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GENERAL APPEAL (Indonesia): Hundreds die due to government's failure to control Cholera outbreak

September 26, 2008

ASIAN HUMAN RIGHTS COMMISSION – URGENT APPEALS PROGRAMME

Urgent Appeal General: AHRC-UAG-012-2008

26 September 2008
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INDONESIA: Hundreds die due to government's failure to control Cholera outbreak

ISSUES: Right to health; health care; government inaction; discrimination
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Dear friends,

The Asian Human Rights Commission (AHRC) has received information regarding the death of hundreds of people in the Dogiyai District in Papua, Indonesia, due to a cholera epidemic. Despite requests to local and national authorities, the epidemic has not yet been prevented from spreading into neighbouring provinces. Local organisations report that 239 people had lost their lives from Cholera as of mid September. The AHRC is deeply concerned about the ongoing deaths due to the outbreak and the lack of sufficient response from state authorities.

CASE DETAILS:

The first cases of diarrhea in the Dogiyai District in Papua, Indonesia, were registered in April 2008, mainly in Ekemanida and Idakotu, as well as in surrounding villages. It has been confirmed that the Cholera Bacterium was the causing agent. So far, the provincial health office has officially confirmed 81 fatal cases in the districts of Dogiyai, out of 552 officially known cases of infection. Additionally the provincial health office has reported 23 cases of infections, resulting in 6 deaths in Obano, the neighboring sub-district.

Local organisations however (Médecins du Monde Papua; PRIMARI), have reported much higher figures of deaths than the official numbers indicate. The fatality number in mid July was 173 (Geraja KINGMI - Christian Evangelical KEmah Church, Please see the list), whilst a report from mid September stated that 239 people had lost their lives by then. There is a large discrepancy between the official numbers of fatalities provided by the provincial health office and those provided by the local NGO's and churches

Although the ministry of health has stated that the outbreak is under control, suspected cholera cases in the areas around lake Tigi and Painai have surfaced in mid-August. The number of cases of diarrhea and the deaths resulting from the epidemic in Paniai has been increasing.

It is reported that the government has not taken appropriate action despite repeated requests from local groups asking for an intervention from health authorities.

To stop the further spread of the epidemic, proper disposal of faecal waste and disinfection is essential. A weekly surveillance system in the infected areas (suspected and confirmed) should be established. Appropriate medical tools and village-level training of community health workers should also be made available. This training should naturally be funded by the Government, and it is regrettable that such training has not already been initiated, given that cholera outbreaks in the recent past have shed many lives in the region (for example as recently as 2006 more than 200 people died in the Jayawijaya regency of Papua). 
 
Unfortunately, the required materials; personnel for the treatment of infected persons; and the prevention of the epidemic from further spreading into the neighbouring District of Paniai, have neither been provided nor initiated at this point in time.

BACKGROUND INFORMATION:

The health infrastructure in Papua is very poor. Papua is Indonesia's most naturally abundant region, with resources such as timber and other minerals prevailing in the area. The revenue created by non-Papuan mining companies and the migration flows of Muslim traders from other regions of the country have not resulted in a visible upsurge in the living conditions of the predominantly Christian communities. Native Papuans blame past transmigration policies imposed by the government, as well as the exploitation of the natural resources, for undermining their livelihood, traditional culture, and way of life.

Under Indonesia's domestic law 23/1992, the government is required to provide sufficient health facilities throughout the nation and take action to combat both infectious and non-infectious diseases in order to decrease mortality rates. Given that the Indonesian Government has ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) and has also incorporated it into domestic law with the implementation of Law number 11/2005, the government must recognize the right of everyone to enjoy the highest attainable standard of physical and mental health, and must maximize available resources to achieve full realization of this right.

ADDITIONAL COMMENTS:

Frustration among members of the indigenous community about the lack of government response has sparked riots in Moanemani. A history of harassment, torture and other forms of human rights violations directed against the indigenous population in Papua means that communities have a high level of distrust towards authorities of the central government. Some have even expressed suspicion that the delay in providing aid is a deliberate failure on the part of the government, intending to harm the indigenous people.

SUGGESTED ACTION:
Please write to the authorities listed below expressing your grave concern regarding the lack of facilities and the negligence of health institutions regarding this case. The authorities must employ all means necessary to ensure that the cholera epidemic is brought under control and that further unnecessary deaths are prevented.

Please be informed that the AHRC has also written to the UN Special Rapporteur on the right to health, the right of indigenous people, and on racism, calling for an intervention in this matter.

To support this appeal, please click here:

SAMPLE LETTER:

Dear __________,

INDONESIA: Hundreds die due to government's failure to control Cholera outbreak

Details: 239 people have died of Cholera Bacterium, Dogiyai District in Papua, Indonesia
Date of incident: since April 2008

I am writing to express my deep concern about the cholera epidemic currently taking place in a number of districts in Papua, Indonesia. At this time, hundreds of people have died from the disease and the Indonesian government has failed to respond despite requests for action to both local and national authorities. Medical assistance has not been dispatched to affected areas and preventative measures have not been implemented in neighboring provinces.

According to the Ministry of Health, there have thus far been 81 fatal cases from the epidemic out of the total 552 cases of known infections in the districts of Dogiyai. Local organizations however, have reported much higher numbers; at least 239 people are reported to have lost their lives by mid September. There is thus a large discrepancy in these figures, and the reliability of official records is made questionable.

Cholera is an easily treatable disease. According to the World Health Organization (WHO), "the prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure". What is deeply disturbing then, is the fact that the Indonesian government has failed to take sufficient action since the first reported cases of diarrhea in the Dogiyai District, dating back all the way to April 2008.

Law number 23/1992 of Indonesian domestic law requires that the government provides sufficient health facilities throughout the nation and that it takes action to combat both infectious and non-infectious diseases. Additionally, as a signatory of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which it has incorporated into its domestic law (Law number 11/2005), Indonesia also recognizes the right of everyone to enjoy the highest attainable standard of physical and mental health, and should accordingly maximize available resources to achieve full realization of this right. As such, the government's current inaction with regards to the cholera epidemic in Papua constitutes a severe breach of these domestic and international human rights laws and standards.

The government has a duty to ensure all citizens' right to health, which would include both treatment and prevention of illnesses and disease. Its current lack of effort to combat cholera and the disease's ongoing spread (suspected cases in Puweta and Kaamu barat districts have surfaced as recently as in mid-August) seems to demonstrate an apathetic attitude toward its own citizens.

Inasmuch as inaction leaves authorities accountable, I urge you to immediately take proper actions to address the cholera epidemic. Dispatching personnel for treatment plus the implementation of a weekly surveillance system in affected, as well as potentially affected, areas is recommended for effective action.

Further, preventative measures such as disinfections; the proper disposal of faecal waste and village-level training of community health workers, should also be taken to stop the spread of the disease.

I look forward to your prompt and effective response.

Yours sincerely,

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PLEASE SEND YOUR LETTERS TO:

1. Mr. Susilo Bambang Yudoyono
President
Republic of Indonesia
Presidential Palace
Jl. Medan Merdeka Utara
Jakarta Pusat 10010
INDONESIA
Fax: + 62 21 231 41 38, 345 2685, 345 7782
Tel: + 62 21 3845627 ext 1003
E-mail: president@ri.go.id

2. Ms. Siti Fadilah Supari
Ministry of Health
Jl. H.R. Rasuna Said
Blok X 5 Kav. 4-9 Blok A
Jakarta 12950
INDONESIA
Tel: +62 21 5201590

3. Mr. Aburizal Bakrie
Ministry of Social Welfare
Jl. Merdeka Barat
No. 3, Jakarta Pusat
INDONESIA
Fax: +62 21 3453289
Tell: +62 21 34832544
E-mail: biro_informasi@menkokesra.go.id

4. Mr. Tigor Silaban
Head of Service Office of Health
Jl. Raya Sentani Kota Rajo
Jayapura 99225
INDONESIA
Fax: +62 967 581 065

5. Mr. Ifdhal Kasim
Chairperson
KOMNAS HAM (National Human Rights Commission)
Jl. Latuharhary No. 4B Menteng
Jakarta Pusat 10310
INDONESIA
Fax: +62 21 3151042/3925227
Tel: +62 21 3925230
E-mail: info@komnasham.or.id

Thank you.

Urgent Appeals Programme
Asian Human Rights Commission (ua@ahrchk.org)

Document Type :
Urgent Appeal General
Document ID :
AHRC-UAG-012-2008
Countries :
Issues :
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Extended Introduction: Urgent Appeals, theory and practice

A need for dialogue

Many people across Asia are frustrated by the widespread lack of respect for human rights in their countries.  Some may be unhappy about the limitations on the freedom of expression or restrictions on privacy, while some are affected by police brutality and military killings.  Many others are frustrated with the absence of rights on labour issues, the environment, gender and the like. 

Yet the expression of this frustration tends to stay firmly in the private sphere.  People complain among friends and family and within their social circles, but often on a low profile basis. This kind of public discourse is not usually an effective measure of the situation in a country because it is so hard to monitor. 

Though the media may cover the issues in a broad manner they rarely broadcast the private fears and anxieties of the average person.  And along with censorship – a common blight in Asia – there is also often a conscious attempt in the media to reflect a positive or at least sober mood at home, where expressions of domestic malcontent are discouraged as unfashionably unpatriotic. Talking about issues like torture is rarely encouraged in the public realm.

There may also be unwritten, possibly unconscious social taboos that stop the public reflection of private grievances.  Where authoritarian control is tight, sophisticated strategies are put into play by equally sophisticated media practices to keep complaints out of the public space, sometimes very subtly.  In other places an inner consensus is influenced by the privileged section of a society, which can control social expression of those less fortunate.  Moral and ethical qualms can also be an obstacle.

In this way, causes for complaint go unaddressed, un-discussed and unresolved and oppression in its many forms, self perpetuates.  For any action to arise out of private frustration, people need ways to get these issues into the public sphere.

Changing society

In the past bridging this gap was a formidable task; it relied on channels of public expression that required money and were therefore controlled by investors.  Printing presses were expensive, which blocked the gate to expression to anyone without money.  Except in times of revolution the media in Asia has tended to serve the well-off and sideline or misrepresent the poor.

Still, thanks to the IT revolution it is now possible to communicate with large audiences at little cost.  In this situation there is a real avenue for taking issues from private to public, regardless of the class or caste of the individual.

Practical action

The AHRC Urgent Appeals system was created to give a voice to those affected by human rights violations, and by doing so, to create a network of support and open avenues for action.  If X’s freedom of expression is denied, if Y is tortured by someone in power or if Z finds his or her labour rights abused, the incident can be swiftly and effectively broadcast and dealt with. The resulting solidarity can lead to action, resolution and change. And as more people understand their rights and follow suit, as the human rights consciousness grows, change happens faster. The Internet has become one of the human rights community’s most powerful tools.   

At the core of the Urgent Appeals Program is the recording of human rights violations at a grass roots level with objectivity, sympathy and competence. Our information is firstly gathered on the ground, close to the victim of the violation, and is then broadcast by a team of advocates, who can apply decades of experience in the field and a working knowledge of the international human rights arena. The flow of information – due to domestic restrictions – often goes from the source and out to the international community via our program, which then builds a pressure for action that steadily makes its way back to the source through his or her own government.   However these cases in bulk create a narrative – and this is most important aspect of our program. As noted by Sri Lankan human rights lawyer and director of the Asian Human Rights Commission, Basil Fernando:

"The urgent appeal introduces narrative as the driving force for social change. This idea was well expressed in the film Amistad, regarding the issue of slavery. The old man in the film, former president and lawyer, states that to resolve this historical problem it is very essential to know the narrative of the people. It was on this basis that a court case is conducted later. The AHRC establishes the narrative of human rights violations through the urgent appeals. If the narrative is right, the organisation will be doing all right."

Patterns start to emerge as violations are documented across the continent, allowing us to take a more authoritative, systemic response, and to pinpoint the systems within each country that are breaking down. This way we are able to discover and explain why and how violations take place, and how they can most effectively be addressed. On this path, larger audiences have opened up to us and become involved: international NGOs and think tanks, national human rights commissions and United Nations bodies.  The program and its coordinators have become a well-used tool for the international media and for human rights education programs. All this helps pave the way for radical reforms to improve, protect and to promote human rights in the region.