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On his 49th day, the baby boy Htun Htun was sickeningly quiet. He had diarrhea and a fever and lay limp in the arms of his mother, one of thousands of refugees from Myanmar to reach this border town in recent months.
Once among the richest countries in Southeast Asia, Myanmar threatens to be the world's next great humanitarian crisis. Through dictatorship, neglect and civil war, Myanmar is emerging as one of the world's deadliest places to be a baby or a mother. Htun Htun has virtually the same chance of surviving until his 5th birthday as a child in the Republic of Congo, according to the latest United Nations statistics. As the scale of the health crisis becomes clear, a senior UN official last month publicly urged Myanmar's military government to end restrictions on aid groups and allow "immediate humanitarian assistance." "It would be a terrible mistake to wait," said Paulo Sergio Pinheiro, the UN's special rapporteur on human rights in Myanmar. Health conditions in the country's eastern reaches have deteriorated sharply in the last year, as the regime launched its most intense military campaign against ethnic minorities in more than a decade, say aid workers and diplomats. "When people talk about a humanitarian crisis, they usually think about a tsunami or an earthquake, but this is a man-made disaster," said Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights in Baltimore. Since the offensive in eastern Myanmar began in February 2006, according to estimates by relief groups, 27,000 civilians have been displaced, joining some 600,000 others uprooted during the previous decade. Those evacuees - mostly Karen, Mon, Karenni, and Shan minorities - are highly vulnerable to malaria, tuberculosis, and other diseases, and they are dying at rates akin to some of Africa's poorest nations, researchers say. Many refugees from the violence have fled across the countryside in search of food and medicine at Thai border towns like Mae Sot. Ma Kheing, a 31-year-old mother of four, said she abandoned her home village of Hti Mo Hti in April, after government troops forced villagers to work as unpaid porters carrying military supplies in heavily mined forests, a regime practice that the International Labor Organization, a UN agency, has condemned. "The (troops) forced the whole village to come and work," Ma said. "Sometimes one day at a time, sometimes two. They gave us no food to eat. It was very difficult." Unable to gather food for her family, Ma set off with her husband and children, trekking three days and nights until they reached the brown waters of the Moei River, the Thai border. They now live among 750 other evacuees at the Ler Per Her settlement, on the Myanmar side of the river, subsisting on aid from foreign relief groups she said after the brief canoe trip to the Thai side. Myanmar, formerly Burma, bears little resemblance to the resource-rich land of its past. A former Buddhist kingdom and, later, British colony, Myanmar is blessed with timber, gems and fertile land; it was the world's leading exporter of rice in 1939. But a coup in 1962 set the nation on a ruinous course of one-party rule and chronic civil war with ethnic minorities. Since coming to power in 1988, the ruling junta has been accused of a range of human rights abuses, prompting economic sanctions from the U.S. and European Union. The regime has more than doubled the size of the military and slashed its spending on health care to less than $1 per person per year, a level "believed to be the lowest in the world," Pinheiro wrote in a UN report last year. The roots of a crisis were evident by 2000, when the World Health Organization ranked Myanmar's as the world's second-worst health care system. Only war-torn Sierra Leone was worse. The results are alarming: One in three children in Myanmar today is malnourished, on par with Angola, the UN says. There are 106 deaths of children under 5 for every 1,000 births, compared with 108 in the Republic of Congo. Moreover, a study by Johns Hopkins found that Myanmar has more than double the rate of drug resistant tuberculosis as its neighbors, and more malaria-related deaths per year (2,500) than India, whose population is more than 20 times as large. Yet Myanmar's government is wary of outside interference and has clamped down on foreign aid agencies. The French section of Doctors without Borders faced new restrictions and withdrew last March. The World Food Program was blocked from feeding hundreds of thousands of civilians for several months in 2005. And the International Committee of the Red Cross has not visited Myanmar prisons in more than a year. As a result, many in Myanmar's eastern reaches are receiving their only medical care from the Back Pack Health Worker Team, a Thailand-based network of some 400 medics who roam the countryside on six-month tours delivering basic care out of straw baskets they carry. Seven medics have been killed by landmines or government troops since the organization began in 1998, said the group's leader, 42-year-old refugee from Myanmar Mahn Mahn. During the military offensive, even they are finding it difficult to administer the most basic life-saving training. "We can't stay in one place. I don't have time to build village latrines or school latrines," said Sai Lao, a 36-year-old Shan-minority medic. Likewise, medic Sai Lar Dawndang, 36, said the violence has limited his opportunity to teach hygiene practices for childbirth, forcing evacuees to fall back on what materials are available. "The villagers cut the umbilical cord with a knife made of bamboo," he said. A survey designed by Johns Hopkins and conducted by the medics found that 1 in 12 mothers in eastern Myanmar is dying during pregnancy or childbirth, a rate comparable to Rwanda, where the UN calculates that 1 in 10 mothers dies. In Thailand, by contrast, the rate is 1 death for every 900 pregnancies. In those conditions, it is easy to understand why malaria has emerged as a deadly risk, said David Downham, a Canadian physician who treats refugees in Mae Sot. "Malaria is an utterly preventable disease," he said. "But if you can't walk safely through the forest without worrying about landmines or violence then you don't think much about (using) a mosquito net." One of the few places refugees can turn is the Mae Tao clinic, here on the Thai side of the border. Each morning, an average of 250 patients turn up at the clinic with everything from spindly infants and infected gunshot wounds to breech births and incurable cancers. They are patients like Htun Htun, the baby boy named for the Saturday on which he was born. He had been sick with diarrhea for four days by the time he reached the clinic. His skin was gray. He weighed barely 7 pounds. His eyes drifted open and shut as he lay, cradled and silent, in the hands of his 27-year-old mother, Ah Win, a fruit picker from the Myanmar town of Kaw Moo Rah. The clinic opened in 1989, when Dr. Cynthia Maung, herself a Burmese refugee, set up a ramshackle practice to treat democracy activists who had fled across the border. Today, the complex has grown to include operating rooms, pediatric and maternity wards, a blood bank, an eye-care facility and a workshop for building prosthetic limbs. On the morning Htun Htun arrived, six women were in labor. When the clinic fills up, the women wait on the floor for their turn to get a bed. "The number of people increases every year, but the services can't increase as fast," said Maung, who never fathomed the clinic would still be needed 18 years after it began. "We thought that the military government would change or the international community would solve it," she said. "But it continues, and it's getting worse."
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