PHA-Exch> Fwd: [wp] Health & human security in West Papua

Tue Dec 23 07:59:02 PST 2008

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Datum: Tue, 16 Dec 2008 21:02:34 +0100
Von: "Pro Papua" <propapua at gmail.com>
An: reg.westpapua at lists.riseup.net
Betreff: [wp] Health & human security in West Papua
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Medical Journal of Australia  • Volume 189 Number 11/12 • 1/15 December
2008

*Health and human security in West Papua *

Susan J Rees, Remco van de Pas, Derrick Silove and Moses Kareth

ABSTRACT

- Recent publications have highlighted the impact of human rights
violations, poverty and

  extraction of natural resources   on the health status of the indigenous
people of West Papua.

  However, the Australian medical literature has so far remained silent on
this issue.

  Long-standing allegations of violence being perpetrated against Papuan
civil society are

  supported by accounts given by West Papuan refugees involved in an
Australian-based

  study.

- Health data collected by Médecins du Monde and other sources provide an
insight into the

  poor health and lack of health care in the province, with high rates of
infant mortality

  and morbidity, maternal mortality, and HIV/AIDS.

- Extraction of natural resources is causing major disruptions to the
traditional livelihoods of

  indigenous Papuans, as a result of environmental degradation, mass
displacement and an

  influx of migrant workers.

- Australian health professionals are urged to assist in remediating this
dire situation, in

  keeping with our tradition of contributing to the health care of societies
in our region.

  MJA 2008; 189: 641–643

The Guardian newspaper 1) and a recent commentary in the Lancet 2) have
drawn attention to the health and human rights situation in West Papua.
Assertions made in these articles are

consistent with those in other recently published reports of the
marginalisation and impoverishment of indigenous West Papuans.3,4)

  In considering the health of West Papuans, we apply the United Nations
definition of "human security", which includes but goes beyond issues of
personal and communal safety to encompass economic, environmental,
educational, health and political conditions.5) Each of these elements gives
cause for concern in West Papua. Of relevance too is the World Health
Organization's renewed commitment to the Alma-Ata Declaration, emphasising
the importance of social and economic conditions in shaping a community's
capacity to achieve optimal health and wellbeing.6)

  Remarkably, the situation in West Papua has until now not received
attention in the Australian medical literature. For this overview of the
health situation in West Papua, we draw on existing documentation, including
data collected by a non-government organisation in West Papua, Médecins du
Monde. This organisation is working in primary health care and in building
human resource capacity in the Puncak Jaya district in the central
highlands, with a special focus on HIV/AIDS and tuberculosis. We also
incorporate preliminary observations from an ongoing mental health project
with West Papuan refugees in Australia.2) The Australian project is applying
both qualitative and clinical measures to document the histories of West
Papuan refugees, explore their resettlement trajectories and acculturation
experiences, and assess their psychological responses to past trauma and
ongoing stresses.

  From the available evidence, we draw attention to three key areas relevant
to health, rights and human security in West Papua; namely, reports of
organised violence perpetrated against Papuan society, the social and health
status of West Papuans (with a particular focus on

HIV/AIDS), and the effects of mineral extraction on the culture and cohesion
of the society.

*Historical context *

West Papua forms the western half of the island of New Guinea. In the 1960s,
the colonial power, the Netherlands, took steps to prepare West Papua for
independence at the same time as Indonesia laid claim to it as part of the
former Netherlands Indies. Leading Western powers granted Indonesia
stewardship of West Papua in 1962, pending a referendum on ndependence. In
1969, after a UN-brokered referendum, West Papua was incorporated formally
into the Republic of Indonesia, a process supported by Australia. However,
less than 1% of the population of 700 000 actually voted in the referendum,
with the overseeing chief UN officer declaring that the "Act of Free Choice"
was anything but democratic.3) Pro-independence

groups have continued to resist Indonesian dominion, but demands for a fully
representative referendum on independence have not been heeded. With the
transition from the Soeharto era,

Indonesia granted the province "Special Autonomy" in 2001.2 The Special
Autonomy Law No. 21 2001 involved the establishment of a West Papuan
representative Council (Papuan People's Council), with the aim of giving
indigenous Papuans more power over their own

affairs, protecting their basic rights, and improving their standards of

health, economy and education. In effect, it appears to have had no impact
on these issues.

*Allegations of repression and violence *

Since the 1960s, concerns have been raised that Indonesian authorities have
been responsible for a campaign of repression and violence, resulting in the
deaths of a large number of West Papuans.4) Instances of murder and abuse
have been documented3 but, because of obstacles to outside agencies' access
to the province, there is no accurate documentation of the number of West
Papuans killed. Indonesian authorities have not formally investigated these
allegations.7) Nevertheless, recent reports have detailed politically
motivated abuses in the province,2-4) and these reports are supported by
accounts given by West Papuan refugees involved in our Australian based
project. The UN Committee against Torture stated that it was

       ... deeply concerned about the numerous ongoing credible and

       consistent allegations, corroborated by the report of the Special

       Rapporteur on Torture and other sources, concerning routine and

       widespread use of torture and ill-treatment of suspects in police

       custody ... especially in Papua, Aceh and in other provinces

       where there had been armed conflicts.8)

*Social and health status *

Health care standards are lower in West Papua than in other regions of
Indonesia.9 District health data from the Puncak Jaya district indicate that
infant mortality is about 85–150 per 1000 live births, with the figure for
those under 5 years of age being 30–50 per 1000 (unpublished data, Médecins
du Monde). Treatable diseases, particularly pneumonia and diarrhoea, are
common causes of mortality in children. Data from across West Papua

suggest that malaria, upper respiratory tract infections and dysentery are
the major causes of childhood morbidity.10)

  Maternal mortality is three times higher than for the remainder of
Indonesia,10 standing at 500–1000 per 100 000 births, with postpartum
haemorrhage being a major cause.9,11 Medical facilities are understaffed and
under-resourced. The ratio of doctors to population varies according to the
area, ranging from 1 : 2000 to 1 : 23 000, with doctors being concentrated
in urban areas.7) A Puncak Jaya legislative board report held by Médecins du
Monde

(Puncak Jaya District Health Office, 2008) indicated that only 8% of the
district budget is allocated to health services. Clinics face a shortage of
essential medications. Underfunding and lack of support have resulted in key
personnel abandoning their posts, further undermining the already fragile
district-level health services.

  According to AusAID, the rate of HIV/AIDS in West Papua is 1.03%, compared
with 0.17% in the remainder of Indonesia.11,12 AusAID estimates that by
2025, the adult prevalence of HIV/AIDS in West Papua could rise to 7%,
compared with a projected 1.08% for the remainder of Indonesia.12) Data from
Médecins du Monde indicate a growing HIV epidemic in the highlands, with an
estimated population prevalence of 2.9%.13) Rapid social change

associated with population movements increases the risk of spread of HIV to
many areas

in West Papua, including the highlands. In the financial year 2007–08, the
Australian government provided a total of  $14.5 million to Indonesia to
commit to West Papua for HIV

prevention.12) In addition, the Australian government has recently invested
$100 million

in a 5-year program aimed at preventing the spread of HIV in neighbouring
Papua New

Guinea (PNG).14) With an eye on the potential spread of HIV to Australia
through the porous border with the Torres Strait, a coordinated program
focusing on West Papua and PNG is imperative. Unless the approach addresses
the social, political and economic disruptions in West Papua and their
potential impact on the entire New Guinea landmass, a focus on distributing
condoms and initiating health promotion campaigns is unlikely to be
adequate. HIV/AIDS therefore needs to be considered as a complex regional
issue, with conflict and social disruption in West Papua being a major
factor leading to its spread.

*Effects of mining on traditional lives and wellbeing *

The Guardian article asserts that mining operations are not complying with
adequate health and safety standards, resulting in the release of toxic
waste into rivers, destruction of natural vegetation, deforestation and
flooding.1)  As a consequence, local communities are facing the loss of
their traditional livelihoods and mass displacement from their lands. In
addition, the influx of large numbers of migrants from other parts of
Indonesia to work in the mines and plantations is leading to fundamental
changes in the demography and culture of affected regions. Unchecked
migration continues to displace the poorest people from jobs and land,

invariably the indigenous Papuans. The risk is that Papuans will become a
minority group in their own homeland. Whereas indigenous Papuans comprised
96% of the population in 1971,

they accounted for only 59% in 2005. 15)

*What we can do *

Although data are limited, the evidence suggests that West Papuans are
experiencing a major challenge to their human security, and that the
community's capacity to improve its own

health is greatly restricted when considered according to the principles of
the Alma-Ata Declaration. Australia's limited focus on the health and human
rights of West Papuans is notable, given that New Guinea is our closest
regional neighbour and Australia's aid program to PNG is the largest in our
region. A fragile political relationship with Indonesia, together with
geopolitical and economic considerations, undoubtedly influence Australia's
present stance. Australian medical professionals have a proud record of
contributing to the health care

of conflict- and disasteraffected societies in our region, and this
tradition should extend to West Papua. We can advocate for more aid funding
for health, as long as there are safeguards to ensure that projects are
implemented with integrity. Greater support could be given to local and
international medical organisations, both those working in the province and
among refugees on the PNG side of the border, to improve primary health
care, to prevent the spread of infectious diseases, and to ameliorate the
psychosocial effects of trauma and displacement. Australian professionals
could also forge stronger links with academic and medical institutions in
West Papua, offering training and exchange programs that would assist in

overcoming the isolation of health personnel in the territory.

  There is a need to advocate for greater access to West Papua by the media,
human rights organisations and researchers. This would allow more accurate
monitoring of key indicators, providing data to clarify the impact of human
rights conditions, ecological damage, and social and cultural disruptions on
communal health and wellbeing.15) There is ample evidence from other
settings to demonstrate the adverse impact of political conflict and the
neglect of human rights on the general and mental health of indigenous
peoples. We can draw on experiences elsewhere to show how political
instability, the disintegration of communities, and population displacement
can hasten the spread of HIV and other communicable diseases.

This commentary aims to encourage Australian health professionals to play a
more active role in addressing the ongoing neglect of health and wellbeing
in West Papua. We have a special regional responsibility to ensure that the
right to health for all applies equally to indigenous West Papuans.

*Competing interests *

None identified.

*Author details *

Susan J Rees, PhD, ARC QEII Fellow, Centre for Population Mental

Health Research1)

Remco van de Pas, MD, Medical Coordinator, Médecins du Monde,

Papua2)

Derrick Silove, MB ChB, MD, FRANZCP, Director, Centre for Population

Mental Health Research1)

Moses Kareth, Research Assistant,1) and West Papuan community

member

1 Psychiatry Research and Teaching Unit, School of Psychiatry, University

of New South Wales, Sydney, NSW.

2 Médecins du Monde, Paris, France.

*Correspondence*: s.j.rees at unsw.edu.au

*References *

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   http:// ww.guardian.co.uk/environment/2008/mar/19/fossilfuels.indonesia(accessed
Mar
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  2008

2 Rees S, Silove D. Speaking out about health and human rights in West
Papua. Lancet 2007;
  370: 637-639.

3 Human Rights Watch. Out of sight: endemic abuse and impunity in Papua's
central

   highlands. Human Rights Watch 2007.
http://hrw.org/reports/2007/papua0707/4.htm

  (accessed Mar 2008).

4 Brundige E, King W, Vahali P, et al. Indonesian human rights abuses in
West Papua:

  application of the law of genocide to the history of Indonesian control. A
paper prepared for

  the Indonesia Human Rights Network by the Allard K Lowenstein
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  Rights Clinic, Yale Law School. New Haven, Conn: Yale Law School, Apr
2004.

  http://www.law.yale.edu/documents/pdf/Intellectual_Life/West_Papua_final_report.pdf

  (accessed Nov 2008).

5 Jolly R, Basu Ray D. United Nations Development Programme. The human
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7 Widjojo Muridan S. Papua road map: negotiating the past, improving
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and

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http://www.arts.usyd.edu.au/centres/cpacs/docs/PAPUA_ROAD_MAP_Short_Eng.pdf

  (accessed Nov 2008).

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  fortieth session, May 2008. http://www.unog.ch/

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   http://www.library.ohiou.edu/indopubs/2000/08/20/0022.html (accessed Nov
2008).

10 Blair DC, Phillips DL. Indonesia commission: peace and progress in Papua.

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   Center for Preventive Action. New York: Council on Foreign Relations,
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11 Butt L, Numbery G, Morin J. The smokescreen of culture: AIDS and the
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    Papua, Indonesia. Pacific Health Dialog 2002; 9: 283-289.

12 Australian Government AusAID. HIV/AIDS activities by country (2007).

    http://www.ausaid.gov.au/keyaid/hivaids/countries.cfm (accessed May
2008).

13 BPS Statistics Indonesia, Ministry of Health, Indonesian Government. Risk
behaviour and

   HIV prevalence in Tanah Papua 2006. Results of the IBBS 2006 in Tanah
Papua, 2007.

http://siteresources.worldbank.org/INTINDONESIA/Resources/Publication/PapuaHIV_en.pdf(accessed
Nov 2008).

14 Australian Government AusAID. HIV/AIDS in Papua New Guinea.

   http://www.ausaid.gov.au/country/png/hivaids.cfm (accessed May 2008).

15 van de Pas R. The effects of low human security on the health status of a
struggling

   population. Do health indicators matter? J R Coll Physicians Edinb 2008;
38: 3-4.

MJA

• Volume 189 Number 11/12 •

1/15 December 2008

-- 
Remco van de Pas
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