East Timor Health Sector
January – December 2000
Beginning at the time of the referendum on independence for East Timor on August 30, 1999, civil unrest during the early month of September lead to the displacement up to 75% of the 850 000 residents of East Timor. Many hundreds of people were killed and a large proportion of private and public buildings heavily destroyed. During this time, 77% of health facilities were damaged. In addition to the physical destruction of health facilities, the emigration from East Timor of doctors and core health professionals (many of them Indonesian nationals) caused the total collapse of the health systems in the territory.
East Timor needed urgent assistance from the international community. Within a few days of the deployment of INTERFET (the International Force for East Timor), OCHA, UNHCR, ICRC and WHO’s Department of Emergency and Humanitarian Action (EHA) had established a presence in East Timor. WHO/EHA role was to immediately coordinate the public health interventions and ensure timely and appropriate information sharing among all partners involved. WHO deployed staff members from HQ, Regional Office for South-East Asia and WHO Country Office in Indonesia as well as employed professionals on short-term assignments. ICRC and fifteen international NGOs, together with military medical teams from INTERFET, began to provide curative services to the general population. During the year 2000, a total of 694,745 consultations and curative interventions were undertaken almost half a million consultations have been provided – more than 80% of the current population of East Timor.
At the early stage in September 1999 to January 2000, WHO together with UNICEF acted as a "Temporary Ministry of Health" coordinating health sector activities in the Territory. ICRC and fifteen International NGOs, together with military medical teams from INTERFET provided curative services to the general population.
On 25 October 1999, by resolution 1272/1999, the Security Council established the United Nations Transitional Administration in East Timor (UNTAET) with overall responsibility for the administration of East Timor through exercise of all legislative and executive authority, including the administration of justice. UNTAET was mandated to consult and cooperate with the East Timorese people to develop national democratic institutions, and to transfer to these institutions its administrative and public service functions.
WHO, with technical back-up from the EHA Department, actively participated in and technically supported the review of health services of East Timor (conducted in December 1999 and January 2000) and the subsequent establishment in February 2000 of the Interim Health Authority - a precursor of the present Division of Health Services.
On 15 July 2000, a transitional Government of East Timor was established, headed by the Transitional Administrator, a Cabinet consisting of 8 Members - four East Timorese and four international staff from ETTA - and a National Council with 33 members. WHO will work in partnership with the Divisions of Health Services and Water & Sanitation under the charge of Cabinet Members for Social Affairs and Infrastructure.
Consistent with the latest developments when East Timor is now ready to move from a state of emergency to development stages, the direction of WHO collaborative activities will be aligned accordingly. In the current situation in East Timor, more than 80% of the population have inadequate income, poor health status, lack of access to adequate health care, safe water & sanitation, insufficient food and nutrition and are faced with poor housing, especially due to wide scale destruction of buildings. Consequently, health would be a major priority for the development of East Timor.
The visit of the WHO Director-General, Dr Gro Harlem Bruntland in October 2000 was instrumental in creating realization in East Timor Transitional Administration on the importance of the health sector, as a major part of social and economical development of East Timor. Consequent upon her visit, health was given priority in administrative as well as at all political levels. This report is intended to give an account of WHO activities during the year 2000.
DEMOGRAPHICS AND HEALTH STATUS
Provisional estimates by the UNTAET Bureau of Statistics, Research and Census (May 2000) put the population of East Timor at 841 000.
Over 280 000 individuals were displaced during the East Timor crisis of 1999; of those, 165 000 have now returned to their usual place of abode. Within East Timor, more than 80% of the remaining population was internally displaced due to destruction of their homes and ongoing violence. UNHCR estimates that about 105 000 East Timorese remain in West Timor, but most of these are eventually expected to return to East Timor. In addition, 6,000 to 10,000 East Timorese are currently residing in Australia; there is no indication of when they may return to East Timor.
Just over 50% of the population is under 20 years of age; children under 5 years of age make up 13.5% of the population.
The birth rate is high (almost 60% in 1998), but an accurate post-crisis estimation is difficult to make.
The true crude mortality rate during and after the crisis is difficult to estimate; few deaths have been reported through the WHO communicable diseases surveillance system or other avenues.
It is thought that over 95% of the population is ethically East Timorese. Ethnic minority groups include a small Chinese community; there is also a small population of Indonesian Muslims who chose to remain in the country after the crisis.
Approximately 9,000 foreign nationals are presently in East Timor, working on reconstruction, aid and development and security related activities.
Unemployment among East Timorese nationals is estimated at 70%. Per capita income is now estimated around US$210 per year, approximately 50% below its 1996 level (Source: (a) Project Appraisal Document on a Proposed Grant in the amount of US$12,7 Million Equivalent to East Timor for a Health Sector Rehabilitation and Development Project, May 24 2000; World Bank Document. Source: (b) Building Blocks for a Nation, November 2000 – The Common Country Assessment (CCA) for East Timor prepared by the UN country team).