Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma

Background: Case reports of human rights violations have focused on individuals’ experiences. Population-based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma. Objective: We describe the association between mortality and morbidity and the household-level experience of human rights violations among internally displaced persons in eastern Burma. Methods: Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months. Results: Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one-third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations. Conclusions: Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population-level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere.

[1]  P. Salama,et al.  Mental health and nutritional status among the adult Serbian minority in Kosovo. , 2000, JAMA.

[2]  G. Burnham,et al.  Mortality before and after the 2003 invasion of Iraq: cluster sample survey , 2004, The Lancet.

[3]  Ola,et al.  No. 14531. International Covenant on Economic, Social and Cultural Rights. Adopted by the General Assembly of the United Nations on 16 December 1966 , 1999 .

[4]  M. Heisler,et al.  A population-based assessment of women's mental health and attitudes toward women's human rights in Afghanistan. , 2003, Journal of women's health.

[5]  C. Crawford,et al.  Karenni refugees living in Thai-Burmese border camps: traumatic experiences, mental health outcomes, and social functioning. , 2004, Social science & medicine.

[6]  V. Sharma,et al.  Usefulness of an inexpensive, Paracheck test in detecting asymptomatic infectious reservoir of plasmodium falciparum during dry season in an inaccessible terrain in central India. , 2002, The Journal of infection.

[7]  M. Clements,et al.  Mortality in the Democratic Republic of Congo: a nationwide survey , 2006, The Lancet.

[8]  P. Bloland,et al.  Malaria Control during Mass Population Movements and Natural Disasters , 2002 .

[9]  A. Kolbe,et al.  Human rights abuse and other criminal violations in Port-au-Prince, Haiti: a random survey of households , 2006, The Lancet.

[10]  R. Malima,et al.  Comparison of the Paracheck-Pf® test with microscopy, for the confirmation of Plasmodium falciparum malaria in Tanzania , 2006, Annals of tropical medicine and parasitology.

[11]  F. Checchi,et al.  Pre-emptive war epidemiology: lessons from the Democratic Republic of Congo , 2006, The Lancet.

[12]  A. Singhanetra-Renard.  Malaria and mobility in Thailand. , 1993, Social science & medicine.

[13]  O. Bilukha,et al.  Death and injury from landmines and unexploded ordnance in Afghanistan. , 2003, JAMA.

[14]  E. Jennings,et al.  Internal displacement: Global overview of trends and developments in 2007. , 2008 .

[15]  P. Farmer,et al.  Pathologies of power: rethinking health and human rights. , 1999, American journal of public health.

[16]  V. Iacopino,et al.  Maternal mortality in Herat Province, Afghanistan, in 2002: an indicator of women's human rights. , 2002, JAMA.

[17]  V. Iacopino,et al.  Prevalence of war-related sexual violence and other human rights abuses among internally displaced persons in Sierra Leone. , 2002, JAMA.

[18]  C. Tomuschat.  International Covenant on Civil and Political Rights , 2020, A Commentary on the International Covenant on Civil and Political Rights.

[19]  Sonal Singh,et al.  The State of Child Health and Human Rights in Nepal , 2006, PLoS medicine.

[20]  M. Scharf,et al.  The International Criminal Tribunal for Rwanda , 1997 .

[21]  F. Sanderson,et al.  Mortality and malnutrition among populations living in South Darfur, Sudan: results of 3 surveys, September 2004. , 2005, JAMA.

[22]  M. Sodemann,et al.  Breastfeeding status as a predictor of mortality among refugee children in an emergency situation in Guinea‐Bissau , 2003, Tropical medicine & international health : TM & IH.

[23]  L. Mullany,et al.  Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma , 2006, Tropical medicine & international health : TM & IH.

[24]  Ola,et al.  No. 14668. International Covenant on Civil and Political Rights. Adopted by the General Assembly of the United Nations on 16 December 1966 , 1999 .

[25]  S. Dharmaratne,et al.  Who died as a result of the tsunami? – Risk factors of mortality among internally displaced persons in Sri Lanka: a retrospective cohort analysis , 2006, BMC public health.

[26]  O. Akanji.  UNICEF: the state of the world's children 1998 , 1998 .

[27]  D. Pallin,et al.  A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo. , 2001, American journal of public health.

[28]  Eric Puybaret,et al.  Universal Declaration of Human Rights , 2006 .

[29]  C. Bellamy.  The State of the World's Children 2005 , 2005 .

[30]  H. D. Petersen,et al.  Human rights violations in Burma/Myanmar. A two year follow-up examination. , 2000, Danish medical bulletin.

[31]  P. Spiegel,et al.  War and mortality in Kosovo, 1998–99: an epidemiological testimony , 2000, The Lancet.

[32]  A. Ascherio,et al.  Deaths and injuries caused by land mines in Mozambique , 1995, The Lancet.

[33]  S. Swiss,et al.  Violence against women during the Liberian civil conflict. , 1998, JAMA.

[34]  A. Singhanetra-Renard.  Population movement, socio-economic behavior and the transmission of malaria in northern Thailand. , 1986, The Southeast Asian journal of tropical medicine and public health.

[35]  K. Thimasarn,et al.  Comparison of field and expert laboratory microscopy for active surveillance for asymptomatic Plasmodium falciparum and Plasmodium vivax in western Thailand. , 2002, The American journal of tropical medicine and hygiene.

[36]  B. L. Cardozo,et al.  Mental health symptoms following war and repression in eastern Afghanistan. , 2004, JAMA.

[37]  A. Keller,et al.  The medical and social consequences of land mines in Cambodia. , 1994, JAMA.