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08 de Nov de 2021
Under Bolsonaro, Indigenous Yanomami see surge in child malnutrition deaths
by Rafael Oliveira on 8 November 2021 | Translated by Roberto Cataldo
With 0.013% of the Brazilian population, the Yanomami accounted for 7% of deaths from child malnutrition in 2019-2020.
More than 50% of Indigenous Yanomami children are underweight and suffering from acute to chronic malnutrition.
Indigenous health advocates blame the problem in part on lack of government support, including the ending of food provisions for community health units.
Another factor is the growing presence of illegal miners inside the Yanomami Indigenous territory, bringing with them disease and contamination; areas more affected by mining also suffer more from malnutrition.
On May 10, the Brazilian newspaper Folha de S.Paulo reported on child malnutrition in the Yanomami Indigenous Territory, located in the country's northern Amazonian region. It featured the image of an 8-year-old Indigenous child from the Maimasi community lying in a hammock, her ribs sticking out due to severe malnutrition.
On the same day, the Palimiu community, also in the Yanomami Indigenous Territory was attacked by illegal miners. Shortly after, President Jair Bolsonaro said that "Criminalizing miners nowadays in Brazil is not fair. I'm not saying that because my father was a miner for a while. That has nothing to do with anything."
According to the Christian missionary who released the image of the Indigenous child, the village had not been visited by health workers in six months. Days later, on May 22, after several other attacks by illegal miners on Palimiu, the Yanomami once again made headlines: a 1-year-old child from the Yaritha community, weighing only 3 kilograms (6.6 pounds), had died from severe malnutrition. An airlift to Boa Vista, the capital of Roraima state, had been requested by the community on the afternoon of May 20, but didn't happen in time.
This tragedy was not an isolated fact. In 2019-2020, the first two years of the Bolsonaro administration, at least 24 Yanomami children under the age of 5 died from malnutrition, according to data obtained by Agência Pública from the Ministry of Health's Special Secretariat of Indigenous Health (SESAI) under a freedom of information request. The real numbers could be even higher, as there is no comprehensive health coverage in the territory, and different isolated peoples live in the Yanomami reserve. The deaths occurred in 15 of the 37 communities that fall under the Yanomami Indigenous Special Health District (DSEI), 11 of which are located in Roraima and the rest in Amazonas state.
Taken as a proportion of the population, Indigenous children are far more likely to die of malnutrition than other children in Brazil. Nationwide from 2019-2020, 352 Brazilian children under 5 died from malnutrition, according to the Ministry of Health's DataSUS database. This means 7% of these deaths occurred in the Yanomami reserve, which holds only 0.013% of the country's population. The figures from both SESAI and DataSUS are still preliminary and may change with future updates.
In 2019, 4.13% of the nearly 5 million Brazilian children under 5 suffered from acute malnutrition (characterized by low or very low weight for their age), according to the Ministry of Health's Food and Nutritional Surveillance System (SISVAN). Information provided by SESAI shows that in the same year, more than half of the 5,260 Yanomami children monitored suffered from malnutrition. The figure was close to 80% in the reserve's Arathaú community.
According to sources consulted by Agência Pública, this situation is a result of a lack of government presence in the Yanomami Indigenous Territory. "Society has to understand that these children are ill because there is no health care in those communities," says Júnior Hekurari, president of the Yanomami and Yek'wana Indigenous Health Council (Condisi-YY), who revealed the case of the child who died of malnutrition in the Yaritha community. "Health is not taken seriously; it's very precarious."
"The situation of vulnerability experienced by the Yanomami is due to lack of government," said Dr. Paulo Basta, a researcher with the Oswaldo Cruz Foundation (Fiocruz), Brazil's leading public health research institute. "They say that they are not vulnerable; they've been placed in a vulnerable situation by the government."
Basta is one of the authors of a study on child malnutrition among the Yanomami carried out in 2019 by UNICEF, with Fiocruz and other government agencies. The researchers found that in the areas of study (Auaris in Roraima, and Maturacá in Amazonas), 81.2% of children suffered from chronic malnutrition and 48.5% from acute malnutrition.
According to Basta, child malnutrition among the Yanomami is especially high in the 1-5 age group. The children often suffer from diarrhea or other illnesses, such as malaria, and are unable to regain weight. "This occurs exactly when they are being weaned. When children are born, they have guaranteed food, that is, breast milk, they are taken care of, with all the nutrients they need to grow," he said. "But then they are weaned and start crawling on the ground with no sanitation, no potable water to drink or wash their hands, and traditional foods are scarce in the territory."
Medical record of a Yanomami child: after an episode of diarrhea at eight months old, after being weaned from breast milk, this child hasn't been able to regain weight.
While the government is largely absent from the Yanomami territory, illegal miners are increasingly making their presence felt, fueled in part by rhetoric from the president. "Illegal mining is the source of all the ills there, at least in Roraima," said Alisson Marugal, a federal prosecutor in Roraima. "If you took mining out, I'm not saying that health would be wonderful, but it would improve a lot."
Marugal filed a lawsuit in March 2021 seeking the reestablishment of food provision at Indigenous basic health units (UBSIs) in the Yanomami Indigenous Territory.
Visits are not taking place regularly
Of the 371 villages in the Yanomami Indigenous Territory, only 78 have these basic health units, and they usually lack more extensive medical facilities. "It's just a small table, a doctor with a stethoscope, a pen, and a medicine cabinet," Basta said. The remoteness of most of these units means they often remain unattended. "There was a time when the Yanomami health district had no air transportation, so a helicopter had to come from Rio de Janeiro. This means that health workers do not go to health units, and [critically ill patients] are no longer transferred," Marugal said.
Even when transport is available, some health workers end up not traveling to health units because of the risk of a hostile encounter with illegal miners. That's what happened in Palimiu, after the series of attacks on the community in May.
In places where there are no health units - nearly four-fifths of the communities - patients depend mostly on visits from teams of health workers. According to missionary Carlo Zacquini, SESAI reduced the size of those teams, which affected the service. "[There are] not enough health workers to visit the villages. When they do visit, they don't stay long enough to complete treatment, or they don't have the medicines to use," he said. "This ends up worsening the situation of malnutrition, with acute verminosis.".
This is confirmed by data obtained by Agência Pública, also through a freedom of information request: only 71 of the 371 Yanomami villages received any visit from nutritionists in 2019-2020. These visits were concentrated in only 11 of the 37 base centers, and eight of the 10 base centers with the highest percentages of underweight children in 2019 did not receive any visit. In addition, out of the 15 base centers where deaths from child malnutrition were recorded between 2019 and 2020, nine did not receive any visit.
For Júnior Hekurari from Condisi-YY, the Yanomami health district must improve its planning for the distribution of employees among base centers. He said they are sending around three employees to areas with up to 4,000 Yanonami. "There is no way workers can visit the communities because they receive patients 24 hours a day. They can't leave the base to visit a community that is two or three days' walk away," Hekurari said.
For Marugal, the prosecutor, the situation also reflects the failure of the educational policy among the Yanomami, which ends up affecting food security, especially in early childhood. "We need to improve education among the Yanomami, with a focus on school meals, to train Indigenous leaders who are politically aware of their territorial rights, of the need to train health agents," he said.
More than a year without food at health units
The Yanomami Indigenous Territory covers nearly 9.7 million hectares (24 million acres) - an area larger than Portugal - in the states of Roraima and Amazonas. Some villages, mainly in the Roraima section, can only be accessed by air, usually using small planes. Others have to be accessed by boat.
For most Yanomami, receiving health care at one of the 78 Indigenous basic health units means walking for hours, sometimes days. For cultural reasons, it's common for parents to travel with their whole families to health units to get treatment for malaria, malnutrition or other illnesses. They often arrive hungry, as they have to give up hunting and gathering along the way. In most cases, patients must remain at the health unit during treatment.
Until 2019, considering the particularities of the Yanomami Indigenous Territory, the local Indigenous health district held annual public procurement procedures and provided food to children and adults with a nutritional deficits and to patients who had to remain at health units for treatment. After those procedures were centralized at SESAI in Brasília, however, the situation changed. A 2017 internal ordinance indicates that the Indigenous health district only has to provide food at Indigenous health houses, which receive Indigenous people who need to undergo more complex treatments in the city. In the case of the Yanomami in Roraima, the health house is located in the state capital, Boa Vista.
After food provision was suspended, many Indigenous people stopped seeking treatment, and Yanomami health centers began to depend on donations from organizations such as the Red Cross and Instituto Socioambiental (ISA), an NGO that advocates for Indigenous and environmental rights, in addition to the federal agency for Indigenous affairs, Funai. During that period, funding platform VOAA started a crowdfunding effort. With the support of Condisi-YY, it raised more than $53,000, which will be used to purchase 200 packages of staple foods and tools.
According to Júnior Hekurari, if children are ill, their parents will try to save them rather than go after food first, so the health units need to have food available. In cases of serious illness like malaria and pneumonia, doctors might decide to hospitalize children but that can't be done if there is no food. If ill children are sent back to the community, their parents won't have the necessary knowledge to administer the medicines as most Yanomami can't read.
In 2020, Marugal presented a recommendation demanding that SESAI resume food provisions at health units in the Yanomami health district, but the agency denied the request, and Marugal filed a public civil action (ACP) in early March 2021.
In April, a week before the conciliation hearing scheduled by the judge in charge, SESAI backtracked and decided to open a food procurement procedure. The contracts were signed in June, totaling around $132,000. Nevertheless, food provisions were not restored at all Yanomami health units, according to Júnior Hekurari. "I was there in Auaris, where more than 50 people had been admitted, and there was no food. And the same happened in Olomai [a community located in the same base center], where there are malnourished people," he said.
Mining and malnutrition
The photo of the malnourished girl on the cover of Folha de S.Paulo brought the subject back into the spotlight. It was obtained and released by Catholic missionary Carlo Zacquini, one of the founders of the Commission for the Creation of the Yanomami Park (CCPY), now the Pro-Yanomami Commission. The organization was one of the leading advocates for the territory's demarcation, which happened in 1992.
Sources of protein are already scarce in some areas, and have grown even scarcer with the illegal presence of the invading miners, according to missionary Carlo Zacquini, who released the photo of the malnourished child. Image courtesy of CCPY.
Working in the region since 1968, Zacquini has become an eyewitness to the impact of the non-Indigenous presence in the territory. He saw the first case of severe malnutrition in the 1970s, during the construction of the Perimetral Norte highway (BR-210). The works also brought outbreaks of malaria, measles and other infectious diseases that didn't previously exist in Yanomami territory, which ended up killing large numbers of Indigenous people living close to the road. "I witnessed the death of dozens and dozens of Indigenous people in a matter of a few days, two weeks, because of a measles epidemic," Zacquini said. "I found people who were almost reduced to their bones because they didn't even have the strength to hunt, much less to work in the fields or collect products in the forest."
In the 1980s, especially from 1987 onward, major invasions by illegal miners began in the Yanomami territory, in the first major gold rush in the region. Instead of removing the miners, Funai expelled the missionaries and volunteer health workers from the area. During this period when health care became scarce, 20-25% of the Yanomami died from disease and attacks by illegal miners.
The last so-called disencroachment, which took place in 1992 when the territory was formally demarcated, reduced the prevalence of diseases such as malaria, but the invasion by the miners didn't stop. The following year, one of these groups killed all the inhabitants of the village of Haximu. Five people were convicted of genocide in an unprecedented court decision that remains the only case of its kind in Brazil.
Since Bolsonaro took office at the start of 2019, the presence of miners in the Indigenous territory has increased significantly. According to the report "Forest Scars," produced by the Hutukara Yanomami Association and the Wanasseduume Ye'kwana Association (Seduume) with the ISA, three macro regions are currently the most affected by mining, all of centered around major rivers. At least nine other base centers in the Roraima part of the Yanomami Indigenous Territory have areas degraded by miners, which also affect nearby regions.
For Dr. Paulo Basta, the presence of miners forces the Indigenous population to turn to processed food and give up traditional foods, affecting their health situation that was already compromised by being forced to give up their nomadic lifestyle and settle down. Image by Christian Braga/Greenpeace.
According to data from the Amazônia Minada project, which monitors applications to mine in protected areas in the region, just over a third of the Yanomami territory, an area larger than Belgium, is subject to such requests. Mining in Indigenous territories is prohibited under Brazil's Constitution. "When mining enters the community, I usually say that it's just the tip of the iceberg," said Basta, the Fiocruz researcher.
"[Miners'] first actions include devastating the forest completely, cutting down trees, driving away all native species, fauna, flora, changing the local ecosystem, which alters the population of mosquitoes and causes malaria. Malaria outbreaks are directly associated with mining," he said.
According to Basta, who has published other articles on the subject, many of the child malnutrition cases in the Yanomami Indigenous Territory are associated with recurrent episodes of malaria among children, which affects their nutritional status in ways that are difficult to reverse.
"We are suffering a miner invasion in the Yanomami Indigenous Territory," said Júnior Hekurari. "It's making the water dirty and carrying various types of diseases into the communities. Where malaria didn't exist, it exists now because it arrived through miners, dirty water that causes contamination, that carries these diseases. It's falciparum malaria [the most severe form of the disease], which didn't exist two or three years ago."
The "dirty water" that Júnior Hekurari referred to includes mercury contamination. The heavy metal is commonly used by miners to separate gold from other sediments. A 2016 study revealed that in some villages up to 92% of residents were contaminated with mercury, including children under 5. Contamination also affects fish, the staple food in some communities. In Maturacá, in the Amazonian portion of the Yanomami territory, a similar study carried out in 2019 found that 56% of women and children in the region had mercury in their bodies.
Their exposure to mercury contamination, malaria and other diseases has left Yanomami fathers and mothers often unable to hunt, sow their crops or collect food. With no electricity and therefore no way to store food for long periods, this inability to search for food due to disease is a key factor in the child malnutrition problem in the territory.
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