Indonesia's death zone

Indonesia's death zone

The Guardian Weekly (UK)

Jakarta is ignoring us while cholera and HIV/Aids spread through our villages, say the inhabitants of West Papua. Cain Nunn investigates.

Despite Indonesia's West Papua region being home to some of the world's largest resource extraction projects, which generate massive wealth for multinationals and for the government in Jakarta, local indigenous people still suffer from poor health.

Documenting that has not been easy, since Jakarta has been reluctant to allow outsiders into this remote region. But recently a few international health NGOs, including Médecins du Monde, have travelled to West Papua, and their data shows a region where tens of thousands out of 2.5 million inhabitants are estimated to be infected with HIV/Aids, and lethal cholera and diarrhoea outbreaks are frequent.

"The health problems of West Papuans are often the result of change taking place too quickly for such a remote people," says Remco van de Pas, the outgoing co-ordinator of Médecins du Monde's Papua operations, who has just returned to Europe after a two-year stint in the province. "Papuans are being overtaken by new development and while the delivery of basic health services lacks support and funding, they're falling way behind in health standards."

A study from 2008 notes that there were hundreds of new reported cases of Aids, taking the total official number to more than 4,000 (50% of Indonesia's total cases). Some health agencies estimate that the real number with Aids has reached 70,000, or about 2.5% of the population. Diarrhoea killed dozens in rural areas while in urban centres, such as Jayapura and Manokwari, food poisoning killed more. Deaths from a cholera epidemic in the Dogiyai and Paniai districts were about 300 by the end of last year.

"We are seeing just the tip of the iceberg of several health problems, and access to clean water and education," according to Van de Pas. "I believe that this cholera bacterium is always there. When people are in a lower nutritional state, or have another disease like HIV/Aids, then they are more vulnerable to this."

"All families in my village, someone dies... every day," says Ipo Hagwan of Northern Kamuu. "People are very scared. It has been getting worse and we don't know how to stop it."

The remoteness of the region makes it difficult for Jakarta to deal with epidemics. But many Papuans feel their welfare is just not a concern for Indonesia. "Since this [cholera] outbreak hit, Jakarta has done nothing to help these people," says Paula Makabori of the Institute of Human Rights Studies and Advocacy (Elsham). "Where are the health services from the government and the World Health Organisation when people are dying every day?"

Makabori says the government's failure to respond quickly to the cholera epidemic caused many more deaths, and the repression Papuans have suffered for years at the hands of the Indonesian military has exacerbated the problem. Papua has been troubled by a low-level separatist insurgency since the 1960s. Journalists need special permission to enter the area, and human rights groups have accused the military of abuses.

Many tribal people in the area affected by the cholera outbreak believe they have fallen ill because Indonesian soldiers have poisoned them, and they are suspicious of any medical treatment. The living conditions of West Papuans can be primitive: they rarely boil water and their wells can become cesspits. Papuans observe traditional customs such as washing dead bodies and keeping them above ground for days before burial.

Diseases such as cholera can spread quickly. "In our village we share a pit for a toilet," says Sabar Ingiwaii from Mimika. "And next to it is a pit for washing. We wash from the earth, like our ancestors always did."

It's not only disease contaminating the waters. The Freeport mine in Timika is the world's largest gold and copper mine and has dumped an estimated 7bn tonnes of tailings and waste into surrounding rivers.

Hauke Tekiman has lived most of his life in the area where communities are nourished by fish from the Ajkwa river: "We were never told not to fish from the river, we never knew that it is poison. And even when we know, we have to eat fish from the river just to survive. But now some fish are dying off and people are starting to get sick, too."

Makabori says the health situation is a prime example of how Special Autonomy status, which was granted to Papua by Jakarta in 2001 and is supposed to deliver improvements in basic living standards for Papuans, hasn't been properly implemented.

Major development goes on, with massive road projects, oil palm expansion, BP's Tangguh Gas project, and the Freeport operations. Indonesian security forces are massing in Papua. The role of the military, and Indonesia's transmigration policies, which has caused an increased Javanisation of Papua, has been linked to the rising rate in sexually transmitted disease in the region.

According to Father Neles Tebay of the Catholic diocese in Jayapura, HIV/Aids is threatening the survival of the indigenous people. However, he welcomes recent moves by local leaders to co-operate with their counterparts in neighbouring Papua New Guinea to curb the spread of the disease. Papua's Provincial Legislative Council has said it wants preventative measures taken to stop the spread of HIV/Aids, although it recently shelved a plan requiring Aids patients deemed to have shown "aggressively sexual behaviour" to be implanted with microchips so they could be monitored.

• Villagers have given pseudonyms as they say they fear persecution.