A Generation in Peril: The Lives of Tibetan Children Under Chinese Rule
III. Healthcare and Nutrition

At the Chinese hospital, . . . I wasn't treated well. They were very rough, and they applied the dressing very forcibly. I asked my father for a Tibetan doctor, and he took me to Phago, where there was a Tibetan doctor with glasses. There, the doctor used a white fluid, which hurt a lot, but made the whites [flesh] go inside. Then he put on a white ointment that didn't hurt at all, and then gave me a black pill; that didn't hurt. Father insisted that the Tibetan doctor take some money, 200 yuan. -Nine years old

The scarcity of data makes it difficult to assess the state of Tibetan children's healthcare and nutrition. Existing reports, however, augmented by accounts of the children we interviewed, suggest that Tibetan children suffer from extremely poor healthcare and many may be unable to take in a diet adequate to their nutritional needs. While China has made substantial strides in some areas of health and nutrition in recent years, Tibetan children's access to healthcare facilities, qualified physicians, immunizations, medicines and health education remains substandard. This proves particularly true for rural Tibetans, who comprise more than eighty percent of the Tibetan population in Tibet. One Lawyers for Tibet source described the operation of China's healthcare system in Tibet as 'the most expensive free healthcare system in the world.' This remark accurately captures the many accounts we heard of prohibitive costs at Chinese hospitals and clinics, which often prevent Tibetan children from receiving basic medical care. Moreover, an inadequate diet and poor water quality, coupled with the lack of vaccinations and standard maternal and child health programs leads to moderate to severe malnutrition and growth stunting. A recent study found that more than fifty percent of Tibetan children in the TAR under the age of seven suffer from growth stunting as a result of malnutrition.

Based upon our interviews and the limited data available, it is difficult to draw broad inferences regarding the status of Tibetan children's health relative to other impoverished regions of the PRC. It is important to emphasize that, unlike in the prior two topics, our research in this area did not reveal clearly that the health and nutritional problems that Tibetan children confront are the result of Chinese rule in Tibet. Many of these problems appear to be symptoms of the same harsh living conditions that characterize other poor and predominantly rural regions of the PRC, such as Xinjiang, Inner Mongolia, Guizhou and Ningxia. Discussion of these issues, consequently, should be considered in this context.

At the same time, we emphasize that the absence of data on health and nutrition results primarily from China's refusal (with few exceptions) to permit independent studies and monitoring of human rights conditions within Tibet. Foreign charities and humanitarian aid projects operate in Tibet, but the government tightly regulates the scope of their activity. In an effort to understand the health conditions for Tibetan children, Lawyers for Tibet conducted mostly anonymous interviews with non-governmental organizations, healthcare workers and others engaged in humanitarian projects within Tibet. But information tends to be anecdotal, so it is difficult to identify patterns and trends that would suggest solutions.

In the context of a human rights study, we also emphasize that government restrictions on the ability of outside organizations to study and publicize the health conditions prevailing in Tibet violate Tibetan children's rights. Under the CRC, states parties agree to pursue economic, social and cultural rights 'where needed, within the framework of international cooperation.' By restricting monitoring and access to information, the government inhibits international cooperation, limiting the ability of international organizations to help children in Tibet.

Even in light of these limitations on access to information, however, it appears that health and nutritional conditions for Tibetan children are in several respects inferior to those prevailing elsewhere in the PRC. Infant mortality rates in the TAR, for example, are much higher than those of the PRC generally. The ICJ cites statistics indicating an infant mortality rate in the TAR of roughly three times the national average. Tibetan children suffer from growth stunting caused by malnutrition. In fact, a recent study published by the New England Journal of Medicine found that '[h]alf of all children in the [TAR] suffer from stunted growth, medical problems and potentially impaired intellectual development as a result of malnutrition . . . .' The Tibetan life expectancy (59.7 years) ranks lowest among China's eighteen 'major nationalities.' Official statistics provided by the PRC indicate that the ratio of doctors and medical aides per village in the TAR is only .61, compared with a 1.8 average for the PRC as a whole. The TAR, in fact, ranks the lowest of all provinces in the PRC in the number of medical personnel per village. Whereas China has roughly 85-95 beds per 1,000 people, the TAR has only 6-22 beds per 1000 people. It is difficult to determine the respective figures for Amdo and Kham because China has broken up these Tibetan provinces and incorporated them within neighboring Chinese regions. Yet our research suggests that similar conditions characterize these areas.

Due to the scarcity of statistics and the difficulty of drawing comparative conclusions, more research in this area is needed, particularly with respect to the causes of malnutrition for Tibetan children, the disparities between Tibet and Chinese provinces, and the PRC's practical capacity (financial, logistical and technical) to improve healthcare and nutritional conditions in Tibet. But our research shows that children in Tibet remain at high risk of malnutrition and disease. Many Tibetan families find themselves unable to obtain basic healthcare, adequate food and, in some cases, clean water for their children. Nutritional deficiencies appear widespread, and health education is nearly absent. These shortcomings threaten the lives and health of the next generation of Tibetans.

A.The International Legal Context: The Rights to Life, Health and Survival -->