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East Timor health crisis rages on; Doctor: A visitor to the country reports its medical infrastructure was ravaged by the recent violence.

THE BALTIMORE SUN

DURING a medical mission to East Timor in July, I witnessed the long-standing health and human rights crisis that had been simmering in the territory since 1975 prepare to boil over into the chaos present in much of the country.

On Aug. 30, after nearly a quarter-century of Indonesian rule, the East Timorese overwhelmingly called for independence from Indonesia, with 78 percent of the people of East Timor voting in favor of self-determination. The underlying tragedy of the bloody weeks after the vote was how preventable the catastrophe could have been, there had been fuller commitment and involvement of the international community. Unfortunately, the flint that would spark a devastating firestorm of army-incited violence had been struck before I arrived.

This conflagration, according to figures released by the United Nations High Commission on Refugees, destroyed half of all domestic dwellings, left up to 500,000 East Timorese missing from their communities, and ravaged East Timor's already-fragile health care infrastructure.

As a member of Physicians for Human Rights, I traveled to the capital city of Dili with representatives of Health Alliance International. We had the task of observing and documenting human rights violations reportedly being committed by the anti-independence militias and the TNI (Indonesian armed forces). The United Nations resolution authorizing the referendum left to the TNI the crucial responsibility of keeping the peace. A responsibility, tragically, they would not only fail to fulfill but would blatantly violate by participating in and, in some cases, leading the militias rampages that they were sworn to prevent.

On July 4, the day after I arrived in the town of Liquica, East Timor, a humanitarian convoy accompanied by clearly marked U.N. vehicles carrying 20 wounded or sick Timorese and 40 medical personnel was attacked. Indonesian security forces reneged on their pledge to escort the convoy, leaving an unarmed medical mission open to attack.

In the ensuing ambush, a U.N. driver was pistol-whipped in clear view of the Liquica police station. This type of brazen attack became the norm in the rampage that followed the U.N.-sponsored vote. July Fourth on the other side of the globe found the United States, a country that had trained and armed many of the Indonesian troops spearheading the violence, including the ferocious Kopassus special forces unit, celebrating its Independence Day with barbecues and fireworks.

Not surprisingly, with such a dangerous situation outside of Dili, our movement was confined to the increasingly tense climate of the capital city. During our brief stay on the island, we closely observed the conditions and services of civilian health care institutions still operating under the constant strain of militia reprisals. Militia and army troops were a common sight on the grounds of Tokuboru Hospital, the one functioning civilian hospital in the territory.

Civilian doctors spoke in hushed and worried tones of the repeated transfer, without patient consent, of wounded civilians into the care of Indonesian army facilities, to face an uncertain fate in an undisclosed location. The fear of disappearing behind the walls surrounding the Indonesian army hospital kept a large percentage of civilians who badly needed care from seeking it, even from civilian facilities.

At a nongovernment clinic, civilian doctors hid for several days the pistol-whipped patient from the Liquica convoy, treating him surreptitiously. When he regained consciousness, the patient did not go to the better-staffed, better-equipped civilian hospital to seek treatment. He went into hiding.

Targets of militias

Medical professionals, whose occupation had forced them to face constant attack and, in the case of two nurses, murder, were also targets in the eyes of the militias. On several occasions, militias menacingly surrounded nongovernment clinics, and various Indonesian authorities confiscated sorely needed and rarely replenished medical supplies.

Even if the militarization and violation of medical neutrality had not occurred, the population was threatened, because East Timor had, shockingly, only four surgeons present before the vote, with virtually no native health care providers to serve a population of about 1 million people.

The task of effectively caring for the teeming caseload of traumatic injuries, malaria and tuberculosis sufferers and victims of widespread malnutrition, already demonstrating wasting in their limbs, became nearly impossible. Once the post-election slaughter reached its height, all international health care workers, except for the 32 employees of Caritas, a Catholic charity, were evacuated, leaving East Timor virtually bereft of physicians and an operational medical facility.

Worst still to come

On Aug. 24, one week before the vote, Physicians for Human Rights released a report, "Health Care on the Brink: Violations of Human Rights and Medical Ethics in East Timor," chronicling the findings of my mission to Dili. A mission, I thought, that had seen the worst that was to befall East Timor. The next month, I was proven wrong.

With the rest of the world, I could do little but watch the body count rise, as the enormity of the tragedy unfolded before my eyes in each new image appearing on television. Physicians for Human Rights drafted a letter on Sept. 3 to President Clinton demanding immediate action by the United States, urging him to end the mounting violence that followed the election, to use the same power that our nation had brought to Indonesia to ensure peace the day of the voting.

The White House appeared able yet unwilling to intervene. The question remains: Even now that peacekeepers have been deployed, what is to be done to end the violence?

Physicians for Human Rights and I support the call by Xanana Gusmao, the East Timorese pro-independence leader recently released from Indonesian prisons, for the U.N. to make a key war reparation: the reunion of families torn apart by the Indonesian rampage. Displaced East Timorese interned by militia forces in West Timor must be repatriated to their home communities in East Timor by the U.N. peacekeepers. After the living have been reunited, the next task facing the international community is the long process of locating and returning the remains of the dead to their families.

Identifying remains

This is a need that Physicians for Human Rights understands all too well from its forensic and family-support work in Bosnia and Kosovo. As in the Balkans, initiatives to facilitate the process of identifying remains and assisting families undergoing the heartbreaking but necessary ordeal of matching bones to memories are required, if families of victims are to step out of the shadow of tragedy into the next stage of their lives.

Also, the United States and its allies must indefinitely suspend military aid to Indonesia, until the troops and commanders responsible for the displacement, slaughter and dehumanization of the Timorese people face an international war crimes tribunal. The U.N. Investigatory Commission being called for is a first step on the road to justice. This tribunal must include the handing down of indictments against soldiers who not only tortured and murdered civilians but also violated the neutral status of medical facilities, by such acts as obstructing access to medical care, an act that violates the basic tenets of international humanitarian law.

No policy of intervention

The Clinton administration lacked a policy of intervention in Indonesia, standing idle as the TNI committed horrendous human rights violations that might never be fully documented. Indeed, the injustice continues, as Timorese are scattered as far as Bali throughout Indonesia's archipelago, with no immediate hope of return to their homeland.

President Clinton must support the liberation of refugee camps in West Timor controlled by the TNI and the militias, and pressure Congress to withdraw its request that the U.N. scale down the size of its force in East Timor. This force is unable to fully disarm the militia units plying their brutal craft in East Timor. Until these terms are met, East Timor will have its hard-won freedom eroded and broken by the violence that began in the hospitals and streets of Dili.

Dr. David Stein is a member of Physicians for Human Rights and a faculty member at the Johns Hopkins School of Medicine and School of Hygiene and Public Health.

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