Air pollution kills about 7 million people worldwide every year, with more than half of the fatalities due to fumes from indoor stoves, according to a new report from the World Health Organization published Tuesday.

The agency said air pollution is the cause of about one in eight deaths and has now become the single biggest environmental health risk.

"We all have to breathe, which makes pollution very hard to avoid," said Frank Kelly, director of the environmental research group at King's College London, who was not part of the WHO report.

One of the main risks of pollution is that tiny particles can get deep into the lungs, causing irritation. Scientists also suspect air pollution may be to blame for inflammation in the heart, leading to chronic problems or a heart attack.

WHO estimated that there were about 4.3 million deaths in 2012 caused by indoor air pollution, mostly people cooking inside using wood and coal stoves in Asia. WHO said there were about 3.7 million deaths from outdoor air pollution in 2012, of which nearly 90 percent were in developing countries.

The new estimates are more than double previous figures and based mostly on modeling. The increase is partly due to better information about the health effects of pollution and improved detection methods. Last year, WHO's cancer agency classified air pollution as a carcinogen, linking dirty air to lung and bladder cancer.

WHO's report noted women had higher levels of exposure than men in developing countries.

"Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves," Flavia Bustreo, WHO Assistant Director-General for family, women and children's health, said in a statement.

Other experts said more research was needed to identify the deadliest components of pollution in order to target control measures more effectively.

"We don't know if dust from the Sahara is as bad as diesel fuel or burning coal," said Majid Ezzati, chair in global environmental health at Imperial College London.

Kelly said it was mostly up to governments to curb pollution levels, through measures like legislation, moving power stations away from big cities and providing cheap alternatives to indoor wood and coal stoves.

He said people could also reduce their individual exposure to choking fumes by avoiding traveling at rush hour or by taking smaller roads. Despite the increasing use of face masks in heavily polluted cities such as Beijing and Tokyo, Kelly said there was little evidence that they work.

"The real problem is that wearing masks sends out the message we can live with polluted air," he said. "We need to change our way of life entirely to reduce pollution." (AP)

source: www.sunstar.com.ph

Yulinda Santosa was talking enthusiastically to some people in the room. She was eloquent, cheerful and seemed perfectly healthy. It's hard to believe that until last year she was still suffering from a serious illness that nearly killed her and forced her to put her life on hold for years.

"It started when I just graduated from high school in 2005. I worked in a factory in Bogor, West Java, and befriended someone who told me that he was suffering from tuberculosis. At that time I wasn't aware that it was highly contagious," Yulinda said.

Yulinda spent almost every day talking to her friend, trying to encourage him to toughen up and face his illness, not realizing that she has risked her health by having close contact without adequate protection.

In 2008 Yulinda started to develop some symptoms including a persistent cough and high fever, and she even vomited blood.

She went to her health clinic and the doctor diagnosed her with tuberculosis and put her on a course of treatment.

"After three months I stopped taking medicines, I stopped coughing. I felt much better and I gained the weight I lost when I was sick. But that was when the real tragedy started," Yulinda said.

In 2010 the illness came back, and the symptoms got worse.

Yulinda had developed multiple drug-resistant tuberculosis (MDR-TB), a strain of the disease that can develop if the initial treatment course is not observed for the full duration of six to eight months.

Yulinda was quarantined for three months while waiting for the doctors to formulate the best treatment for her. Eventually they referred her to Persahabatan Hospital in North Jakarta.

"So that was it. I had to quit college and my job, moved away from my family so I would not infect them and stayed alone in a rented room near the hospital," she said.

Every day for three years she wore a surgical mask and went to the hospital for her treatment, taking 15 pills and enduring severe side effects including nausea and skin rashes.

Her only consolation was developing friendships with other MDR-TB patients in the hospital.

"The treatment was unbearable sometimes. I was once kicked out of my rented room by the landlady when she found out I had tuberculosis. My fellow patients started to die one by one, so of course it was hard," Yulinda said.

Yulinda was lucky because the drugs and the treatment were paid for by donors and the hospital.

And after a long struggle she was declared free of tuberculosis in February last year.

After contacting some of the other former patients that she met during her treatment, Yulinda formed a group called Peta or Pejuang Tanggung (Tough Fighters).

The group motivates tuberculosis patients to stick to their treatment by giving them encouragement and support.

Massive challenge

It is estimated some 7,000 Indonesians are suffering from MDR-TB.

Tjandra Yoga Aditama, director general of disease control and environmental health at the Health Ministry, said that only 1,000 MDR-TB patients were undergoing treatment currently, and that all medical expenses were paid by the state.

While Indonesia has been lauded internationally for its success in diagnosing and treating tuberculosis patients, the disease remains a serious challenge for the country.

The World Health Organization estimated there are 456,000 new tuberculosis cases in Indonesia annually, meaning that it shoulders the fourth largest new diagnosis-burden in the world after India, China and South Africa.

Indonesia is also home to the seventh largest number of sufferers of MDR-TB.

A patient who develops MDR-TB must undergo a treatment for at least 24 months. The drugs alone cost $4,000.

MDR-TB can develop into extensive drug-resistant tberculosis, or XDR-TB, for which the survival rate is only 15 percent.

The condition can also develop into totally drug-resistant TB (TDR-TB) where the patient does not respond to any drug treatments at all.

Tjandra said currently there are 20 cases of XDR-TB in Indonesia; four have been cured while the rest are still undergoing intensive treatment.

"Tuberculosis is still a serious problem not only for Indonesia, but for the world," Tjandra said.

The conventional diagnosis tool used to detect the new cases of tuberculosis has been used for more than 100 years and the newest drug currently available is more than 40 years old, Tjandra said.

"We need more updated drugs, the new drugs are underway but they are not yet available on the market," he said.

The tuberculosis vaccine, Bacillus Calmette-Guerin vaccine (BCG) which is included in Indonesia's national routine immunization program, is highly unreliable — it has been more than 90 years since the vaccine was invented.

"It has been proven that the BCG vaccine does not have any significant impact in slowing down the tuberculosis epidemic," Tjandra said.

Double burden

Ibnu Rizal has a slightly different story from Yulinda. He does not have MDR-TB but he is HIV positive and has been diagnosed with tuberculosis, the most common infection for those with the immune deficiency virus.

Rizal, 28, is an inmate at Salemba Penitentiary in Central Jakarta.

He has been in prison for three years for drug abuse and will be released in the near future.

Instead of feeling relieved and happy, Rizal is feeling weary because he will have to return to his family and tell his wife that he has tuberculosis and HIV and may possibly have infected her.

"I just don't know how I should tell her. This will come as a great shock for her," he said.

Rizal found out about his HIV status in 2010 but did not start antiretroviral (ARV) therapy until 2013 because he was afraid of not being able to keep up with his treatment.

An interrupted treatment might have resulted in him developing a resistance and needing to switch to the second line of the drugs, which have more side effects.

Rizal was forced to start his treatment when he later found out he no longer responded to the first line of ARV. On top of that he developed tuberculosis after staying in the damp and overcrowded prison.

"Overcrowding in prison is a serious problem that hampers our efforts to manage tuberculosis transmission," Tjandra said.

The Health Ministry reported that tuberculosis was the most common cause of death in prisons.

Dyah Ayu Ertikawati, the director for tuberculosis control at the Health Ministry, said some 30 percent of Indonesian prisoners have been affected by the disease because most inmates are living in a damp cell, cramped together in a confined space.

Dyah said Indonesia has started a more progressive approach by introducing the tuberculosis control program in 200 out of 420 prisons in the country.

The program focuses on fixing ventilation systems in prisons for better air circulation and setting up booths to collect spit samples for testing.

Tjandra said the Health Ministry has been working closely with the penitentiaries directorate to control tuberculosis from spreading.

"Right now the program is focused on managing the co-infection between tuberculosis and HIV among the inmates.

I am exploring the possibility of solving the poor sanitation problem as well," he said.

Better access to treatment

"If we want to ensure the patient's adherence we have to make sure the access to medication is easy and nearby, that's what we have been trying to achieve," Tjandra said.

He said patients' low adherence was the main reason for tuberculosis's enduring prevalence. He said the Ministry has been developing a system where a patient can access the treatment and the medication at the nearest health clinic instead of coming all the way to a satellite hospital.

Indonesia has also purchased 23 units of Gen-Expert, the most cutting-edge medical device that is able to rapidly diagnose tuberculosis. Indonesia will purchase 49 more devices by the end of 2014.

"For now we only use Gen-Expert to diagnose MDR-TB and the diagnosis is free of charge," Tjandra said.

Millions of people worldwide have tuberculosis but are yet to be diagnosed. Poor diagnosis rates are often exacerbated by poor socio-economic conditions and stigma.

"Drugs alone cannot beat tuberculosis in the community, the disease is a condition strongly influenced by low nutrition, poverty, social stigma, environment, rapid urbanization, and large population displacement in many countries. And these are factors that result in so many unreported cases," Dr Poonam Khetrapal Singh, WHO Regional Director for Southeast Asia, said.

"We have made substantial progress in tuberculosis, but unless we address the social, economic and behavioral determinants that impact the disease, our fight will not be over," she said.

Indonesia is aiming to eradicate tuberculosis by 2030 but it is generally admitted the target is a daunting task. For a country to be able to declare itself rid of tuberculosis, the prevalence of active infections in the general population must not exceed 10 cases per 100,000 people.

The current rate in Indonesia is 185 per 100,000 people and in prisons it is much higher. Indonesia also aims to reduce the mortality rate from the disease by 95 percent by 2035.

source: www.thejakartaglobe.com

In Israel, the disease is diagnosed mainly among foreigners or immigrants, but even here, bacteria are becoming more resistant to existing antibiotics.

The World Health Organization warned on Thursday that resistance of tuberculosis strains to antibiotics is growing, threatening the life and health of people around the world who have been diagnosed with the often-fatal infectious disease spread by mycobacteria.

WHO director-general Dr. Margaret Chan said in Geneva before World TB Day on March 24 that almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in 2012, yet less than 25 percent of these people were diagnosed, mainly due to a lack of access to quality diagnostic services. The disease is diagnosed in Israel, mainly among foreigners or immigrants from countries where TB is endemic, but even here, bacteria are becoming more resistant to existing antibiotics, which are given over a period of months to defeat the mycobacteria.

"Earlier and faster diagnosis of all forms of TB is vital," said Chan. "It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease." An innovative international project in 27 countries is making promising progress in diagnosing MDR-TB, she continued. The project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, helped to triple the number of MDR-TB cases diagnosed in participating countries.

The theme for World TB Day 2014 is "Reach the 3 Million". One third of the estimated nine million people falling ill with TB each year do not get the care they need. In many countries, it is hard for people to access diagnostic services – particularly for MDR-TB. Some countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In some cases, patient samples have to be sent to other countries for testing. Moreover, traditional diagnostic tests can take more than two months to get results. Chan noted that the situation is beginning to change, as new technologies can rapidly diagnose TB and drug-resistant TB in as little as two hours and prices are going down. Between 2009 to 2013, the number of MDR-TB cases diagnosed in the 27 countries tripled, with 36 000 diagnosed in 2013 alone.

"The gap in access to TB diagnostics and care is far from filled, but is narrowing. With the impetus of modern laboratories, we are on the right track finally to handle MDR-TB," said Dr Mario Raviglione, director of WHO's Global TB Program.

source: www.jpost.com

By Nuraini Razak

An island once suffering from a record number of malaria cases has managed to eradicate all indigenous cases of the disease, which is a leading cause of death among children under age 5.

SABANG, Indonesia, 19 March 2014 – When Adelia's fever simply did not go down, she was tested for the second-most-common malaria parasite – malaria vivax. That was in 2011. Thanks to immediate and effective treatment, Adelia, who is now 9 years old, managed to recover fully. But many others before her were not so lucky.

"On Sabang island, basically everyone had malaria at one point in their lives. We were so used to it," Adelia's mother, Rahmawati, explains. "But when it happens to one of your own children, I must say, I was terribly worried."

At one point, Batee Shok, the village Adelia and her mother call home in Aceh province, broke all records, with the highest number of malaria cases to be registered in a single village in Sabang.

Eliminating malaria

Adelia was not yet born when the Indian Ocean tsunami hit Aceh province in 2004 and triggered a massive post-disaster response in the region, but the groundwork on implementing the malaria interventions that would one day save her life was soon to begin.

"After the tsunami, there was an increase in malaria cases in Sabang," recalls Dr. Titik Yuniarti, Head of Communicable Disease Control in the district health office. "In 2008, we started working with UNICEF to eliminate malaria."

Financial and technical support from UNICEF catalyzed greater government investment in controlling malaria and in enhancing health systems – and budget allocations from the local government have steadily increased. Reporting has improved among hospitals and private physicians, as has more rapid investigation of reported cases.

In addition to political commitment and community engagement, strict malaria surveillance by the local health department was essential. The local health office included each malaria case in a database, providing information on all possible aspects that may have influenced a person's risk of exposure, including where he or she lived and whether there were habitats of Anopheles mosquito larva nearby.

These efforts have yielded enormous success. "[T]oday we can claim that we no longer have any indigenous cases on the island," says Dr. Yuniarti.

Indeed, it was Adelia who suffered the last case of indigenous malaria among Sabang's 30,000 inhabitants.

"No one should die from a mosquito bite"

Community volunteers, trained by UNICEF, play a vital role in preventing spread of the disease. The volunteers go door-to-door to check on the health of residents and ask whether they are using their insecticide-treated bed nets correctly. A first line of defence against malaria, the nets are distributed by the local government with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The volunteers also collect blood samples. Though the task has earned them the nickname "Dracula," testing for malaria is critical to identify active cases of the disease, initiate timely treatments and prevent its further spread.

"I want malaria to be eliminated from my island," says volunteer Srikayanti of Sabang. "It's ridiculous; no one should die from a mosquito bite, especially no child."

Three years ago, she made daily house calls for Adelia after she was diagnosed with malaria. Srikayanti wanted to make sure that Adelia fully adhered to her treatment – Artemisinin-based combination therapy – so that the malaria parasite could be fully removed from her system.

Saving more lives

Sabang's significant gains have implications for saving more children like Adelia from this deadly disease.

The lessons learned in Sabang are now being applied in seven more districts in Aceh province – and have become a model for scaling up surveillance in other malaria-endemic regions throughout Indonesia.

source: www.unicef.org

American business magnate, investor, computer programmer, inventor and philanthropist William Henry "Bill" Gates III will soon arrive in Jakarta to support the establishment of Indonesia Health Fund (IHF), a minister has stated.

"The presence of Bill Gates in Indonesia early next month will give a good impetus to local business makers to join Indonesia Health Fund," Coordinating Minister for Peoples Welfare Agung Laksono stated here on Tuesday.

Agung explained that IHF is expected to help the Government of Indonesia overcome numerous health problems, particularly those endured by the poor community in the country.

Therefore the minister has encouraged all business makers in the country to participate in the Indonesia Health Fund program to overcome health problems in Indonesia.

Agung added that Bill Gates is expected to arrive in Indonesia early in April 2014 and is scheduled to visit a number of community health centers and donate funds for the IHF.

Meanwhile, Mayapada Group Chairman and CEO Dato Sri Taher stated that Bill Gates initiative to donate funds for IHF could be an example for business makers in Indonesia to follow.

"With the establishment of IHF, the business makers in Indonesia are expected to be willing to allocate some of their profits toward the needs of the people at large," Taher noted.

He pointed out that the donation from the business makers could then be used to overcome major health problems like malaria, tuberculosis (TBC), dengue fever, and others including family planning programs.

According to World Health Organization (WHO), around 50 percent of Indonesian population live in malaria prone areas.(*)

source: www.antaranews.com

Across the globe, numerous countries share the goal of improving the efficiency of healthcare systems. Mobile technologies can help directly address some of the most stubborn healthcare problems including exploding costs, providing care to seniors, access in impoverished areas, and the treatment of deadly disease.

Countries around the world use mHealth to help transform various aspects of their healthcare systems. The figure below includes data from the World Health Organization on mHealth initiatives. Thirty eight percent of countries who participated reporting using call centers. A sizable numbers of countries described the use of reminders, telemedicine, records, and treatment in healthcare.

Researchers at GSMA estimate the size of the global mHealth market will be five times larger in 2017 than in 2013. The largest market in 2013 is projected to be United States followed by China. Together they will occupy about one third of the market with United States accounting for about one quarter of projected revenue. The other BRIC countries besides China will also likely see large growth in the field of mHealth.

The growth of mHealth is expected to explode in the next few years in China. The firm iiMedia predicts that the mHealth market will grow more than 50% each year in 2016 and 2017. In particular the market for wearable mobile medical equipment is expected to double in size between 2011 and 2017.

Interested in learning more about the future of mHealth? Read the paper co-authored by scholars by the China Academy of Telecommunication Research and the Center for Technology Innovation entitled "mHealth in China and the United States: How Mobile Technology is Transforming Health in the World's Two Largest Economies."

source: www.brookings.edu

STORY HIGHLIGHTS

• A new global partnership for development encompassing both knowledge and finance is critical to end extreme poverty within a generation.
• Credibility and accountability for the goals that we set as development actors require an accelerated pace of implementation, the capacity to measure and track our progress, and better and smarter aid.

March 13, 2014 – As the 2015 deadline for achieving the Millennium Development Goals (MDGs) gets closer, the World Bank Group (WBG) is setting ambitious targets and reforming the way it does business to support a sustainable post-2015 development framework.

The WBG is working with the United Nations (UN) and other multilateral development banks (MDBs) to make MDGs meet their objectives. While member states are the ones driving the Post-2015 agenda, the World Bank's contribution from its ability to push the "data revolution," or to help build a consensus on a new financing framework is being recognized by the international community.

The WBG is also committed to better leverage resources and knowledge to support strong economic growth and to tackle rising income equality, gender imbalance, climate change and fragility, according to World Bank Vice President of External and Corporate Relations Cyril Muller, who spoke at a high-level seminar "The Post-2015 Development Agenda: Towards a New Partnership for Development," in Moscow.

"We must seize this Post-2015 moment so we can end extreme poverty around the globe, while making development significantly more equitable and more sustainable. Only by achieving these goals can we be assured that we will be contributing to a more peaceful and secure environment for our children's generation. Close Quotes"

Cyril Muller
World Bank Group

The eight MDGs – eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality, improving maternal health, combating HIV/AIDS, malaria and other diseases, ensuring environmental sustainability, and a global partnership for development – were adopted in 2000 by UN member states.

Since then, several MDG targets have been met or are close to being achieved. For example, the proportion of people living in extreme poverty has been halved globally, and over 2 billion people got access to improved sources of drinking water. But some other goals, including preventing maternal deaths and environmental sustainability, require more work going forward. A sustainable development agenda post 2015 is critical to accelerate work in these areas and to expand the results that have been achieved already.

The ability to finance such a framework depends on many factors.

Global development cooperation that attracts aid from diverse sources, emphasizes domestic resource mobilization, and capitalizes on the potential of the private sector is critical. So are good policies, the capacity to implement them, and credible institutions which increase the impact of scarce resources and leverage additional resources from domestic and foreign, public and private sources.

The WBG is working with the UN and regional counterparts to add value to this process with a strong emphasis on means of implementation, financing for development and data. In setting the twin goals of ending poverty and boosting shared prosperity, the WBG is also putting the focus on sustainable and inclusive growth at the center of country level operations and aiming to better leverage resources and knowledge to support the MDGs.

source: www.worldbank.org

Noor Jahan rocked slowly on the floor, trying to steady her weak body. Her chest heaved and her eyes closed with each raspy breath. She could no longer eat or speak, throwing up even spoonfuls of tea.

Two years ago, she would have left her upscale home — one of the nicest in the community — and gone to a hospital to get tests and medicine for her failing liver and kidneys. But that was before Buddhist mobs torched and pillaged her neighborhood, forcing thousands of ethnic Rohingya like herself to flee to a hot, desert-like patch of land on the outskirts of town.

She was then stuck in a dirt-floor bamboo hut about a quarter-mile from the sea. She and others from the Muslim minority group have been forced to live segregated behind security checkpoints and cannot leave, except for medical emergencies. Often not even then.

Living conditions in The' Chaung village and surrounding camps of Myanmar's northwestern state of Rakhine are desperate for the healthiest residents. For those who are sick, they are unbearable. The situation became even worse two weeks ago, when the aid group Doctors Without Borders was forced to stop working in Rakhine, where most Rohingya live.

The government considers all 1.3 million Rohingya to be illegal immigrants from neighboring Bangladesh, though many of them were born in Myanmar to families who have lived here for generations. Presidential spokesman Ye Htut accused Doctors Without Borders of unfairly providing more care to Muslims than Buddhists and inflaming communal tensions by hiring "Bengalis," the name the government uses to refer to the Rohingya.

Myanmar, a predominantly Buddhist nation of 60 million, emerged from a half-century of isolating military rule in 2011. Nascent democratic reforms have generated optimism in the international community — the World Bank recently pledged $2 billion in development aid — but waves of ethnic violence, mainly against the Rohingya, have raised concerns from the U.S. and others.

Before Doctors Without Borders was shut down, Rakhine Buddhists regularly protested the group in what Vickie Hawkins, its deputy head of mission in Myanmar, described as a slow strangulation. Staff members were intimidated. Landlords became too fearful to rent houses for their operation. Boat captains declined to ferry patients.

The situation intensified after the organization said it treated 22 Rohingya patients who were wounded and traumatized following an attack in January. The government has staunchly denied that a Buddhist mob rampaged through a village, killing women and children, but the United Nations concluded more than 40 people may have been killed.

Talks are still ongoing between the government and Doctors Without Borders over whether the group will be allowed to continue working in Rakhine state. Dr. Soe Lwin Nyein, the Health Ministry's deputy director general, said Wednesday that the government was continuing to accept HIV and tuberculosis drugs from the group for patients in Rakhine.

Many sick patients located in the camps outside of the state capital, Sittwe, prefer to visit Doctors Without Borders' small facility that sits among a tangle of flimsy thatch-roofed shacks. It is a trusted source of care, having worked in Rakhine state for two decades.

To see a doctor now, patients living in the camps must secure referrals from government physicians and frequently pay bribes to security guards to get past checkpoints. Treatment is then only permitted at one hospital, forcing some from remote areas to travel for hours.

Additionally, many fear violence outside their Muslim area. Aid workers said protesters once stormed a hospital in town, forcing officials to lock the doors while some Rohingya patients fled in terror.

Rohingya in Myanmar have faced decades of systematic discrimination that bars them from certain jobs and requires special permission for them to marry, among other restrictions. But their lives were far more peaceful before ethnic violence erupted in mid-2012. Up to 280 people have been killed in Rakhine and tens of thousands more have fled their homes, most of them Rohingya.

Before the clashes, Jahan's family lived comfortably in the heart of Sittwe. They were well-known among both Buddhists and Muslims, owned five houses and ran a construction supply business. When surrounding Muslim areas started burning nearly two years ago, they paid the police to guard their concrete home and believed they were protected. But mobs torched and looted it anyway.

The family fled their now-bulldozed house with some jewelry and around $5,000 in cash. They can no longer access additional money in their bank accounts because they left their identity cards behind.

The stress was especially hard on 48-year-old Jahan. Suffering from diabetes, liver and kidney disease, she started deteriorating about three months after being corralled into the Muslim area, when the family ran out of medicine and food became scarce.

She fell unconscious in December, and her husband, Mohamad Frukan, traveled with her to a nearby government clinic and waited for an emergency referral. Eventually, the Red Cross was able to take them to a Sittwe hospital since the clinic itself has no doctors.

Once in town, Frukan said, a security guard shouted ethnic slurs at them and a nurse tried to give them different drugs than the doctor had prescribed. The family was not able to leave the facility, and was forced to rely on guards to bring them food. He said some were helpful, while others were indifferent or downright mean.

Jahan was told she needed to see a specialist in the country's main city of Yangon, but Rohingya need special permission for such a trip — a process that was too complicated and costly for the couple. Instead, after being treated for nine days, she was sent back to the dilapidated house made of bamboo slats and pieces of corrugated tin — still one of the nicest homes in the neighborhood, when compared to the saggy huts surrounding it.

Jahan's condition soon worsened. She couldn't stand or lie down, so she sat, drawing one agonizing breath after another. The doctor asked that she return a week or two later for a checkup, but by then, Frukan said, security around the camp had tightened and there was no way for the family to leave.

Instead, he decided to pay $300 for a boat to take his wife to Bangladesh. He was prepared to carry her through chest-high water for 45 minutes to reach the vessel, but when he tried to arrange it, the boat captain took a look at her and simply shook his head. He wouldn't take the risk of her dying on the way.

There was little that Frukan could do but cry. The couple had traveled to Yangon for care just four years ago, and if the violence hadn't uprooted their lives, they could have done it again.

"Life is so miserable for us," Frukan said. "Sometimes I am out of my mind thinking about her, but she never knows that. Whenever I look at her, it just hurts so much, and it's so painful. I think my daughters might even die seeing their mother every day and night."

Lives have always been at greater risk in Rakhine, the second-poorest state of one of Asia's poorest countries. The situation is worse away from the Sittwe camps, in isolated and predominantly Muslim northern Rakhine state.

In 2011, before the violence erupted, the European Community Humanitarian Office reported that acute malnutrition rates in parts of northern Rakhine reached 23 percent, far above the 15 percent emergency level set by the World Health Organization. In one township, the number of deaths among children under 5 is nearly triple the national rate, according to the U.N.

Now the situation is even more dire, with families split and lives disrupted. An estimated 75,000 Rohingya have left the country by boat, including Jahan's son and son-in-law, though neighboring countries are reluctant to accept them.

In the camps, many suffer from diarrhea and respiratory illnesses, including tuberculosis, in cramped shelters with no ventilation. Agencies such as UNICEF highlight poor hygiene, sanitation and a lack of clean drinking water. It's a possible public health disaster in the making, especially during the rainy season, when the choking dust turns to gooey mud. Potential outbreaks such as measles and cholera remain a worry.

Pregnant women are particularly at risk. A quarter of Doctors Without Borders' emergency referrals involved complications during labor. One Rohingya woman, Asamatu, started bleeding four days before giving birth to a baby girl last month and died three days later in a camp filled with barefoot children and open sewage ditches.

"She was so weak at the end she couldn't stand," said sister Hasinara as she breast-fed her 15-day-old niece. "If we hadn't been here, the father would be working normally and earning money and she would have given birth in a better place."

The strain is hardest on the poor, who cannot even afford basic medication sold at small pharmacies along a road near several of the camps. An underground group has been smuggling everything from antibiotics to aspirin into the area using business channels, but it's far from enough.

And sometimes, money doesn't matter.

In early March, two months after his desperate efforts to get his wife to a doctor, Frukan walked along a dusty potholed road before sunset in a white skull cap and a crisp shirt. He had been praying for Jahan, whom he fell in love with and married 35 years ago. He would have handed over his entire fortune to save her.

"She died in the middle of nothing," he said. "We couldn't do anything in the middle of nothing."

Now all Frukan has left is his guilt and a mound of fresh dirt surrounding a large white concrete grave. The best he could give her.

"If I talk about her, I feel I will die," he said sitting in a shady courtyard outside the house. "I try to make myself comfortable by going to the mosque, but if I talk about what happened to her, I will die."

____

Associated Press writers Esther Htusan in The' Chaung and Robin McDowell in Yangon contributed to this report.

____

Follow Margie Mason on Twitter: twitter.com/MargieMasonAP

Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

source: www.washingtonpost.com