest threatened and forced to accept the conversion. countries in the world for ethnic and religious Kumari’s case was later heard by the Supreme minorities. In 2012, targeted attacks against Court, which ruled that the girl should choose. the country’s minority communities rose The question raised by human rights defenders significantly, with little or no action taken by and community spokespersons was whether her the government to protect them. In September decision ultimately to remain with her husband

140 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 could truly be voluntary. While the facts of the for the banning of the Ahmadiyya community case remained disputed, it drew considerable in Pakistan. According to the HRCP at least 20 media and political attention to the situation Ahmadis were killed in 2012 because of their facing religious minorities in the country. religious identity. In September, a young Christian girl, Rimsha Baluchistan, where ethnic Baluchis are Masih, who suffers from a learning disability, was fighting for a separate state, has long seen large- held on remand in an adult prison for blasphemy scale human rights violations. In August 2012, and accused of damaging parts of the Qur’an. following a fact-finding mission, the HRCP said Several weeks later, Rimsha was freed on bail the situation had shown little improvement in after witnesses had stated that she had been the past year and serious violations, including framed. Under Pakistan’s oppressive blasphemy enforced disappearances, continued to be laws, bail is normally not permitted; Rimsha’s reported amid widespread impunity in the lawyers had pleaded for her release, however, on province. The HRCP stated in its annual report the basis that the girl was a juvenile. An imam in that 125 mutilated bodies had appeared in the the area was subsequently arrested for planting first 10 months of the year; in addition, the burnt pages of the Qur’an in the girl’s bag. The HRCP recorded 34 disappearances; while 26 case was finally thrown out of court. Rimsha’s people were traced and released, the remainder plight highlighted how the blasphemy laws can are still missing. The HRCP argued that the be abused by individuals. human rights situation in Baluchistan should Despite increasing national and international be seen more broadly beyond the conflict with condemnation, Pakistan has done nothing the Baluch independence movement, given the to remove these laws. In November, when increased targeted attacks against Hazara, other Pakistan was reviewed by the UN Human Shi’as and other religious minorities in the Rights Council under its four-year UPR, more province. than 15 countries raised concerns over the laws Violations also continued to be reported from and asked for them to be repealed. Several Pakistan’s Federally Administered Tribal Areas international organizations, including MRG, (FATA), which are also affected by conflict. drew attention to the difficult and threatening HRW reported that thousands of people conditions under which religious minorities live, arrested in 2009 in the Swat valley and FATA having to face killings, abductions, attacks, rape, on suspicion of being involved with the Taliban forced conversion and extortion, many of which remain in custody under anti-terrorism laws. are conducted by members of violent religious This area is particularly affected by internal extremist groups but commonly supported by displacement due to the conflict. In September state agents and enabled by the legal system. 2012, aid agencies warned that due to the Pakistan’s Muslim minority Ahmadiyya protracted conflict around 400,000 children community continued to face intolerance displaced because of the conflict were at risk from throughout the year. In August, the local malnutrition and disease. Ahmadiyya community was prevented from attending religious prayers to mark the Eid- Health al-Fitr festival in Rawalpindi. In December, Pakistan is not expected to meet the child masked men desecrated an Ahmadiyya grave mortality target set for 2015. At present, the site, in Lahore, breaking down and destroying number of deaths of children under one year over 100 gravestones. A similar incident had of age per 1,000 live births is 75, against the occurred in Faizalabad earlier in the year. Millennium Development Goals (MDG) target No action was taken by the police following of 40. Attaining high immunization coverage for these incidents. The Islamist Tehrik-e-Khatme childhood diseases is an important intervention Nabuwwat organization had previously pressured with regard to reducing child mortality. the police to remove Islamic inscriptions from However, less than half of Pakistan’s children the gravestones. Earlier in the year, this group are fully immunized. Immunization coverage has had held a conference in Lahore that had called actually fallen in all the provinces except Punjab,

State of the World’s Minorities Asia and Oceania 141 and Indigenous Peoples 2013 with the sharpest decline seen in Baluchistan (19 shockingly high, at 758 per 100,000 live births. per cent). Cultural practices of ethnic minorities living in In December 2012, nine health workers Baluchistan do not allow women to seek services/ vaccinating children against polio were shot and information from male health staff. The majority killed in Karachi and Peshawar. Pakistan is one of of Basic Health Units in the province are reported four countries in the world where new polio cases to have no female health workers. Almost a quarter were still emerging, despite a massive nationwide of the Basic Health Units do not have personnel to immunization programme. There were 58 offer family planning counselling or other services; reported cases in 2012, down from 198 cases in almost 40 per cent do not have a maternity kit; 2011. Misinformation about the immunization and almost half do not have a labour room. programme led some Islamists and Muslim Geographical disparities can been seen across the preachers in Pakistan to say the polio vaccine is a country, especially between Punjab (with the western plot against Muslims. The killing of the most personnel and facilities to serve women) and health care volunteers in December was a major Baluchistan (with the least). setback to the effort to reach full immunization coverage for polio and resulted in the UN calling Sri Lanka off the campaign. Minority rights remain critically challenged in Malnutrition contributes to 35 per cent of Sri Lanka as the country’s human rights situation under-five deaths and more than 40 per cent of deteriorated further in 2012 in a climate of children are either moderately or severely stunted; impunity. Serious human rights violations, such malnutrition rates in two provinces are above as abductions, arbitrary arrest and detention, emergency levels. The national nutrition survey torture and sexual violence continue to be of 2011 reveals that Sindh is the poorest and reported from the country’s former conflict areas, most food-deprived province, with 72 per cent which are considered the homeland of the ethnic of families being food insecure. It is followed by Tamil minority. Baluchistan, where 63.5 per cent of families are These areas remain heavily militarized; in food insecure. addition to checkpoints blotting the region, Pakistan’s maternal mortality ratio has the military also runs businesses, farming and declined, from 400 per 100,000 in 2004–5 to development projects, and controls civil society 276 per 100,000 in 2006–7, but meeting the activity in these areas. There is very limited MDG target of 140 per 100,000 will require freedom of expression or assembly in the further immense resources and efforts. The country’s north and east and, while people are maternal mortality ratio in Baluchistan is allowed to move in and out of the area, they

Maternal health status in Baluchistan compared with national figures

70% 60% 50% 40% 30% 20% 10% 0% Prenatal care from a skilled Facility deliveries Delivered by skilled birth health provider attendant

Baluchistan National source pdhs 2006-07, mics 2009

142 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 are heavily monitored. Tamil women in the country’s Chief Justice, Shirani Bandaranayake, country’s north are especially vulnerable in these on corruption allegations that she denies. Sri situations. Lanka’s highest court ruled that the proceedings In March 2012, the Regional Director of the were illegal, and lawyers and civil society activists Jaffna Hospital, Sinnaiah Savaroopan, reported took to the streets for days, protesting against the to the BBC that in the previous two months move and warning against interference with the there were 56 cases of rape and severe violence judiciary and breakdown of rule of law. Despite against women and girl children reported to national and international condemnation, the Sri his hospital. MRG’s partner organizations Lankan parliament voted Bandaranayake out and working in northern Sri Lanka say they receive a she was sacked from her position by the President number of complaints of sexual attacks, violence in January 2013. and abuse, in some cases by the military, but Hardly any effort has been made by the Sri frequently women are afraid to make formal Lankan government on issues of accountability, complaints. They also say women are coerced justice and reconciliation. Over three years since into sex work and/or sexual relationships with the end of the armed conflict thousands of military personnel to gain access to resources victims, including families of the disappeared, are or services. There are also major development awaiting justice in Sri Lanka. Attempts by family projects taking place in the north and east members, women especially, to seek justice or without consultation with local communities, simply mourn for their dead have been brutally and there are serious concerns regarding land obstructed by the government. In March 2012 acquisition and land-grabbing by state agents for the United Nations Human Rights Council development projects. Large sections of minority passed a resolution on Sri Lanka, calling on lands remain under military control with no the government to do more to protect human access for civilians. rights and to implement its own Lessons Learnt In 2012 there were also notable targeted and Reconciliation Commission (LLRC) report attacks against minority rights activists, recommendations. human rights defenders and media personnel. Sri Lanka’s national-level performance on Paramalingham Tharsananth, secretary of the health is generally quite good compared to students’ union of the University of Jaffna, was other South Asian states, but minority areas brutally assaulted by masked men close to a have poorer health outcomes. Available national military checkpoint in Jaffna. statistics on Sri Lanka are from 2006, released The year 2012 also saw a new wave of in 2008 in the Demographic and Health Survey widespread targeted attacks against minority (DHS 2006); they indicated higher levels of Muslim places of religious worship and business child malnutrition in the former conflict areas establishments by extremist Buddhist groups and in the east of the country. The survey was monks. In April 2012 a mosque was attacked not conducted in the north at the time as the in the north central town of Dambulla, and armed conflict was taking place. In the former subsequently the government issued demolition conflict-affected districts, such as Trincomalee, orders for the building. There has been a 28.1 per cent acute and 30.5 per cent chronic national campaign against Muslim religious malnutrition was recorded among children, practices, including on ‘halal’ certification for which is higher than the national average. These food. There is evidence of state involvement figures are expected to be much higher in the or at least complicity in the attacks and police country’s north, where access to medical care was inaction during the attacks. Attacks against limited for nearly three decades. Christian religious places of worship, particularly According to the UNDP 2012 Human Evangelical churches, continued to be reported Development Report, the four districts with throughout the year, especially in the south of Sri the highest rates of maternal mortality were Lanka. areas with high levels of minorities. The At the end of 2012 the Sri Lankan parliament maternal mortality rate in the northern town began impeachment proceedings against the of Killinochchi was 102 per 100,000 births as

State of the World’s Minorities Asia and Oceania 143 and Indigenous Peoples 2013 Above: Tamil tea plantation workers, Sri Lanka. statistics. The health care facilities available to MRG. plantation workers are inferior to those available in other sectors. One health facility must serve against the national average of 39.3. the inhabitants of multiple plantations, which Several thousand, including children, also means the facilities are overextended and lacking faced permanent physical injuries received during in resources. The plantation workers face a the last stages of the war and have faced varying variety of risks (mechanical, medical, etc.) as a degrees of trauma and mental illness. Due to the part of their daily lives. The health care facilities government’s position that there were minimal in place do little to help those who have been civilian casualties in the conflict, many of these severely disabled by their working conditions people are not receiving the required medical (e.g. back, leg, heart injuries). The increase in attention and psychosocial support. NGOs and the use of pesticides on the plantations has had other organizations providing counselling are adverse effects on the workers, including the strictly monitored by the military, and sometimes spread of disease. Despite these dangers, the attacked on the grounds that they are collecting workers are not offered any additional health evidence to support international allegations of care outreach. war crimes. Following the conflict, many female- Within family planning programmes, maternal headed households are facing high levels of and child mortality rates are particularly high. poverty, which is also likely to affect the health Expecting and new mothers are of low body conditions of women and children in these areas. weight and give birth to underweight and Plantation areas where most Tamils of undernourished infants. Mothers lack adequate Indian origin live have some of the worst health pre- and post-natal nutrition education.

144 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 began to ease sanctions following the vote. Observers such as the Alternative Asean Network South on Burma noted ‘widespread irregularities, threats, harassment, vote-buying and censorship’. In three constituencies of conflict-ravaged East Asia Kachin state, authorities postponed the vote altogether. Nevertheless, the international Irwin Loy community responded positively to the by-election. Still, the well-being of Burma’s As the world nears the 2015 deadline to achieve diverse and numerous ethnic minority groups the Millennium Development Goals, events in is necessarily a measure of the extent of the South East Asia during 2012 underscored the country’s reforms. unequal progress that has been made in many Throughout the year there were worrying countries. In many parts of the region, there are developments, including anti-Muslim troubling and consistent gaps in health outcomes demonstrations and violence, the continued between the majority and the often marginalized persecution of ethnic minorities in conflict zones, minorities. In eastern Burma, maternal health and the marginalization of minority communities remains dire for minority women in conflict in tenuous ceasefire areas. In each case, the zones, despite hopeful but tenuous ceasefires. instability had detrimental effects on the health Incidence rates of HIV soar unacceptably of already marginalized populations. In eastern high above the national average in Indonesia’s Burma, for example, the maternal mortality rate Papuan provinces. In the Philippines, a pair of is triple that of the country as a whole, making calamitous natural disasters exposed an uneven this statistically among the most dangerous places response to survivors, while maternal and in the world to be a pregnant woman. At the child health indicators in parts of conflict-torn same time, drug-resistant malaria is spreading Mindanao have actually worsened. Meanwhile, along this eastern border heavily populated by in Vietnam, researchers say the gap in access to minority groups. It now means that Burma maternal health is widening – and it is largely accounts for more than half of all malaria-related drawn down ethnic lines. The year’s events deaths in South East Asia, according to The show that basic rights for minorities are not an Lancet medical journal.6 inconsequential ideal – they have a direct impact The dire health situation in such areas is on health and lives. exacerbated by long-standing conflicts, which displace and destabilize civilian populations. Burma Fighting continued between the Burma Army During 2012, Burma continued to re-engage and the Kachin Independence Army through with the international community following the year, following the crumbling of a 17-year years of isolation. The government continued ceasefire in 2011. Numerous attempts at peace its gradual release of political prisoners, touted talks failed to produce an end to the violence. In tenuous ceasefire agreements with armed ethnic the meantime, civilians caught in the crossfire militias and lifted aspects of its once crippling continued to suffer. A March report from HRW media censorship. accused government soldiers of blocking needed In April, the country held by-elections to fill humanitarian aid, torching villages and firing on vacant parliamentary seats. Opposition figure innocent civilians. Rights groups say the conflict Aung San Suu Kyi ran and won her seat, less has displaced as many as 75,000 civilians. A than 18 months removed from long-term house further 10,000 who attempted to flee to China arrest. Critics charged that the government was were denied basic care, including safe water using a by-election – in which its control of supplies, food, sanitation and health care, HRW power was never in doubt – as a modest show to reported in June. encourage the lifting of international sanctions. Also in June, the Kachin Women’s Association Indeed, the United States and European Union Thailand (KWAT) said it had documented

State of the World’s Minorities Asia and Oceania 145 and Indigenous Peoples 2013 Above: Rohingya families living in basic home- included allegations of arbitrary arrest, physical made shelters in Rakhine state, Burma. Mathias violence and forced labour. Eick EU/ECHO. In Shan state, a short-lived ceasefire with the Shan State Army North (SSA-N) broke down in cases in which 43 women or girls were raped or June as the rebel group clashed with the Burma sexually assaulted in the 12 months leading up to Army. In December, the Shan Women’s Action June 2012. Burmese soldiers, the report stated, Network (SWAN) said civilians were frustrated ‘have used rape systematically as a weapon of by the continuing violence despite a more than war’. A later report documented the killings or year-long peace process. injuries of 26 civilians between September 2012 One of 2012’s most worrying developments and February 2013. was the surge in violence between Buddhists and In Karen state in eastern Burma, the minority Muslims. This was centred in troubled government touted its ceasefire with the Karen Rakhine state, where tensions between ethnic National Union (KNU) and its military wing, Rakhine Buddhists and Rohingya Muslims the Karen National Liberation Army (KNLA). spilled over into bloodshed. Though violence But a May report by the Karen Human Rights often grew from back-and-forth retaliations, it Group (KHRG) detailed abuses post-ceasefire, quickly developed into a humanitarian crisis with either at the hands of the Burma Army or the tens of thousands of mostly Rohingya Muslims Democratic Karen Buddhist Army (DKBA), a driven from their homes. In May, a Rakhine splinter faction of former KNLA fighters. These woman was raped and murdered; the assailants

146 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 disproportionately high. Naw, who lost four of Case study her children before they were five years old, says she feels safer having a baby here in this clinic. That’s why she pays for transport across the Despite the Moei River, which acts as a natural border here between Thailand and Burma, so she can reach ceasefire, health the clinic on the Thai side. Naw says, ‘I’m not young any more. I care woes continue know I’m old to be having a baby. I should be delivering in a proper health centre.’ in south-eastern The year 2012 began with hopeful news in Naw’s native Karen state: the announcement of Burma a ceasefire between the Burmese government and the Karen National Union (KNU), who have been engaged in one of the longest-running civil In a bustling waiting room, Naw sits on a wars in the world. fold-up chair, her hair caught in the breeze of An October survey from The Border a whirling fan. Consortium (TBC), an umbrella organization of Her arms rest over the bump just international groups delivering aid to Burmese beginning to show beneath her clothes. refugees in Thailand, estimated that 10,000 This will be the eleventh time she has been people were displaced in south-eastern Burma pregnant. However, it is the first time she will during 2012. It is still a worrying figure, but far actually consult with a health professional less than the estimated 75,000 a year that had during the sensitive prenatal months. been recorded prior to this. For many like her, the Mae Tao Clinic in Even as hostilities cooled during the year, the western Thai town of Mae Sot along the however, the health situation remains perilous. Burmese border is the only opportunity to The TBC survey suggested almost three-quarters access reliable health care. of people in the south-east’s rural areas do not ‘When I was in the countryside in Burma, have access to safe drinking water, while almost there would be only one midwife for the half cannot access proper latrines. entire village,’ says Naw, who asked that her While Burma has boosted funding for its name not be published. ‘If I wanted to get health services recently, the national health proper health care, I had to go to a big city budget still comprises only 3 per cent of total and spend money.’ government expenditure, according to medical It is a vital issue in south-eastern Burma, journal The Lancet.7 People like Naw have turned which has suffered from years of clashes to the international community, through the between Burmese troops and armed ethnic Mae Tao Clinic, which has a target population militias fighting for autonomy. That includes of about 150,000 people on both sides of the decades of fighting over the border in Karen border. state, where many of the patients who cross For others, who cannot reach the clinic, the the border to reach the clinic live. situation is often dire. Groups like the Backpack The instability means the maternal Health Workers Team, based in Mae Sot, are mortality rate in south-eastern Burma – trying to take health care to those who need it. describing the rate of women who die during For years, the group has sent mobile teams into pregnancy – is more than three times the remote areas to deliver health care. In just the national rate, at 740 deaths per 100,000 live first six months of 2012, health teams dealt with births. more than 45,000 individual cases. Mortality rates for infants and Mahn Mahn is the group’s director. He says children under the age of five are also last year’s KNU ceasefire has made travelling in

State of the World’s Minorities Asia and Oceania 147 and Indigenous Peoples 2013 Case study continued eager to take advantage of the relative calm.8 Mahn Mahn says, ‘There are direct health the region easier for health workers. But even impacts, but also indirect ones from land with a ceasefire, health problems are just as confiscation, conflicts between locals and worrying. Preventable illnesses like malaria, workers.’ diarrhoea and acute respiratory infections are still Mahn Mahn says he hopes a permanent prevalent in the target area. At the same time, end to the fighting will see the health aid workers say the relative calm has sparked situation improve. However, the path ahead a renewed interest in large-scale development remains difficult. projects, particularly in the mining sector. There have been more reports of land confiscation as ‘We see only the ceasefire, but we don’t see proponents of these development projects are the peace process clearly. We need to see what the peace process will be in order for the Below: Karen amputee at the Mae Tao Clinic political situation to stabilize. Without solving in Thailand, found along the Burmese border. the political situation, the ceasefire is not Brendan Brady. sustainable.’ ■

148 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 were reported to have been three Muslim men. most persecuted people on earth’ – refused A week later, an incensed Rakhine mob attacked citizenship by Burma, and unwanted by a bus and beat to death 10 men perceived to neighbouring Bangladesh. While the antipathy be Muslim. The violence sparked a series of in Burma has been cultivated by outspoken retaliatory attacks. According to official estimates, extremist Buddhist monks, ordinary citizens the attacks left 80 people dead and displaced a have also participated in large anti-Rohingya and further 90,000, mostly Rohingya, by the end of anti-Muslim gatherings. This was highlighted the month. by an October demonstration in the capital, Aid workers warned of a burgeoning Yangon, when thousands of monks marched in ‘humanitarian crisis’ for Rohingya Muslims the streets to protest the Organization of Islamic fleeing the violence. Conditions in temporary Cooperation’s stated plans to help the Rohingya. camps were described as ‘alarming’, with health Violence between majority Buddhists and experts expressing particular concern over minority Muslims flared elsewhere in Meikhtila malnutrition rates among displaced Rohingya. in central Burma in March 2013. Media and The violence saw many Rohingya attempt to rights groups reported on a massacre of at least flee Burma in boats, only to be turned back 25 Muslims in late March. by neighbouring Bangladesh, where tens of The future prospects for long-term peace in thousands of displaced Rohingya already live in Burma’s disparate ethnic regions are inextricably official and unofficial refugee camps. In a June tied to the government’s renewed push for the report based on interviews with fleeing Rohingya, development of the country’s natural resources. the UK-based Equal Rights Trust charged that But critics say the push for development in the military had not only turned a blind eye to these still sensitive areas has brought with it the violence against Rohingya, but that it had increased militarization. A November report by actively participated in ‘state-sponsored violence’ the Ta’ang Students and Youth Organization against them: (TSYO) highlighted problems associated with the controversial Shwe Gas Pipeline, which will ‘The military became more actively involved in allow the shipment of oil and gas between China committing acts of violence and other human rights and the Bay of Bengal. Burma has deployed abuses against the Rohingya including killings and additional military units to guard the pipeline mass-scale arrests of Rohingya men and boys in route, amid pressure from armed ethnic militias. North Rakhine State. This has caused an increased The pipeline’s construction has led to land proportion of men and boys to flee the country, confiscation, forced labour and other rights resulting in increased incidences of rape of the abuses, the report states. women left behind, committed by Myanmar security A February 2013 report by the Transnational personnel.’ Institute warns that the sudden development rush sparked by Burma’s political changes has actually Violence again erupted in October, leaving fuelled ethnic conflict. The authors estimated more than 100 people dead, according to that 65 per cent of approved foreign direct official estimates. HRW suggested that the investment had been injected into three conflict- death toll could be far higher. While there ridden states alone: Rakhine, Shan and Kachin. has been violence on both sides, human rights The report states: groups warn that many of the consequent attacks have been focused on Rohingya ‘Instability and the lack of effective regulatory communities, often with the complicity of a mechanisms has provided opportunities for government unwilling or unable to protect rapacious, large-scale resource extraction, such as them. For example, HRW released satellite mining, hydropower dams and logging, as well as images following the October attacks showing illegal cross-border trading. The impact on local whole villages belonging to Muslim families communities has been severe, and the benefits few burned to the ground. and far between.’ The stateless Rohingya are often called ‘the

State of the World’s Minorities Asia and Oceania 149 and Indigenous Peoples 2013 pregnant, because they don’t know when they will Case study have to go on the run again. They don’t want to have to flee while pregnant. So they ask us to give them birth control. We try to give things like birth Continued fighting control pills and condoms, but we don’t have enough. They don’t know that you have to keep taking causes human rights the pills and they don’t know where to get other medicine. So if we give them enough for one month, abuses and health they just use it for one month, and that’s it. So they concerns in Burma’s will get pregnant again. ‘One of the women in the camp was heavily non-ceasefire areas pregnant when she had to run away. She suffered a miscarriage on the journey. Pregnant women have to stay in a safe place and not have anything to worry Lway Poe Ngeal is a Palaung woman who left about except to take care of their own health. But she Burma for better education opportunities in couldn’t do that. Then even after she miscarried, she neighbouring Thailand. Now, she works with the still had to run.’ Palaung Women’s Organization, which advocates for the rights of an ethnic minority community Increasingly, some Palaung farmers have had concentrated in northern Shan state. to turn to opium cultivation to survive. The Palaung civilians have become caught up increasing availability of narcotics has sparked an in the violence between the Burma Army and addiction problem. Poe Ngeal has seen the effects armed ethnic militias, including the Kachin in the camps. Independence Army (KIA), the Ta-ang National Liberation Army (TNLA) and the Shan State ‘One of the fathers is a drug user. His wife has to Army-North (SSA-N). Upon returning from her starve because of it. Her husband doesn’t care about most recent aid mission in early 2013, Poe Ngeal anything; he just cares about drugs. So when they says there are at least 2,000 internally displaced fled from the fighting, she was pregnant. She gave people (IDPs) from Palaung communities living birth to her baby after arriving in the camp. After, in five basic camps in northern Shan state near the family didn’t have anything to eat. Eventually, Kachin state. Aid has barely trickled in to these her husband took the baby and sold it. He trafficked camps. Food and water shortages are common the baby. It’s such a horrible story. We don’t know and medicine is difficult to obtain. how we can help them. We can only support them with small humanitarian aid, but we can’t help ‘The new IDPs cannot access humanitarian aid. everyone.’ They don’t have shelter. They don’t have a safe place to stay. They don’t have food, water, or medicine Burma’s president, Thein Sein, has received too. They don’t have anything because they had to international attention because of the country’s run away from their homes suddenly. It is a new life recent political reforms. But Poe Ngeal worries for them. They have to start their lives again.’ that these cautious changes have overshadowed the continuing humanitarian crisis in conflict zones. Many men have fled or migrated elsewhere in search of work. That means women are taking on ‘There are still serious human rights violations in increasing responsibilities and bearing the burden Palaung areas. You see the IDPs running away from of displacement. For many women in the camps, their homeland. So how can they survive and live one of the biggest fears is becoming pregnant again. their lives? If the political situation is not stable, they cannot go back to their homeland. They cannot ‘Some women tell me that they don’t want to get survive. That is very worrying for me.’ ■

150 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Cambodia titles rather than communal ones, which has The issue of land rights dominated concerns for caused division in some communities. By signing indigenous peoples in Cambodia during 2012. on to private titles, some indigenous families have An escalation in controversial economic land given up the right to traditional land cultivation concessions, or ELCs, continued to exert pressure methods and other cultural traditions on their on marginalized communities throughout the ancestral lands inside ELCs. The scheme was country, especially indigenous groups relying initially meant to include access to collective on ancestral and communal lands for their communal titles, with the purpose of honouring livelihoods. At the same time, the government’s indigenous groups’ traditional ways of living. overt support of private firms, often run But the government later decided to delay the by individuals with close ties to the ruling granting of collective ownership, according to Cambodian People’s Party (CPP), contributed to local media. In early 2013, however, authorities what local rights group called the ‘worst year’ on announced a plan to begin mapping the ancestral record for activists trying to defend their land. land belonging to a handful of ethnic Bunong A study by local rights group Licadho reported communities seeking collective titles. that authorities had carved up nearly one-quarter An analysis of a proposed agricultural of the country’s land mass as ELCs awarded to ownership law by Licadho suggests the private interests. Of these, at least 98 concessions, government intends to encourage communities totalling more than 700,000 hectares, affect to abandon traditional shifting methods of land that indigenous communities live on or cultivation. use, according to a September 2012 report from While facing pressure on land issues, Surya Subedi, the UN Special Rapporteur on health statistics for marginalized indigenous the situation of human rights in Cambodia. communities continue to be cause for concern. The government says ELCs are a vital part of For example, births in urban areas of Cambodia its strategy to develop what is a largely rural- are more likely to be attended by a skilled health based country, but critics say the policy has professional, compared with rural provinces seen hundreds of thousands of Cambodians like Mondulkiri or Ratanakkiri, where many threatened by eviction in the last decade. The indigenous groups reside. roots of Cambodia’s land problems can be traced In his report, Subedi, the Special Rapporteur, back to the Khmer Rouge, who abolished private warned that forced evictions and relocations ownership and monetary currency during their resulting from land concessions exacerbate disastrous rule from 1975 to 1979. an already challenging health situation, in The country held nationwide commune many cases making it harder for indigenous elections in June 2012, which were dominated by communities to access water, sanitation and basic the ruling CPP. Before this, Prime Minister Hun health services. Sen announced a moratorium on the granting Yet divisive resource projects slated for of ELCs, as well as a new land-titling scheme development near indigenous communities seem nationwide. But critics say the programme has likely to heighten problems in the near future. been too secretive, while others have speculated Plans for hydropower projects in the Cardamom that it was more likely part of electioneering in Mountains could displace roughly 1,000 mostly the lead-up to the commune elections, or the indigenous people. The Lower Sesan 2, a dam general elections planned for July 2013. project of Mekong tributaries in northern While Cambodia’s land problems have affected Cambodia, will also see an estimated 5,000 a broad cross-section of society, indigenous people resettled. groups have been particularly impacted by ELCs In April, well-known conservationist Chut and the renewed land-titling efforts. The titling Wutty was gunned down while accompanying scheme is especially of interest to indigenous journalists to a suspected illegal logging site in the communities, who have lived for generations Cardamom Mountains. After altering the official on communally run land. But the government explanation of how Wutty died, authorities titling scheme has favoured individual private claimed Wutty was shot and killed by a military

State of the World’s Minorities Asia and Oceania 151 and Indigenous Peoples 2013 police officer, who was in turn accidentally its faults, which include serious allegations of killed by a private security guard working for a political interference, the court’s backers see it logging company. A provincial court convicted as a rare symbol of justice following years of the security guard of causing an accidental death impunity for Khmer Rouge perpetrators. and sentenced him to two years in prison, only to While the court is pursuing crimes committed suspend the remaining sentence. against the Cambodian people as a whole, the Wutty had become a thorn in the side of the two remaining elderly defendants on trial – the government by shining a spotlight on illegal Khmer Rouge regime’s chief ideologue, Nuon logging. He also campaigned on behalf of Chea, and its former head of state, Khieu indigenous communities in Prey Lang forest, a Samphan – are also charged with genocide lowland evergreen forest in central Cambodia. specifically against the minority Cham Muslim Critics saw Wutty’s death as a tragic community and ethnic Vietnamese, who continuation of repeated attempts to intimidate historians believe were both specifically targeted and threaten land rights activists. Throughout by the regime. the year, activists reported numerous cases where community organizers had been summoned to Indonesia appear in court to face charges of incitement, Indonesia, the world’s largest Muslim-majority or where authorities disrupted rights training nation, is also an intensely diverse country whose sessions. A January 2013 report from the citizens are drawn from an estimated 300 separate Jesuit Refugee Service focused attention on ethnic groups, speaking different languages and the under-studied problem of discrimination practising multiple religious faiths. While the against Cambodia’s Vietnamese minority, country is often held up as a model of religious which comprises an estimated 5 per cent of the tolerance and democracy, alarming instances population. Many Vietnamese in Cambodia live of intolerance, which sometimes spilled into in limbo, having been denied the documents violence, shows that the reality is far removed required for citizenship, even though many from the political platitudes. speak the Khmer language and were raised in There were numerous examples throughout Cambodia. The report argues that such groups the year. Members of Indonesia’s Ahmadiyya are at risk of statelessness. Being denied basic community, a Muslim community branded citizenship rights also makes these already heretics by religious conservatives, continued vulnerable groups more susceptible to human to face persecution. In April, members of trafficking. fundamentalist group Islamic Defenders Front Additionally, members of the Khmer Krom (FPI) attacked an Ahmadi mosque in Singaparna, minority – ethnic Khmer from southern Vietnam West Java, according to the Asian Human Rights – continued to report difficulties accessing basic Commission (AHRC), which contends that services. Though the government’s stated policy police did little to stop the damage. is to welcome Khmer Krom in Cambodia, That same month, the AHRC says FPI advocates for Khmer Krom say they face members forced an Ahmadiyya religious leader discrimination in practice. on Batam Island to sign an agreement to The Extraordinary Chambers in the Courts of stop holding religious activities. In July, local Cambodia, the UN-backed war crimes tribunal media reported that ‘an angry mob’ attacked set up to try senior leaders of the Khmer Rouge and injured three Ahmadis in Bogor. Other regime, continued its work throughout the year. Ahmadiyya communities continue to be But it faced increasing questions over the status marginalized. Local media reported that 120 of future cases and the likelihood of seeing a members of the Ahmadiyya community remain full trial against its frail and ageing defendants. displaced in West Nusa Tenggara province, seven In March 2013, Ieng Sary, the regime’s former years after a mob attacked and burned their foreign minister, died at the age of 87. The court homes. They are unable to obtain basic identity also continues to be dogged by funding shortfalls, cards, preventing them from accessing needed which threatened to disrupt proceedings. Despite health and education services.

152 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Ratanakkiri alone, authorities have issued land Case study concessions to private firms for at least 157,000 hectares of land where indigenous communities live, according to estimates from a September In Cambodia’s report by the UN Special Rapporteur on human rights in Cambodia. Naturally, these projects remote Ratanakkiri cause conflict with local indigenous communities. For example, in early 2013, multiple indigenous province, resource communities complained about at least three separate Vietnamese-run rubber firms, according exploitation to local media. Complaints included accusations of the bulldozing of community farmland and puts pressure filling in a lake vital for food and irrigation. Such firms had been granted controversial economic on indigenous land concessions in the area. Despite the resource development, the province remains one of the communities most impoverished in the country. Them worries about the health of her six children, because the nearest clinic is at least 15 km away. Ploy Them is an ethnic Tampuan woman living in Ratanakkiri province in Cambodia’s ‘If my family gets sick, the nearest clinic is far away remote north-east. from here. This year, my son got very sick. He In 2004, Them says the government couldn’t eat anything or even swallow. We spent awarded a land concession to a firm that a lot of money to get there. We had to take loans quickly opened up a large gem mining from other people just to pay for the trip. Now my operation. Her fellow villagers were allowed daughter is sick with diarrhoea. I want to take her to stay, but some of the gem mine infringed to the health clinic, but if we don’t have money, on the local community forest. By the time what can we do? We just stay here and do what we the company left several years later, the water can.’ flowing in a nearby stream had become undrinkable. Today it has an oily sheen and Them says that recently a representative from a villagers are afraid to bathe or wash their new company came to the village and showed clothes in it. A well provided by an NGO residents a map of a land concession they broke down. They now rely on a basic well planned to develop. Some of the concession that villagers dug nearby. overlapped with parts of the community’s land. The company has not yet returned, but Them ‘We don’t drink the water any more. We used to says people in her village are worried about the wash in the stream, but the water is no good to future. use now. If the water is not clean, then it’s not very good for living. The company was trying ‘We really don’t want to lose the land. If we lose the to look for gems and they made the water dirty. land, we will surely die. We can’t live without land When people drank the water, they became sick.’ to farm. All the villagers want to stop the company because we can’t afford to lose our land.’ ■ Ratanakkiri is a hotbed of activity for resource exploitation industries. In recent years, large-scale logging, rubber and agro- business plantations and mining operations have opened up as a result of economic land concessions granted by the government. In

State of the World’s Minorities Asia and Oceania 153 and Indigenous Peoples 2013 A report by Ahmadiyya advocacy group Lajnah of rape and sexual intimidation even after the Imaillah, submitted to the UN’s Committee attacks, while those driven into shelters, as with on the Elimination of Discrimination against the Ahmadiyya communities in West Nusa Women (CEDAW) in July, outlined health Tenggara, have lost their jobs and been prevented concerns for a group of displaced Ahmadis who from registering their marriages. had fled violence from their homes in West Nusa In its concluding statement, the committee Tenggara province. Some children from a group expressed deep concern about the pressures faced of 170 people living in temporary shelters on by rural and indigenous women. Women from Lombok island were suffering from malnutrition, rural settings were much less likely to be able to while others had dropped out of school. give birth in a health facility than their urban Rights groups also called on authorities to stop counterparts, a worrying problem that directly attacks against minority Shi’a Muslims. In July, affects uneven maternal mortality rates, the a Shi’a cleric from Madura Island was convicted committee stated. of blasphemy for his religious teachings. An Overall, Indonesia has made progress in August incident left one Shi’a man dead in the lowering its maternal mortality rate, from a same community after an attack in which a mob baseline of 390 deaths per 100,000 live births to also burned down 35 homes belonging to Shi’a 228, according to the government’s Millennium families. By the start of 2013, rights groups said Development Goals (MDGs) update last year. local authorities were threatening the families The goal is to reach 102 deaths per 100,000 already displaced by the violence with forced live births in 2015. However, the results are eviction. uneven across the vast archipelago, with troubling Persecution against Christians also continued differences between urban areas and the rural in parts of Indonesia, with groups blocking some villages where many minority and indigenous congregations from holding religious services. women live. The discrepancy can be blamed in In April, for example, local officials in an area part on a weaker health system in outlying areas. outside Jakarta obstructed 100 members of the Indonesia’s often heavy-handed crackdown on Filadelfia Batak Christian Protestant Church the movement for autonomy and self-governance from worshipping. In 2009, local authorities in West Papua continued to have detrimental stopped the planned construction of a church impacts on indigenous Papuans in the country’s there, and the congregation has faced continuous easternmost provinces. opposition. In June, police shot and killed independence Overall, the Jakarta-based Setara Institute for activist Mako Tabuni, whose death triggered Democracy and Peace recorded 264 cases of angry demonstrations. Police claim the vice- violations against religious freedoms during 2012 chairman of the National Committee for West – a figure that has risen steadily over the last six Papua (KNPB) violently resisted arrest, but years. activists and rights groups dispute this. Also Rights groups say such persecution against that month, KNPB leader Buchtar Tabuni was religious minorities continues to occur in part arrested after police accused his organization of because of a weak government response. For engaging in violence. example, authorities have encouraged Christian Throughout 2012, activists and rights groups and Shi’a communities to relocate, while court accused police and military of employing prosecutions against perpetrators of violent intimidation tactics against activists, including attacks are rare. arbitrary arrests, shootings and torture. In a June In July’s CEDAW session examining report, the Commission for Missing Persons Indonesia, the country’s National Commission and Victims of Violence (Kontras) outlined on Violence Against Women (Komnas what it said was a drastic increase in reported Perempuan) warned that acts of intolerance torture incidents over the past 12 months, against religious minorities could see an increase predominantly at the hands of police. The rights in violence against women in particular. Women group said they had recorded 86 allegations of from religious minorities face additional threats torture – triple the previous total. Roughly 40 per

154 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 cent of reported victims were from the Papuan … does not recognize the application of the provinces. indigenous people concept as defined in the UN The continuing conflict in West Papua is Declaration on the Rights of Indigenous Peoples exacerbating what is already a worrying health in the country’. situation for civilians. According to Indonesia’s National AIDS Commission, AIDS prevalence Laos rates are at least 15 times higher than the Laos, a single-party state, nominally allows for national average. This suggests a need to step up freedom of religion, so long as worshippers awareness and education efforts in high-risk areas. adhere to one of the state-sanctioned groups At a national level, heightened HIV infection within four recognized religions: Bahá’i, rates are generally found in traditionally high-risk Buddhism, Christianity and Islam. Evidence groups. However, in Papua, health professionals from rights monitors shows authorities continued say the problem is more widespread across the to harass and repress those who attempted to general population. At the same time, NGOs, exercise their rights outside of these parameters, including those working in the health sector, say particularly in rural areas. the authorities have made it increasingly difficult The US-based Human Rights Watch for Lao to work in the area, which suggests that West Religious Freedom (HRWLRF) highlighted Papua’s political stability will be an important a number of cases throughout the year. In determinant in changing health outcomes for February, for example, HRWLRF says local minority groups. officials threatened to expel 10 Christian families Cases of land conflict between private in northern Laos’ Luang Prabang province, unless companies and indigenous communities they renounced their faith. The organization says continued through the year. Protesters have Lao authorities have cracked down in particular often found themselves on the receiving on new Christian converts in Savannakhet end of excessive police force when staging province. demonstrations. In February 2012 for example, A joint 2012 report between the Lao police shot and injured five farmers in Sumatra’s Movement for Human Rights (MLDH) and Riau province. The AHRC said the farmers were Paris-based International Federation for Human peacefully protesting against a palm plantation Rights (FIDH) noted that many Christians in firm. Laos come from already marginalized ethnic The national government’s broad development minority groups. The report stated, ‘Repression plans seem likely to be a source of future conflict against Christians has not diminished and has if not handled carefully. Indonesia’s Economic even intensified in 2012.’ The US Commission Master Plan (MP3EI) seeks to stimulate growth on International Religious Freedom (USCIRF) through a focus on so-called ‘economic corridors’ listed Laos as a ‘watch list’ country because of – clustering and connecting industrial and ‘serious religious freedom abuses’. special economic zones throughout the country. Ethnic diversity in Laos is expansive; officially, It is crucial that indigenous groups themselves the government recognizes 49 separate groups, are included in any such planning that affects but there are likely quadruple the number. Rights their land and livelihoods; failure to do so could groups say the Hmong continue to be among instead increase tensions with affected groups. the most persecuted, because of Hmong leaders’ In May, Indonesia was subject to scrutiny as support of the United States during the Vietnam part of the UN Human Rights Council’s UPR War. Of particular concern are a group of 4,700 process. Member states urged Indonesia to ensure that Thailand forcibly repatriated to Laos in that perpetrators of assaults against religious late 2009 – a group that included 158 who had minorities were brought to justice and to ensure already been granted refugee status before their the rights of indigenous peoples. But some rights deportations. Other than a tightly controlled groups were disappointed by Indonesia’s response visit in 2010, neither rights monitors nor aid to the UPR, which included a passage stating that workers have been granted access to the camps ‘given its demographic composition, Indonesia where the returned Hmong were held. According

State of the World’s Minorities Asia and Oceania 155 and Indigenous Peoples 2013 Above: Hmong boy at a market in Laos. Chris This is representative of Laos’s overall Stowers/Panos. struggle to bring adequate health care to remote communities, where many minority groups live. to the MLDH, ‘repatriated Hmong have been A World Health Organization (WHO) profile victims of imprisonment, re-education and of the health sector noted that the government discrimination’. claims 93 per cent of the population lives within Unanswered questions also remain about an average walk of 90 minutes to the closest prisoners detained in Vientiane’s Somsanga drug health facility, but there are ‘major differences’ detention centre – ostensibly a facility for treating in accessibility compounded by ethnicity and drug addiction that critics say is more of a prison gender. for undesirables. HRW researchers say there is A separate WHO/Ministry of Health report evidence that Hmong have been detained there. on the mental health system noted a large gap in Landmines or other unexploded ordnance the distribution of health professionals between (UXO) still kill or injure about 100 people urban and rural settings. All the country’s each year in Laos, one of the most heavily psychiatric treatment centres are located in the bombed countries on earth. The government capital, Vientiane, rendering it highly prohibitive itself acknowledges that assistance to landmine for ethnic minorities living in the highlands to and UXO survivors is ‘still inadequate’. As the access them. The report concluded, ‘Inequity of International Campaign to Ban Landmines access to mental health services for other minority notes, ‘Most survivors come from the poorer users … is a major issue in the country.’ remote areas, belong to ethnic minorities, and are A study published in the Asia-Pacific Journal disproportionately disadvantaged by the existing of Public Health in November examined health limitations in the provision of service.’ inequalities in the country. The authors found

156 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 highland Mon-Khmer minorities reported staged a large-scale rally in Kuala Lumpur. ‘significantly worse health, even after making Organizers claimed up to 300,000 people adjustments for their living in inaccessible areas’.9 attended. As in previous Bersih protests, police While the government is attempting to reduce responded in a harsh manner, arresting hundreds. the geographic inequalities in the health system, In June, three UN special rapporteurs issued the results have been slow in some cases. For a statement urging the government to protect example, a July news report from Inter Press activists from harassment, drawing attention to Service (IPS) showed that many rural minorities claims of intimidation against Bersih organizer were unaware of a new mobile midwife Ambiga Sreenevasan. programme – a year after health authorities had During 2012, parliament approved legislation launched it. to replace the Internal Security Act, which Land issues in the country continued to had been used to harass government critics in place pressure on minority communities. In a previous years. But its replacement, the Security January report submitted to the UN Committee Offences (Special Measures) Act, still allows those on the Elimination of Racial Discrimination suspected of ‘security offences’ to be detained (CERD), the Unrepresented Nations and without trial. The new legislation, Amnesty Peoples Organization (UNPO) warned that land International stated, ‘merely replaces one concessions for rubber plantations were stripping oppressive regime with another’. In multicultural Hmong people of their land with inadequate Malaysia, the issues of ethnicity and religion are compensation. never far from the surface. Islam is the majority During 2012, Laos broke ground on its religion, with significant Buddhist, Christian controversial Xayaburi hydropower dam. The and Hindu minorities. In June, JAIPP, the 1,285 megawatt dam would be the first project Islamic affairs council in Penang, investigated on the mainstream of the Lower Mekong River after Christians were accused of proselytizing and have adverse effects for the food supply to Muslims. No evidence was found of this, downstream. About 2,000 people around the according to rights group Suara Rakyat Malaysia, area are expected to be displaced – a number or Suaram, but the issue nonetheless highlighted that includes many indigenous Lao Theung the sensitivities of religious matters in the families. Conservationists say the project, and country. In October, Suaram said parents at others planned on the Mekong, could decrease SK Pos Bihai, a school for indigenous children fish supplies and have a major impact on food in Kelantan state, accused a Muslim teacher of security in the future. slapping their non-Muslim children because they In December, prominent human rights activist could not recite an Islamic prayer. Government Sombath Somphone went missing. Supporters officials initially denied the claims. believe Sombath was abducted. The government Peninsular Malaysia’s diverse indigenous has denied involvement, but international rights peoples, collectively known as Orang groups and diplomats have expressed grave Asli, comprise less than 1 per cent of the concern. overall population, yet face worrying health discrepancies. For example, a report by the Malaysia Women’s Aid Organisation (WAO) examined In Malaysia, controversial new legislation drew Malaysia’s progress on gender equality. It pointed broad criticism from rights groups at home and out that studies show Orang Asli women have abroad. The Peaceful Assembly Act was passed in a lower life expectancy than men. They also late 2011. Critics, including civil society groups run a greater risk of malnutrition and have high and the political opponents of Prime Minister rates of postpartum haemorrhage and puerperal Najib Razak, said the law’s ‘excessive restrictions’ sepsis. As researcher Colin Nicholas of the would be used by the government to crack down Center for Orang Asli Concerns has noted, ‘With on public demonstrations, rather than support the majority of them living below the poverty freedom of assembly rights. line, their narrow margin of survival makes In April, the anti-corruption coalition, Bersih, the Orang Asli’s health situation precarious.’

State of the World’s Minorities Asia and Oceania 157 and Indigenous Peoples 2013 Orang Asli communities also find themselves the population as a whole. battling over land and development in their often Ethnicity remains a hot-button issue in resource-rich areas. Early in the year, 13 Temiar Malaysia, particularly in the lead-up to planned protesters in Kelantan were arrested after they elections in 2013. Analysts say ethnic Chinese protested against an agricultural project slated for voters are becoming increasingly disillusioned development on their ancestral lands, according with Razak’s ruling coalition, with public opinion to rights organization Aliran Kesedaran Negara. surveys suggesting an increasing lack of support. Activists in the area have also warned of the This may have ramifications for ethnic minorities increased threat posed by rubber plantations. in general, should the coalition decide to shore In Borneo’s Sarawak, extensive plans for up its support by instead focusing on policies massive hydropower projects are of major popular with majority ethnic Malays. Already in concern to indigenous communities. The first 2012, minority politicians complained of veiled such project, the Bakun dam, was responsible for threats of violence. the forced displacement of 10,000 indigenous Meanwhile, China continued to show that it people before it was finished in 2011. Now, had the ability to export its domestic agenda to activists are fighting against the next projects in neighbouring countries in its pursuit of minority line – the Murum and Baram hydropower dams, Uighurs. Radio Free Asia (RFA) reported that 11 which rights groups say could displace more than Uighurs whom Malaysia previously repatriated 20,000 indigenous people altogether. to China had been sentenced to prison terms in In October, 450 Orang Ulu villagers – a China on charges of ‘separatism’. At the end of general name used to describe several tribes on the year, Malaysia again bowed to China’s wishes, Sarawak – protested against local leaders who forcibly returning six Uighurs with pending they said had pledged support for the Baram asylum claims. HRW called it ‘a grave violation project without their consent. In September, of international law’. villagers at risk of losing their homes blockaded construction of the Murum dam, which was The Philippines expected to be completed in 2013. A September The year 2012 in the Philippines was bookended report from the Forest Peoples Programme noted by a pair of natural disasters that shone a that the expansion of palm oil plantations in spotlight on the hardships faced by minority Sarawak is proceeding at a rate of 90,000 hectares and indigenous groups – already marginalized each year. populations that suffered from an uneven The WAO report also highlighted the abuse of disaster response in the aftermath of the damage. Penan women and girls in Sarawak. The report Tropical Storm Washi, known as Sendong in included allegations of abuse at the hands of the Philippines, slammed into Mindanao in timber workers, underscoring the interconnection mid-December 2011 before touching down in between resource-exploitation without sufficient Palawan. Both areas have a significant population local consultation and human rights problems. of minorities or indigenous peoples. The storm An April briefing by the Global Health Group killed more than 1,200 people and left 300,000 said Malaysia should focus its anti-malaria fight homeless – one of the Philippines’ worst natural in part on Borneo, where indigenous populations disasters in years. In February 2012, more than remain at high risk. The government has set a month after the storm hit, UNICEF reported a goal of eliminating malaria on peninsular an alarming rise in child malnutrition rates Malaysia by 2015; however, the deadline is five attributable to the storm’s effects. years later on Malaysian Borneo. The malaria One year later, a report on Sendong’s effects issue for indigenous peoples in Sarawak and by the Internal Displacement Monitoring Sabah is indicative of unequal access to vital Centre (IDMC) warned of an uneven response services. While the usage of ineffective traditional to survivors in places like Northern Mindanao’s remedies and environmental factors contribute to Cagayan de Oro. Some respondents told the problem, indigenous peoples on Malaysian researchers that authorities had classified them Borneo also lack the same access to health care as as migrants rather than Sendong survivors,

158 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 preventing them from accessing aid. The January the May shooting death of Margarito Cabal to 2013 report stated, ‘Evidence suggests that his opposition to the controversial Pulangi V Sendong survivors in Cagayan de Oro have not hydropower dam in Mindanao. Groups like received equal treatment on the basis of their KAMP point the finger at the government of political opinion or ethnic or social origins.’ In President Benigno Aquino III or its agents. In surveys of affected areas, there were anecdotal October, KAMP claimed there had been 30 reports of gender-based violence and coerced extra-judicial killings of indigenous activists or prostitution at relocation sites. This suggests an their supporters in the 28 months since Aquino urgent need to study and address this issue as had taken office. In a May statement, the UN’s part of future planning for disaster response. Special Rapporteur on the rights of indigenous In December 2012, Typhoon Bopha, known peoples, James Anaya, urged South East Asian as Pablo in the Philippines, struck Mindanao, governments, including the Philippines, not to killing more than 1,100 people and displacing ‘sideline’ the rights of groups ‘who derive their hundreds of thousands. Again, medical experts livelihoods, traditions and ways of life directly raised concerns of lingering health impacts, from their natural environments’. He highlighted particularly in areas where the storm had the case of the bio-ethanol energy project in destroyed local health clinics and severely Isabella province, which has displaced indigenous damaged larger hospitals. farmers. However, disaster response experts applauded Sadly, the killings continued even after year’s the government in February 2013 for introducing end. In February 2013, Dexter Condez was the Act Protecting the Rights of Internally killed while on his way home from a meeting Displaced Persons. The IDMC called it ‘the first about land rights: Condez was youth leader of its kind in Asia’, particularly for highlighting and spokesperson for the Atis, an indigenous the rights of indigenous peoples and women. community living on the island of Boracay, a While this may be a positive development, fast-developing tourist destination. In 2011, the throughout the year alarming acts of violence government had granted the Atis a certificate of against indigenous people, often land rights ancestral land title to a 2.1-hectare waterfront activists and their supporters, continued to site. This decision has been challenged by tarnish the Philippines’ human rights record. In property developers, and the Atis remain severely March, Lumad leader Jimmy Liguyon was shot marginalized. to death, allegedly at the hands of a paramilitary Since coming to power, Aquino has largely group, according to Kalipunan ng mga staked his legacy on a peaceful resolution Katutubong Mamamayan ng Pilipinas (KAMP) to the long-standing conflict in Mindanao. – an alliance of indigenous peoples’ groups. In Violence between the Philippine Army and July, Willem Geertman, a Dutch missionary pro-independence groups, most notably the who advocated on behalf of indigenous peoples Moro Islamic Liberation Front (MILF), has had in Central Luzon, was shot dead in front of his severe effects on civilians over the course of a office, KAMP stated. In September, the AHRC more than four-decade conflict. In its year-end reported that the son of a tribal leader opposed report, human rights watchdog Karapatan said to local mining operations was shot on his way the military continues to falsely accuse some to school in Zamboanga del Sur in western civilians caught in the violence of being ‘Muslim Mindanao. In October, Gilbert Paborada was terrorists’. shot dead in front of his home in Cagayan de In October the government and MILF reached Oro. Paborada led an advocacy organization that a deal the Aquino administration touted as a opposed plans for a local palm oil plantation. roadmap to peace. The deal sees MILF dropping The reported violence against indigenous its demands for outright independence, in activists often went hand in hand with land favour of an ‘autonomous political entity’ to disputes, primarily over private development be known as Bangsamoro. This represents a projects opposed by local communities in hopeful step towards ending the violence in resource-rich areas. For example, KAMP linked troubled Mindanao. However, much work

State of the World’s Minorities Asia and Oceania 159 and Indigenous Peoples 2013 remains to be done to ensure a lasting peace there were four times as many Muslims exposed in the lead-up to 2016 and beyond, when the to unprotected water sources, while Muslims framework agreement calls for the election of also had to travel double the distance to access the Bangsamoro legislature and the formation health clinics or schools, according to the report. of a government. A disarmament plan must still Previous studies have noted that when displaced be agreed upon and implemented, as must a Muslims seek shelter in Christian communities method of ensuring that the rights of non-Moro women often face the bulk of discrimination, minorities are respected. At the same time, not as many are easily identifiable if they wear everyone is on the same page. Militant group headscarves. At the same time, key health Abu Sayyaf remains on the sidelines, as does statistics in the Autonomous Region in Muslim the Bangsamoro Islamic Freedom Movement, a Mindanao (ARMM) are troubling. The ARMM MILF breakaway group that, in August, clashed has the highest levels of under-five, infant and with the army in the lead-up to the peace neonatal mortality of all 17 regions, according to accord, causing the temporary displacement of a January 2013 study on health inequality in the an estimated 60,000 civilians, according to the Philippines. In Northern Mindanao, under-five IDMC. To its credit, the framework agreement and neonatal mortality rates actually increased includes passages – albeit brief ones – calling between 2000 and 2007. on parties to respect the ‘customary rights and In late December, the Philippines took a major traditions’ of the region’s indigenous peoples. step when President Aquino supported legislation While the peace process is welcome, it does that would make it easier for women to obtain not negate the years of significant suffering by contraceptives and would make sex education civilians. In February 2012, the World Bank mandatory in public schools. The issue was a and World Food Program released a general divisive one in a country where the Catholic population survey of central Mindanao, Church holds significant influence. However, which highlighted the far-reaching effects of abortion remains illegal in the Philippines. the conflict. During the UN’s UPR for the Philippines in The report estimated that 40 per cent of May, the Committee on Economic, Social and families in the survey areas had been displaced by Cultural Rights (CESCR) urged the government fighting at least once between 2000 and 2010. to address the issue of maternal deaths Compared to Christians in the survey area, stemming from unsafe abortions by ‘reviewing’

160 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Left: Karen people from Burma work in fields in towards Malayu in Southern Border Provinces Mae Sot, Thailand. William Daniels/Panos. of Thailand (ACARM) – claimed that state discrimination against Malay Muslims has its legislation on abortions. Sweden urged the ‘created an environment of distrust’ between Philippines to amend legislation to allow for authorities and the local affected communities. abortion in cases of rape, incest or when the ACARM highlighted problems for Malay health of a pregnant woman is threatened. Muslims in accessing health care. These include communication problems for elderly Muslims in Thailand public hospitals and the failure of some health The unresolved conflict in Thailand’s south care centres to accommodate Muslim customs. continued to be a source of instability and human ACARM also says Malay Muslim women have rights abuses throughout 2012. While Thailand been disproportionately affected by the Thai is predominantly Buddhist, its southern border military’s response to the conflict, shouldering the provinces are home to a majority Malay Muslim responsibilities for providing for their households population. A separatist insurgency – and the if male family members are killed or arrested. often-criticized response from Thai security forces Thailand is home to diverse ethnic minority – continued to see civilians caught in the middle communities, particularly in its northern hill and even targeted. Since 2004, more than 5,000 areas. In its CERD submissions, the Coalition people have been killed. on Racial Discrimination Watch (CRDW) In February, a truck bomb explosion in front highlighted problems of racial discrimination. of a public health office killed a retired teacher For example, reports in local media that ethnic and injured 13 other civilians. One month later, minority communities had cut down trees a roadside bomb struck down four soldiers. Also propagated the view that such groups were in March, nine people were killed and a further responsible for the destruction of forest areas. 70 injured after a series of bomb explosions, Indigenous peoples in forest areas have become which authorities blamed on separatists. ‘scapegoats’ for climate change, CRDW argued, Insurgents also continued attacks on public citing an Environment Ministry practice sector civilians. This included a December attack that fines forest-dwelling communities like in which insurgents allegedly shot dead two ethnic Karen or Hmong for practising shifting ethnic Thai Buddhist teachers. Some insurgent agriculture techniques. fighters view civilians such as teachers and civil The report noted that there were still more servants as legitimate targets because they are than 100,000 indigenous people who had no perceived to represent the Thai government. access to the public health system. A significant HRW counted 11 separate attacks on schools problem is many indigenous people’s inability or teachers in the preceding month and a half to obtain legal status. NGOs who work with before the December killings. such communities say that applicants suffer Civilians have also been victims of violence from a lack of information on procedure. perpetrated by the army. In January, for example, While the government allows in-process Thai troops killed four people initially identified applicants to receive health care, the National as insurgents. But the military later admitted the Commission on Human Rights of Thailand four were not linked to the separatist movement. notes, ‘public health services are still elusive for Critics say the military has targeted innocent hill peoples who have not yet received status’. Muslim civilians suspected of being insurgents In its concluding observations from an August with insufficient evidence. In submissions to session, the CERD stated: the UN CERD, a coalition of advocacy groups based in the south said 80 per cent of arrests ‘The Committee is concerned about the inadequate made following insurgent attacks were based on access to social welfare and public services by certain false assumptions or accusations from a third ethnic groups because of language barriers and the party. The coalition – the Alliance for CERD limited availability of such services where these Alternative Report on Racial Discrimination groups live.’

State of the World’s Minorities Asia and Oceania 161 and Indigenous Peoples 2013 Thailand has long been home to tens of unregistered church group, the Vietnam Good thousands of refugees who have fled fighting in News Mission, while according to UNPO, the eastern Burma. Though Burma has struck fragile other belonged to the registered Evangelical ceasefires with some armed ethnic militias, the Church of Vietnam (North). In early January situation remains volatile. Along Thailand’s 2013, authorities began tearing down a western border, more than 150,000 people, both monastery in Hanoi, according to Asianews.it, a registered and unregistered, make their homes Catholic news website. in what have become semi-permanent refugee In late December, Vietnamese police camps. In the past, Thai officials have publicly arrested Le Quoc Quan, a Catholic lawyer mused about sending refugees back to Burma as who was an outspoken advocate for democracy the country opens up. and freedom of religion. In August, police In a July visit to both countries, the UN High conducted a mass raid on Degar Christians in Commissioner for Refugees, António Guterres, Kontum, a highland province. According to said it is imperative that the refugees not be the Degar Foundation, more than 30 mostly forced to return, particularly while the situation elderly people were injured when they could across the border remains uncertain. But life in not disperse quickly enough. In November, the and out of the refugee camps in Thailand remains group reported that police arrested six Degar tenuous. Refugees staying within the camps are Christians in a separate raid. Degar refers to not allowed to work. Those who try to make the indigenous peoples of the central highlands, a living outside the camps are often without who were called Montagnards by the former status and at risk of deportation. A September French colonial administration. report by HRW, meanwhile, said that dwindling Buddhist orders not sanctioned by the funds mean health organizations are struggling government also faced harassment. In June, to provide adequate assistance in the camps. police beat a monk from the outlawed Unified One French NGO downsized its outreach staff Buddhist Church of Vietnam, after arresting and cut its mental health services by 40 per him for not wearing a helmet while driving cent. Camps have also lost skilled refugee health a motorbike, according to RFA. The US workers and teachers to resettlement, resulting Ambassador to Vietnam, David Shear, later met in less experienced replacements and, noted one with the leader of the church in an apparent NGO official, ‘a decline in services’. The HRW show of support. report states, ‘With a reduced support network But the US’s own stance on Vietnam’s and fewer coping skills and after so many years treatment of religious minorities is mixed. with restrictions on movement, proscriptions on During 2012, the USCIRF once again the right to work, and dependency on outside aid, recommended that Vietnam be designated as many camp residents experience domestic abuse, a ‘country of particular concern’ (CPC) by the depression, and other social and mental health US State Department – countries that display problems.’ severe violations of religious rights, which could then be subject to US government sanctions. Vietnam But Vietnam has not been included on the State Vietnam’s Constitution nominally allows for Department’s final CPC list since 2006. Some freedom of belief and religion, but only ‘lawful observers have attributed this discrepancy to religious organizations’ are protected by law. the United States’ renewed strategic interests in Sanctioned religions include Buddhism, Cao Dai, Asia, which include a warmer relationship with Catholicism, Hoa Hao, Islam and Protestantism. Vietnam. Followers of religious denominations that do not A controversial new government decree on enjoy official status faced particular problems religion approved in late 2012 may see the throughout the year. situation worsen for religious minorities. Decree In June, authorities demolished two Christian 92 include new requirements to obtain legal churches built by ethnic Hmong in Dien Bien status, including a provision stipulating that province. One of the churches belonged to an applicants must not previously have ‘infringed

162 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 on national security’. Such broad wording seems Krom community – ethnic Khmer who live in likely to increase the ways in which authorities southern Vietnam – accessing basic health care can crack down on unsanctioned groups. can be problematic. In its CERD submission, Meanwhile, freedom of expression continued the Khmers Kampuchea-Krom Federation (KKF) to be tightly controlled during the year. said many Khmer Krom have difficulty accessing According to the Committee to Protect government-subsidized health care and are Journalists, Vietnam had locked up 14 journalists treated as ‘second-class citizens’ even when they by December. These included journalists who are able to. reported on religious minorities and other In its CERD submission, the Vietnam sensitive topics. Committee on Human Rights (VCHR) said Land conflicts continued to be a contentious the introduction of user fees for health care two issue through the year. In July, authorities jailed decades ago has led to ‘alarming disparities’ three activists who were outspoken about land between ethnic minorities and the overall issues. Land in Vietnam is owned by the state, population. These include significant differences which grants usage rights to individuals. For in infant mortality and poverty rates. And a Vietnam’s indigenous peoples in particular, WHO bulletin from December 2012 warned of uncertainty over land-ownership is a pressing ‘increasing ethnic inequity’ in maternal health concern. care in Vietnam. While women in Vietnam were Vietnam is in the early stages of preparing for more likely than in past years to receive proper REDD – Reduced Emissions from Deforestation antenatal care and give birth in a health facility, and Forest Degradation, the UN-backed initiative ethnic minority women were at greater risk of not that applies financial incentives to preserve forest receiving such treatment. The WHO stated that: areas. But with uncertain tenure rights, this has the potential to be a future flashpoint. A 2012 briefing ‘Inequity in maternal health care utilization has paper by the Asia Indigenous Peoples Pact (AIPP) increased progressively in Viet Nam, primarily warned that pilot projects in Vietnam showed along ethnic lines, and vulnerable groups in the that much work remains to be done to ensure country are at risk of being left behind. Health- that indigenous peoples are properly included care decision-makers should target these groups in meaningful consultation. A 2012 study by a through affirmative action and culturally sensitive local NGO, Culture Identity and Resources Use interventions.’ Management, noted a wide gap between rights in Vietnam’s forestry laws, and the reality for In its concluding observations on Vietnam, indigenous peoples on the ground. the UN CERD said it is ‘deeply concerned As part of its submission to the UN CERD, at the sizeable socio-economic gap between which reviewed Vietnam in 2012, UNPO disadvantaged ethnic minorities and the warned that land disputes are seeing indigenous majority Kinh, even when they live in the communities literally losing ground to Kinh same mountain area’. For many marginalized people, who form Vietnam’s ethnic majority: communities in remote locations, this economic gap compounds the inequality in accessing ‘Indigenous groups … report that large tracts health care. Anand Grover, the UN’s Special of fertile farms and valuable forest lands have Rapporteur on the right to health, noted in a been confiscated and reallocated to ethnic Kinh July report on Vietnam: without fair compensation. In many instances, the indigenous families are relocated to areas that lack ‘The poor and near poor, especially those in rural access to basic infrastructure and services, including and mountainous areas predominantly populated by schools and healthcare facilities.’ ethnic minorities, are often burdened by additional expenditures on food, travel and accommodation Health outcomes among ethnic minority and in order to access basic health services. In many indigenous groups are continually lower than instances, these expenditures amount to more than those of the general population. In the Khmer the cost of the health services sought.’

State of the World’s Minorities Asia and Oceania 163 and Indigenous Peoples 2013 to Chinese Human Rights Defenders (CHRD), the law marks a ‘step in the right direction’, East Asia but fails to close loopholes allowing police and government officials to commit political Emily Hong dissidents to psychiatric institutions against their will. The year 2012 also saw major reforms China in China’s Criminal Procedure Law, a process Despite China’s once-in-a-decade leadership that has been ongoing for almost ten years. The transition, political developments and legal Danish Institute for Human Rights argues that reforms in 2012 failed to signal a departure from the law has created a ‘two track criminal system’, long-standing policies towards minorities and representing progress in areas of procedural rights indigenous peoples. The lead-up to the transition and a ban on torture, but only for ‘ordinary was marked by a crackdown in which over 130 criminals’. The legislation simultaneously legalizes human rights activists were detained or faced the detention without charge of those suspected restrictions between September and November. of terrorism, corruption or jeopardizing national During the week of the National Party Congress, security, charges often brought against Tibetan, 11 Tibetans set themselves on fire, reflecting a Uighur and other minority dissidents. However, sense of desperation for political change in Tibet. controversial ‘disappearance’ clauses (which On 15 November, the Chinese Communist would have allowed authorities to detain suspects Party unveiled its new leadership, including without family notification) were removed due Party Secretary Xi Jinping and six others, notably to overwhelming criticism, according to the Dai excluding two senior reformist members. Unlike Hua human rights journal. the last grouping, the majority of new Politburo The government continued to crack down on members have coastal constituencies, prompting activists in China’s ethnic autonomous regions. concern that they may have even less reason to The government intensified its crackdown in tackle ethnic issues in inland China. Xi became Tibetan regions after a record number of self- the country’s president in March 2013. immolations by Tibetans, reflecting a wider In a speech following the congress, Xi only trend in heightened surveillance and repression mentioned ‘ethnic groups’ as part of a narrative since protests in 2008. Eighty-two Tibetans self- celebrating the Party’s transformation of ‘the immolated in 2012; self-immolations continued impoverished and backward Old China into the in 2013. The government opened fire on Tibetan New China that has become prosperous’. China’s protesters in January 2012, and those involved leaders continue to emphasize ethnic unity and in self-immolation-related protests have received modernization but have failed to address the sentences of up to 13 years. In February 2013, grievances of the country’s ethnic minorities, who repression intensified with authorities detaining comprise 8.5 per cent of the population. 70 ‘criminal suspects’ linked to ‘inciting’ acts of In May 2012, the dramatic escape of blind self-immolation. disability rights activist Chen Guangcheng Environmental degradation linked to natural brought China’s human rights issues to world resource extraction in Tibet came to the forefront headlines. Chinese and international NGOs in April 2013, with a deadly mine-related highlighted his case in September when China landslide killing 83 in the Gyama Valley near participated in its first-ever review under the Lhasa. The Gyama mine, along with other major UN Convention on the Rights of Persons with development projects, is part of the government’s Disabilities, which it adopted in 2008. five-year plan to make Tibet a mining centre and The UN Committee on the Rights of Persons hydropower engine of China. with Disabilities criticized the then draft mental Amnesty International highlighted the cases health act for violating the free and informed of several Uighur political prisoners, including consent of the individual. The new mental health a famous writer who died in prison due to law was passed in October and prompted mixed ill health in 2012. Another prisoner remains responses from human rights groups. According critically ill with cancer. Amnesty International

164 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 also reported on new testimony which shows that hundreds of Uighurs disappeared during Case study by Rinnai Ngadan the Urumqi riots of 2009, many of whom are still missing. This is part of wider repression in the Xinjiang Uighur Autonomous Region, as Maternal deaths indicated by the alarming number of Uighurs on trial for ‘endangering state security’. Uighurs, remain high for who account for less than 1 per cent of the population in China, comprise about half of China’s ethnic all those on trial for endangering state security, according to Dai Hua journal. minorities In Inner Mongolia the Southern Mongolian Human Rights Information Center celebrated the news that, after years of efforts by activists, Many minority women in western China the regional government has agreed to consider a do not give birth in hospitals because proposal to bring in new legislation to promote of poor-quality facilities and culturally the use of the Mongolian language in 2013. insensitive care. In November, local NGOs Green Sina and Despite China’s national progress in the Green Earth Volunteers found evidence that areas of maternal and infant health, rural and toxic water from a coal-processing factory was ethnic minority regions lag behind. A 2010 being illicitly dumped in the Tengger desert of UN report tracing China’s progress towards Inner Mongolia, contaminating the underground the Millennium Development Goals shows water and endangering herders in the area. that maternal mortality rates are almost China’s socialist health care system was once twice as high in western regions, where many lauded by the World Health Organization ethnic minorities live, than in wealthier (WHO) as an example for other developing eastern provinces. countries, with ‘Barefoot doctors’ (chijiao yisheng) Since 2000, China has campaigned for providing basic services to some of the most all women to give birth in hospitals, in an rural ethnic areas.10 Market reforms of health effort to reduce the number of mother and care since the 1980s led to widespread public newborn deaths. And yet such a policy focus discontent over the lack of affordable health care. ignores two persistent realities that hinder In response, the Chinese government launched maternal and child health for rural minority major health reforms in 2009, with a goal of women – lower-quality care in rural hospitals achieving universal health coverage by 2020. and a lack of understanding of traditional More than 95 per cent of the population is now birthing practices. covered by some public health insurance, but Studies show that ethnic minority women patients still have to pay for at least 60 per cent are much less likely to seek health care or of out-patient costs and 50 per cent of in-patient give birth in hospitals than the majority costs, according to a 2012 review published Han population. A major study in 2007 in The Lancet medical journal.11 Critics argue investigated the challenges of using maternal that without a focus on structural causes of health care services for Yi and Mong ethnic discrimination, such reforms will have uneven minority women in a remote area of south- impacts. west China’s Sichuan province. China is ‘on track’ towards meeting all of its The study found that accessibility, while health-related Millennium Development Goals, clearly a factor given the lack of good roads but given the lack of data disaggregated for and transport, was not as important as many minorities, it is doubtful that national statistics presume. are representative of remote ethnic areas, which Hospital deliveries are very expensive. The often lack basic health infrastructure. government’s new cooperation insurance Rural migrant workers living in urban areas,

State of the World’s Minorities Asia and Oceania 165 and Indigenous Peoples 2013 Case study continued would prefer not to be shaved, to be allowed to walk around during labour and to give scheme was introduced in the area in 2006, birth in a position similar to the traditional and although most women have paid their semi-sitting position, which was not contributions, many do not know how to use the available as a choice in the hospital. scheme. Furthermore, costs of a hospital birth – The focus on western medical approaches including medication, transportation and family to health and childbirth, and the lack of accommodation – exceed any reimbursement sensitivity to local culture and practices, available through the scheme. contributes to the lack of trust and desire for Women are also staying at home because of the minority women to give birth in a hospital poor quality of care in township hospitals, where setting. The government also does not medical staff cannot perform caesarean sections support relationships between health staff or keep safe blood supplies. and experienced traditional midwives. Lack of understanding of local culture and beliefs In spite of China’s progress towards health among health care staff is another important and targets, health issues among ethnic minorities neglected barrier. The cultural inappropriateness continue to be neglected. The government’s of birthing practices causes women discomfort and emphasis on increasing accessibility and embarrassment; and there is a lack of incentives improving health infrastructure ignores such as pain relief during labour.12 the much-needed improvement in service Researchers noted how women said that they quality. Most critically, a bias towards western medicine in hospitals does not give Below: Yi woman from Yunnan Province, sufficient attention to the potential and role China. Eric Lafforgue. of traditional health practices. ■

166 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 including minorities, are denied access to social would not address discrimination against services and health care under the hukou – or minorities, and called for the government to household registration system. Most of the adopt an anti-discrimination law. estimated 200 million migrants are still registered Following December elections, the Liberal as rural residents and so are excluded from Democratic Party announced it will exclude accessing health insurance, or must pay higher Korean schools attended by third- or fourth- prices for health care they can rarely afford. In generation North Korean students from tuition December, the government announced it will subsidies, citing poor political relations between speed up household registration reform but the the two countries. Since then, local governments, details have yet to be revealed. including the Tokyo municipal government, have followed suit. Schools for children of migrant Japan workers, such as Brazilian and Peruvian schools, Despite Japan’s public narrative of racial and have also not received financial support from the cultural homogeneity, the country is home to government. several minorities. These include the Burakumin, Students of Korean schools have also been the descendants of outcastes during the Tokugawa target of hate crimes, a trend that has worsened period, Ainu and Okinawan indigenous peoples, in recent years. The government has failed to ethnic Korean and Chinese populations, and its respond to violence against girl students, and so ‘newest’ minorities nikkeijin, Latin Americans of schools have changed the design of noticeably Japanese descent who began to return to Japan Korean school uniforms to less conspicuous in the late 1980s. The year 2012 saw several styles. major events for minority rights and health in Japan’s minorities also face multiple forms Japan – its second UPR by the UN Human of discrimination with regard to health care. Rights Council in October and a visit by the Disadvantaged migrants face multiple barriers Special Rapporteur on the right to health in to accessing health care, particularly emergency, November. HIV/AIDS and maternal health care. Migrants In an August 2012 report the Japanese and asylum-seekers held in detention centres NGO Network for the Elimination of Racial are particularly at a disadvantage. In a 2012 Discrimination documented how legal authorities report, the UN High Commissioner for Refugees refused to deal with multiple cases of hate speech (UNHCR) asked the government to consider against minorities on the basis that there is no changing its current policy requiring asylum- legal mechanism or law to prohibit such racial seekers to pay for medical care up front and wait discrimination. The report also documents for later reimbursement. speeches from a handful of elected officials who A 2012 study published in BMC Public have publicly remarked upon Japan’s status as Health showed that, despite the universal ‘one nation, one language and one ethnicity’ and health insurance policies for legal residents, linked economic success to its status as a country documented Latin American immigrants of ‘one race’. The anti-discrimination network disproportionately lack health insurance has pointed to the persistent problem of internet- coverage.13 A joint report by the Ainu based hate crimes including so-called ‘Buraku Association of Hokkaido, the Buraku Liberation Lists’, which name town wards populated by League Central Women’s Division and other descendants of the Burakumin community. One NGOs urged the government to provide boy who discovered his Buraku origins on the counsellors who can offer culturally sensitive care internet committed suicide. for Ainu, Buraku and Korean women who face In Japan’s UPR in October, several NGOs and domestic violence. The minority organizations UN member states underscored the persistence of claimed there is complete failure to ensure direct and indirect discrimination against Japan’s the active participation of Buraku, Ainu and minorities. The Network for the Elimination of Zainichi Korean women in the deliberation, Racial Discrimination expressed concern that preparation and evaluation of women’s policy, the proposed national human rights institution including health.

State of the World’s Minorities Asia and Oceania 167 and Indigenous Peoples 2013 arrived, I saw that there were many homeless Case study by Emily Hong people, like me, working. I realized then that this company recruits in the poorest areas.’ Kazuyuki Iwasa, the first Japanese worker to sue Japan’s Burakumin the government for radiation-related illness, 40 years ago – was a Burakumin. Photographer Kenji minority hired Higuchi, whose work documents the exploitation of nuclear plant workers, has highlighted Iwasa’s to clean up after case, which was rejected by the government. In a speech on the Fukushima 50, he spoke of Iwasa’s Fukushima tragic case and untimely death: ‘Of course his origin had something to do with his job. In our social structure a discrimination creates another The nuclear disaster highlights health hazards discrimination.’ for the country’s marginalized workers. The term ‘Burakumin’ refers not to a distinct In November 2012, Anand Grover, the UN ethnic group but to people living in Buraku, Special Rapporteur for health, made a trip to areas where many but not all residents are Japan to investigate the right to health in the descendants of the outcastes of feudal society context of the triple earthquake, tsunami and during the Edo period. They were given work, nuclear disaster that devastated the country such as leatherwork and butchery, considered in March 2011. His report highlighted the ‘tainted’ according to Buddhist and Shinto beliefs. tremendous health risks for nuclear plant workers Despite the formal abolition of the caste system exposed to high levels of radiation. At a press in 1871 and special government measures in the conference, the Special Rapporteur said, ‘I was 1970s to prevent third parties from searching distressed to learn that there is a practice of Buraku ancestry, the Burakumin – who number employing a large number of contract workers between 1 and 3 million – remain one of the through a layer of sub-contractors’. most excluded and disadvantaged communities in Both Amnesty International Switzerland Japan. and an investigative documentary produced Discriminatory attitudes towards Buraku by European television network Arte have remain deeply ingrained in Japanese society. claimed that many of these temporary workers According to the Buraku Liberation League are from Japan’s most excluded minority – the (BLL), between 10 and 50 per cent of people Burakumin. surveyed in several prefectures do not want It is difficult to verify how many of the clean- relatives to marry a person of Buraku origin and up workers are Burakumin, but one Burakumin do not want to live in a school district which worker, temporarily employed at a nuclear plant includes a Buraku area. in Hamaoka, speaks about his recruitment in the The BLL’s survey of 12,000 Burakumin Arte documentary. ‘The Burakumin, the Japanese women has shown the continued effects of such Untouchables,’ Yoshito Fujita says, ‘when I discrimination on employment opportunities.

Mongolia dominated politics in Mongolia. After the Mongolia is one of Asia’s fastest-growing elections, Amnesty International called for new economies, but the gaps between urban and rural legislation to combat discrimination against populations, particularly among ethnic minorities minorities and marginalized groups, particularly and nomadic communities, continue to grow. A non-Mongolian nationals, who are often targets new governing coalition led by the Democratic of discrimination. Party took power in July 2012, replacing the In a speech at the UN General Assembly Mongolian People’s Party, which has historically in November, Mongolia’s UN Permanent

168 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 Between 60 and 70 per cent of women upcoming presidential election in May 2013. surveyed work in irregular precarious jobs, Eighty per cent of the country’s exports are a number 1.5 to 2 times higher than the minerals; the Oyu Tolgoi copper and gold average. In a 2012 report on minority mine, the largest foreign investment project in women in Japan, the BLL claims that Mongolia, is expected to contribute one-third of ‘difficulty for Buraku women in obtaining the country’s GDP by 2020. stable jobs originates in their educational The National Human Rights Commission backgrounds, which leave them no choice of Mongolia highlighted the negative impact of but to take seasonal or irregular work’. mining on the environment, the health of local Such structural discrimination leads some people, and nomadic culture and traditions in an Burakumin to take jobs in some of the October 2010 report. The Chief Commissioner most ‘dirty, dangerous, and difficult’ said the ‘right to health protection is violated industries, including the nuclear sector. during mining exploration, extraction, and According to Yuki Tanaka, a Professor at processing and transportation activities’. Hiroshima City University, Japan’s poor, Hospitals in mining-affected counties are unable including many Burakumin, have difficult to provide adequate services to residents and buying into the national health insurance migrant workers, and there are a high number programme because of the high premiums. of industrial accidents and occupational diseases A further issue is the practice of among those working at mining sites. subcontracting, which causes lack of Dukha, Mongolia’s smallest ethnic minority, accountability. The Fukushima plant is no have also felt the impacts of mining and loss of exception. Plant owner and spokesperson access to natural resources. The 200 remaining for TEPCO, Yoshigi Hitosugi, denied reindeer herders in Mongolia’s north-west have ultimate responsibility for the health and had to abandon pastures due to deforestation safety of temporary workers in an interview and chemical contamination caused by small- with Arte. According to Hitosugi: ‘We scale gold and jade mining. The ban on Dukhas’ currently employ three hundred people traditional hunting methods since 2010 has also at the site of Fukushima through sub- affected the nutritional diet of herders. In a 2012 contractors. In the end, we do not know United Nations Environment Programme report, who is involved or what conditions are one woman expressed concern that Dukha proposed for the most dangerous tasks.’ children are smaller than children born in other The dearth of public information on parts of the country and that pregnant women do workers’ health and safety in the ongoing not have access to regular medical care. clean-up at Fukushima points to a larger In the past few years, UN agencies have problem – the persistence of intersecting focused on projects aimed at benefitting the forms of discrimination faced by Japan’s country’s ethnic and linguistic minorities. most marginalized minorities. ■ The UN Education, Science and Culture Organization (UNESCO) is working with the government to establish public television and radio channels in minority languages and community radio projects in minority populated areas of four provinces. Representative highlighted human rights as a UNESCO has also worked with the WHO to priority of the National Action Plan for 2012– improve health and sanitation in rural Mongolia, 16, including abolishing the death penalty and including areas populated by ethnic and linguistic minimizing the negative impact of business on minorities, by training health care workers, human rights. improving basic water facilities and reducing Natural resource extraction is a hot political the spread of infectious diseases in rural county issue in Mongolia, as evident in debates hospitals. The UN Population Fund (UNFPA) surrounding the parliamentary election and has provided ‘mobile health care’ in remote areas

State of the World’s Minorities Asia and Oceania 169 and Indigenous Peoples 2013 Above: Dukha people in Mongolia. Hamid by 2020. This is in addition to the large number Sardar/Corbis. of migrants who come to Korea for work, approximately 550,000 in 2011. Demographic in the wake of a dzud – severe cold weather – shifts have stimulated public debate on questions which destroyed the livelihoods of thousands of around ethnicity and the Korean ‘nation’, in Mongolian herders in 2010. This has included contrast to the dominant nationalist discourse mental, reproductive and maternal health for historically focused on ‘one blood’ present in women. textbooks just ten years ago. The government, despite outward South Korea encouragement of ‘multiculturalism’ – such as In 2012, Jasmine Lee became the first naturalized sponsoring poster campaigns for the damunhwa Korean to win a seat in South Korea’s National gajeong (multicultural family) in Seoul’s subway Assembly. This marked an important step stations – has not embraced a multicultural ideal. towards Koreans coming to terms with an Government-sponsored ‘multicultural family increasingly ethnically diverse society. However, support centres’ provide courses on Korean despite the government support for ‘multicultural language and culture, prompting criticism that families’, official policies towards immigrants such centres aim to assimilate minorities rather remain pro-assimilation in practice. than foster multiculturalism. Public sentiment In January 2012, immigrants and children also remains ambivalent. Xenophobic discourse of immigrants comprised 2.5 per cent of the was ignited in August, when a group of protesters population. One out of ten marriages in the gathered at the immigration office calling for the country are international and the number of abolition of multicultural policies. naturalized Koreans is projected to reach 200,000 South Korea’s UN UPR in October

170 Asia and Oceania State of the World’s Minorities and Indigenous Peoples 2013 health care receivers and in Laos: a cross-sectional 2012 highlighted both positive and negative health care providers’, BMC study of 24 162 men developments with regard to discrimination Health Services Research, vol. and women’, Asia-Pacific against minorities. The government noted its 13, 2013, p. 166. Journal of Public Health, 27 November 2012, efforts to ‘ensure that marriage immigrants 4. Thapa, J., ‘The other side retrieved June 2013, http:// adjust well to society’. It referred specifically to of the coin: disparities aph.sagepub.com/content/ in achievement of health early/2012/11/22/1010539 the Multicultural Family Support Act, which related Millennium 512466566 includes provisions for health care and education Development Goals (MDGs) in Nepal, 10. Hood, J., ‘Between for ‘marriage immigrants’. Himalayan Journal of entitlement and Several states urged South Korea to improve Sociology & Anthropology, stigmatization: the lessons vol. 5, 2012, http:// of HIV/AIDS for China’s treatment of migrants and refugees, and provide www.nepjol.info/index. medical reform’, in W. Sun children of undocumented migrants with health php/HJSA/article/ and Y. Guo (eds), Unequal viewFile/7040/5690; China, London, Routledge, care. NGOs estimate that 17,000 children of Ministry of Health and 2013, pp. 141–2. undocumented migrant workers have no access to Population (MOHP) [Nepal], New ERA, and 11. Yip, W.C., Hsiao, W.C., health care. NGOs expressed concern regarding ICF International Inc., Chen, W., Hu, S., Ma, J. the new Refugee Act, which will be enforced in Nepal Demographic and and Maynard, A., ‘Early July 2013. The Advocates for Public Interest Law Health Survey 2011, appraisal of China’s huge Kathmandu, Nepal, and complex health-care have noted a lack of any mechanism to assess Ministry of Health and reforms’, The Lancet, vol. the dangers a person could face upon return Population, New ERA, 379, no. 9818, 3 March and Calverton, MD, ICF 2012, pp. 1880–1. to his/her country of origin and the Korean International, 2011. Bar Association has criticized the ‘accelerated’ 12. Harris, A., Zhou, Y., Liao, 5. ‘Socioeconomic inequalities H., Barclay, L., Zeng, W. procedures, which they believe could lead to in global and relative self- and Gao, Y., ‘Challenges abuse. In 2010, Korea recognized 11 per cent of rated health in Laos: a cross- to maternal health care sectional study of 24 Hood, utilization among ethnic asylum applicants compared to a global average J., ‘Between entitlement and minority women in of 38 per cent. stigmatization: the lessons resource-poor region of of HIV/AIDS for China’s Sichuan Province China’, In July 2012, a New Zealand woman teaching medical reform’, in W. Sun Health Policy and Planning, English in South Korea appealed to the UN and Y. Guo (eds), Unequal vol. 25, pp. 311–18, 2010, CERD when she was forced to take a second China, London, Routledge, retrieved June 2013: http:// 2013, pp. 141–2. heapol.oxfordjournals.org/ HIV test within nine months. The government content/25/4/311.full. first introduced mandatory HIV testing for 6. ‘Early appraisal of China’s pdf+html huge and complex health- foreign teachers in 2007. An article in the care reforms’, The Lancet, 13. Pilar Suguimoto, S., Ono- Journal of Korean Law has claimed that this vol. 379, no. 9818, 3 March Kihara, M., Feldman, M.D. 2012, pp. 1880–1. and Kihara, M., ‘Latin constitutes racial discrimination since testing American immigrants have is not required for Korean teachers or ethnic 7. ‘Burma: health and limited access to health transition’, The Lancet, vol. insurance in Japan: a cross- Korean non-citizens. Foreign teachers are the 379, no. 9834, 23 June sectional study’, BMC only foreign workers still mandated for HIV 2012, p. 2313, retrieved Public Health, vol. 12, ■ June 2013, http://www. no. 238, 2012, retrieved testing, since reforms in 2010. thelancet.com/journals/ June 2013: http://www. lancet/article/PIIS0140- biomedcentral.com/1471- 6736(12)60998-2/fulltext 2458/12/238

8. Back Pack Health Worker Footnotes Team, Provision of Primary Healthcare among 1. Barros, A.J.D. et al., ‘Equity 2. From UNFPA fact sheet the Internally Displaced in maternal, newborn, and on child marriage in Persons and Vulnerable child health interventions Kazakhstan. Populations of Burma, in Countdown to 2015: 2012, retrieved June 2013, a retrospective review 3. Singh, L. et al., ‘Public http://www.backpackteam. of survey data from 54 health care in Afghanistan: org/wp-content/uploads/ countries’, The Lancet, vol. an investigation in reports/2012%20Mid%20 379, no. 9822, 2012, pp. suboptimal utilization of Year%20Report%20final- 1225–33, retrieved July facilities’, Health, vol. 4, 0409122.pdf 2013, http://www.thelancet. no. 10, 2012, pp. 794–801; com/journals/lancet/article/ Rahmani, Z. and Brekke, 9. Andersson, M. and Lundin, PIIS0140-6736(12)60113- M., ‘Antenatal and obstetric A., ‘Socioeconomic 5/fulltext care in Afghanistan – a inequalities in global and qualitative study among relative self-rated health

State of the World’s Minorities Asia and Oceania 171 and Indigenous Peoples 2013 ICELAND

ATL ANTIC FINLAND

OCEAN NORWAY SWEDEN RUSSIA

ESTONIA

LATVIA IRELAND UNITED DENMARK KINGDOM LITHUANIA Kaliningrad (Rus.) BELARUS NETHERLANDS GERMANY POLAND BELGIUM LUXEMBOURG CZECH REP. UKRAINE

SLOVAKIA

LIECH. MOLDOVA FRANCE SWITZERLAND AUSTRIA HUNGARY SLOVENIA ROMANIA CROATIA BOSNIA GEORGIA ANDORRA SAN MARINO SERBIA PORTUGAL AND HERZE. BLACK SEA MONACO MONTENEGRO AZERBAIJAN

Kosovo SPAIN BULGARIA ARMENIA MACEDONIA AZER. ITALY ALBANIA TURKEY GREECE

CYPRUS

MEDITERRANEAN SEA Europe Katalin Halász ccess to health care and the full vulnerable groups. MdM urges EU member states enjoyment of the highest attainable and institutions to ensure health coverage for the A standard of health is seriously limited most vulnerable people and tackle discrimination for many ethnic, religious and linguistic and social exclusion that cause ill health. The minorities and migrants in Europe. The demand MdM study draws attention to an increasingly for health care is growing rapidly, as a result of large number of undocumented migrants and ageing populations and demographic changes, refugees left without medical attention, which but the delivery of equal, accessible and high- they link to the experience of frequent police quality health services at affordable cost remains harassment combined with the fear of being a distant goal. reported to the authorities and subsequent The European Convention on Human Rights deportation. (ECHR) and the European Social Charter (ESC) These findings are confirmed by the European of the Council of Europe are the main regional Network Against Racism (ENAR). The human rights instruments in Europe relating to organization has also pointed to the poor health health and human rights. Relevant articles in the outcomes for ethnic and religious minorities ECHR relate to the right to life (Article 2), the and migrants, and highlighted the particular prohibition of torture and inhuman or degrading vulnerability of elder minorities and migrants. treatment (Article 3) and the right to private and The ENAR has called for targeted measures family life (Article 8). Article 11 of the Charter particularly for older minorities and migrants provides for the removal as far as possible of in the framework of the 2012 European Year causes of ill health and the prevention of diseases of Active Ageing and Solidarity between as well as measures to promote health. However, Generations. when it comes to effectively implementing According to the ENAR, significantly lower these provisions there are many shortcomings. health outcomes and greater prevalence of Implementation is overseen by a supervisory certain chronic conditions among minorities mechanism based on a system of collective and migrants of all ages are explained by a complaints and national reports, although it number of factors: discrimination; prejudice by should be noted that only 15 of the 43 ratifying staff and patients; communication and language states have accepted the collective complaints barriers and the lack of interpreting services; procedure. cultural and financial barriers; poor working and In 2012 the Médecins du Monde (MdM) living conditions; lack of information on health published a study on health care provision for care entitlements; as well as legal challenges in vulnerable groups in countries of the European accessing health care. Union (EU). The report provides evidence of Research by the Fundamental Rights Agency the impact of the financial crisis on health and (FRA) of the EU on inequalities in access to health-related issues. As minorities are often health care confirmed that language is a key economically and socially excluded, they have barrier, particularly for minority older persons been hit first by the wave of unemployment, and women, who interact less with mainstream economic hardship and poverty. This, combined society and are more likely to be engaged with government cuts in health care spending in housework and in the home. Particular and increased user charges for services, means health problems in older age, like dementia or that vulnerable groups are now even less likely stroke, also contribute to the loss of ability to to receive the necessary health care, while the communicate in the majority language, which in number of people facing precarious living turn makes diagnosis and treatment extremely conditions is increasing. difficult. Lack of consideration among health The MdM research was conducted in health professionals of diverse cultural practices also centres and backed by patient interviews in 11 prevents some groups from accessing health countries. It raises grave concerns regarding services. Muslim women, for example, can feel the lack of access to primary health care and uncomfortable with male medical staff antenatal care for Roma, migrants and other or interpreters.

174 Europe State of the World’s Minorities and Indigenous Peoples 2013 Most of the trends and issues with relevance The continued rise of far-right nationalist to minority protection identified in 2012 ideologies is a worrying trend. During his trial remain largely similar to those reported in that took place between April and June 2012, previous years. Following the economic crisis Anders Behring Breivik, the Norwegian mass and reduced financial support for equality and killer behind the 2011 attacks, said he would do diversity programmes, and for human rights and the same thing again and pleaded guilty. He was minority organizations, there is a clear risk that sentenced to at least 21 years’ imprisonment on fewer anti-discrimination cases will be brought 24 August 2012. Breivik, who is supported by a forward and that there may be less scrutiny of the number of far-right British extremists, including implementation of legal provisions. members of the English Defence League and In most EU countries, the shift towards the National Front, accused his investigators more restrictive migration policies continued, of creating a racist plot against him in order to particularly on access to health care. In discredit his extreme anti-Muslim ideology. September 2012 Spain introduced reforms In Poland, the anniversary of the country’s to limit access to health care for adult independence on 11 November turned violent undocumented migrant workers. Amnesty in Warsaw when the police clashed with 20,000 International and other non-governmental neo-Nazi nationalists in Warsaw. As MRG organizations (NGOs) have accused the has previously reported, far-right support does government of breaking international agreements not only play out on the streets but in recent by excluding a significant section of the years has gained a foothold in many European population from public health care. parliaments as well. Hungarian member of Health care systems across Europe are parliament Marton Gyongyosi, of the far-right struggling to balance concerns over reducing party Jobbik, called for public authorities to health care expenditure with how to guarantee draw up a list of Jews in government positions as existing human rights standards. A 2011 FRA they pose a ‘national security risk’. The Jobbik report on the right to health for undocumented party is the country’s third most powerful party, migrants in 11 EU member states maintains that and is known for its anti-Semitic and anti- the exclusion of irregular migrants from health Roma rhetoric. Gyongyosi’s call was vehemently care has a potential detrimental effect on the condemned, not just by anti-racist and human whole community. The FRA points out that rights organizations but also by the Hungarian while all those residing in a country should have parliament and government. access to certain basic health care, for example in In parallel, racially motivated violence case of a pregnancy or a serious illness, it is often committed both by extremist groups and other seriously limited for migrants in an irregular perpetrators is a worryingly persistent aspect of situation. European minority life. Two reports issued in The treatment of asylum seekers and the 2012 by the FRA confirm that hate crime is a poor conditions of immigration detention reality. The EU Minorities and Discrimination centres in many European countries continued Survey (EU-MIDIS) provides evidence of ethnic to be a great concern in the reporting year. minorities’ experience of crime, including vehicle Children and unaccompanied minors are often theft, burglary, assault and serious harassment. held in detention, which has a serious negative The first EU-wide survey of ethnic minority impact on their health. The International and immigrant groups and their perceptions of Detention Coalition has launched a campaign racially or ethnically motivated crime showed asking governments to stop detaining children that 24 per cent of the 23,500 respondents said and their families. Seventy-five organizations they had been a victim of crime at least once in are supporting the campaign, including the the previous 12 months. On average, 18 per cent European Council on Refugees and Exiles of all Roma and 18 per cent of all sub-Saharan (ECRE), Amnesty International and the Jesuit African respondents indicated that they had Refugee Service. Adult detainees suffer from poor experienced at least one racially motivated crime conditions in detention centres as well. in the last 12 months.

State of the World’s Minorities Europe 175 and Indigenous Peoples 2013 In its study on victims’ rights, the FRA showed Right: A couple living in a Roma camp in Italy. that victims of hate crimes experience symptoms Robin Hammond/Panos. of severe trauma, such as depression, suspicion of others, self-blame and a profound sense of recognized the EU’s contribution to peace in isolation. The physical harm resulting from hate Europe over the past 55 years, but warned violence is often less significant than the intensity that the past achievements are under growing of fear and anxiety, and the sense of violation, threat if the EU does not maintain the central vulnerability and humiliation. Understanding the importance of defending human rights within impact of hate crimes on individual victims is its borders. Grave concerns remain: widespread therefore essential in the provision of health care discrimination across Europe against people services and mental support. The FRA strongly from ethnic, religious and gender minorities; recommends better training for those who work the social and economic exclusion of Roma; with victims, such as police officers, public the failure to uphold the rights of migrants prosecutors and judges. In many cases, however, and refugees; and the growing number of hate victims and witnesses are reluctant to report crimes across the continent. Many minorities crimes to law enforcement agencies, the criminal experience discrimination on multiple grounds. justice system or even to NGOs and victim Women belonging to minority groups can be support groups. As a result, perpetrators are rarely discriminated against based on ethnic, religious, brought to justice, and victims are not adequately gender and sexuality grounds for example. The cared for by health services. regional legal framework remains inadequate Violence against women also often goes with regard to providing adequate protection unreported, and undocumented female domestic against discrimination. The prompt adoption and workers are particularly vulnerable to violence. implementation of the proposed EU Directive on According to the European Women’s Lobby implementing the principle of equal treatment these women are more likely to continue between persons irrespective of religion or belief, enduring violence because of discrimination disability, age or sexual orientation (also known by police officers and because of the fear of as the ‘Horizontal Equal Treatment Directive’) deportation. In many cases, when undocumented would help with addressing this legal gap, but the women do report violence or domestic violence, debate on the proposal has not moved forward they are not provided with medical and significantly over recent years. psychological support, shelter or access to justice. In January 2012, Rashida Manjoo, the UN Roma Special Rapporteur on violence against women, Roma, Europe’s largest minority group, visited anti-violence shelters and detention continued to face widespread discrimination and centres in Italy’s major cities, as well as Roma grave human rights abuses, including violent and Sinti community camps. She urged the assaults, during 2012. UNICEF estimates that country to do more to protect women from almost 50 per cent of the Roma population in violence and provide psychological and economic Europe are under 15 (out of an estimated 10–15 support to victims. In Italy, a fragmented million Roma). Many Roma are reported to have legal framework, inadequate investigation and a poorer health status and worse access to health punishment of perpetrators, and poor support services than majority populations in many for women victims of violence contribute European countries. to invisibility of this issue and the silence According to a 2011 Open Society Foundation surrounding it. Undocumented migrant women (OSF) study, Roma are disproportionately are particularly vulnerable. unvaccinated, have poorer than average nutrition, In December, the EU received the 2012 experience higher rates of low birth weight, Nobel Peace Prize for its ‘contribution for infant mortality and tuberculosis. Social and over six decades to the advancement of peace economic exclusion and discrimination, poor and reconciliation, democracy and human housing and lack of access to appropriate health rights in Europe’. Human rights organizations care also contribute to poor health outcomes.

176 Europe State of the World’s Minorities and Indigenous Peoples 2013 Furthermore, as the OSF review states, Roma During his 2011 mission to Hungary, the often cannot access health care because UN Special Rapporteur on contemporary forms they lack identity cards or other documents of racism, racial discrimination, xenophobia required for health insurance. Roma are also and related intolerance, Githu Muigai, visited disproportionately represented among the poor Roma families living in public social housing across Europe and often cannot afford to pay in the north-east. Although housing projects for medicine or transport to health facilities for have been established in Hungary and 160 example. anti-segregation plans were set up as part of the Experience of discrimination in health care Decade of Roma Inclusion Programme, the settings deters some Roma from seeking medical UN Special Rapporteur found communities help. In fact, between 11 and 23 per cent of living in substandard housing without basic Roma responding to a 2009 FRA EU-MIDIS services and infrastructure, including running survey reported that they had experienced water and electricity. He also noted that, despite discrimination in health services by health care health care reforms in 2006, which included the personnel in the year prior to the survey. setting up of a supervisory authority to receive These findings are echoed in the 2012 Council complaints and training for medical staff, Roma of Europe review, ‘The human rights of Roma still face discrimination and have a lower life and Travellers in Europe’ that, among other expectancy rate. issues, discusses the right to health. The Council During the extraordinarily cold winter of of Europe draws attention to the link between 2012 the number of fatalities among Roma poor housing and health status. Segments of the across Eastern Europe was devastating. The Roma community live in slum housing, in close European Roma Rights Centre (ERRC) called proximity to garbage dumps, and have no access on the governments of Albania and Lithuania to quality water and sanitation. to stop forced evictions during the harsh winter.

State of the World’s Minorities Europe 177 and Indigenous Peoples 2013 In Vilnius – at a time when temperatures had dropped to under minus 30 degrees in the Case study municipality – the authorities gave written notice to four families with six children under 12, including a six-month-old baby, informing them Forced sterilization of plans to demolish their houses. The ERRC urged the authorities to respect, protect and of Roma women fulfil the right to adequate housing, to suspend the planned evictions, and to find sustainable housing solutions for all affected families. After decades of silence, Roma women who were The year 2012 saw a number of landmark forcibly sterilized by the state in Eastern Europe rulings in the European Court of Human Rights. have won their cases in the European Court. In May the Court ruled that evicting Roma from Forced sterilization of Roma women Batalova Vodenitsa, on the outskirts of Bulgaria’s remained unacknowledged in Eastern Europe capital Sofia, would violate the right to private for a long time, until a number of court cases and family life. The Court ruled in favour of brought the proportions of this shocking 23 Bulgarian nationals living in the settlement practice to light. In the Czech Republic, the with about 250 other Roma. Following the practice of sterilizing Roma women without ruling, Bulgarian authorities cannot proceed their informed consent has continued, with with the eviction without safeguards and special cases as recently as 2009. consideration for the vulnerable, such as the In the past two years, the European Court elderly and children. of Human Rights has ruled in favour of a The Court also ruled in cases of violence. In number of Roma women who had been for- its judgment of 12 June the Court found that cibly sterilized by a Slovak state hospital. The Slovakia had failed to carry out an effective Court declared that the practice constituted a investigation into a violent attack against 10 violation of their fundamental rights. Roma individuals in the town of Ganovice-Filice ‘I am pleased that the European Court con- (in the case of Koky and others v. Slovakia). The firmed [our claims] and admitted that they 10 applicants were awarded a total of €55,000 in sterilized us without our consent,’ said one of damages. In October, a Bulgarian Roma woman, the women, identified as I.G. in the case in Yolanda Kirilova Yotova, who was gunned down November 2012. ‘In my name, and the name and disabled outside her house by a youth, was of other Roma women, I thank the European awarded more than €15,000 by the Court. The Court,’ she added. In its third verdict against Court also ruled against Hungary for violating Slovakia, the Court ruled in favour of the two Article 3 of the ECHR in a case of excessive plaintiffs (a third applicant passed away in police force against a Roma woman. 2010) and granted compensation of €28,500 These rulings set timely precedents, as an and €27,000 and reimbursement of their alarming number of attacks against Roma legal fees. The applicants were the first who continued across the region. According to the were willing to bring cases against doctors in ERRC, in the first half of 2012 alone, at least 20 Slovakia and inspired other women to come attacks were carried out in four Eastern European forward and do the same. countries (Bulgaria, the Czech Republic, The applicants had submitted a complaint Hungary, Slovakia) leading to 10 deaths of Roma to the Court in 2004, claiming that they people. had been forcibly sterilized after caesarean sections at the hospital in Krompachy Armenia between 1999 and 2002. Legally minors at The absence of political representation for the time, they were asked to sign a document minority communities and civil society that they thought was required for delivery organizations is also a key concern in Armenia. by caesarean section. The doctors sterilized The country’s largest minority are the Yezidis,

178 Europe State of the World’s Minorities and Indigenous Peoples 2013 them without the consent of their legal guardians and officially ended after the collapse of the as required by Slovak law. It was only during an communist regime in 1990. Systematic forced investigation years later that it was revealed the sterilization was used to curb the supposedly documents were actually requests for sterilization. ‘high, unhealthy’ fertility rate among Roma The Court followed the reasoning from its and the practice continued after the break- two recent judgments in V.C. v. Slovakia (2011) up of the country into Slovakia and Czech and N.B. v. Slovakia (2012). Finding that Republic in 1993. the sterilizations were not life-saving medical According to estimates by the Czech interventions and that they were performed ombudsman, as many as 90,000 women from without the requisite informed consent, the the former Czechoslovakia became infertile as Court held that this treatment violated the a consequence of such interventions. In some right to freedom from inhuman and degrading cases in Czechoslovakia some Roma women treatment and the right to private and family life. were threatened or offered incentives to The Court also found that Slovakia had failed in undergo the operation. Similar cases, but far its obligation to protect the reproductive health fewer, have been reported in Hungary. of Roma women, and that it did not conduct a For years women who had been forcibly prompt and reasonable investigation as required sterilized stayed silent, and some were even by Article 3 of the ECHR. ashamed to tell their own husbands. These three important judgments were In November 2009, the Czech government followed by yet another case, in June 2012, in expressed regret for ‘individual failures’ in which the Court significantly raised the amount carrying out sterilizations, but many women of compensation awarded to the applicant by are still waiting for adequate redress. In a Slovakian court, arguing that the sterilization December 2012 the Czech government settled caused her psychological suffering and had out of court with a woman of Roma origin seriously affected her position as a woman in after she filed a complaint with the European the Roma community. Court of Human Rights in Strasbourg. The The practice of forced sterilization of Roma agreement included compensation of 10,000 women in Czechoslovakia started in the 1970s Euros and the concession that the government was at fault. Meanwhile, in Slovakia, the liberal opposition Freedom and Solidarity party (Svoboda a Solidarita – SaS) proposed in August 2012 that the state should introduce a subsidy for voluntary sterilizations for women over 35 who have more than three children. According to the authors of the draft law, the measures are a form of social benefit as the state would take over the costs of the operation, which could contribute toward reducing the ‘extremely high birth rates in [Roma] settlements’. While the proposal was based on voluntary participation, it underscored the fact that sterilization as a form of social control is not a thing of the past. It remains an ongoing and inherently stigmatizing issue for Roma women. ■

Left: A woman stands in a Roma settlement, Slovakia. Bjoern Steinz/Panos.

State of the World’s Minorities Europe 179 and Indigenous Peoples 2013 with a population of about 40,000. Although the Armenian Ombudsman stated in a 2011 Case study by Jack Denith report that national minorities have favourable conditions for preserving their national identity, the chair of the Yezidi National Union voiced Bulgaria: his concerns about the lack of minority language and cultural education of Yezidi children living community in the capital. The chair of the World Union of Yezidis raised similar concerns, pointing at the monitoring lack of representation of the minority community in the National Assembly of Armenia. During an improves access interview in March, the head of the Department for Ethnic Minorities and Religious Affairs to health services insisted that the government had increased its financial support for Yezidis and Armenia’s other for Roma minorities, in particular in the area of education. In a recent move the government raised the legal age of marriage of women from 17 years A campaign run by Roma NGO Amalipe old to 18 years old, the same as for men. This has improved awareness of health issues may lead to conflict with the Yezidi community, and rights, and access to health services. where girls get married as early as 13 or 14. The Roma in Bulgaria live, on average, 10 community insists that the change is ‘inhuman’ years less than ethnic Bulgarians. High and will ruin their families. The government rates of poverty among Roma communities argues that the new minimum age will help combine with other socio-economic factors to eliminate gender inequality and bring the adversely affect their health and their ability country into compliance with the 1979 UN to access adequate health care. For example, Convention on the Elimination of All Forms of a 2011 survey carried out by the United Discrimination against Women. Nations Development Programme, the World Bank and the European Commission Azerbaijan found that 48 per cent of Bulgarian Roma Minority groups in Azerbaijan face long-standing had medical insurance, compared to 85 per discrimination and harassment and lack of cent for non-Roma living in the same area. consultation within decision-making processes. National legislation has been drawn The country’s main minority groups include up to address these inequalities, but Lezgins (2.2 per cent), Russians (1.8 per cent), implementation of these policies has been Armenians (1.5 per cent although this figure is ‘close to zero’ say Lyubomir Lazarov and contested) and Talysh (1.0 per cent). Deyan Kolev of the Amalipe Center for The Farsi-speaking Talysh community in Interethnic Dialogue and Tolerance, a Roma Azerbaijan has come under scrutiny from the NGO. Although the legislation sounded government as it has cracked down on civil good on paper, there was a lack of financial society in the aftermath of the Eurovision Song and administrative support for the proposals, Contest that the country hosted in 2012. Most and no mechanisms to allow participation by of the Talysh live in southern Azerbaijan, mainly Roma communities. in rural areas near Iran. Four Azerbaijani human In 2011, Amalipe decided to put Roma at rights organizations, the Human Rights Club, the heart of assessing and monitoring health the Institute for Reporters’ Freedom and Safety, services in Bulgaria. Following a model the Institute for Peace and Democracy and first proposed by Abhijit Das of the Public the Alliance for Defense of Political Freedoms, Health Institute in India, Amalipe developed used the occasion of the song contest to raise a system to enable communities to monitor awareness about forced evictions and arrests and

180 Europe State of the World’s Minorities and Indigenous Peoples 2013 health care services themselves, and carry police brutality against journalists in the country. out their own research into their own health The awareness campaign, known as ‘Sing for needs and how local services met (or failed Democracy’, was joined by 30 local NGOs to meet) them. and 15 international human rights watchdogs. Amalipe established local volunteer President Ilham Aliyev accused civil society clubs that brought young people, women leaders, human rights activists and journalists of and informal leaders together with trained trying to ruin the country’s reputation. moderators (also from the community) to The arrest of a prominent Talysh advocate on discuss health issues. Together with the separatism charges was condemned by human Amalipe project team, these community rights defenders as politically motivated. Hilal organizations conducted surveys of the Mammadov, a mathematician and newspaper health of Roma women and their use and editor, was arrested on charges of treason and knowledge of health care services. They also espionage for Iran in June. His predecessor on developed a health information campaign the Talysh-language Tolyshi sado paper, Novruzali using community theatre. Mammadov, was arrested in 2007 after he The challenges were substantial: not only published an article on the history of the Talysh; in terms of Roma health, but also in terms of he died in prison in 2009, while serving his the barriers to improving access – from poor 15-year sentence. In July human rights activists diet and an inability to afford medication, and Talysh representatives organized a press to facing discrimination from medical staff. conference in Moscow in order to demand the High rates of poverty make health insurance release of Hilal Mamedov, who was arrested in a rare luxury for the majority of Roma, while June on bogus drug possession charges. Pre- the rural areas where many Roma live have trial hearings commenced in January 2013, and only a few general medical practitioners the trial continued in March and April 2013. working insufficient hours to cover the Mammadov’s request that the trial be public was population. rejected by the judge. The surveys found that these factors were compounded by a lack of awareness Germany of health issues, such as what rights to Germany’s minorities face difficulties accessing health people have, or what services are health care. Turks in the country tend to visit available (half of the women surveyed by hospitals because of their mistrust of general the communities did not have information practitioners (GPs), according to the German on when doctors visited their village). These newspaper Die Welt. A 2012 analysis by the issues were influenced in turn by Bulgarian MdM showed that 68 per cent of the patients and Roma scepticism about the ability or visiting their centre in Munich only had access willingness of civil institutions to create to emergency care in hospitals, and only 8 per positive change. cent were covered by health insurance or by Through the information campaign, the health insurance system of their country of advocacy activities of the project team origin. Greater use of hospital for treatment by and free gynaecological checks organized minorities is not only more expensive, it also within the project, the Roma communities often means a delay in treatment and increases improved access to a number of health the likelihood of surgery being needed. services, from primary health facilities to Language barriers are one of the main issues emergency and hospital care. From simple when trying to obtain health care for minority measures such as raising awareness about groups. Even those whose command of German what services are available to communities is excellent tend to be less informed during and what they are entitled to receive, hospital visits than the majority population. substantial improvements were made by the Translators are not only relevant for minority communities themselves. ■ members who do not speak sufficient German or who require psychotherapy, they are also needed

State of the World’s Minorities Europe 181 and Indigenous Peoples 2013 for an ageing population in which minority Right: Doctors examine a man of African origin members whose first language was not German at a medical centre in Greece. may lose their language skills due to dementia REUTERS/John Kolesidid. or Alzheimer’s disease. Access to primary care and preventative medicine is also problematic. descendants of migrants working in the public Although Germany has a culture of regular health sector. check-ups and health monitoring, minorities A ruling on circumcision that was handed often only see doctors when they are already sick down by a court in Cologne in June sparked an or feel at risk of illness, which means they often outcry among Muslim and Jewish communities miss out on preventative medicine and health and led to joint protests in the country. The check-ups for children. The MdM study noted judge ruled that the circumcision of a young that, whereas in other European cities, lack of boy on religious grounds amounted to grievous knowledge about patients’ rights was the key bodily harm and contravene the right to choose barrier to accessing health care, this was hardly an religion freely in later life, and was therefore issue at their treatment centre in Munich since illegal. The case arose when the circumcision the vast majority of visitors, lacking permanent of a Muslim boy had gone wrong and the boy residency, hardly had any rights at all. was admitted to hospital. ‘We consider this to Minority children whose parents both come be an affront [to] our basic religious and human from a migrant background are also more rights,’ stated the unusual joint statement, signed likely to be overweight and have bad teeth than by leaders of the Rabbinical Centre of Europe, majority children, which is partly due to lack the European Jewish Parliament, the European of preventative medicine and dental hygiene. Jewish Association, Germany’s Turkish-Islamic Integration and social status play a role as well: Union for Religious Affairs and the Islamic the more well-integrated (assessed on the basis Centre Brussels. of language proficiency and resulting improved In September the state government in Berlin social status and employment situation) and announced that circumcision was legal there, as more wealthy minority families are, the less likely long as it was properly carried out. The federal they are to suffer from hepatitis, tuberculosis government also responded by stating that it and other poverty-related illnesses, and the more wants to legalize the procedure explicitly and likely they are to report allergies. proposed a new law. According to the draft law, Inclusion and full participation in Germany’s circumcision is legal in Germany. In the first social and economic life is a constant and six months of a boy’s life, it can be performed unresolved issue for minority groups. Under- by a member of the boy’s religion who has representation of minorities in the public sector received the necessary training or a doctor. After is a fact, which Chancellor Angela Merkel has that age, it can only be performed by a doctor. said she wants to change, after leading a national The German parliament approved the bill in integration summit in Berlin in January. The December. German government confirmed that it wanted to visibly increase the number of immigrants Greece working in the public sector, which, according Violent attacks and racist and xenophobic to national integration commissioner Maria political activities intensified in the country after Böhmer, served as a model for the rest of the the neo-Nazi extremist party Golden Dawn labour market. Whether the government does a won 6.9 per cent of the votes for the Hellenic better job of ensuring the public sector reflects Parliament in June. In December the European the demographics of the country remains to be Commission against Racism and Intolerance seen. According to a study by the Organisation (ECRI) of the Council of Europe urged the for Economic Co-operation and Development Greek authorities to take firm and effective action (OECD), Germany takes a ‘sad last place’ to ensure that the activities of Golden Dawn do compared to the 34 other member states of not violate the free and democratic political order the OECD when it comes to the number of or the rights of any individuals.

182 Europe State of the World’s Minorities and Indigenous Peoples 2013 At the same time, illegal immigration witnessed many unaccompanied minors without remained a real political issue for the country, documentation living under highway underpasses which is already struggling with the impact of and without any government support. the eurozone crisis. According to the European Meanwhile, in August, authorities carried Commission, 40 per cent of the Middle East and out one of the country’s biggest crackdowns on South Asia migrants who entered the EU without suspected undocumented migrants in Athens, the required documents in 2012 came through deploying 4,500 police officers in the capital and Greece. The country, which is due to complete a detaining more than 7,000 migrants in less than 12.5 km long anti-migrant wall along its Turkish 72 hours. Most were released, but about 2,000, border, deployed 1,881 additional guards on its mostly from Africa and Asia, were arrested and border to prevent a surge of Syrian refugees from sent to holding centres pending deportation. Turkey. The first detention centre for undocumented The poor treatment of refugees and asylum migrants opened in April. The centre, north-west seekers is an ongoing concern. The UN Special of Athens, which is composed of box homes and Rapporteur on the human rights of migrants, is surrounded by high wire fences, is meant to François Crépeau, urged the country to protect house some 1,200 people. A further 50 centres migrants but at the same time underlined the are planned to be built by mid-2013. Previously, responsibility of the EU to fund and support plans were announced by the government to hold measures to establish a civilian asylum and first illegal immigrants in detention for compulsory reception centre that would effectively screen health checks and treatment for HIV/AIDS migrants with vulnerabilities. He had himself and other contagious ailments, and hold them

State of the World’s Minorities Europe 183 and Indigenous Peoples 2013 indefinitely if they are considered a risk to public health. In its 2012 overview of the conditions of Case study by Rita Bence persons excluded from health care systems in the EU, MdM stated that over 70 per cent of the violence suffered by migrant patients occurred Hungary: Roma after their arrival in the country. Throughout 2012 brutal assaults against children arbitarily migrants by people affiliated to Golden Dawn and by other perpetrators were steadily separated from increasing. In Crete, a 25-year-old homeless Egyptian man was beaten with metal bars. He families had to have life-saving surgery, which ended with the removal of a kidney. Just a day before, a group of four men attacked two Algerian The case of a Roma woman whose children migrants with iron and wooden bars and knives. were taken away because of alleged ‘mental The two men in their mid-20s were treated for disabilities’ shows how social services are extensive head injuries and stab wounds. Police failing vulnerable families in Hungary. arrested 25 men in connection with an attack The Hungarian Civil Liberties Union on a Pakistani man at the Attiki metro station has been representing a case that shows and confirmed that many were members of eloquently how the most vulnerable people the Golden Dawn party. The party has several can be abused and how authorities treat them initiatives related to health (such as blood arbitrarily, affecting the most important supplies) that are open for Greek citizens only aspects of their lives. if they can prove they have a Greek father and A 20-year-old woman called LV was show a Greek identity card. Civil society and placed under guardianship because of alleged private initiatives, however, have launched ‘learning disabilities’. She has two children, programmes that help all people, including both of whom were taken away from her minorities. The Boroume non-profit organization by the authorities who said that she is not for example organizes the distribution of surplus able to take care of them. She has a partner, food for charity throughout the country. a 40-year-old man, who is her guardian and lives together with her in quite poor Russia circumstances but they can make ends meet. In 2011 the Advisory Committee on the Council This man is the father of the two children of Europe’s Framework Convention on National though he is not registered as such officially. Minorities sharply criticized Russia on the lack LV maintains the household and takes of participation of persons belonging to national care of two of her sister-in-law’s children. minorities in public life, which is limited to the According to a medical examination she organization of cultural events. According to the Advisory Committee, there are no effective consultation mechanisms in place to ensure that minorities have an opportunity to influence and information in the Russian Federation,’ she effectively decisions on issues concerning them. said. ‘At least four new legal provisions have In July 2012, the UN High Commissioner been made that will have a detrimental effect on for Human Rights Navi Pillay also expressed human rights in the country.’ concerns that a series of legislative amendments Of concern are the restrictive amendments to in the Russian Federation would seriously the law on public rallies, a bill limiting freedom restrict human rights in the country. ‘In just two of information on the internet, the restoration of months, we have seen a worrying shift in the defamation provisions into the Criminal Code, legislative environment governing the enjoyment and a restrictive new law on non-commercial of the freedoms of assembly, association, speech organizations, which would effectively require all

184 Europe State of the World’s Minorities and Indigenous Peoples 2013 has been diagnosed with a minor learning several substantive and procedural mistakes. disability. Although we are not physicians, Fortunately, the child protection authority it seems obvious that she is a loveable and decided to give back the little son to his responsible woman who is able to take mother. responsibility for her deeds and looks after The lawsuit referring to guardianship children every day. Despite all these facts, is still in progress. The approach of the both of her children were taken away by the judge clearly shows strong discrimination. child protection authority. They justified this At the first trial she spoke to LV and her decision stating that ‘she is disabled’ and her family rather arrogantly; she asked irrelevant partner, who is also her guardian, has three questions and tried to confuse them. other sons, so they are too poor to provide According to Hungarian law, people for the children. under guardianship can be deprived of the She was given no information about right to vote. This happened to LV too, and where the first child went; she cannot even we want to help her to retrieve it. In this contact her and is not allowed to visit her. regard the judge asked extremely difficult The second child was taken away soon after questions, such as: ‘What is your opinion she arrived home from the hospital after about the Fourth Amendment of the giving birth. She could visit her little son Fundamental Law?’ This question cannot only once a week. At first the boy was placed be a measurement of the voting capacity, in an institute; later he was placed with because plenty of average people cannot foster parents. LV usually travelled many answer this. kilometres alone by bus to see her son; she We are hoping for the best outcome of knows the timetable and the fares of the the lawsuit. We are planning to appeal line, which is more evidence that she is well- if necessary, as we want to hinder such oriented. discriminative and arbitrary procedures. The most troubling aspect is that it is The fact that Roma people generally everyday practice to take children away from live in extreme poverty makes them more their parents in the area where this couple vulnerable, and they often do not know lives. The authority did the same thing in how to go about defending their rights. the case of LV’s mother and sister-in-law. Authorities mostly abuse these situations This happened against the explicit request of through obscure administrative procedures the affected families. that impair the innate human rights of The Hungarian Civil Liberties Union Roma. The situation is very difficult for LV. appealed in the child custody case, and sued She knows that the health and development the authority to end its guardianship of LV. of her children may be at risk if they are Due to the appeal the authority was forced to grow up in care. ■ obliged to repeat its procedure because of

NGOs that receive foreign funding to register freedom of expression. as ‘foreign agents’. Under the provisions, NGOs Another move of the government on civil involved in politics and receiving foreign funds society that sparked international opposition in will have to issue twice-yearly reports on their 2012 was the closure of Russian’s indigenous activities and financial audits. Because of limited peoples’ umbrella organization RAIPON, state support, many NGOs need to seek foreign because of an ‘alleged lack of correspondence funds. Failure to comply will be punishable by between the association’s statutes and federal heavy fines or even a two-year prison sentence. law’. According to Russia’s Ministry of Justice, Journalists and human rights activists see the which ordered the closure in November, the bill as an attempt to crush dissent and restrict indigenous peoples’ association will be closed for

State of the World’s Minorities Europe 185 and Indigenous Peoples 2013 Above: An indigenous reindeer herder sits on his into oblivion, and that minorities in what he snowmobile, Russia. Justin Jin/Panos. called a multi-ethnic society must live under the umbrella of Russian culture. six months until the statutes have been adjusted. Among the most vulnerable groups in For over 20 years RAIPON has represented more Russia are the country’s indigenous peoples. than 250,000 indigenous people from 40 groups Although there is no unified system of inhabiting huge Arctic territories of the Russian health monitoring of indigenous peoples, Federation from Murmansk to Kamchatka. Its some general trends show significantly first vice-president, Pavel Sulyandziga, a Russian lower average health outcomes compared indigenous rights activist of Udege nationality, to majority populations. According to the said that the decision was illegal and he is 2002 Census the average life expectancy of determined to fight it. Russian indigenous peoples was 15 years This will be not an easy task given the strong below the Russian average. Equally, for these stance of President Vladimir Putin, who in groups, the disease-propensity is 1.5 times January warned that ethnic tensions could tear higher than for central Russian peoples. This Russia apart. He stated that he would toughen includes a significant increase in diseases such migration rules and keep a tight rein on Russia’s as tuberculosis, hepatitis and illnesses spread regions to prevent it following the Soviet Union through parasites (see case study).

186 Europe State of the World’s Minorities and Indigenous Peoples 2013 and anaemia is the increasing use of imported Case study by Irina L. Stoyanova store-bought, ‘ready-made’ foods and decreasing consumption of traditional foods such as meat and local plants. Indigenous Infectious diseases, particularly tuberculosis, and sexually transmitted infections are health care a growing problem. The prevalence of tuberculosis among indigenous peoples of the system in the Russian north is almost five times higher than among non-indigenous people, and the death remote areas of rate is almost nine times higher than among the non-indigenous population. Rates of active the Russian north tuberculosis for Siberian Inuit, for instance, are alarmingly high. The mortality due to this disease is as high as 40 cases per 100 persons High prevalence of tuberculosis and in the Khanty-Mansi Autonomous Okrug and other infectious diseases, particular in the Yamalo-Nenets Autonomous Okrug problems with alcohol and mental this index is 87, whereas in Russia this average health, and difficulties accessing health index is 10. care are among the most pressing health Tuberculosis is a particular problem for problems facing indigenous peoples in indigenous peoples because of the effect of Russia’s far north. low temperatures, reduced immunity and There are few studies and little data on poor living conditions. In Krasnoyarsk Krai, the health of indigenous peoples in the for example, the spread of tuberculosis in the Russian Arctic, because these groups live last three years is particularly exacerbated due in remote areas with few medical services. to lack of clean drinking water and adequate Considerable variation exists across the sewerage systems. Poor sanitation and hygiene different regions of the Russian north, conditions of the population in northern influenced by local geographic, ethnic, settlements greatly contribute to the spread of administrative and political factors. not only tuberculosis but also other infections, Nevertheless, the following general such as dysentery, hepatitis and parasitic worm observations about Russian indigenous infestations. peoples’ health can be made. As of 2004, the average life expectancy Access to healthcare and medicine of Russian indigenous peoples was 15 years shorter than the Russian average. Mortality rates are significantly above the national average; infant mortality rates are estimated to be twice as high as the national average. Poor health and other factors have led to drastic declines in the indigenous population and some small Yamalo-Nenets Autonomous Okrug indigenous groups have reached the brink of extinction. Khanty-Mansi Autonomous Okrug

Changes in traditional diets, together Russia with a general decrease in physical activity, 87% 10% have significantly impacted the health of 40% the indigenous population. A contributing factor for the increase in diabetes, obesity Tuberculosis mortality rates

State of the World’s Minorities Europe 187 and Indigenous Peoples 2013 Case study continued medical education doesn’t seem to be an option, since the young physicians after graduation from medical The remoteness and small size of indigenous school, won’t go back home, no matter how you try settlements affects access to and the expense of to entice them. The situation is extremely difficult – medical care. All indigenous peoples of Russia our own people don’t come back, and outsiders don’t are entitled to free medical care system coverage, come to the countryside.’ which includes a compulsory annual check-up at state and municipal health care facilities. Yet Alcohol dependency and mental health federal and regional health care programmes Another serious problem facing Russian do not always provide medical brigades to visit indigenous populations is alcohol dependency. remote areas. For example, the village of Pareni The Committee on Northern Affairs and in Kamchatka has reportedly had no access National Minorities states in its materials that to medical care for two years. In Chukotka, it over the past 10 years there has been an almost takes up to 28 hours for medical attention to twenty-fold increase in alcohol abuse among be received. In remote villages the only way to indigenous peoples, particularly among women receive medical help is via a scheduled flight or air and adolescents. In the Yamal region, for instance, ambulance service. there is a serious concern about girls smoking Medical personnel often lack modern, mobile and becoming addicted to alcohol as they mature equipment that allows them to go out and and become mothers in the future. A growing examine the population in remote settlements, proportion of indigenous households’ income such as reindeer herding camps. Nomadic goes on purchasing alcohol. reindeer herding is the traditional livelihood Studies demonstrate that alcohol abuse in the of many indigenous peoples of the Russian Russian north is linked with a range of social and north. Working with indigenous peoples out in economic factors. Problems arise when reindeer the tundra is complicated due to the practical herders move to permanent settlements. The ever- difficulties of carrying out examinations in the growing availability of liquor and advertisements constantly moving reindeer herding camps, as for beer and alcohol beverages, the isolation of well as difficulties with controlling the prescribed the parents from their children, who are away treatment. at boarding schools, and the stressful effects Poorly equipped health care facilities and lack of ‘modernization’ are among the factors that of investment mean that it is extremely difficult often lead to alcohol dependency. This is why to retain medical staff and attract specialists to awareness of the particular psychological issues come and work in rural hospitals. According to facing indigenous peoples is important if effective Dr Victor Mizernyuk, the Head Physician at the psychotherapeutic help is to be offered. Lovozero Central Municipal Hospital: The steady growth of suicides and violent ‘To rely on the indigenous population and give them behaviour among the indigenous populations in

Turkey marginalized peoples in 2012, although it While the Turkish government’s approach to maintained promising dialogue with group minorities in 2012 ‘remained restrictive’, in the representatives. For the first time, minorities words of the European Commission’s assessment other than those officially recognized by of Turkey’s progress towards EU membership, Turkey were invited to parliament, to express there were signs of increasing respect and interest their views on a new Constitution. Currently in protection for minority rights. only Armenians, Greeks and Jews are officially The Constitution Conciliation Commission recognized as minority groups. (CCC), composed of members from the four In February parliament heard a submission parties represented in parliament and formed calling for legislation against hate crimes from a to oversee changes to Turkey’s Constitution, platform of 60 groups representing a wide range failed to reach consensus on key issues affecting of minorities, including Alevi, Christian, Roma,

188 Europe State of the World’s Minorities and Indigenous Peoples 2013 the Russian north is another alarming trend. Tayyip Erdoğan has suggested that a referendum Suicide rates are up to four times the Russian will be needed in the second half of 2013 average. The Yamalo-Nenets Autonomous even if all parties reach a consensus on a new Okrug and Koryak Okrug have some of Constitution. the highest rates in the world: 133.6 cases Nevertheless, prevailing attitudes in per 100,000 people. In comparison, the government and the media towards minority national suicide rate average is approximately groups remained a cause for concern in 2012. 38 cases per 100,000. Homicide rates are The European Commission noted that there correspondingly 70 per 100,000 among had been no progress in introducing legislation indigenous peoples, and 27 per 100,000 for against hate speech and hate crimes, as the national average. recommended by the Council of Europe. Studies Also reported among indigenous peoples of news reports in 2012 by the Hrant Dink of the Russian north are mental disorders and Foundation found that the prevalence of direct poisoning by drugs and toxic substances. A and explicit hate speech in opinion columns large number of mental disorders – significant and news articles was double that of 2011. delays in development, signs of emotional The Hrant Dink Foundation was set up after distress and psychological tension – are found the assassination of Turkish-Armenian editor in indigenous children and the prevalence of Hrant Dink in 2007. In January 2012, more these conditions is increasing with each year. than 20,000 people marched to mark the five years since his murder, and to protest a court Urgent areas of action ruling that there had been no state complicity in It is important to: the assassination; the court’s decision was later p Collect reliable data on the health and living reviewed by the Supreme Court. In May 2013, conditions of indigenous groups in Russia. the Supreme Court acknowledged that there had The federal and local authorities need to been a criminal conspiracy; the new decision enact legislation for the introduction of paved the way for a retrial. mandatory unified statistical health reports The situation for Roma in Turkey remained and annual monitoring of the health of difficult, characterized by discrimination, indigenous peoples. prejudice and restricted socio-economic p Train medical personnel to consider the opportunities. In June, an administrative conditions in the north and the specific court cancelled a redevelopment project in psychological challenges facing the the predominantly Kurdish and Roma Balat indigenous peoples, and provide better neighbourhood in Istanbul after five years of training for doctors and nurses from among wrangling, and the controversial Sulukule project the residents of remote areas. ■ in Istanbul’s Fatih municipality (which had resulted in the eviction of thousands of Roma in 2008) was also cancelled. However, the mayor of the municipality was confident that the state LGBT and disability rights groups. Similarly, court would overturn the Sulukule ruling. Turkey’s foreign minister Ahmet Davutoğlu held There was an increase in the number of an unprecedented meeting with Greek Orthodox Turkish applications to the European Court of Patriarch Bartholomew at the patriarchate in Human Rights for the sixth year in a row, with Istanbul. The Patriarch also proposed new most cases concerning the right to a fair trial and constitutional protections for religious minorities protection of property rights. and religious freedom to the CCC. In May a In August, a number of minority foundations proposal from the Republican People’s Party reported that the process for returning property and the Peace and Democracy Party, which held by the government was dogged by would make the state responsible for eliminating bureaucratic problems and a timeframe that discrimination against women, was rejected by was too short to allow the foundations to make the other two parties. Prime Minister Recep their claims. Between August 2011 and January

State of the World’s Minorities Europe 189 and Indigenous Peoples 2013 31, 2013, approximately 300 properties were and displacement on both sides, talks began in returned to minority foundations (which often October to negotiate a ceasefire. In early 2013, comprise religious communities). the implementation of a ceasefire between the Although the conflict between government government and the Kurdistan Workers’ Party forces and the Kurdistan Workers’ Party (PKK) held the promise of bringing an end to (PKK) continued in 2012 with bombings and decades of violent conflict. counter-insurgency operations causing deaths While the government promised to recognize

190 Europe State of the World’s Minorities and Indigenous Peoples 2013 Left: Kurdish girls in Turkey take a break from their jobs in a textile workshop. Carolyn Drake/Panos.

International that the 20-year limit on judicial settlement is imminent for many cases, and they face being ‘timed out’ of receiving compensation through the courts. Ensuring that cases are settled and judgments enforced represents an important step towards ensuring sustainable peace in Turkey. In November, Amnesty International reported that prison doctors routinely refuse to conduct medical examinations of Kurdish prisoners on hunger strike. Kurds in Turkey suffer from discrimination in accessing health care; for example, Kurds may be unable to access medical services in their own language. Although there are concerns about the effects of the privatization of Turkey’s health care system on the poorest citizens, south-east Turkey’s reputation for treatment in hospitals staffed by Kurdish speakers has attracted Iraqi Kurds to cross the border for medical services. Although provision of services in Kurdish is still far from comprehensive, the Turkish health system still offers better services for Kurds than neighbouring Iraq. The conflict in Syria had an increasing impact on Turkey during 2012, as the numbers of registered refugees rose from 9,500 in January to 144,755 by the year’s end, in spite of restrictions put in place in August. ■

Kurdish ethnicity through constitutional reform, there remain political obstacles to achieving this and ensuring the stability of the peace agreement. While some cases of financial and legal settlement for crimes committed by the state against Kurds in the 1990s were settled in 2012, it was noted by Human Rights Watch and Amnesty

State of the World’s Minorities Europe 191 and Indigenous Peoples 2013 LIBYA

LEBANON SYRIA

ISRAEL/OT/ Palestinian Authority

EGYPT JORDAN

IRAQ

KUWAIT

IRAN

SAUDI ARABIA BAHRAIN QATAR

U.A.E .

OMAN YEMEN

ARABIAN SEA Middle East and North Africa Said Shehata n 2012, the Middle East and North Africa be characterized by deep divisions. Tariq witnessed several dramatic changes that al-Hashimi, the Sunni vice-president, was I affected ethnic and religious minorities in sentenced to death in absentia on terrorism different countries. Egypt elected its first Muslim charges, but he insisted that the charges and Brotherhood president, Mohamed Morsi, and the sentence were politically motivated. Tensions country experienced waves of violence and instabil- in the government reflected the fraught ity after he came into office.1 Morsi was a polarizing relations between the Sunni and Shi’a Muslim figure and steps taken by his government caused communities. Christians, Turkmen, Yezidis concern among minority communities. While and other minorities in Iraq continued to be the number of fatalities and injuries from sectar- targeted, and large numbers remained displaced. ian violence decreased in 2012 compared to 2011, For smaller minorities, such as the Sabean Coptic Christians continued to experience attacks Mandaeans, their continuing existence as a on churches and properties throughout the year, community is in doubt. and some were imprisoned. The violence reached its In Syria, the violence increased for the second peak a few months after year’s end with an attack year since the uprising in March 2011. According on the Coptic Orthodox Cathedral, seat of the com- to the Office of the High Commissioner for munity’s Pope, in April 2013. Human Rights (OHCHR), nearly 93,000 During 2012 the ‘Arab Spring’ turned into people had been killed by spring 2013. By the an ‘Arab Autumn’ in Egypt and other countries, end of 2012, 750,000 had left the country, and such as Libya, Tunisia and Yemen. A 2012 Pew well over 2 million people had been displaced Center study found that the Middle East and inside Syria. Minorities, such as Christians North Africa region ranked the worst with regard and Alawites, fear being targeted if the Bashar to government restrictions on freedom of religion al-Assad regime collapses. There were cases of and religious sectarian violence; according to the Christians being forced to leave their houses and Pew Center, governments in the region are more flee for their lives by both government and anti- restrictive than anywhere else. government forces. In Libya, there were elections for the General In Saudi Arabia, Shi’a Muslims continued to National Congress in July, but there were face arrest and detention. In Iran, the regime disputes about representation of some areas, continued to discriminate against minorities. such as Jebel Nafusa. At the same time there There were executions and imprisonment were several incidents of violence, since the of members of different ethnic and religious government was unable to control the militias. minorities in 2012, including Ahwazi Arabs. The American ambassador to Libya was killed Across the region then, the picture is gloomy. in Benghazi in September. Prime Minister Ali There is an urgent need throughout the Middle Zidan formed a new government, which was East and North Africa to ensure the protection of approved by the General National Congress minorities, in accordance with UN instruments in October. Zidan attempted to forge a broad of human rights and minority rights. Secular coalition by including liberals and Islamists in his authoritarian regimes, as in Syria, have sought cabinet. Meanwhile, the situation for minorities to convince minorities that they are safer when remained serious, with non-Arabs and Christians their forces remain in control. However, in the being targeted by militant groups. Black Libyans, long term, this strategy is fraught with danger for including persons of sub-Saharan origin, were minorities, as they risk being targeted by opposition particularly vulnerable. The population of forces as having been too closely linked to such Tawergha remained displaced, after having been regimes. Clearly, true democracy remains a distant forced out of the city in August 2011 by armed prospect for both minorities and majority groups. groups from Misrata. In Iraq, there were hundreds of incidents of Egypt violence and in one day more than 100 people In June 2012 the country elected its first Islamist were killed. The number of civilian casualties president, Mohamed Morsi of the Muslim increased. The political scene continued to Brotherhood’s Freedom and Justice Party. This

194 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 marked a turning point for Egyptians generally 100 families escaped after Christian homes and and minorities in particular. There were shops were set on fire. hopes that Morsi could be a president ‘for all While the number of fatalities and injuries Egyptians’, as he said on several occasions, but from sectarian violence fell in 2012 compared Morsi excluded opponents from decision-making with 2011, the situation remained very serious processes and appointed members of the Muslim and escalated in early 2013 with the attack on Brotherhood to key positions in government. the Coptic Orthodox St Mark’s Cathedral, seat Morsi faced repeated controversy in taking of the Coptic Pope Tawadros II, in April 2013. some decisions, such as setting the date of the Two people were killed and over 80 were injured. House of Representatives elections for April Police fired tear gas into the compound and were 2013, despite widespread fears that the country accused of standing by as assailants attacked those was not yet prepared, and with regard to the inside. The congregation had gathered to mourn reinstating of the People’s Assembly (the lower four Copts who had died the weekend before house of parliament) in July, despite a ruling in religious violence in Khosous. A Muslim also by the Supreme Constitutional Court that died in that earlier incident. the electoral law was flawed. Morsi was also During 2012 a number of Copts were criticized for rushing the draft Constitution to imprisoned on blasphemy charges. In September referendum in December. Although nearly two- Bishoy Kameel, a Copt from Sohag, was detained thirds of voters backed the new Constitution, it and then sentenced to six years in prison after was widely criticized for ignoring women and posting cartoons on Facebook allegedly insulting not going far enough to protect minorities. For to the Prophet Muhammad and President Morsi. example, Article 43 affirmed freedom of religion Also in September, Alber Saber, an atheist from but limited it to Islam, Christianity and Judaism a Coptic family, was sentenced to three years’ – risking the further exclusion of Bahá’is. Several imprisonment on blasphemy charges with regard articles appeared to criminalize defamation of to both Islam and Christianity. He posted videos religion; similar clauses or legislation in other critical of religions. He was released in January countries have led to the targeting of minorities.2 2013 and left the country. In contrast, Ahmed Religious minorities, including Copts, Mohammed Abdullah, known as Abu Islam, Shi’as and Bahá’is, continued to experience mocked Christianity on his TV show and tore discrimination and their situation did not the Bible in front of the American Embassy in improve in 2012. There has been an increase Cairo. He was tried but released on bail. in attacks on Christians and churches in Egypt In May, 12 Copts in Minya were sentenced to since the fall of the former regime. The Egyptian life in prison and eight Muslims were acquitted government has failed or been slow to protect by an Emergency State Security Court in Copts, who comprise about 10 per cent of the connection with clashes between Muslims and population, and other religious minorities. Christians in 2011. No Muslims were jailed on There were a number of incidents in which this occasion. The case went to retrial in January Copts and churches were targeted during the 2013. year. In January 2012, homes of Copts in Sharbat The violence and lack of accountability gave village, near Alexandria, were burned following rise to a growing climate of impunity. Moreover, rumours of an alleged relationship between a legislation remained in place requiring official married Muslim woman and a Christian man. In permission that made it difficult for Coptic February, eight Christian families were evicted communities to construct churches; no new from the village by police, and local religious churches were built during 2012. A rising and political figures, reportedly following a number of Copts were leaving the country by the so-called ‘reconciliation’ session. The eviction end of 2012, according to community leaders. was overturned two weeks later after media Shi’a Muslims, Bahá’is and other religious campaigns and a visit by some parliamentarians minorities also face discrimination. Analysts to the village; however no one was prosecuted. fear that Egypt is becoming increasingly divided In August, in Dahshour, Giza governorate, about along religious and political lines. The lack of

State of the World’s Minorities Middle East and 195 and Indigenous Peoples 2013 North Africa official recognition of Shi’a Islam and the Bahá’i who was tried for sexual assault of some female faith puts these groups in a difficult position with protesters was acquitted by a military judge. regard to their religious practices and their daily Moreover, an article guaranteeing equality lives. Some Egyptian Sunnis question whether between men and women was removed from the Shi’as are real Muslims; this stereotype persists 2012 Constitution, although there is provision in spite of some attempts by al-Azhar University, for equality before the law without discrimination a leading Sunni institution in Egypt and the and an article that says that the state shall Muslim world, to bring Sunnis and Shi’as guarantee coordination between the duties of the together. woman and her public work. It will also provide In January 2012, Egyptian authorities protection and care for divorced and widowed reportedly closed the Shi’a Husseiniya mosque in women. Cairo to prevent Shi’a Muslims from observing With regard to Nubians, activist Manal the annual Ashura rituals. The mosque had only al-Tiby was the representative for Nubians in just been opened. Shi’as are forbidden from the Constituent Assembly, but she withdrew building their own religious places where they her membership in September 2012 in protest can practise their beliefs. There were no Shi’a against what she described as the domination representatives in the Constituent Assembly. of Islamists in the drafting of the Constitution. In addition, there have been media attacks on The new Constitution makes no mention of Shi’as by some Salafist TV channels (Salafists are Nubians as a distinct ethnic group. Tens of a strictly orthodox Sunni Muslim sect, which Nubians held demonstrations against selling land advocates a return to the early Islam of the time that they claim is ancient Nubian property. The of the Prophet and the first four Caliphates). government replied that development projects Mohamed Afour, a Shi’a teacher, was in this area were planned to benefit the Nubian sentenced to a year in prison after having been community. ‘Nubians want full citizenship, arrested while reportedly practising his Shi’a where their history is celebrated and taught in rituals in a mosque. The Egyptian Initiative schools’ curricula, going back to the land around for Personal Rights said that he was sentenced the lake, naming the lake (currently called Lake because of his faith. The state continues to apply Nasser) Nubia Lake and having a say in the discriminatory measures against Shi’as, while development plans in their region,’ according leaving the community exposed to the growing to writer and activist Fatma Emam. Emam was danger of Salafi extremism, according to Ahmad referring to the mass relocation of whole Nubian Rasem El-Nafis, a prominent Shi’a scholar. communities in 1964 to make way for the Aswan According to El-Nafis, the Egyptian authorities High Dam on the Nile. do not offer adequate protection. Bahá’is were previously not eligible to obtain Iran identity cards because the only options under Iran has many minorities, including Ahwazi ‘religion’ were Muslim, Christian or Jew. But in Arabs, Azeris, Bahá’is, Baluchis, Christians 2009 a court allowed Bahá’is to leave the field and Kurds. Activists and members of those empty. However, many of them have yet to groups continued to face discrimination and receive identity cards, and this affects their daily marginalization by the Iranian authorities. lives, regarding matters such as inheritance, legal Representatives of Iranian minority groups marriage and pensions. expressed their frustration and disappointment With regard to women, sexual harassment at the regime because it deprives them of continued without any serious steps by the their rights, including those mentioned in the government to stop it. For example, in June, Constitution. In 2012, the Iranian government at least six Egyptian and foreign women were did not allow the UN Special Rapporteur on sexually assaulted in Tahrir Square, Cairo. On human rights in Iran, Ahmed Shaheed, into rare occasions, cases were referred to the courts the country to investigate the human rights but there have been no prosecutions of those who situation. Shaheed urged the Iranian government committed these acts. The only military officer to end discrimination against women as well as

196 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 individuals inside hospitals and medical centres Case study by Sarah el Ashmaouy who are willing to help Nubians in dire need of health care. But the problem remains bigger than the action of individuals. Egypt: Nubian There is a long history of government neglect of Nubians in Egypt. Many Nubians were community forced to leave their land to make way for the health support Below: Nubian children in Aswan, Egypt. systems Ry Tweedie-Cullen.

The opening of a new hospital in Aswan only underlines the government’s long-term neglect of the health needs of Nubians. In January 2011, then President Mubarak inaugurated the new Aswan hospital; Aswan is the capital of Nubia in Southern Egypt. Meanwhile, in Cairo, the Nubian community had organized a support system for members of their community who need to access health care that was not available in Aswan. Each of the 22 villages of the Nubian region collected money to rent or buy a modest space in Cairo where inhabitants of the same village could stay while receiving health care in Cairo. This was coordinated through the Nubian club, which was created to maintain the cohesion of the Nubian community in Cairo and has an apartment in Tahrir Square for Nubians to meet and seek support if facing any troubles. The Nubian club was thus at the heart of the self-created health care support system. This self-support system is a symptom of the problem of health care in Egypt, particularly in the peripheries of the country like Nubia. Despite the efforts of the Nubian community in Cairo to help Nubians living elsewhere to access services, the quality of health care accessed in Cairo by Nubians depends on their income and resources, which are usually among the lowest in the country. To tackle this, Cairo Nubians have consolidated networks of

State of the World’s Minorities Middle East and 197 and Indigenous Peoples 2013 North Africa Case study continued ethnic and religious minorities. While there are mechanisms in Iran for respecting human rights, construction of the Aswan Dam in the 1960s. violations are reported in the testimonies of 221 The government promised compensation and individuals collected between November 2011 shelter; however, the resettlement plan offered and July 2012, according to Shaheed. Minority poorly designed buildings for Nubian families. languages are prohibited in both government There were very few employment opportunities institutions and as subjects to be taught in in the urban ‘new’ Nubia, and as a result many schools. Schools in minority regions are very Nubians moved to Cairo for better education poor and the rates of drop-out and illiteracy are and employment opportunities. Nubians had higher in those areas than the national average, little or no access to basic services according to the Baluchistan People’s Party. The Aswan hospital is the only one in the Dozens of Ahwazi Arabs have been detained, new Nubia to serve the 22 villages of the tortured and executed since demonstrations Aswan governorate. The eight medical centres broke out in Khuzestan province in April 2011. scattered around new Nubia are difficult to The year began with security round-ups in the access, lack basic medical equipment and region, leading to the arrest of at least 65 people. often have no personnel. In some places, Twenty-seven Ahwazi Arab residents of Shush in Nubians have to travel 44 km to access their Khuzestan were arrested because of their alleged closest medical centre, some of which are involvement in a campaign to boycott the March not even equipped to treat injuries or deliver parliamentary elections and expressing support babies. The lack of the simplest equipment, for the ‘Arab Spring’. In June four Ahwazi such as antidotes for scorpion bites or dialysis Arabs, including three brothers, were executed machines, has led to deaths from diseases on charges of ‘enmity against God’, after having which are easily preventable. The Aswan been accused of killing a law enforcement hospital, for example, only has two dialysis official. Family members disputed the charges. machines, one of which is not functional. They had been arrested during demonstrations This is not only due to the poor health care in the province of Khuzestan. In July 2012, five policies of the Egyptian government but also Ahwazi Arabs were sentenced to death and a sixth the lack of reliance on local resources. Doctors received a 20-year prison sentence. International from Cairo who work in the hospital leave human rights groups contested the charges and Nubia three days a week to go back home, argued that they were arrested because of their while Nubian medical students pursue their connection to demonstrations in February and careers in Cairo. Nubians have frequently March 2011 ahead of the sixth anniversary of addressed their local governor, demanding protests by Ahwazi Arabs in 2005 calling for better social services, including health care. a better life for their people. According to the Each time, their demands have been met Unrepresented Nations and Peoples Organization with a promise of policy change, followed by (UNPO), a total of nine Ahwazi Arabs were a ‘bureaucratic’ excuse that refers the action awaiting execution by October, after further back to the Cairo cabinet. capital convictions later in the year. Lost in the pile of files referred back to the Ahwaz city was rated as the most polluted city Cairo cabinet, the lack of action on the issue in the world by the World Health Organization of health care in Nubia has left Ahmad, an (WHO) in 2011 and the rate of asthma among 11-year-old boy from Aswan who suffers from children there has long been higher than the epilepsy, no choice but to travel to Cairo. regional average. Life expectancy is the lowest Here he hopes to find an Egyptian doctor in Iran. A critical issue is the prevalence of who will finally sign a form that will enable particles smaller than 10 micrometres (PM10), him to access health care in Cairo, rather than since these penetrate deep into the lungs and the the Aswan hospital, which cannot provide him bloodstream. The WHO recommends a limit with the care he needs. ■ of 20 micrograms of PM10 per cubic metre of air; Ahwaz city records 372 micrograms.

198 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 Heightened health risks from such intense air Below: Ahwazi Arab man and child, Iran. pollution include cancer, hypertension, diabetes Alan Rempfer. and birth defects. Causes include desertification resulting from river diversion and the draining is generally prohibited, according to Amnesty of marshes, as well as petrochemical and other International. industries located in the area. In State of the While Khuzestan is a rich province on World’s Minorities and Indigenous Peoples account of the large-scale oil production, the 2012, MRG analysed the connections between area suffers from poverty and a lack of adequate natural resource extraction, land rights and social services. In addition, the towns of Bostan, discrimination against minorities, including a Dashte-Azadegan and Hovazeh have inadequate case study on Iran. access to health care centres and are subject to Ahwazi Arabs complain of being forced frequent deaths because of untreated accidents. out of the oil-rich province of Khuzestan The Dashte-Azdegan region has the highest rates in order to replace them with majority of child malnutrition, according to the Ahwaz Persians. In addition, the authorities consider Human Rights Organization. their call for equality as a threat to national Kurds also face persecution in Iran. Journalist security. According to the Ahwaz Human and founder of the Human Rights Organization Rights Organization, they are not allowed of Kurdistan Mohammad Sadiq Kabudvand went to teach their native language, and this on hunger strike in May and July, according to violates the Iranian Constitution as well as Amnesty International; he had been denied access the international human rights norms. The to his seriously ill son and was himself refused government also prohibits Arabic-speaking medical treatment. In June, Mohammad Mehdi Iranians to name their children with non- Zalieh Naghshbandian, a Kurd, died in Rajaee Shi’a Arab names. The use of minority Shahr prison because of inadequate medical languages in schools and government offices attention by prison officials. Three Kurds were

State of the World’s Minorities Middle East and 199 and Indigenous Peoples 2013 North Africa executed in September in Oroumieh, after having Iran officially recognizes three non-Islamic been found guilty of illegal political activities. religious groups – Zoroastrians, Christians and The situation is also difficult for the Baluch Jews. During the autumn, Christian pastor minority. Public demonstrations or acts Youssef Nadarkhani was released after having of violence by extremists provoke a harsh been jailed for nearly three years for his beliefs government response. In October, three men in 2012. He was acquitted of apostasy, but was were hanged in Zahidan prison, a few days convicted of evangelizing to Muslims. He was after a suicide bombing in Chabhar. The three subsequently re-arrested in December and then men were not connected to the bombing released once more in January 2013. Religious incident – rather their executions appeared to minorities are not allowed to proselytize and be intended as a signal from the government there are restrictions on published religious that acts of defiance would not be tolerated. materials. In January 2013, Saeed Abedini, an One was reportedly a teenager. The Baluch Iranian-born American pastor, was sentenced to People’s Party noted that 11 political prisoners eight years in jail for establishing Christian house were awaiting execution in October. MRG has churches; he had been arrested in September. In previously reported how the Baluch minority are September 2012, the UN Special Rapporteur caught in the struggle between armed insurgents on human rights in Iran reported that at least and the Iranian authorities, with violent acts 300 Christians have been arbitrarily arrested and by the former serving as a pretext for further detained since June 2010. militarization and repression by the latter. Women face discrimination in a number of Iraq areas, especially with regard to family law. A It has been a decade since the US-led invasion number of women’s rights activists remained of Iraq in 2003. The sectarian conflict between imprisoned in 2012. One of them was released the Shi’a and Sunni communities has escalated, in November after spending 1,622 days in a and tensions between different groups have detention centre, according to the International grown. The sizeable Sunni population accuses Campaign for Human Rights in Iran and the government of Shi’a Prime Minister Nouri Campaign for Equality. Zainab Bayazidi, al-Maliki of marginalizing them. Everyone in a member of the Campaign for Equality Iraq is exposed to attacks and violence, and (previously called the Campaign for One the resulting deaths and injuries have blighted Million Signatures to Change Discriminatory Iraqi daily life. According to the UN Assistance Laws in Iran), was arrested and sentenced to Mission to Iraq (UNAMI), the number of imprisonment because of her work challenging civilian casualties rose to at least 3,238 reported inequality. Bayazidi has also been active in the deaths in 2012, compared with 2,771 the year Human Rights Organization of Kurdistan. In before (other sources reported higher figures). addition, 36 universities across the country The year 2012 was the first since 2009 in banned female enrolment across certain subjects, which the figures had increased. The escalation and set quotas limiting the number of women continued beyond year’s end; May 2013 on other courses as well as enforcing gender witnessed the bloodiest month of violence since segregation in their institutions. June 2008, in which 1,045 Iraqi civilians and The persecution of Bahá’is by the government security officials were killed. intensified during the year. Human Rights Watch The cycle of violence affected Shi’a and Sunni (HRW) noted a crackdown on the community groups, as well as smaller minority communities. in Semnan, leading to the closure of at least Shi’a Muslims experienced the worst attacks of 17 businesses. Amnesty International reported any religious community in 2012, with pilgrims that at least 177 Bahá’is were detained for their celebrating religious festivals especially targeted. religious beliefs during 2012. Seven Bahá’i leaders In January 2013, Shi’a pilgrims were targeted by continued to serve 20-year prison terms after insurgents who killed and injured hundreds. In their arrest in 2009, despite vocal international May, Sunni mosques and areas were attacked, protests. which resulted in the killing and injuring of

200 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 hundreds. And in August, a leading Sunni cleric, Below: A Sabean Mandaean bride participates in Sheikh Mahdi al-Sumaidaie, was seriously injured a wedding ritual, Iraq. Shiho Fukada/Panos. and four of his bodyguards were killed in an attack on his convoy; the attack occurred after signs of having been tortured. In January 2013, a the sheik had celebrated the beginning of the tent full of Turkmen mourners in Tuz Khurmato Eid al-Fitr holy day. He had urged all Iraqis to was struck by a suicide bomber; at least 35 people renounce violence and work together. were killed and over 100 were wounded. Tensions between the Shi’a and Sunni Ethnic and religious minorities have been communities escalated after the fugitive Iraqi targeted in Iraq since 2003. The fact that vice-president, Tariq al-Hashimi, was sentenced minority communities do not have the protection to death in absentia in September allegedly for of militias makes them more vulnerable to orchestrating terror attacks on officials and kidnapping for ransom; nor do they get the security forces. Hashimi was the most prominent necessary protection from the authorities. Bomb Sunni politician in the country. The Shi’a holy attacks and suicide bombings have been used day of Ashura in November passed peacefully, in areas where minorities live. Large numbers albeit following a string of car bombings just of the smaller religious communities, including before. Only days after, at least 40 Shi’as were Christians, Sabean Mandaeans and Yezidis, have killed in attacks in Baghdad and southern Iraq. left the country. Violence has even reached the In March 2013, the tenth anniversary of the US Iraqi Kurdistan Region, which has been safer invasion was marked by a series of attacks in than the rest of Iraq. Reports of sectarian violence Shi’a areas that killed nearly 60 people. were fewer there than elsewhere, although Smaller minority communities also faced religious minority communities noted cases of attacks. According to UNPO, two Turkmen arbitrary detention, harassment, discrimination teachers were found dead in December near and threats by officials of the Kurdistan Regional Humera, south-west of Kirkuk; both bodies bore Government (KRG). Some members of minority

State of the World’s Minorities Middle East and 201 and Indigenous Peoples 2013 North Africa groups wear veils or hide their religious symbols homes. A controversial amateur internet video to avoid being targeted. According to Christian launched in September sparked a wave of such women in Iraq interviewed by MRG, social death threats by militant groups. In addition, pressures and the increasing sectarian tensions several Christians were killed or kidnapped, and lead them to keep a low profile. churches were attacked during the year. A radical Christians continued to flee the country. The group attacked a church in Dohuk in May and current population is believed to be less than half looted some of its contents. In September, the its pre-2003 size. Some were reportedly forced Chaldean Catholic Sacred Heart Cathedral in to sell their homes to militants at cheap prices. Kirkuk was hit by a bomb blast; there were no Christians had previously fled Baghdad for the casualties. Although the building may not have comparative safety of the northern provinces. been the intended target, the attack added to The flight north was especially marked following a general sense of vulnerability. A local human the large-scale attack on Our Lady of Salvation rights group reported three other attacks on Church in Baghdad in 2010, which left 56 churches in the city during the year. It was Christians and 2 priests dead. Dwindling estimated that only 25,000 Christians now live resources, lack of employment prospects and in Mosul while their number was 75,000 in a sense that the violence is coming closer led 2003. Christian displaced to decide finally to leave Other minorities were attacked, such as the country. For example, in May, 20 Christian the killing of a Yezidi and his wife in Sanjar families reportedly fled Mosul after receiving district north of Mosul and a Shabak person threatening letters calling on them to leave their in Nineveh by militants. In December, a

202 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 Left: A Shi’a Muslim girl takes part in the Ashura Saudi Arabia festival, Saudi Arabia. REUTERS/Zaki Ghawas. Although King Abdullah made some efforts at reform in 2012, restrictions remain tight Sabean Mandaean goldsmith was killed in his for women and non-Sunni Muslims. Saudi shop south of Baghdad. Moreover, 20 graves law neither recognizes nor protects freedom belonging to Sabean Mandaeans were attacked of religion. In addition, restrictions on those in Kirkuk. A local human rights organization freedoms have been implemented by the religious tallied the following serious attacks on members police or Muta’ween. of minorities: 5 killings, 5 kidnappings and 12 Shi’a Muslims comprise 10–15 per cent of murder attempts against Christians; 2 killings the population in Saudi Arabia. The majority and 4 kidnappings against Yezidis; 2 killings of of the population are Sunnis who follow a strict Sabean Mandaeans; and 26 killings of Shabaks. Wahhabi interpretation of Islam. There is also There were other less serious attacks, as well as a small number of Christians who are largely incidents that went unrecorded. expatriates, and also Hindus, Buddhists, Sikhs There are inadequate health facilities in areas and others. where many minorities live. A key issue during The majority of Shi’as live in the country’s the year was the prevalence of suicides among Eastern Province, especially in al-Ahasa and minorities. There were, for example, about 50 al-Qatif. Human rights groups say there is suicides in the city of Sinjar, mainly inhabited systematic discrimination against Shi’a Muslims by Yezidis. The UN is planning a sensitization in education, employment and justice. Shi’as campaign in schools in order to train teachers are also under-represented at the higher levels of and pupils about the issue. Among the main government. reasons for these tragedies were dire poverty and Members of Saudi Arabia’s Shi’a community failure to get asylum abroad. Other minorities have repeatedly protested in the wake of the have also witnessed increases in the suicide ‘Arab Spring’ in 2011, calling for their rights rates. to be respected. According to HRW, the Saudi Some Iraqi women, including those who security forces have killed 11 Shi’a protesters lost their husbands in the armed conflict, have since 2011, while other sources report somewhat experienced financial problems and have been higher figures. Al-Qatif has witnessed a number sexually exploited. Those displaced, including of demonstrations in support of Shi’as in Bahrain women belonging to minorities, face serious and calling for reforms to their own situation, risk of abuse by people smugglers. While the which is characterized by discrimination and parliament passed a law in April to tackle marginalization. Hundreds of Shi’as were arrested trafficking, enforcement remains a serious during 2012, particularly in the Eastern Province, problem faced by women who are vulnerable to in connection with protests. While many have sexual abuse. been released, some 180 protesters remained in There is a need to reform the educational detention at year’s end. Demonstrations also curriculum to reflect the variety of different resulted in violence, causing injuries as well as communities and encourage tolerance. A minority deaths. The detention of the influential Shi’a alliance worked during the year with the Ministry leader Sheikh Nimr Al-Nimr led to an increase of Education to bridge ethnic and religious divides in protests and resulting violence. Al-Nimr was through education. The alliance reviewed the arrested in early July because of his statement that material provided to children studying at the Shi’as should be respected and live in dignity, intermediate level and made recommendations. otherwise the Eastern Province should secede. Many of these were accepted and the revised Four men were killed in the demonstrations that textbooks were distributed to schools in September followed the Sheikh’s arrest – three died during 2012. A key recommendation was that Iraqi protests immediately after El-Nimr’s arrest and children needed to learn more about the wide a fourth was killed five days later in al-Awamiyah. range of minorities in their country and their Further arrests in the Eastern Province led contributions to its history and culture. to short-term detentions and concerned Shi’a

State of the World’s Minorities Middle East and 203 and Indigenous Peoples 2013 North Africa religious practice. The only explanation given all-male Shura Council (Consultative Assembly) was usually that these were in connection with for the first time. There is still separation between private worship. It seemed as if these detentions the two sexes inside the Council and they have were primarily in areas where the population is to speak through a communication system and more evenly split. Where Shi’a Muslims represent enter through special gates; but it is a step that a local majority, there was apparently some should be welcomed. The Council will also have improvement in the possibilities to pray publicly. four Shi’a members and one of them is a woman. Recently, the Saudi authorities arrested some Women will also have the right to vote in 2014 Shi’a Muslims and charged them with spying for municipal elections. According to HRW, women Iran. Shi’a Muslims insist that they are innocent are banned from travelling or going through and that there is only a spiritual link between medical procedures without permission from them and Iran. their male guardians. For example, in July an Although King Abdullah has sponsored operation for a woman was postponed at the dialogues with religious groups, there is no King Fahd hospital because her male guardian freedom of religion for non-Sunni Muslims. was not there to authorize it. In addition, there Public expression of Christianity and other non- was controversy surrounding the news that male Muslim religions is banned. Mosques are the only guardians were receiving automatic text messages public places of worship in Saudi Arabia, and the when their female dependents crossed the borders construction of churches, synagogues or other of the country. non-Muslim places of worship is not allowed. In March two women-staffed police stations In addition, the 35 Christian Ethiopians who opened for the first time in Jeddah and Riyadh were detained in December 2011 for ‘illicit to encourage women to use police facilities. mingling’ during a private religious service were However, violence against women continues to go deported in August. The detainees claimed that unpunished. In May a court convicted a man who they were arrested because of their Christian faith, assaulted his wife, but it was a lenient sentence: and several human rights organizations reported to learn by heart five parts of the Qur’an and 100 that the police interrogation was mainly about sayings of the Prophet Muhammad. their faith. Twenty-nine of the Ethiopians were women, and they were subjected to strip searches. Syria In February, Hadi al-Mutif was released Atrocities and violence since March 2011 have after 18 years behind bars. He was convicted turned the uprising in Syria against the Bashar of insulting the Prophet, although according to al-Assad regime into a prolonged crisis. The HRW the judges showed bias in the conduct continuous fighting between the army and of al-Mutif’s case on account of the fact that armed opposition groups had resulted in the he belongs to the minority Isma’ili Muslim deaths of around 93,000 people by spring 2013. community. He was only freed after his By the end of 2012, 750,000 had fled across the repentance was accepted by the chief Mufti. country’s borders, and there were well over 2 During 2012, the government school textbook million internally displaced. In February 2012, reform project continued, resulting in the the UN High Commissioner for Human Rights, elimination of some intolerant messages, but Navi Pillay, warned that the situation in Syria discriminatory language remains. Some content had ‘reached horrific dimensions’, describing the still justifies the exclusion and killing of Muslim situation as ‘an intolerable affront to the human minorities and those deemed to be ‘apostates’, conscience’. while Christians and Jews are reportedly There are different groups within the political described as violating monotheism. and armed opposition. The opposition is supported by several countries, such as Qatar, Women’s rights Saudi Arabia and Turkey. In June 2013, the US Although King Abdullah has made some reforms, announced that it would provide direct military many restrictions on women remain. In January support to the opposition; the European Union 2013, King Abdullah appointed 30 women to the (EU) lifted its arms embargo the month before.

204 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 The regime is backed by Iran, Russia and the southern Syria, where Druze mainly live, in Hezbollah organization in Lebanon. So far no order to protect their people. Some Druze have solution has been proposed to end this conflict. been involved in fighting against armed militant Some minorities, such as Christians and Alawites, groups, such as Jabhat al-Nusra (an al-Qaeda have been targeted, because they are believed to linked group). There were kidnappings and an support the regime. Sectarian divides have grown attack on a Druze village in early 2013. in Syria between Sunnis, Alawites, Christians and There are growing concerns that Alawites Druze, especially since 2012 according to UN could be the main target of discrimination if the reports and refugees interviewed by MRG. regime collapses. Some protesters associated the The UN commission of inquiry also warned whole Alawite community with the Assad regime; that the fighting increasingly has a sectarian as a result, Alawites were particularly targeted in aspect. Regime troops and pro-government reprisal attacks during 2012. Several international militia have committed massacres, according human rights organizations, including Amnesty to the commission. At checkpoints and International, called for the protection and safety detention centres, government forces have of minorities in Syria, especially those suspected committed murder, torture, rape and enforced of backing the Assad regime, by any future disappearances following arbitrary detentions. government. In this context, Adama Dieng, In its February 2013 report, the commission the UN Special Adviser on the prevention of noted a disturbing pattern, namely the shelling genocide, urged all parties to the conflict to by government forces of whole neighbourhoods, adhere to international humanitarian and human with bread lines and hospitals being particularly rights law, especially those provisions which targeted. Opposition armed forces have also been prohibit the targeting of individuals or groups guilty of murder, torture, hostage-taking and based on religious or ethnic identity. arbitrary arrests. While the offences are grave on Kurds are denied their basic rights. They both sides, the commission noted, the scale of represent about 10 per cent of the Syrian attacks on civilian populations was far greater population. Their language is not recognized from the government side.3 Citing local activists, and is not taught in schools. In addition, Kurds HRW reported that at least 865 detainees had who could not prove their residence in Syria died during 2012 while in government custody. from 1945 onwards were denied their Syrian At the beginning of the uprising, anti-Christian nationality according to Law 93 of 1962. About and anti-Alawite slogans were reported. Some 300,000 Kurds do not have citizenship and are opposition groups have banned such chants. stateless. This puts pressure on their daily life in However, there are concerns that the divisions employment, travel and marriage. It should be among different groups in Syria may well be noted that President Assad issued a decree to grant deepening. citizenship to Kurds living in Hasaka in 2011. President Assad belongs to the minority Towards the end of 2012, there were reports of Alawite group and relies on Alawite support fighting between the opposition Free Syria Army to stay in power, backed by certain members and Kurdish fighters linked to the Democratic of other minorities, especially Christians and Union Party (PYD), raising fears of a power Druze, plus a select group of Sunni majority struggle. Kurds have otherwise kept their distance businessmen. Alawites comprise about 10 per from the fighting to avoid being targeted. Kurds cent of the population, Christians, about 10 per have set up checkpoints along the main road of cent, while about 70 per cent are Sunni Muslims. Qamishli, the unofficial capital of the Kurdish Druze, a community whose faith emerged from area. The lack of government presence in the Isma’ilism and Shi’a Islam, make up 4–5 per cent Kurdish areas has given them more freedoms of the population; they have generally avoided and they have started teaching the Kurdish taking sides in the current conflict. While a few language, which was forbidden before the March Druze have aligned themselves, the majority have 2011 uprising. By assuming responsibility to stayed neutral and have established checkpoints keep security in their region, a cultural renewal and militias in their areas, especially Suwaida, has been made possible, with Kurds now able

State of the World’s Minorities Middle East and 205 and Indigenous Peoples 2013 North Africa to speak their language freely. But this has not meant that the Kurdish region has been isolated Case study from the conflict. According to media reports, schools have been closed and medical assistance has been hard to come by. There have also been Christians in Syria government air strikes against the region. Shi’a Muslims also faced difficulty in 2012. For example, according to HRW, a Shi’a place Fears for Syria’s ancient Christian commu- of worship in Idlib was destroyed by opposition nities continue as they are attacked by both forces towards the end of the year. Shi’as living in the militias and government forces. Zarzour were displaced from their village, because The Syrian Christian community makes up they were seen as supporters of the regime. approximately 10 per cent of the population, Harassment of Christians reportedly increased but its size has been declining since the during 2012. Government forces raided the March 2011 uprising due to displacement Syrian Orthodox Um al-Zennar Church in Homs and emigration. There are Greek Orthodox, in February, leading Christians to join protests Greek Catholic, Syrian Orthodox, Syrian in greater numbers in that city. In May, security Catholic, Armenian Catholic, Assyrian forces arrested worshippers gathered at St Cyril’s and Chaldean Christians. The number of Cathedral in Damascus to remember a deceased Syrian Christians abroad is about 5 million, opposition activist. Christians left their homes in although this number is rising due to the villages of Ghasaniyeh and Jdeideh in Latakia displacement and emigration. governorate for fear of the opposition forces, as Syrian Christians have their own courts well as the urgent humanitarian situation, and that deal with marriage, divorce and worries about government air strikes and shelling. inheritance. Damascus contains a sizeable Two churches were reported to have been looted Christian community. in December. The plight of Christians in Syria was Some Christians have reportedly left their articulated by eyewitnesses, journalists and homes because they do not have a militia to religious leaders. For example, a Syrian protect them from attack. Some churches have refugee in Lebanon said that Christians have been set on fire. A local priest told a BBC no guns while they have been attacked by journalist that some young and unemployed both armed militias and the government. Christians have come under pressure from the A Catholic charity representative said that regime to defend themselves. They were told that many Christians feel they have to support armed militant groups were going to kill them. Assad because they fear what may happen It should be said that many Christians have if the rebels win: they may face the same refused to be armed. Some arrangements between tragedy as Christians in Iraq. Church leaders Christian activists and opposition forces were express fears that Syria may lose its Christian struck not to target the Christian areas. minority. Emigration has increased. Some sources reported increased intolerance and Tunisia employment discrimination as key reasons The Jasmine Revolution in Tunisia opened for Christians choosing to leave. Churches the door to other countries in the region to and Christian institutions, such as schools change their regimes. The first free elections and hospitals, have been destroyed. Neither after the ousting of President Zine El-Abidine the government forces nor the opposition Ben Ali took place in October 2011. The militias admit those attacks. According to the moderate Islamist Ennahda party, led by Rashid Archbishop of the Syrian Orthodox Church, El-Ghanoushi, won a majority in the National Yohanna Ibrahim, some churches have been Constituent Assembly along with two smaller closed because of the ongoing fighting. The coalition parties. number of worshippers has declined by over At the time of publication, the Constitution

206 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 50 per cent because of security issues, except out of fear; Shi’as also fled the region for in the areas that have Christian majorities and the same reason. And Christians are now where security arrangements can be made. The on the move in order to avoid increased Archbishop noted in spring 2013 that more than intolerance, targeting by militant groups, 30,000 Christians had fled Aleppo and more the threat of government bombardment than 6,000 Armenians had left for Armenia, and the increasingly dire humanitarian while more than 300,000 Christians were situation. ■ internally displaced by then. In Syria, caution and fear now characterize Below: The Um al-Zennar Church was relations between the different elements of damaged during clashes between Syrian rebels society. Each community is cautious when and the Syrian government in Homs, in 2012. dealing with other groups. Alawites left Aleppo REUTERS/Yazen Homsy.

State of the World’s Minorities Middle East and 207 and Indigenous Peoples 2013 North Africa remained in draft form. The prime minister were injured. The men reportedly accused the was chosen from the Ennahda party, first organizers of being Shi’a Muslims. Hamadi al-Jabali and then Ali Larayadeh. Jews have been under pressure since the Some government policies have been heavily departure of the ousted President Ben Ali. criticized, such as the apparently lenient handling There have been occasions when members of of members of the radical Salafist movement the Salafist movement have shown hostility to who have attacked activists and intellectuals the Jewish community. For example, during without being charged for their actions. In this the January visit of Ismail Haniyeh, the prime context, Chokri Belaid, head of the opposition minister of the Hamas government in Gaza, a Democratic Patriots Party and a critic of Islamist group of Salafists shouted, ‘Kill the Jews. It is parties, was assassinated in February 2013. While our religious duty.’ The slogan was condemned there have been reports of arrests, it is not yet by Ennahda party officials. In this context, the known who committed this crime. Drafts of Tunisian Association to Support Minorities the Constitution raised concerns. There were sued Sheikh Ahmad Al-Suhayli of Rades for demonstrations against Article 28 of the first hate speech against Jews, following a sermon draft, which stated that women and men’s roles that was broadcast live in November on ‘fulfil each other’, while not explicitly affirming Hannibal TV. The lawyer who represented the equality between the sexes. Draft Article 3 was association argued that the sermon violated the criticized since it allowed for the criminalization 2011 Decree 115, which criminalizes calls for of religious offences, with the risk that it would hatred. Throughout 2012, there were repeated pave the way for restrictions on freedom of media reports that members of Tunisia’s Jewish expression. In January 2013, HRW noted community were expressing unease about the that the second draft had brought several key new political order and the impunity apparently improvements. It did express concern, however, enjoyed by religious extremists. At the same time, about draft Article 15, which gave greater weight President Moncef Marzouki attempted to send to national legislation than to international a reassuring message when he visited the historic human rights treaty obligations. The organization El Ghriba synagogue on the island of Djerba also worried that judicial independence was at Passover. The visit was significant on many insufficiently protected. Finally, it noted that levels, not least since Passover in 2012 marked only Muslims could become president, a the tenth anniversary of a suicide bombing at provision that contradicted a general the synagogue that killed 21 people. And the equality clause. Jewish community received support from the Tunisia has small minority communities. The authorities when an event organized by the estimates for the size of the Berber community prominent Islamist cleric Youssef al-Qaradawi vary from 1 to 2 per cent of the population. was relocated from the island of Djerba to Tunis. There are also small Jewish, Bahá’i and other The gathering was supposed to have been held religious minority communities. four days before the annual Jewish hiloula (or Islam is the only religion taught at public pilgrimage) to the island during the Lag Ba’Omer schools, but history as taught in public secondary holiday, and there were fears of something going schools also covers the history of Judaism and wrong. The pilgrimage went ahead as planned. Christianity. While 500 people came on the 2012 pilgrimage Attacks by members of the Salafist movement compared with 5,000 in 2010 (it was cancelled in were an increasingly worrying tendency, 2011), the turn-out was still viewed positively by especially since the authorities appeared to the community. do little to bring the perpetrators to justice. Jews have lived in Tunisia since Roman Journalists, artists and human rights defenders times. Jewish influence can be found in music, were among the targets. In August, for example, a culture, names and other aspects of life in group of men attacked a festival to commemorate Tunisia. Their number exceeded 100,000 after the international day for Jerusalem in Bizerte, the Second World War, but currently fewer north of Tunis, and at least three activists than 2,000 Jews live in Tunisia, and about

208 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 half of the community lives on Djerba. It is the second biggest Jewish community in the Case study by Hanan Hammoudeh Arab world after Morocco. Debates about the community’s future have been ongoing but intensified in November, after the police Palestinian refugees arrested five Tunisians in Zarzis for allegedly planning to kidnap Jews belonging to wealthy in Lebanon families to get a ransom. Jews in Tunisia reportedly feel a need to maintain a low profile. For example, Jewish men The poor conditions in the camps in generally do not wear the kippah (the Jewish male Lebanon where Palestinian refugees have head-covering). Haim Bittan, the chief rabbi been living for more than 60 years lead of Tunis, noted in an interview that Tunisian to chronic ill health and mental health Jewish men wear a hat instead of the kippah. He problems. explained, ‘People might think we are Zionists and we do not want that, so we wear a hat.’ ‘[Health issues] are a result of the pressures There are no laws that restrict the wearing of the of life, poverty, the lack of movement, the kippah, but the rising influence of the Salafist electricity, the water, and the overcrowding.’ movement and fears that the head-covering or Ahed Khalil, aged 22, Burj el Barajneh other Jewish symbols may be misinterpreted are refugee camp resident. the main reasons cited for being cautious. This Often calling themselves ‘forgotten is of course hard on practising Tunisian Jews people’, Palestinian refugees make up10 per since they feel a religious obligation to wear cent of the population of Lebanon. Facing the kippah or other Jewish symbols. While The marginalization and discrimination, these Economist magazine reported that the Tunisian residents are without basic human rights. authorities strengthened security for the spring Besides their lack of political and civil rights, 2013 hiloula, it noted that pro-Palestinian they are denied access to public health care graffiti simultaneously appeared on government and largely depend on aid and the charity buildings in Tunis. sector for health provision. Today, most of Nevertheless, the few Jews who remain these refugees live in camps and locations that in Tunisia are generally unwilling to leave. are characterized by water contamination, While Silvan Shalom, Israel’s deputy prime where health risks are exacerbated by minister, called on Tunisian Jews to leave the overcrowding. Meanwhile, laws prohibit the country in December 2011, the reaction from expansion of the camps. A peek into the life the community was largely negative. A BBC of the camps illuminates the intersection of reporter interviewed Jacob Lelouche, who runs marginalization, social exclusion, poverty, the last kosher restaurant in Tunisia. Lelouche and the consequent health impact among the expressed his opposition to leaving, since he present minority. felt safe. Most Christians are foreigners, but there are Doctor visits and hospital care some converted Tunisians. While it is difficult On average, a doctor at a health clinic run by to get a comprehensive picture of this group, the United Nations Relief and Works Agency MRG interviewed a Tunisian Christian convert (UNWRA) sees 117 patients daily. Hospital in February 2013 who described how he had felt care is often inaccessible to Palestinian so threatened that he had decided to leave the refugees due to high costs, and those in need country. The Tunisian Association to Support of care often seek aid from charities and Minorities documented that a Salafist attacked other people in order to pay hospital fees. the Russian Orthodox Church in Tunis and Poor health is both a symptom and a cause broke its crosses. The suspected person was of economic hardships among the refugee arrested. ■

State of the World’s Minorities Middle East and 209 and Indigenous Peoples 2013 North Africa Case study continued with electricity wires … Children are dying as a result of this.’ Among these is Ahmad community. An American University of Beirut Yakoub, a Burj el Barajneh resident who report published in 2010, which took into was 14 at the time of his electrocution and account mental, physical, acute and chronic subsequent death. Between the years of 2010 health issues, indicated that 57 per cent of and 2012 in the Burj el Barajneh camp alone, households said they had made visits to a an estimated 20 people lost their lives as a doctor or incurred medical costs resulting result of electrocution. At a minimum, one from chronic illnesses; thus chronic illness electrocution-related death in the camp is is the most common reason for receiving estimated to take place every 2–3 months. medical care. The most common of chronic illnesses was found to be hypertension, Mental health and the political environment which was at a 32 per cent prevalence among With regard to mental health, 21 per cent Palestinian refugees with chronic illnesses, of Palestinian refugees surveyed for the compared with 14 per cent among the American University of Beirut study reported Lebanese population. Overall, the study found psychological problems, including distress, a 31 per cent chronic illness incidence among depression and anxiety. It was suggested that Palestinian refugees, compared with the 17 per the stresses of the Lebanese civil war and cent among the Lebanese population. lack of civil rights within the country have contributed to these burdens. Ahed said that Health behind camp walls the environment was a principal factor tied According to the report, 66 per cent of to the mental health issues among the camp Palestinian refugee camp homes were affected population, caused by ‘poverty, the lack of by leaks and dampness, with water leaking movement, the electricity, the water, and the from every one in three ceilings. The report overcrowding’. also indicated that higher illness prevalence Palestinian refugees in Lebanon have long was associated with some housing traits been victims of political scapegoating. Due common to camp infrastructure. People who to Palestinian factions’ role in the Lebanese lived in homes that had asbestos, eternit, or civil war, the population has long been wood in their walls had an astounding 100 stigmatized and has been approached with per cent of chronic illness prevalence. Homes defence rhetoric. Ahed says that the camps are in which four or more people lived per room approached from a security angle, and this has were associated with higher prevalence of thwarted adequate responses to issues such as functional disabilities and acute illnesses. health. Deprived of basic rights due to claimed Ahed, a 22-year-old resident of the Burj el security measures and embedded fears of Barajneh refugee camp in Beirut, described the permanent settlement, the health predicament overcrowding of the camps as ‘nas fo’ ba ‘ad’, of Palestinian refugees continues. ■ a figurative phrase in Arabic literally meaning ‘people piled on top of one another’. The Palestinian refugee population has double the prevalence of disability of the Lebanese population, despite no significant difference in birth defects, and 20 per cent of disability cases among the Palestinian refugee population are the effects of accidents. When describing the environmental factors contributing to poor health in the camps, Ahed referred to, ‘[T]he electricity. Old infrastructure and water pipes intertwined

210 Middle East and State of the World’s Minorities North Africa and Indigenous Peoples 2013 Endnotes

1. Prior to going to press, President Morsi was removed from office in July 2013 by the Egyptian military.

2. In July 2013, interim President Adly Mahmud Mansour issued a decree outlining steps to be taken to revise the 2012 Constitution.

3. See OHCHR, ‘UN commission of inquiry: all parties becoming increasingly reckless with human life as the Syrian conflict drags on’, retrieved July 2013, http://www.ohchr.org/EN/ NewsEvents/Pages/DisplayNews. aspx?NewsID=13003&LangID=E

State of the World’s Minorities Middle East and 211 and Indigenous Peoples 2013 North Africa Reference assumptions in at least two important aspects. Peoples under Firstly, in those country situations of most concern in 2013, where the threat of genocide or mass Threat 2013: killing is greatest or is rising most quickly, foreign military intervention is not the exception but the Civilian protection norm. Whether it be the deployment of a multi- lateral force under the auspices of NATO, the and military African Union or the UN, a military intervention launched by a foreign government or governments, intervention or the arming and logistical support of proxy militias by neighbouring or interested states, the Mark Lattimer great majority of countries where the threat of mass killing is acute or killing is ongoing have been Introduction subject to armed intervention, in some cases on Foreign news reports of a whole community several occasions going back a decade or more. under violent attack in another part of the world Secondly, there is a complex causal relationship quickly prompt the reflection: what should we between civilian security and armed intervention do? In the western media, the question is rarely in practice. While it is possible that foreign posed without quickly leading to calls for armed military action may halt an episode of mass intervention. No matter which other potential civilian killing or decrease its intensity, it may responses are tried – diplomatic pressure, also prolong or intensify killing, or even initiate sanctions, international prosecutions – the failure a conflict where there was none before. In some to intervene militarily inevitably invites the cases, it may end one conflict, but start another; judgment: ‘We did nothing’. or have the effect of shifting violence away from The 2013 release of the Peoples under Threat one people or population group onto another or index highlights the need to question this set of others.

Major Risers since 2012

Rank Rise in rank Country Group Total 2013 since 2012

5 1 Pakistan Shi’a (incl. Hazara), Ahmadiyya, Hindus and other religious minorities; Baluchis, Mohhajirs, Pashtun, Sindhis 20.42 6 8 Syria Political targets, Shi’a/Alawites, Christians, Kurds, Palestinians 20.09 10 1 Nigeria Ibo, Ijaw, Ogoni, Yoruba, Hausa (Muslims) and Christians in the North 18.41 11 2 Yemen Zaydi Shi’a, ‘Akhdam’, Southerners 18.35 17 4 Central African Kaba (Sara), Mboum, Mbororo, Gula, Aka Republic 15.88 23 13 Libya Black Libyans, Sub-Saharan migrants, Tebu, Berbers 13.71 25 36 Mali Tuareg, Arabs, Maure, and others in the north 13.11 26 5 Equatorial Guinea Bubi, Annobon Islanders 12.99 27 19 Kenya Borana, Kalenjin, Kikuyu, Luyha, Luo, Muslims, Turkana, Endorois, Masai, Ogiek, other indigenous groups 12.92 28 6 Algeria Berbers, Saharawi 12.89

State of the World’s Minorities Reference 213 and Indigenous Peoples 2013 This is the eighth year that Peoples under Threat long list of other states that are already engaged in has used statistical analysis based on authoritative supporting one or other side in the war, including indicators to identify those communities or Qatar, Saudi Arabia, Turkey, Russia and Iran. The peoples around the world most at risk of mass involvement of the Lebanese group Hezbollah killing. Unlike most early warning tools, Peoples in support of the Syrian government has also under Threat was developed for the specific increased the danger of the conflict spilling further purpose of contributing to civilian protection. into Lebanon, which itself rose in the index this This year’s release illustrates starkly, however, year. just how little we know about the efficacy In Yemen in 2012 a major military offensive, of international action to prevent atrocity. supported by the US, targeted Islamic militants It underlines the urgent need to track the in the south, and the conflict displaced tens consequences of any foreign military intervention, of thousands of civilians. The US continued a to ensure that intervention does not do more separate campaign of drone strikes across the harm than good. country. In the north, scene of an earlier Saudi Arabian military intervention in 2009, continuing Rising threats in 2013 conflict between al Houthi rebels and the At least half the states that have risen most government and Sunni tribes caused casualties significantly in Peoples under Threat in 2013, and and displacement in both Zaydi Shi’a and Sunni eight out of 10 of those most at risk, have been communities. Yemen now has the dubious subject to recent large-scale or systematic foreign distinction of having risen in the Peoples under military interventions. Threat index seven years in a row. The two states that have risen most The government of President François Bozizé prominently in the index this year are both at of the Central African Republic had benefitted the centre of intense controversy concerning from military support from both neighbouring international intervention. The recent general Chad and from France over the years, but he election in Pakistan saw fierce criticism of US was finally overthrown in a rebellion in March military action, in particular the systematic use 2013. Victorious fighters of the Séléka alliance of unmanned drones to drop bombs in the north have been responsible for a wave of human rights and west of the country. Drone killings, including abuses, tens of thousands of people remained an unverified number of civilian casualties, have displaced and the humanitarian situation in the caused intense resentment among communities country has deteriorated markedly in one of the in the tribal areas. While the elections were hailed world’s forgotten crises. as the first transfer of power from one elected Libya and Mali are two recent cases where government to another in Pakistan’s history, they success has been claimed for large-scale foreign were marked by violence and the outcome shows military interventions, the first in support of deep regional divisions. Lashkar-e-Jhangvi and rebels, the second in support of the government. other sectarian extremists, widely believed to be Both countries have risen sharply in the index this funded from abroad, have intensified a murderous year, following major rises last year too. campaign against the Shi’a and other religious NATO air power helped topple Libya’s President minorities, and have operated with almost Gaddafi in 2011 and led to democratic elections in complete impunity. 2012. Large areas of the country, however, remain At least 93,000 people are now estimated by under the effective control of different militia the UN to have been killed in Syria’s conflict. groups, and security for much of the population This is the third year in a row that Syria has worsened over the last year. Most of the Sub- risen in the index, and previous fears expressed Saharan population were expelled during the in Peoples under Threat that whole communities rebellion in 2011 and dark-skinned Libyans, would become at risk of sectarian killings are sadly including former residents of Tawergha, remain being increasingly realized. In June 2013 the US vulnerable to racist attacks and arbitrary detention. announced for the first time that it would provide French President François Hollande was direct military support to Syrian rebels, joining a awarded the Houphouët-Boigny Peace Prize by

214 Reference State of the World’s Minorities and Indigenous Peoples 2013 UNESCO in June 2013 for his decision to send invasion. The African Union mission in Somalia French troops to Mali earlier in the year to regain was able to claim considerable success in pushing the north of the country from Islamist rebels. al Shabaab back from major cities including Following the intervention, Arab properties in Mogadishu, although the group was responsible Timbuktu and other key northern towns were for a deadly attack on the UN compound in looted and much of the Arab population forced June 2013 and continues to control large areas to flee, as were Tuaregs who were perceived to of South-Central Somalia, including those where have initiated the rebellion. The UN estimated the vulnerable Bantu population live. A further that some 470,000 people in all have fled the 78,000 people fled Somalia as refugees in 2012, fighting, with Arabs and Tuaregs remaining at risk according to UNHCR. of reprisal attacks as well as inter-ethnic clashes in Civilian deaths in Afghanistan continue to run the north. at nearly 3,000 a year, the great majority due to attacks by the Taliban and other anti-government Peoples at greatest risk forces. The US has sought peace talks with the At the head of the Peoples under Threat table Taliban in advance of a withdrawal of US troops are those country situations where peoples are from Afghanistan in 2014, but Tajik, Uzbek and at greatest risk. Somalia, Afghanistan and the Hazara leaders have formed a new National Front Democratic Republic of Congo have all been to oppose any accommodation with the Pashtun- subject to multiple military interventions by dominated Taliban, in a move that underscores both foreign armies and inter-governmental the deep ethnic divisions in the country. organizations, over the course of decades. Nigeria re-entered the top 10 this year as the Both the Kenyan and Ethiopian armies threat rose from conflict between Christian and were active again in Somalia over the last Muslim communities, much of it over land, in year, conducting major bombing and ground Plateau and neighbouring states and in the north- operations against al Shabaab, a rebel group east. The Islamist group Boko Haram issued formed in 2006 to oppose a previous Ethiopian an ultimatum calling on Christians to leave in

Peoples most under threat – highest rated countries 2013

Rank Country Group Total

1 Somalia Minorities incl. Bantu, Benadiri and ‘caste’ groups (Gabooye etc.); clan members at risk in fighting incl. Hawiye, Darod, etc. 23.29 2 Sudan Fur, Zaghawa, Massalit and others in Darfur; Dinka, Nuba, Beja 21.93 3 Afghanistan Hazara, Pashtun, Tajiks, Uzbeks, Turkmen, Baluchis 21.44 4 Iraq Shi’a, Sunnis, Kurds, Turkmen, Christians, Mandaeans, Yezidis, Shabak, Faili Kurds, Baha’is, Palestinians 20.59 5 Pakistan Ahmadiyya, Baluchis, Hindus, Mohhajirs, Pashtun, Sindhis, other religious minorities 20.42 6 Syria Political targets, Shi’a/Alawites, Assyrians, Kurds, Palestinians 20.09 7 Burma/Myanmar Kachin, Karenni, Karen, Mons, Rakhine, Rohingyas, Shan, Chin (Zomis), Wa 20.06 8 Dem. Rep. of the Congo Hema and Lendu, Hutu, Luba, Lunda, Tutsi/Banyamulenge, Batwa/Bambuti, other groups 19.92 9 Ethiopia Anuak, Afars, Oromo, Somalis, smaller minorities 19.30 10 Nigeria Ibo, Ijaw, Ogoni, Yoruba, Hausa (Muslims) and Christians in the North 18.41

State of the World’s Minorities Reference 215 and Indigenous Peoples 2013 January 2012 and then launched a campaign of is Peoples under Threat calculated?’ on p. 219). attacks on Christians in the north-east, killing Under this rubric, embeddedness in the hundreds and displacing thousands. Following international system not only brings with it the imposition of a state of emergency in three a range of economic benefits which it would states in north-eastern Nigeria in May 2013, be costly to lose, but also exposes a national accompanied by a media blackout, the Nigerian government to a level of continuous pressure to army has been accused of arbitrary killings and conform to minimum international standards. disappearances in its operations against Boko Globalization, the expansion of international Haram. trade and the growth in inter-governmental In Darfur in Sudan the joint UN/African organizations have significantly reduced instances Union peace-keeping force (formerly the of international isolation. The remaining world’s largest) scaled back to 16,000 troops as exceptions – of which North Korea is the most progress was made with the implementation of striking example – present profound human rights the Darfur peace agreement. Conflict between challenges. rebels and the government continued, however, Emerging from relative isolation over the last and included attacks by the Sudanese air force two years, Burma/Myanmar has made tentative and by government-backed militias on civilians moves towards democratization, most visibly in in IDP camps. A set of humanitarian crises the appointment of a civilian government and continue to unfold on both sides of the border the release from house arrest and election to with the newly-independent state of South Sudan. Parliament of the opposition leader, Aung San In South Kordofan and Blue Nile in Sudan, Suu Kyi. Burma has accordingly fallen in the the Sudanese armed forces were responsible index this year, although it remains in the top 10. for indiscriminate shelling of villages in their In addition to widespread human rights violations campaign against the Sudan Revolutionary Front, associated with renewed conflict in Kachin state, an alliance of existing rebel groups. In the latest inter-community violence has caused the deaths agreement between Sudan and South Sudan in of hundreds of Muslims, particularly Rohingya March 2013, their respective forces were due to in Rakhine state. Dam construction and other undertake a UN-monitored withdrawal from a major development projects across the country demilitarized zone on the border, but violations have drawn a huge increase in international have already been reported. Inter-ethnic violence investment, but have themselves created further continued in Jonglei state in South Sudan, concerns for indigenous and ethnic minority particularly between Lou-Nuer and Murle. communities who fear displacement and the loss of their livelihoods. International trade and cooperation Cooperation extends beyond trade relations. Foreign military intervention lies at one end of International cooperation to promote and a spectrum of possible international engagement encourage respect for human rights and and it is instructive first to consider peaceful fundamental freedoms is actually enshrined means of influencing a state’s human rights in international law as one of the founding performance. principles of the UN. Such cooperation includes Although international relations with any given oversight mechanisms, including the UN state are complex and can have negative as well as Human Rights Council, through which member positive effects on human rights, a condition of states’ pledge to promote human rights can be general isolation from international exchange and scrutinized. Whether it be through the agencies cooperation, when combined with other factors, of the UN, through regional inter-governmental signals danger. The Peoples under Threat index organizations, or through bilateral cooperation, uses the country credit risk classification assigned states can also benefit from a wide range of by the Organization for Economic Cooperation ‘technical assistance’ programmes, from advice and Development (OECD) as a proxy for low on legal drafting and rights monitoring through trade openness, one of the known antecedents to to training in human rights standards for judges, genocide or mass political killing (see box: ‘How lawyers and law enforcement agencies.

216 Reference State of the World’s Minorities and Indigenous Peoples 2013 More generally, international aid for of two men with outstanding ICC indictments development is a major source of income for for crimes against humanity for their role in the most of the world’s poorest states, including 2007–8 post-election violence. Kenya rose sharply many near the top of the Peoples under Threat again in the Peoples under Threat table this year. table. Whether or not it is a formal condition for Both Kofi Annan and his successor as UN receiving aid, accepting international observation Secretary-General, Ban Ki-moon, described or assistance on human rights is often seen as the Kenya mediation as the first application part of the package. Conversely the removal of of the new norm of ‘responsibility to protect’ aid, or the threat of its removal, can provide a (R2P). At the UN world summit in 2005, UN major lever of influence over a government to member states had agreed that, although an improve its human rights performance. In 2012, individual state carried the primary responsibility for example, the EU and a number of other for protecting its population, the international governments partly suspended aid to Rwanda community also had a ‘responsibility to protect’ following a report by a UN group of experts into populations from genocide, war crimes, ethnic Rwandan support for the M23, a rebel group in cleansing and crimes against humanity. This neighbouring Democratic Republic of Congo responsibility was to be discharged through (DRC) whose murderous activities have sparked a ‘appropriate diplomatic, humanitarian and other renewed humanitarian crisis. peaceful means’ but, should peaceful means be inadequate and national authorities manifestly The toolbox of coercion fail to protect their populations, also through Beyond international oversight and the provision taking collective action, ‘in a timely and decisive or withholding of aid, a range of other means are manner’, through the UN Security Council. available to the international community to seek Much of the groundwork for developing to modify a state’s behaviour. These include, but the norm of responsibility to protect was are not limited to, diplomatic pressure, litigation undertaken by the International Commission before international tribunals or the International on Intervention and State Sovereignty, set up Court of Justice, suspension or expulsion under the auspices of the Canadian government. from international organizations, severance of Borrowing heavily from just war theory, the diplomatic relations, economic sanctions, arms Commission identified six necessary criteria embargoes, international prosecutions of military for a justified military intervention: just cause, or political leaders, and travel bans or asset freezes. right intention, last resort, proportional means, The use of a number of these tools is illustrated reasonable prospects and right authority. For the by the response to inter-ethnic violence in Kenya, just cause threshold to be met, the Commission when over 1,300 people were killed following explained that there must be serious and a disputed general election in December 2007. irreparable harm – such as large-scale loss of life Intense diplomatic pressure, including a threat or ethnic cleansing – occurring to human beings from the EU Development Commissioner to or imminently likely to occur. The criteria of just reduce aid and the imposition of a US travel cause and right intention in particular remain ban on a number of Kenyans, led to a set of deeply controversial, given that most military power-sharing accords, mediated by former UN interventions in history have not been undertaken Secretary-General Kofi Annan. A commission for humanitarian reasons and that the intention of inquiry established under the accords or motivation of states can be difficult to certify. recommended the prosecution of those most The responsibility to protect envisages states responsible for the violence, with a recourse to taking collective or multi-lateral action, but it the International Criminal Court (ICC) should does not specify which form of mandate might national prosecutions not progress. In the event, be appropriate for such action, other than the ICC opened an investigation in 2010. A that it should be in accordance with the UN new general election in Kenya in March 2013 Charter, including Chapter VII. The first military passed off relatively peacefully, but resulted in implementation of the responsibility to protect the election as President and Deputy President is accepted to be Security Council Resolution

State of the World’s Minorities Reference 217 and Indigenous Peoples 2013 1973 in 2011, which authorized UN member that appear over-determined. The Iraqi case has states to ‘take all necessary measures . . . to perhaps occasioned more debate than any other protect civilians and civilian populated areas’ in in recent years, but difficult questions on the Libya, including by the establishment of a no-fly aims and effects of armed intervention could zone (although NATO was later criticized for equally be posed concerning many of the critical exceeding its mandate when it went on to support country situations in the Peoples under Threat the overthrow of President Gaddafi). Since the index, including inter alia Somalia, Afghanistan, 1990s, however, UN missions have evolved from Pakistan, the DRC, Yemen and Libya. In each a traditional peace-keeping role, in which lightly- case, humanitarian grounds have been among armed personnel were deployed post-ceasefire those cited to justify military intervention, but it with the consent of both parties to the conflict, to remains hard to establish whether the majority multi-function missions with wide humanitarian of civilian killing is the cause or the effect of aims including, increasingly, ‘peace enforcement’. sustained intervention, particularly in the case of The UN’s largest peace-keeping operation, in interventions that comprise multiple episodes. the DRC, provides a good case study of this In specific cases it may be possible to draw development, with the mission’s latest incarnation at least interim conclusions. Even in the case including an ‘intervention brigade’ with the of Iraq, most commentators would agree both power to ‘carry out targeted offensive operations’ that the population of Iraqi Kurdistan feel to neutralize armed groups threatening state more secure following the removal of their authority and civilian security (UNSC 2098, nemesis Saddam Hussein and also that the 2003 March 2013). invasion triggered an unprecedented level of Although military interventions authorized sectarian violence between Arab Sunni and Shi’a. by the UN Security Council or other inter- Two international military interventions that governmental organizations have increased in produced a definite, immediate improvement recent years (see opposite), it should be noted that in civilian protection were the UK operations most interventions continue to be undertaken in Sierra Leone in 2000 to help halt a rebel by neighbouring states or world powers. advance on the capital Freetown; and the EU/ Furthermore, interventions using the regular French Operation Artemis to secure the town forces of a national government or governments of Bunia in Ituri in the DRC in 2003. (It is are themselves outnumbered by the widespread notable that both these were limited operations practice of providing military, financial or focused on securing one urban area and were logistical support to proxy militias or rebel launched with the cooperation of the national groups. host government.) However, with over 16 years’ continuous experience of repeated foreign Armed intervention and mass killing: interventions by both foreign governments and cause or effect? inter-governmental actors, the DRC case more Ten years ago in 2003 the United States led than any other demonstrates the complexity a military coalition to intervene in Iraq. One of disentangling the lines of causality linking narrative for what then happened describes the intervention and civilian killing or protection. removal of a government responsible for gross A growing number of academic research human rights abuses and the installation of a institutes now compile data on inter-state fledgling democracy. Another version of the same conflict and other instances of international events tells how an illegal invasion started a war military action. Of particular interest is the that has to date cost the lives of at least 112,000 updated International Military Intervention civilians and left the country in a semi-permanent dataset (IMI), compiled by Jeffrey Pickering and state of conflict, with approximately 400 civilians Emizet F. Kisangani at Kansas State University. continuing to be killed every month. This records 444 separate instances of military That both these narratives can exist, credibly, intervention across international boundaries by at the same time is an indication of the difficulty regular armed forces from 1989 to 2005. It has in identifying cause and effect in a series of events the advantage of using the same definitions and

218 Reference State of the World’s Minorities and Indigenous Peoples 2013 Peoples under threat following military interventions

50

40

30

20

10

0

International military interventions 1989–2005 (no.) 0 5 10 15 20 25

Peoples under Threat index 2013 Source: IMI 1989-2005; MRG

Higher threat after hostile interventions

9

8

7

6

5 Human development of peoples under threat 25.00 4

20.00 3

15.00

PUT 2 10.00

Number of hostile interventions 1989–2005 1 5.00

0 0.00 0 0.1 5 0.2 0.3 10 0.4 0.5 15 0.6 0.720 0.8 250.9 Peoples underHDI Threat index 2013 Source: IMI 1989-2005; MRG

coding as an earlier dataset covering the Cold example whether it was hostile, supportive or War era, thus providing a consistent body of data neutral) and on the motivation or issues driving from 1946 onwards, and includes information intervention. (The data excludes support for on the direction of military intervention (for proxy militias, paramilitaries, mercenaries or

State of the World’s Minorities Reference 219 and Indigenous Peoples 2013 other non-regular forces.) of rebel groups, from inter-ethnic or inter-religious IMI records an increase in the use of foreign conflict, or indeed from foreign attack. The military intervention, from approximately 16 correlation between the level of current threat to foreign military interventions launched every year population groups and a history of international during the Cold War period to 26 interventions military intervention can be demonstrated by initiated per year in the post-Cold War years of plotting the 2013 index (for 114 countries) 1990–2005. Interventions by major powers (i.e. against the IMI data on military interventions the five permanent members of the UN Security by target country over the period 1989–2005. Council) increased slightly, with US and French The correlation is particularly strong for hostile activities accounting for most of the increase, interventions (i.e. those coded in IMI as opposing but the greatest proportional increase was seen governments or supporting rebels). A higher in interventions mounted by international number of hostile interventions in the 1989–2005 organizations, including the UN, NATO period corresponds to higher levels of current threat and other regional organizations (Pickering (see graph on p. 217). and Kisangani, ‘The International Military Intervention Dataset: An updated resource for Monitoring the impact of intervention conflict scholars’, Journal of Peace Research 46, It should be stressed that even if there is a 2009). correlation between military intervention and a This finding of an increase in foreign military subsequent rise in the level of threat to civilian intervention is consistent with the high levels population groups, it cannot be assumed that of armed intervention noted earlier in countries one causes the other. There might be significant ranked highly in the 2013 Peoples under differences in the situation in target countries Threat index. Other studies in the literature ex ante, or intervening variables – the nature demonstrate a relationship between armed or direction of the intervention, the level of intervention and an increase in human rights wider international support – may be as or more violations. Working from a sub-set of the IMI important. But it does underline the need for data for the period 1981–2001, Dursun Peksen more research. It also highlights the point that finds that foreign military intervention increases interventions, particularly belligerent ones, often the likelihood of violations of physical integrity do not turn out the way they were intended, as rights, particularly in the case of interventions the case of Iraq tragically demonstrates. that are supportive towards the target government One of the conditions for a justified intervention or neutral (‘Does Foreign Military Intervention under the R2P doctrine is a reasonable prospect Help Human Rights?, Political Research Quarterly of success. It might be argued that a test based 65, 2012). He hypothesizes that the use of only on reasonableness sets the bar too low, but repression is essentially a policy choice adopted it would help if the test were correctly applied. by the government and that supportive or neutral Reasonable prospect is often judged just in terms military intervention enhances the state’s coercive of the immediate military objective, whether it be power and encourages more repressive behaviour. gaining air supremacy, defeating a military force, Interestingly, he finds no major statistically or establishing effective control of territory. But if significant difference between humanitarian the just cause for an armed intervention is civilian intervention and non-humanitarian intervention. protection, then success should also be judged in He notes the value of these findings in shedding terms of civilian protection. As Taylor Seybolt, light ‘on the empirical relevance of ongoing author of a major study on military interventions, policy debates showing that interventions might has argued: ‘A reasonable prospect of success is as inadvertently do more harm than good – at least critical to legitimate humanitarian intervention in the case of human rights – even if they are as just cause. If an intervention is not likely to do initiated by IGOs or liberal democracies’. more good than harm from a humanitarian point Peoples under Threat is designed to assess the of view, it cannot be justified in humanitarian risk to population groups not just from terms. This is true even if the other criteria of government repression but also from the activities right authority, right intention, last resort and

220 Reference State of the World’s Minorities and Indigenous Peoples 2013 proportional means are met. Despite its essential moral question is perhaps more straightforward: character, the prospect of success is undervalued how many lives should be risked to save other and has been the subject of too little study. lives? The calculus is still complex, but the This lack of attention may help to explain why currency is the same. Perhaps the greatest scandal, so many humanitarian interventions have gone under such circumstances, is the failure to monitor awry’ (Taylor B. Seybolt, Humanitarian Military loss of life following an armed intervention, so Intervention, SIPRI, OUP, Oxford, 2007, p. 26). the question can at least be put. After the Libyan There is perhaps no older ethical problem in intervention, for example, NATO was heavily politics than the morality of the use of force. criticised for failing to investigate over 70 civilian The state will reserve to itself the monopoly of the deaths caused by its aerial bombardment. But legitimate means of violence, but when and how there remains even more confusion about the far violence can be employed to maintain order are greater numbers killed in the Libyan conflict by questions that have been posed by governments both government and rebel forces, the majority through the ages. In the era of decolonization, after the start of foreign intervention. Even today, we also became familiar with the revolutionary’s credible estimates of the number killed range from dilemma: is it right to spill blood to win liberty? 15,000 to 30,000 (around half of them civilians). Although the answer to such questions may be If there is a basic failure even to count the dead, influenced by an estimation of how much blood then the relative success of an intervention can might be necessary, it also depends on the wider never be properly evaluated. political beliefs of the individual confronted by the As the threat of mass killing continues to be dilemma and the relative value he or she places on faced by peoples around the world, there is an life, as opposed to freedom or order. As such, the urgent need for reliable data on the consequences problem always escaped simple resolution. as well as the causes of military intervention, to In the current debates over responsibility to ensure that civilian protection is improved in protect and armed intervention, the fundamental practice. Additional research by Jack Dentith.

How is Peoples under Threat calculated? cide early warning and prevention, Professor Barbara Harff, a senior consultant with the Since the genocide in Rwanda in 1994, US State Failure Task Force, constructed and our ability to identify those situations most tested models of the antecedents of genocide likely to lead to genocide or mass killing has and political mass murder and her results improved. A number of comparative stud- were published in 2003 (‘Assessing Risks of ies of the factors preceding historic episodes Genocide and Political Mass Murder since of political mass killing had been undertaken 1955’, American Political Science Review 97, since the 1970s, including by Helen Fein and February 2003). Her optimal model identi- Ted Robert Gurr, but it was not until the fies six preconditions that make it possible to 1990s that researchers such as Rudolf Rummel distinguish, with 74 per cent accuracy, between and Matthew Krain pioneered quantitative internal wars and regime collapses in the period longitudinal analysis of a wide range of such 1955–1997 that did, and those that did not, factors, enabling the testing of different causal lead to genocide and political mass murder hypotheses. Rummel, for example, showed the (politicide). The six preconditions are: political very strong relationship between concentration upheaval; previous genocides or politicides; of government power and state mass murder; exclusionary ideology of the ruling elite; auto- Krain demonstrated the correlation between cratic nature of the regime; minority character existing armed conflict or political instability of the ruling elite; and low trade openness. and the onset and severity of mass killing. Minority Rights Group International has Following the early work of the Clinton drawn on these research findings to construct administration’s policy initiative on geno- the Peoples under Threat table, although

State of the World’s Minorities Reference 221 and Indigenous Peoples 2013 responsibility for the final table is exclusively risk than others in any given state. Minority our own. Peoples under Threat is specifically Rights Group International has identified those designed to identify the risk of genocide, mass groups in each state which we believe to be killing or other systematic violent repression, under most threat. (This does not mean that unlike most other early warning tools, which other groups or indeed the general population focus on violent conflict as such. Its primary may not also be at some risk.) It should be application is civilian protection. noted that although these groups are most Indicators of conflict are included in often minorities, in some cases ethnic or the table’s construction, however, as most, religious majorities will also be at risk and in although not all, episodes of mass ethnic or relevant cases are therefore also listed in the religious killing occur during armed conflicts. table. In some cases, all the groups in the War provides the state of emergency, domestic country are at risk of ethnic or sectarian killing. mobilization and justification, international One indicator that has been tested and cover, and in some cases the military and discarded by a number of studies is the general logistic capacity, that enable massacres to be level of ethnic or cultural diversity in a society. carried out. Some massacres, however, occur in Krain did not find any correlation between peacetime, or may accompany armed conflict ‘ethnic fractionalization’ and the onset of from its inception, presenting a problem to genocide or political mass killing. Similarly, risk models that focus exclusively on current neither of the patterns of ethnic diversity tested conflicts. In addition, severe and even violent by Harff had any effect on the likelihood repression of minorities may occur for years of mass killing (although she did find the before the onset of armed conflict provides the minority character of the ruling elite to be catalyst for larger scale killing. significant). These findings are supported by The statistical indicators used all relate to research on the relationship between diversity the state. The state is the basic unit of enquiry, and conflict. rather than particular ethnic or religious groups The overall measure is based on a basket at risk, as governments or militias connected to of 10 indicators. These include indicators the government are responsible for most cases of democracy or good governance from the of genocidal violence. Formally, the state will World Bank; conflict indicators from the reserve to itself the monopoly over the means Center for Systemic Peace and other leading of violence, so that where non-state actors are global conflict research institutes; indicators responsible for widespread or continued killing, of group division or elite factionalization it usually occurs with either the complicity of from the Fund for Peace and the Carnegie the state or in a ‘failed state’ situation where Endowment for International Peace; the State the rule of law has disintegrated. Certain Failure Task Force data on prior genocides characteristics at the level of the state will and politicides; and the country credit risk greatly increase the likelihood of atrocity, classification published by the OECD (as a including habituation to illegal violence among proxy for trade openness). For citations and the armed forces or police, prevailing impunity further information, see the notes to the table. for human rights violations, official tolerance For a fuller discussion of the methodology, see or encouragement of hate speech against State of the World’s Minorities 2006. particular groups, and in extreme cases, prior Based on current indicators from experience of mass killing. Egregious episodes authoritative sources, Peoples under Threat seeks of mass killing targeted principally at one to identify those groups or peoples most under group have also seen other groups deliberately threat in 2013. ■ decimated or destroyed. However, some groups may experience higher levels of discrimination and be at greater

222 Reference State of the World’s Minorities and Indigenous Peoples 2013 State of the World’s Minorities Reference 223 and Indigenous Peoples 2013 Country Group Conflict indicators

A. Self- B. Major C. Prior genocide/politicide Table 1 determination armed conflict conflicts Peoples under Threat 2013

Somalia Minorities incl. Bantu, Benadiri and 4 2 1 ‘caste’ groups (Gabooye etc.); clan members at risk in fighting incl. Hawiye, Darod, etc.

Sudan Fur, Zaghawa, Massalit and others 5 2 1 in Darfur; Ngok Dinka, Nuba, Beja

Afghanistan Hazara, Pashtun, Tajiks, Uzbeks, 4 2 1 Turkmen, Baluchis

Iraq Shi’a, Sunnis, Kurds, Turkmen, 5 2 1 Christians, Mandaeans, Yezidis, Shabak, Faili Kurds, Bahá’ís, Palestinians

Pakistan Shi’a (incl. Hazara), Ahmadiyya, 5 2 1 Hindus and other religious minorities; Baluchis, Mohhajirs, Pashtun, Sindhis

Syria Political targets, Shi’a/Alawites, 5 2 1 Christians, Kurds, Palestinians

Burma/Myanmar Kachin, Karenni, Karen, Mons, 5 2 1 Rakhine, Rohingyas, Shan, Chin (Zomis), Wa

Dem. Rep. of the Congo Hema and Lendu, Hutu, Luba, 2 2 1 Lunda, Tutsi/Banyamulenge, Batwa/Bambuti, other groups

Ethiopia Anuak, Afars, Oromo, Somalis, 5 2 1 smaller minorities

Nigeria Ibo, Ijaw, Ogoni, Yoruba, Hausa 5 2 1 (Muslims) and Christians in the North

Yemen Zaydi Shi’a, ‘Akhdam’, Southerners 4 2 0

Iran Arabs, Azeris, Bahá’ís, Baluchis, 5 0 1 Kurds, Turkomen

Israel/OPT Palestinians in Gaza/West Bank, 5 2 0 Israeli Palestinians, Bedouin

South Sudan Murle, Nuer, Dinka, Anuak, Jie, 0 2 0 Kachipo

Zimbabwe Ndebele, Europeans, political/ 2 0 1 social targets

Chad ‘Black African’ groups, Arabs, 3 1 0 Southerners

Central African Republic Kaba (Sara), Mboum, Mbororo, 0 2 0 Gula, Aka

Cote d’Ivoire Northern Mande (Dioula), 3 1 0 Senoufo, Bete, newly-settled groups |

Philippines Indigenous peoples, Moros 5 2 1 (Muslims), Chinese

Russian Federation Chechens, Ingush and others 5 2 1 in North Caucasus; indigenous northern peoples, Roma, Jews

Sri Lanka Tamils, Muslims 4 1 1

Burundi Hutu, Tutsi, Batwa 0 0 1

Libya Black Libyans, Sub-Saharan 2 1 0 migrants, Tebu, Berbers

224 Reference State of the World’s Minorities and Indigenous Peoples 2013 Indicators of group division Democracy/governance indicators Total

D. Massive E. Legacy of F. Rise of G. Voice and H. Political I. Rule of law J. OECD movement – vengeance factionalized accountability stability country risk refugees and – group elites classification IDPs grievance

10.0 9.6 9.8 -2.088 -3.073 -2.354 7 23.29

9.9 10.0 9.9 -1.714 -2.609 -1.259 7 21.93

9.0 9.4 9.4 -1.489 -2.513 -1.937 7 21.45

8.5 9.7 9.6 -1.130 -1.955 -1.500 7 20.59

9.0 9.6 9.1 -0.830 -2.697 -0.899 7 20.42

9.0 9.2 8.7 -1.738 -1.839 -0.659 7 20.09

8.2 8.7 8.6 -1.857 -1.159 -1.423 7 20.06

9.7 9.3 9.5 -1.484 -2.210 -1.599 7 19.92

8.7 8.1 8.7 -1.335 -1.633 -0.714 7 19.30

6.5 9.7 9.8 -0.757 -1.940 -1.248 5 18.41

8.7 9.0 9.8 -1.351 -2.291 -1.250 7 18.35

7.6 8.6 9.3 -1.549 -1.455 -0.902 7 17.03

7.3 9.5 8.1 -0.976 -1.977 -0.434 7 16.91

9.9 10.0 10.0 -1.066 -1.134 -1.481 8 16.17

8.4 8.7 9.8 -1.457 -1.042 -1.755 7 16.12

9.5 9.1 9.8 -1.350 -1.291 -1.462 7 15.96

9.7 8.5 9.1 -1.123 -2.036 -1.283 7 15.88

9.0 9.0 9.9 -1.129 -1.414 -1.262 7 15.58

6.2 7.6 8.0 -0.015 -1.386 -0.512 4 15.05

5.0 7.9 8.0 -0.942 -0.875 -0.780 3 14.95

8.7 9.1 9.2 -0.535 -0.542 -0.075 6 14.65

8.9 8.0 7.9 -0.979 -1.812 -1.154 7 14.46

5.1 7.0 8.0 -1.573 -1.010 -1.159 7 13.71

State of the World’s Minorities Reference 225 and Indigenous Peoples 2013 Country Group Conflict indicators

A. Self- B. Major C. Prior genocide/politicide Table 1 determination armed conflict conflicts Peoples under Threat 2013

Lebanon Druze, Maronite Christians, 2 1 0 Palestinians, Shi’a, Sunnis

Mali Tuareg, Arabs, Maure, and others 5 2 0 in the north

Equatorial Guinea Bubi, Annobon Islanders 1 0 1

Kenya Borana, Kalenjin, Kikuyu, Luyha, 2 1 0 Luo, Muslims, Turkana, Endorois, Masai, Ogiek, other indigenous groups

Algeria Berbers, Saharawi 2 1 1

Kyrgyzstan Uzbeks, Russians 1 1 0

Bosnia and Herzegovina Croats, Bosniac Muslims, Serbs, 2 0 1 Roma

Nepal Madheshis (Terai), Dalits, Janajati, 2 0 0 linguistic minorities

Thailand Chinese, Malay-Muslims, Northern 5 2 0 Hill Tribes

Uganda Acholi, Karamojong, Basongora, 1 0 1 Batwa

Guinea Fulani (Peul), Malinke 0 0 0

Laos Hmong, other highland peoples 4 0 0

Turkey Kurds, Alevis, Roma, Armenians 5 2 0 and other Christians

Angola Bakongo, Cabindans, Ovimbundu, 2 0 1 Pastoralists, San and Kwisi

Eritrea Afars, Saho, Tigre, religious 0 0 0 minorities

Georgia Adzhars, Abkhazians, South 4 1 0 Ossetians

Colombia Political/social targets, Afro- 3 2 0 descendants, indigenous peoples

Kosovo Serbs, Roma/Ashkali/Egyptians, 4 0 0 Bosniaks, Turks, Gorani

Rwanda Hutu, Tutsi, Batwa 0 0 1

China Tibetans, Uyghurs, Mongols, Hui, 5 0 1 religious minorities

Uzbekistan Tajiks, Islamic political groups, 1 0 0 religious minorities, Karakalpaks, Russians

Niger Djerema-songhai, Hausa, Tuaregs 4 0 0

Tajikistan Uzbeks, Pamiris, Russians 1 0 0

Bangladesh Ahmadiyya, Hindus, other religious 3 0 0 minorities; Chittagong Hill Tribes

Djibouti Afars 3 0 0

Cambodia Cham, Vietnamese, indigenous hill 0 0 1 tribes (Khmer Leou)

Azerbaijan Armenians 4 0 0

North Korea Political/social targets, religious 0 0 0 minorities

226 Reference State of the World’s Minorities and Indigenous Peoples 2013 Indicators of group division Democracy/governance indicators Total

D. Massive E. Legacy of F. Rise of G. Voice and H. Political I. Rule of law J. OECD movement – vengeance factionalized accountability stability country risk refugees and – group elites classification IDPs grievance

8.2 8.4 9.1 -0.405 -1.546 -0.676 7 13.54

5.5 6.0 4.5 0.139 -0.710 -0.503 7 13.11

3.0 6.6 8.2 -1.853 -0.092 -1.207 7 12.99

8.4 8.9 9.0 -0.226 -1.307 -1.010 6 12.92

6.5 8.1 6.8 -1.027 -1.352 -0.822 3 12.89

5.3 8.4 8.3 -0.754 -1.047 -1.250 7 12.85

6.5 8.0 8.7 -0.209 -0.903 -0.336 7 12.69

7.7 9.0 8.2 -0.526 -1.550 -0.987 7 12.59

6.7 7.8 8.8 -0.448 -1.020 -0.241 3 12.47

8.2 7.7 8.7 -0.544 -1.098 -0.398 6 12.40

8.0 7.9 9.2 -0.928 -1.428 -1.474 7 12.39

5.5 6.3 8.6 -1.603 0.009 -0.918 7 12.29

6.5 8.6 7.5 -0.168 -0.927 0.077 4 12.28

6.9 6.5 7.0 -1.167 -0.332 -1.230 5 12.25

7.1 6.4 8.1 -2.158 -0.790 -1.274 7 12.20

7.2 8.3 9.1 -0.180 -0.750 -0.163 6 12.19

8.4 7.2 7.7 -0.148 -1.254 -0.264 4 12.04

6.3 7.9 8.0 -0.258 -1.128 -0.574 7 12.03

7.6 8.5 7.9 -1.287 -0.047 -0.306 7 12.01

5.9 7.9 6.9 -1.644 -0.698 -0.428 2 11.97

5.7 7.7 8.7 -2.026 -0.607 -1.392 6 11.96

6.9 7.7 8.6 -0.296 -0.882 -0.495 7 11.91

5.6 6.9 8.3 -1.352 -1.006 -1.208 7 11.91

6.8 8.9 8.9 -0.312 -1.498 -0.719 6 11.88

6.9 6.5 7.5 -1.328 0.270 -0.746 8 11.78

5.9 7.3 8.0 -0.905 -0.440 -1.029 6 11.65

7.6 7.2 7.8 -1.307 -0.566 -0.871 5 11.64

5.3 6.6 7.7 -2.187 -0.446 -1.302 7 11.58

State of the World’s Minorities Reference 227 and Indigenous Peoples 2013 Country Group Conflict indicators

A. Self- B. Major C. Prior genocide/politicide Table 1 determination armed conflict conflicts Peoples under Threat 2013

Cameroon ‘Westerners’, Southerners 2 0 0

Haiti Political/social targets 0 0 0

Indonesia Acehnese, Chinese, Dayaks, 5 0 1 Madurese, Papuans, religious minorities

Venezuela Indigenous peoples, Afro- 0 0 0 descendants

Egypt Copts, Shi’a, Bahá’ís; Nubians, 0 1 0 Bedouin

India Assamese, Bodos, Nagas, Tripuras, 5 2 0 other Adivasis; Kashmiris, Sikhs, Muslims, Dalits

Guinea Bissau Balanta, Fula (Fulani), Manjaco, 0 0 0 Mandinga, Papel, Ejamat (Felupe), Jola (Diola), Susu , Cape Verdeans

Mauritania Haratins (‘Black Moors’), Kewri 0 0 0

Ecuador Afro-descendants, indigenous 2 0 0 peoples

Serbia Bosniaks, Ethnic Albanians, Croats, 2 0 1 Roma

Vietnam Montagnards (Degar), other 2 0 1 highland peoples, religious minorities

Nicaragua Indigenous peoples, Creoles 3 0 0

Timor Leste ‘Westerners’, ‘Easterners’, Muslims, 0 0 0 Chinese

Guatemala Indigenous peoples, Garifuna 0 0 1

Belarus Poles 0 0 0

Congo (Rep.) Lari, M’Boshi, Aka 1 0 0

Liberia Dan, Krahn, Ma, other groups 0 0 0

Turkmenistan Uzbeks, Russians, Kazakhs, religious 0 0 0 minorities

Fiji East Indians, Fijians 0 0 0

Notes to Table Self-determination conflicts in 2013 were ranked Sources of the indicators are as follows: on a scale of 0–5 as follows: 5 = ongoing armed § Conflict indicators: The base data used was conflict; 4 = contained armed conflict; Monty G Marshall, ‘Major Episodes of Political 3 = settled armed conflict; 2 = militant politics; Violence 1946–2012’ (Center for Systemic 1 = conventional politics. Major armed conflicts Peace, 2013) and, for self-determination were classified as 2 = ongoing in late 2012; conflicts, Monty G Marshall and Ted R Gurr, 1 = emerging from conflict since 2007 or ‘Peace and Conflict 2005’ (CIDCM, University ongoing conflict with deaths under 1,000. of Maryland, 2005) updated for 2012 using § Prior genocide or politicide: Harff, US Political figures from Center for Systemic Peace, MRG Instability Task Force (formerly State Failure and the Heidelberg Institute for International Task Force). 1 = one or more episodes since Conflict Research (Conflict Barometer 2012, 1945. Heidelberg, HIIK, 2013). § Indicators of Group Division: Failed States Index,

228 Reference State of the World’s Minorities and Indigenous Peoples 2013 Indicators of group division Democracy/governance indicators Total

D. Massive E. Legacy of F. Rise of G. Voice and H. Political I. Rule of law J. OECD movement – vengeance factionalized accountability stability country risk refugees and – group elites classification IDPs grievance

7.0 7.5 9.2 -1.064 -0.613 -1.038 6 11.41

8.1 7.0 9.0 -0.728 -0.905 -1.376 7 11.40

6.3 7.1 7.0 -0.082 -0.820 -0.662 3 11.33

4.5 6.7 7.3 -0.924 -1.301 -1.630 7 11.32

6.4 8.8 8.8 -1.127 -1.286 -0.419 5 11.21

5.5 7.9 6.8 0.405 -1.201 -0.081 3 11.12

7.5 5.7 9.2 -0.968 -0.702 -1.311 7 11.09

6.5 7.5 8.1 -0.954 -1.187 -0.887 7 11.09

6.0 6.9 8.2 -0.309 -0.728 -1.140 7 11.07

6.3 7.9 8.0 0.291 -0.334 -0.330 6 10.82

4.4 6.0 6.9 -1.483 0.169 -0.465 5 10.79

4.3 6.2 6.8 -0.577 -0.381 -0.710 7 10.43

7.7 6.8 8.3 0.096 -0.504 -1.188 8 10.40

5.9 7.1 6.0 -0.347 -0.726 -1.030 5 10.39

3.3 6.5 8.0 -1.630 -0.287 -1.076 7 10.34

7.7 6.3 6.7 -1.053 -0.240 -1.159 6 10.16

8.9 6.5 8.4 -0.298 -0.495 -0.961 7 10.10

3.9 6.4 7.7 -2.115 0.214 -1.412 6 10.06

3.3 7.6 7.9 -0.987 0.021 -0.905 8 10.01

Fund for Peace and the Carnegie Endowment Israel and the Occupied Palestinian Territories, the for International Peace, 2012. latter have been used. § Democracy/Governance Indicators: Annual Indicators were rebased as necessary to give an equal Governance Indicators, World Bank, 2012. weighting to the five categories above, with the § OECD country risk classification: Organisation exception of the prior geno-/politicide indicator. for Economic Cooperation and Development, As a dichotomous variable this received a lesser ‘Country Risk Classifications of the Participants weighting to avoid too great a distortion to the final to the Arrangement on Officially Supported ranking. Resulting values were then summed. Export Credits’, January 2013. Where no The full formula is: classification is given, a value of 8 was accorded. (A/2) + (Bx1.25) + (Cx2) + (D+E+F)/6 + (G+H+I)/-1 + (Jx0.625) Data for Kosovo include some indicators relating to Serbia. Where separate indicators are available for

State of the World’s Minorities Reference 229 and Indigenous Peoples 2013 International International International International Convention Convention Covenant Covenant on on the on the on Civil and Economic, Prevention and Elimination Political Rights Social and Punishment of All Forms 1966 Cultural of the Crime of Racial Rights 1966 of Genocide Discrimination 1948 1965

Status of Africa Algeria p pu p1 p ratification Angola p1 p of major Benin p p1 p international Botswana p p and regional Burkina Faso p p p1 p Burundi p p p p instruments Cameroon p p1 p relevant to Cape Verde p p1 p minority and Central African Republic p p1 p indigenous Chad p p1 p Comoros p p P P rights Congo p p1 p as of 1 February 2012 Côte d’Ivoire p p p1 p p Ratification, accession Democratic Republic of the Congo p p p1 p or succession. Djibouti p p1 p P Signature not yet Egypt p p p p followed by ratification. Equatorial Guinea p p1 p

Eritrea p p p pu Ratification of Ethiopia p p p p ICERD and Declaration p p p p on Article 14. Gabon p p p1 p pU Ratification of Gambia ICERD and Signature of Ghana p p p1 p Declaration on Article 14. Guinea p p p1 p p1 Ratification of Guinea Bissau p p! p ICCPR and Optional Kenya p p p Protocol. Lesotho p p p1 p p! Ratification of p p p! p ICCPR and Signature of Liberia Optional Protocol. Libyan Arab Jamahiriya p p p1 p P! Signature of ICCPR Madagascar p p1 p and Optional Protocol. Malawi p p1 p

Mali p p p1 p

Mauritania p p p

Mauritius p p1 p

Morocco p pu p p

Mozambique p p p

Namibia p p p1 p

Niger p p1 p

230 Reference State of the World’s Minorities and Indigenous Peoples 2013 Convention Convention ILO 111 ILO 169 International ICC Rome African African on the on the Rights Discrimination Convention Convention on Statute of the Charter on Charter on Elimination of of the Child (Employment Concerning the Protection International Human and the Rights and All Forms of 1989 and Indigenous of the Rights Criminal Peoples’ Rights Welfare of the Discrimination Occupation) and Tribal of All Migrant Court 1998 2003 Child 1990 against Convention Peoples in Workers and Women 1979 1958 Independent Members of Countries Their Families 1989 1990

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State of the World’s Minorities Reference 231 and Indigenous Peoples 2013 International International International International Convention Convention Covenant Covenant on on the on the on Civil and Economic, Prevention and Elimination Political Rights Social and Punishment of All Forms 1966 Cultural of the Crime of Racial Rights 1966 of Genocide Discrimination 1948 1965

Status of Nigeria p p p p Rwanda p p p p ratification Sahrawi Arab Democratic Republic of major São Tomé and Príncipe P P! P international Senegal p pu p1 p and regional Seychelles p p p1 p Sierra Leone p p p instruments Somalia p p1 p relevant to South Africa p pu p1 P minority and Sudan p p p p indigenous Swaziland p p p Togo p p p1 p rights Tunisia p p p1 p as of 1 February 2012 Uganda p p p1 p p Ratification, accession United Republic of Tanzania p p p p or succession. Zambia p p1 p P Signature not yet Zimbabwe p p p p followed by ratification.

pu Ratification of ICERD and Declaration on Article 14. pU Ratification of ICERD and Signature of Americas Declaration on Article 14. Antigua and Barbuda p p p1 Ratification of p pu p1 p ICCPR and Optional Argentina Protocol. Bahamas p p p p p! Ratification of Barbados p p p1 p ICCPR and Signature of Belize p p p P Optional Protocol. Bolivia p pu p1 p P! Signature of ICCPR Brazil p pu p1 p and Optional Protocol. Canada p p p1 p

Chile p pu p1 p

Colombia p p p1 p

Costa Rica p pu p1 p

Cuba p p P P

Dominica p p

232 Reference State of the World’s Minorities and Indigenous Peoples 2013 Convention Convention ILO 111 ILO 169 International ICC Rome African African on the on the Rights Discrimination Convention Convention on Statute of the Charter on Charter on Elimination of of the Child (Employment Concerning the Protection International Human and the Rights and All Forms of 1989 and Indigenous of the Rights Criminal Peoples’ Rights Welfare of the Discrimination Occupation) and Tribal of All Migrant Court 1998 2003 Child 1990 against Convention Peoples in Workers and Women 1979 1958 Independent Members of Countries Their Families 1989 1990

p p p p p p p

p p p p p p

p P

p p p P P p P

p p p p p p p

p p p p p p p

p p p P p p p

P p p P

p p p p p p

p p P p p

p p p p P

p p p P p p

p p p p p P

p p p p p p p

p p p p p p

p p p p p p

p p p P p p

American Additional Convention on Protocol to Human Rights the American 1969 Convention on Human Rights in the area of Economic, Social and Cultural Rights 1988

p p p p

p p p p p p p p

p p p P

p p p p p

p p p p p

p p p p p p p p

p p p p p p p

p p p p

p p p p p p p P

p p p p p p p p

p p p p p p p

p p p

p p p p p p

State of the World’s Minorities Reference 233 and Indigenous Peoples 2013 International International International International Convention Convention Covenant Covenant on on the on the on Civil and Economic, Prevention and Elimination Political Rights Social and Punishment of All Forms 1966 Cultural of the Crime of Racial Rights 1966 of Genocide Discrimination 1948 1965

Status of Dominican Republic P p p1 p Ecuador p pu p1 p ratification El Salvador p p p1 p of major Grenada P p p international Guatemala p p p1 p and regional Guyana p p1 p Haiti p p p instruments Honduras p p p1 p relevant to Jamaica p p p1 p minority and Mexico p pu p1 p indigenous Nicaragua p p p1 p Panama p p p1 p rights Paraguay p p p1 p as of 1 February 2012 Peru p pu p1 p p Ratification, accession Saint Kitts and Nevis p or succession. Saint Lucia p P Signature not yet Saint Vincent and the Grenadines p p p1 p followed by ratification. Suriname p p1 p

Trinidad and Tobago p p p1 p pu Ratification of United States of America p p p P ICERD and Declaration p pu p1 p on Article 14. Uruguay p pu p1 p pU Ratification of Venezuela ICERD and Signature of Declaration on Article 14. p1 Ratification of Asia ICCPR and Optional Afghanistan p p p p Protocol. Bangladesh p p p p p! Ratification of Bhutan P ICCPR and Signature of Brunei Darussalam Optional Protocol. Cambodia p p p! p P! Signature of ICCPR p p P p and Optional Protocol. China Democratic People’s Republic of Korea p p p

India p p p p

Indonesia p p p

Japan p p p

Kazakhstan p pu p1 p

Kyrgyzstan p p p1 p

Lao People’s Democratic Republic p p p p

234 Reference State of the World’s Minorities and Indigenous Peoples 2013 Convention Convention ILO 111 ILO 169 International ICC Rome American Additional on the on the Rights Discrimination Convention Convention on Statute of the Convention on Protocol to Elimination of of the Child (Employment Concerning the Protection International Human Rights the American All Forms of 1989 and Indigenous of the Rights Criminal 1969 Convention on Discrimination Occupation) and Tribal of All Migrant Court 1998 Human Rights against Convention Peoples in Workers and in the area of Women 1979 1958 Independent Members of Economic, Social Countries Their Families and Cultural 1989 1990 Rights 1988

p p p p p P

p p p p p p p p

p p p p p p

p p p p p

p p p p p p p

p p p p p

p p p P p P

p p p p p p p p

p p p p P p

p p p p p p p p

p p p p p p p

p p p p p p

p p p p p p p p

p p p p p p p p

p p p p

p p p p

p p p p p

p p p p p

p p p p p

P P P P

p p p p p p p

p p p p P p p P

p p p p

p p p p p

p p

p p

p p p P p

p p p

p p

p p p

p p p P

p p p

p p p

p p p p P

p p p

State of the World’s Minorities Reference 235 and Indigenous Peoples 2013 International International International International Convention Convention Covenant Covenant on on the on the on Civil and Economic, Prevention and Elimination Political Rights Social and Punishment of All Forms 1966 Cultural of the Crime of Racial Rights 1966 of Genocide Discrimination 1948 1965

Status of Malaysia p Maldives p p p1 p ratification Mongolia p p p1 p of major Myanmar p international Nepal p p p1 p and regional Pakistan p p p p Philippines p p p1 p instruments Republic of Korea p pu p1 p relevant to Singapore p minority and Sri Lanka p p p1 p indigenous Tajikistan p p1 p Thailand p p p rights Timor Leste p p p as of 1 February 2012 Turkmenistan p p1 p p Ratification, accession Uzbekistan p p p1 p or succession. Vietnam p p p p P Signature not yet followed by ratification.

pu Ratification of

ICERD and Declaration Europe on Article 14. Albania p p p1 p pU Ratification of p pu p1 ICERD and Signature of Andorra Declaration on Article 14. Armenia p p p1 p p1 Ratification of Austria p pu p1 p ICCPR and Optional Azerbaijan p pu p1 p Protocol. Belarus p p p1 p p! Ratification of Belgium p pu p1 p ICCPR and Signature of p p p1 p Optional Protocol. Bosnia and Herzegovina p pu p1 p P! Signature of ICCPR Bulgaria and Optional Protocol. Croatia p p p1 p Cyprus p pu p1 p

Czech Republic p pu p1 p

Denmark p pu p1 p

Estonia p pu p1 p

Finland p pu p1 p

France p pu p1 p

Georgia p pu p1 p

236 Reference State of the World’s Minorities and Indigenous Peoples 2013 Convention Convention ILO 111 ILO 169 International ICC Rome on the on the Rights Discrimination Convention Convention on Statute of the Elimination of of the Child (Employment Concerning the Protection International All Forms of 1989 and Indigenous of the Rights Criminal Discrimination Occupation) and Tribal of All Migrant Court 1998 against Convention Peoples in Workers and Women 1979 1958 Independent Members of Countries Their Families 1989 1990

p p

p p p

p p p p

p p

p p p p

p p p

p p p p p

p p p p

p p

p p p p

p p p p p

p p P

p p p p

p p p

p p p P

p p p

European Framework Charter for Convention for Regional or the Protection Minority of National Languages Minorities 1992 1995

p p p p p p

p p p

p p p P p p

p p p p p p

p p p p P p

p p p

p p p p P

p p p p p p p

p p p p p

p p p p p p

p p p p p p

p p p p p p

p p p p p p p

p p p p p

p p p p p p

p p p p P

p p p p p

State of the World’s Minorities Reference 237 and Indigenous Peoples 2013 International International International International Convention Convention Covenant Covenant on on the on the on Civil and Economic, Prevention and Elimination Political Rights Social and Punishment of All Forms 1966 Cultural of the Crime of Racial Rights 1966 of Genocide Discrimination 1948 1965

Status of Germany p pu p1 p Greece p p p1 p ratification Holy See p of major Hungary p pu p1 p international Iceland p pu p1 p and regional Ireland p pu p1 p Italy p pu p1 p instruments Latvia p p p1 p relevant to Liechtenstein p pu p p minority and Lithuania p p p1 p indigenous Luxembourg p pu p1 p Malta pu p1 p rights Monaco p pu p p as of 1 February 2012 Montenegro p p p1 p p Ratification, accession Netherlands p pu p1 p or succession. Norway p pu p1 p P Signature not yet Poland p pu p1 p followed by ratification. Portugal p pu p1 p

Republic of Moldova p p p1 p pu Ratification of Romania p pu p1 p ICERD and Declaration p pu p1 p on Article 14. Russian Federation p p1 p pU Ratification of San Marino ICERD and Signature of Serbia p p p1 p Declaration on Article 14. Slovakia p p p1 p p1 Ratification of Slovenia p p p1 p ICCPR and Optional Spain p pu p1 p Protocol. Sweden p pu p1 p p! Ratification of p pu p p ICCPR and Signature of Switzerland Optional Protocol. The former Yugoslav Republic p p p1 p of Macedonia P! Signature of ICCPR p p p! p and Optional Protocol. Turkey Ukraine p pu p1 p

United Kingdom of Great Britain p p p p and Northern Ireland

Middle East

Bahrain p p p p

Iran (Islamic Republic of) p p p p

238 Reference State of the World’s Minorities and Indigenous Peoples 2013 Convention Convention ILO 111 ILO 169 International ICC Rome European Framework on the on the Rights Discrimination Convention Convention on Statute of the Charter for Convention for Elimination of of the Child (Employment Concerning the Protection International Regional or the Protection All Forms of 1989 and Indigenous of the Rights Criminal Minority of National Discrimination Occupation) and Tribal of All Migrant Court 1998 Languages Minorities against Convention Peoples in Workers and 1992 1995 Women 1979 1958 Independent Members of Countries Their Families 1989 1990

p p p p p p

p p p p P

p

p p p p p p

p p p p P P

p p p p p

p p p p P p

p p p p p

p p p p p

p p p p p

p p p p p P

p p p p P p

p p P

p p p P p p p

p p p p p p p

p p p p p p p

p p p p p p

p p p p p

p p p p P p

p p p p p p

p p p P P p

p p p p p

p p p P p p p

p p p p p p

p p p p p p

p p p p p p p

p p p p p p

p p p p p p

p p p p P p

p p p p

p p p P p p

p p p p p p

p p p P

p p P

State of the World’s Minorities Reference 239 and Indigenous Peoples 2013 International International International International Convention Convention Covenant Covenant on on the on the on Civil and Economic, Prevention and Elimination Political Rights Social and Punishment of All Forms 1966 Cultural of the Crime of Racial Rights 1966 of Genocide Discrimination 1948 1965

Status of Iraq p p p p Israel p p p p ratification Jordan p p p p of major Kuwait p p p p international Lebanon p p p p and regional Oman p Qatar p instruments Saudi Arabia p p relevant to Syrian Arab Republic p p p p minority and United Arab Emirates p p indigenous Yemen p p p p rights as of 1 February 2012 Oceania p Ratification, accession Australia p pu p1 p or succession. Cook Islands P Signature not yet Fiji p p followed by ratification. Kiribati

Marshall Islands pu Ratification of Micronesia (Federated States of) ICERD and Declaration on Article 14. Nauru P P! pU Ratification of New Zealand p p p1 p ICERD and Signature of Niue

Declaration on Article 14. Palau P P p1 Ratification of Papua New Guinea p p p p ICCPR and Optional p Protocol. Samoa Solomon Islands p p p! Ratification of ICCPR and Signature of Tonga p p Optional Protocol. Tuvalu

P! Signature of ICCPR Vanuatu p and Optional Protocol.

Number of states parties 141 (1 sig) 175 (45 Art 14) 167 (115 op) 160 (6 sig)

Compiled by Natasha Horsfield and Electra Barbouri Sources: http://treaties.un.org/Pages/Treaties. aspx?id=4&subid=A&lang=en (http://www2.ohchr.org/english/bodies/docs/ RatificationStatus.pdf this has been fully updated as of 2006 so above link more relevant) http://www.unhchr.ch/tbs/doc.nsf/ Statusfrset?OpenFrameSet http://www.iccnow.org/?mod=romesignatures

240 Reference State of the World’s Minorities and Indigenous Peoples 2013 Convention Convention ILO 111 ILO 169 International ICC Rome on the on the Rights Discrimination Convention Convention on Statute of the Elimination of of the Child (Employment Concerning the Protection International All Forms of 1989 and Indigenous of the Rights Criminal Discrimination Occupation) and Tribal of All Migrant Court 1998 against Convention Peoples in Workers and Women 1979 1958 Independent Members of Countries Their Families 1989 1990

p p p

p p p P

p p p p

p p p P

p p p

p p P

p p p

p p p

p p p p P

p p p P

p p p P

p p p p

p p p

p p p p p

p p p

p p p

p p

p p

p p p p

p

p P

p p p

p p p p

p p P

p

p p

p p p p

187 (2 sig) 193 (2 sig) 169 22 45 (16 sig) 120

http://www.achpr.org/ http://www.acerwc.org/ratifications/ http://www.oas.org/juridico/english/Sigs/b32.html http://www.iccnow.org/documents/signatory_chart_ http://www.cidh.oas.org/ Nov_2011_EN.pdf http://conventions.coe.int/ http://www.oas.org/juridico/english/sigs/b-32.html http://www.ilo.org/ilolex/english/convdisp1.htm http://www.oas.org/juridico/english/sigs/a-52.html http://www.ilo.org/ilolex/english/convdisp1.htm http://conventions.coe.int/Treaty/Commun/ChercheSig. asp?NT=148&CM=8&DF=&CL=ENG http://www.iccnow.org/documents/ RATIFICATIONSbyRegion_December2011_eng.pdf

State of the World’s Minorities Reference 241 and Indigenous Peoples 2013 Who are Selected minorities? abbreviations

Minorities of concern to MRG are disadvantaged ACHPR – African Commission on Human and ethnic, national, religious, linguistic or cultural Peoples’ Rights groups who are smaller in number than the rest AHRC –Asian Human Rights Commission of the population and who may wish to maintain AU – African Union and develop their identity. MRG also works with CEDAW – Committee for the Elimination of indigenous peoples. Discrimination against Women CERD – Committee on the Elimination of Racial Other groups who may suffer discrimination are of Discrimination concern to MRG, which condemns discrimination CESCR – Committee on Economic, Social and on any ground. However, the specific mission Cultural Rights of MRG is to secure the rights of minorities and CRC – Convention on the Rights of the Child indigenous peoples around the world and to improve ECOWAS – Economic Community of West African cooperation between communities. States FGM – Female Genital Mutilation HRW – Human Rights Watch IACHR – Inter-American Commission on Human Rights IACtHR – Inter-American Court on Human Rights ICC – International Criminal Court ICG – International Crisis Group IDPs – internally displaced people IMR – Infant Mortality Rate MDGs – Millennium Development Goals MMR – Maternal Mortality Rate NGO – non-governmental organizations OECD – Organisation for Economic Co-operation and Development OHCHR – Office of the High Commissioner for Human Rights OSCE – Organization for Security and Cooperation in Europe UNAIDS – UN Programme on HIV/AIDS UNDP – UN Development Programme UNEP – United Nations Environment Programme UNESCO – UN Education, Science and Culture Organization UNHCR – UN High Commissioner for Refugees UNICEF – UN Children’s Fund UNPO – Unrepresented Nations and Peoples Organization UPR – Universal Periodic Review USCIRF – US Commission on International Religious Freedom WHO – World Health Organization

242 Reference State of the World’s Minorities and Indigenous Peoples 2013 in-exile. Her recent research focuses on the interplay Contributors between culture and rights, the local strategies of minority and indigenous human rights defenders, Maurice Bryan (Americas) is a Caribbean- and corporate human rights abuses. born writer and communications consultant with a special focus on the use of information Hanan Hammoudeh (Middle East case study) technology in a rights-based approach to was a Conflict Prevention Intern at MRG and is social and economic development and cultural a candidate MSc Human Rights at the London processes. He has worked in over 30 countries in School of Economics. Previously she has worked Latin America, the Caribbean, Asia and Africa, in human rights, democracy development and and currently spends most of his time in Central co-existence ventures. America. Paul Hunt (Foreword) is a Professor of Carla Clarke (Litigating indigenous peoples’ right International Human Rights Law at the School of to health) is MRG’s Legal Cases Officer. She is Law, Essex University, UK. He served as a member a qualified lawyer who has worked in both the of the UN Committee on Economic, Social and government and NGO sectors. She holds an MA in Cultural Rights (1999–2002) and UN Special Human Rights from Essex University. Rapporteur on the right to health (2002–2008). The UN has published his human rights reports Jack Dentith (Turkey) is a writer and researcher on a range of issues including access to medicines, based in London, UK. Trained in the anthropology water and sanitation, mental health and sexual and of development, his research focuses on the reproductive health. transition to sustainable and equitable economics. Paige Wilhite Jennings (West and Central Africa) Nicole Girard (Minority women’s vulnerability to has worked with inter-governmental organizations HIV/AIDS in South East Asia) is the Programme and NGOs in Central Africa, Central and South Coordinator for the Asian component of MRG’s America and the Caribbean. Minority Realities programme. She has been researching and writing on issues facing minority Mark Lattimer (Peoples under Threat) is the communities in Asia for 10 years. Executive Director of MRG. Formerly he worked with Amnesty International. Recent publications Katalin Halász (Europe) is a researcher, writer include (as editor) Genocide and Human Rights and activist with expertise in anti-discrimination (Ashgate 2007). legislation, minority rights, Roma rights and racism as a crime. Over the last decade she has Corinne Lennox (Addressing health inequalities worked for national and international human rights in the post 2015-development framework) is a organizations in Hungary, Germany, India, Belgium Senior Lecturer in Human Rights at the Institute and the UK, and at the European Court of Justice of Commonwealth Studies, University of London in Luxembourg. She is currently undertaking a and Associate Director of the Human Rights PhD in Visual Sociology at Goldsmiths College, Consortium, University of London. Her research University of London, on the representation of race focuses on minority and indigenous rights and ethnicity in contemporary visual arts. protection and on human rights and development. She has worked as a human rights practitioner and Emily Hong (East Asia) is a writer and trainer consultant, including for MRG, the UNDP and the currently pursuing a PhD in anthropology at OHCHR. Cornell University. Emily has spent more than four years in Thailand, including on the Thai–Burma Irwin Loy (South East Asia) is a multimedia border, working as a trainer and training adviser to journalist and editor based in Phnom Penh, minority rights activists from the region, and as a Cambodia, where he focuses on human rights and campaigner for Burma’s democracy movement- development issues. He has filed news and feature

State of the World’s Minorities Reference 243 and Indigenous Peoples 2012 reports from around the South East Asia region for of the Amazonia-Yungas Observatory of international media. Biodiversity, Indigenous Health and Equity, and has worked for over 25 years with low- Farah Mihlar (South Asia) has worked as income communities in Asia, Africa and Latin a journalist covering South Asia for over ten America. She has advised UN agencies, national years. Since 2004 she has worked on human governments and NGOs on health equity, rights, including at the UN Office for the High rights and environmental sustainability. She Commissioner of Human Rights. She currently holds the Royal Society Kohn award for science works as Conflict Prevention Coordinator at MRG. communication, and is on the editorial board of six international journals. Daniel Openshaw (Central Asia) is Press and PR Officer for the Royal College of General Irina L Stoyanova (Russia case study) is a Practitioners in London, UK, and a freelance researcher, writer, and educator whose work researcher and writer. He was previously a Research focuses on indigenous peoples’ rights and activism, Assistant at MRG where he worked on the Central sustainability, and international environmental Asia chapter and others, for State of the World’s policy. The Circumpolar North region, in particular Minorities and Indigenous Peoples 2012. He holds an the indigenous peoples of Siberia and the Saami of MA in Chinese Studies from the School of Oriental Scandinavia, has been a special interest of hers. She and African Studies, University of London. has worked with the Rainforest Foundation, The Nature Conservancy, MRG and the UN Permanent Audrey Prost (South Asia case study) is a senior Forum on Indigenous Issues. lecturer at University College London’s Institute for Global Health, and has been working with Indian Prasanta Tripathy (South Asia case study) is the civil society organization Ekjut since 2008. Director of Ekjut and an Ashoka Fellow.

Soumendra Sarangi (South Asia case study) is Inga Thiemann (Southern Africa) is a human a doctoral candidate in Anthropology at Utkal rights campaigner and researcher on the issues of University, India, and partners with Ekjut for his gender and racial discrimination, as well as sexual research. violence. She is a PhD candidate at University College London, working on human trafficking. Said Shehata (Middle East and North Africa) Inga holds postgraduate qualifications in Advanced is an expert on Islamic issues in the Middle East International Studies (Dipl.) from Johns Hopkins and Europe. He has published academic papers University SAIS, and International Peace and and newspapers articles on Islam and politics in Security (MA) from Kings College London. the Arab world, and is a former lecturer in Middle East Politics and International Relations at the Beth Walker (SWM Editor) is former London Metropolitan University. He has worked as Commissioning Editor at MRG. She is currently a consultant for MRG’s Egypt and the Middle East an editor at chinadialogue, an English-Chinese programmes. bilingual environmental website. Her work focuses on water and sustainable development on the Carolyn Stephens (Improving indigenous Tibetan Plateau and the rivers that originate there. maternal and child health) is Professor of Beth has worked in Beijing and Shanghai in China, Ecology and Global Health of the National and for an HIV/AIDS NGO in Yunnan province. University of Tucumán (UNT), based in She studied Chinese at the University of Oxford. Argentina, and is UCL Honorary Professor of Ecology and Global Health Equity at the Laura A. Young (East Africa) is an attorney and UCL Institute of Health Equity. She is an independent consultant focused on human rights environmental and social epidemiologist and rule of law in Africa, with specific expertise working on health equity, environmental in gender, social inclusion and governance in sustainability and human rights. She is Director transitioning states.

244 Reference State of the World’s Minorities and Indigenous Peoples 2013 Jacqui Zalcberg (Oceania) is a human rights lawyer who has worked on a range of international Acknowledgements indigenous rights cases in a variety of international and domestic forums. This has included working With thanks to Carl Soderbergh for considerable for the UN Indigenous Peoples and Minorities Unit editorial input, Jasmin Qureshi for production and the US-based NGO EarthRights International. coordination, publications interns Jack Dentith She has also been engaged as a legal adviser to the and Inga Thiemann for all their wonderful research UN Special Rapporteur on the rights of indigenous support, Sophie Richmond for copy editing and peoples, and founded and coordinated the Human Tom Carpenter for design. Rights Law Clinic at the Law Faculty of the In addition to the MRG staff who provided their Humboldt University, Berlin. feedback on earlier drafts, we would like to thank and acknowledge the following individuals who Holly Ziemer (Mental health care for survivors have contributed their thoughts, comments, advice of torture and conflict) is the Director of and expertise to this edition of State of the World’s Communications for the Center for Victims of Minorities and Indigenous Peoples: Gunilla Backman, Torture. Prior to this, Holly served as Director of Alan Barnard, Gretchen Bauer, Bruce Bennett, Communications for the Minnesota Smoke-Free Judith Bueno De Mesquita, James Caron, Rowan Coalition and also worked as an Account Supervisor Callick, Dawn Chatty, Bhavna Dave, Jess Duggan- for the public relations firm Shandwick International Larkin, Shaun Ewen, Kathryn Falb, Nicholas (now Weber Shandwick), and as Director of Farrelly, Loris Heise, Joanna Hoare, John Macleod, Communications for Minnesota Attorney General Rebecca Marsland, Fiona McCallum, Roberta Hubert H. Humphrey III. She has a background in Medda, Claudia Merli, Erik Mobrand, Eureka journalism, having worked as an associate producer Mokibelo, Matthew Newman, Felix Ndahinda, for several PBS Frontline documentaries and has Ayub Odida, Sarah Ossiya, Dr Francisco Panizza, written for various print media. Gaye Sowe, Marcus Stahlhoferm, Georgie Stevens, Louise Tillin, Alexandra Xanthaki and Sarah Zaidi.

State of the World’s Minorities Reference 245 and Indigenous Peoples 2012 Minority Rights Group International

Minority Rights Group International (MRG) is a non-governmental organization (NGO) working to secure the rights of ethnic, religious and linguistic minorities and indigenous peoples worldwide, and to promote cooperation and understanding between communities. Our activities are focused on international advocacy, training, publishing and outreach. We are guided by the needs expressed by our worldwide partner network of organizations which represent minority and indigenous peoples. MRG works with over 150 organizations in nearly 50 countries. Our governing Council, which meets twice a year, has members from nine different countries. MRG has consultative status with the United Nations Economic and Social Council (ECOSOC), observer status with the African Commission on Human and People’s Rights, and is registered with the Organization of American States. MRG is registered as a charity and a company limited by guarantee under English law. Registered charity no. 282305, limited company no. 1544957.

Discover us online:

MRG website Visit our website for news, publications and more information about MRG’s work: www.minorityrights.org

Minority Voices Newsroom An online news portal that allows minority and indigenous communities to upload multimedia content and share their stories: www.minorityvoices.org

Peoples under Threat map and Directory of minorities and indigenous peoples Visit MRG’s online interactive Peoples under Threat map where you can view and compare detailed country information on the world’s minorities and indigenous peoples: www.peoplesunderthreat.org.

246 Reference State of the World’s Minorities and Indigenous Peoples 2013 minority rights group international

State of the World’s Minorities and Indigenous Peoples 2013 Events of 2012 In almost every country in the world, minorities and indigenous peoples suffer greater ill-health and receive poorer quality of care than other segments of the population. They die younger, face higher rates of disease and struggle more to access health services compared to the rest of the population. More often than not, this ill-health and poor healthcare is a symptom of poverty and discrimination. At the same time, numerous grassroots initiatives have emerged during recent years. This year’s edition of State of the World’s Minorities and Indigenous Peoples presents a global picture of the health issues experienced by minorities and indigenous communities, features country profiles and case studies, and makes recommendations for addressing these key issues.

ISBN 978-1-907919-40-4