By Orlando de Guzman & Andrew Marshall

If you don’t like hospitals—and who apart from health professionals does?—then you’ll hate Dhaka Hospital during one of the Bangladesh capital’s regular cholera epidemics.

Last October, when we filmed Dhaka’s Cholera Wars for Al Jazeera, the emergency ward was seething with men, women and children, many of them severely dehydrated and fighting for life. Patients moaned as nurses connected them with intravenous needles to bags of saline. Hospital orderlies pushed away trolleys piled with buckets of diarrhoea and vomit.

And all the while more patients arrived, by wheelchair or stretcher, or half-carried by fretful relatives, until they spilled out into makeshift wards set up in the parking lot.

It looked like pandemonium, but it wasn’t. The Cholera Hospital, as locals call it, is efficient and deceptively high-tech. (Look closely, and you’ll see that medical staff track each patient with handheld computers.) And it is unrivaled at treating large numbers of patients with potentially fatal diarrhoeal diseases such as cholera. “If you arrive alive at our hospital,” its director Mark Pietroni told us, “then you leave alive.”

We quickly realized that what we were filming was not a hospital, but a factory of miracles. Its staff save thousands of lives.

Dhaka has two cholera outbreaks each year: roughly, one before and one after the monsoon. Left untreated, cholera can kill in hours and it spreads quickly, which is why it so terrifies people. “You can start being ill at ten the morning and be dead by two in the afternoon,” says Pietroni. But treat it promptly, and even the sickest patients make a full recovery. Patients who were stretchered into Dhaka Hospital were walking out—albeit gingerly—within 24 hours.

Dhaka Hospital is part of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), a world leader in its field. One morning, while filming around the centre’s sprawling compound, a grey-bearded figure shambled past. “That’s Richard Cash,” explained a staff member in a reverential undertone. “He should have a Nobel prize.”

Now 70 years old, Cash pioneered the use of oral rehydration solution (ORS), a simple mixture of salt, sugar and water, to treat cholera and other diarrhoeal diseases. ORS is thought to have saved more than 50 million lives.

Today, ORS is the primary weapon in Dhaka Hospital’s fight against cholera. Treatment is free, but that doesn’t mean only the poorest go there. So do affluent Bangladeshis, who know the hospital’s no-frills appearance belies a standard of care offered almost nowhere else. We often saw sick children cradled by mothers in fine sarees and gold jewellery.

While we were filming in Bangladesh, another cholera epidemic was raging in Haiti, which had been devastated by a powerful earthquake in January 2010. By late October, the Caribbean country had reported about 3,800 cases and 280 deaths, a mortality rate of more than 7%. During the same period, Dhaka Hospital probably treated at least half that number of cholera patients, and we didn’t hear of a single death.

We left Bangladesh with a new appreciation for the staff of Dhaka Hospital and the ICDDR,B—and for the people of the world’s most densely populated large country. The poverty of Bangladeshis, and the disasters they endure, are well-documented. We hope that Dhaka’s Cholera Wars also shows their courage and resilience in the face of an age-old disease.

Watch Dhaka’s Cholera Wars on Al Jazeera

MEET COLONEL FISH SAUCE
By Orlando de Guzman & Andrew Marshall

We nicknamed him, rather cruelly, “Colonel Fish Sauce,” after the pungent staple ingredient in Thai cooking. The Royal Thai Army had invited us to film its drug rehabilitation program at a vast military base outside Bangkok, and the colonel’s bizarre advice to young drug users seemed to embody all that was wrong about the place.

“Eat lots of fish sauce,” he urged the men, who sat on the ground next to the colonel’s well-shined boots. “It replaces calcium and makes you sweat. The drugs come out with your sweat.”

Get caught on a minor drugs charge in Thailand, and you will likely be detained at a military-style boot camp like this, run by the armed forces or police. The one we visited for Al Jazeera’s “101 East” program is fairly typical. There, guarded by officers from an artillery regiment, a hundred or so men underwent the army’s version of rehab: four months of dawn-to-dusk military exercises.

They are not alone. Every year, hundreds of thousands of drug offenders end up at boot camps across Asia. Some camps are brutal: detainees at facilities in China, Vietnam and Cambodia have been subjected to torture and forced labor, reports Human Rights Watch. All are ineffectual: relapse rates hover between 60% and 95%, reports the World Health Organization. So why do most Asian governments still favor them?

One charitable answer: out of sheer panic. Asia is awash with a highly addictive drug called methamphetamine. The pill form is often known by its Thai name yaba (“crazy medicine”), while the purer, crystalline form is called ice, shabu, or speed. According to the United Nations Office on Drugs and Crime, it is now the “first choice drug” in China, Japan, Taiwan, and much of Southeast Asia.

Every year, police in these countries seize millions of yaba pills and hundreds of kilos of ice. But this still represents only a tiny fraction of what Asia produces and consumes. With law-enforcement agencies proving incapable of shutting off the supply, then reducing demand is paramount. But the repressive rehab policies favored by most Asian governments have barely dented it.

Methamphetamine can be eaten, smoked, snorted, or injected. Euphoric highs—the drug boosts energy, self-esteem and sexual pleasure—are often followed by crashing lows. Withdrawal symptoms can include fatigue, anxiety, paranoia, insomnia, loss of appetite, and depression.

Addiction is hard to treat. There is no methadone-like substitution drug. (Fish sauce is no help.) Heavy users can take months or even years to recover. Dependence is best treated with psychosocial and other behavioral therapies, which require time, money, and expertise.

It is cheaper and easier to incarcerate men at army camps and march them up and down for four months, often much longer. If high relapse rates don’t bother Asian governments much, it’s because boot camps aren’t really designed to rehabilitate users. They are designed to punish users, and thereby demonstrate that a government is tough on drugs.

Asians are sick of the havoc that methamphetamine is wreaking on families and communities. They desperately want solutions, and politicians are always happy to promise quick fixes. The Association of Southeast Asian Nations, for example, absurdly insists that its 10 member countries will be “drug free” by 2015. Good luck. In 2009, more than 135,000 people were arrested on drug-related charges in Thailand alone.

Detention centers were partly designed to decriminalize users and keep them out of Asian prisons already overcrowded with drug offenders. Sure, most boot camp detainees don’t get criminal records. But they are stigmatized, cut off from their families and jobs, and eventually released back into drug-saturated societies with no real-life training to help them stay clean.

One surprising exception to this is Malaysia. Surprising, because this Muslim-majority nation isn’t exactly famous for its progressive policies. (Recently, one state sent dozens of schoolboys to a boot camp to address their “effeminate tendencies.”) The Global Commission on Drug Policy recently urged world leaders “to articulate publicly what many of them acknowledge privately”: that repressive strategies don’t work. Zuraidah Mohamed, who last year took charge of Malaysia’s National Anti-Drugs Agency (NADA), has done exactly that.

“We’ve been in this compulsory [drug rehab] business for 28 years,” she told us. “The result is not encouraging at all. Something had to be done.” That something is what NADA calls Cure & Care Clinics. Drug users report to these clinics voluntarily and are treated as patients with a chronic, relapsing disease. At a clinic outside Kuala Lumpur, we filmed a group therapy session in which Malaysian men and women sat in a circle with counselors and discussed what triggered them to relapse into drug use. The difference between this spirited session and the one run by Colonel Fish Sauce couldn’t have been more striking.

NADA now runs seven Cure & Care Clinics and plans to open another 10 by 2013. Skeptics note that Malaysia still has 20 compulsory rehab centers, where conditions can be appalling—inmates rioted and set fire to one in Johor state just last week. But NADA’s change of direction remains a laudable exception in a region where the trend is still toward increasing compulsory rehab. Methamphetamine is Asia’s favorite high, but repressive and counterproductive drug policies are proving just as hard a habit to kick.

Watch Asia’s Speed Trap on Al Jazeera’s 101 East program.

It was not the last time I would be confused with Andrew MacGregor Marshall, a Reuters veteran of 17 years until his recent resignation. Traffic to this website has spiked in recent days, and a glance at the search terms suggests that I’m not the person many of you are looking for. You’re looking for “the other Andrew Marshall,” who plans to publish on his own website a story based on a trove of sensitive U.S. embassy cables acquired via WikiLeaks.

There are many differences between me and Andrew, but here is one: I live in Bangkok, where I can be jailed for up to 15 years for offending Thailand’s royal family; Andrew lives in Singapore, where he cannot. Last month, a U.S. citizen was arrested in Thailand for allegedly posting a link on his blog to a banned biography of King Bhumibol Adulyadej. So forgive me if I don’t post a link to my namesake’s new website. I urge you to google “Andrew MacGregor Marshall” instead.

But my favorite response was an article on a travel website called www.atvisit.com. “Why the Beautiful Kuta Beach Bali to be Dirty With Garbage?” reads the headline. “Kuta beach is one beach which is known by its exotic,” it continues. “But why commencement the period of Dec 2010 to April 2011 there is extravagant increase of trumpery?” It ends with the solemn advice, “Act with for not littering.”

Kuta is not the only beach reviewed by the site. It also considers those of the Bahamas. Xanadu beach is “not uncomfortably huddled,” Mather Town is “an excellent abode for those who savor converging locals,” and Taino offers “all the tralatitious pastimes.” And don’t miss Golden Rock, which boasts “stunning hot sands on the boundary of a spectacularly dismal actress.”

The site belongs to an Indonesian called Herry Hendro. In another era, Hendro’s linguistic exuberance would mark him out as Surabaya’s answer to James Joyce. In fact, he writes in Indonesian and his computer puts it into English. His site demonstrates the limitations—or, if you like, the thrilling possibilities—of Google Translate.

For Hendro doesn’t restrict himself to tropical beaches. Here is his appraisal of the Kendall Hotel near Massachusetts Institute of Technology: “A breakfast strike, wireless internet, and a conceding to FITCORP suitableness edifice use are included with your stick. Additionally, meeting rooms are accessible for your byplay or ethnical events.” The hotel is “utterly situated as a propulsion disc for exploring the area or conducting line in either Beantown or University.”

Hendro also pays tribute to Saltspring Island, in British Columbia, which is famous for its “showy anaesthetic characters” and “the factual, old-fashioned sumptuosity” of its lodgings. But be warned: your voyage from the mainland could be hampered by an “unforesightful shipping fuckup.”

EAT, PRAY, DUCK: BALI’S ONGOING WOES
Trash, traffic and trigger-happy cops. Isn’t Bali supposed to be paradise?

By Andrew Marshall

The annual monsoon transforms Bali. Rain sweeps across slumbering volcanoes. Moss thickens on ancient temple walls. Rivers swell and flush their trash and frothing human waste into the sea off Kuta Beach, the island’s most famous tourist attraction, where bacteria bloom and the water turns muddy with dead plankton. “It happens every year,” shrugs Wayan Sumerta, a Kuta lifeguard, who sits with his love-struck Japanese girlfriend amid dunes of surf-tossed garbage. So why, in early March, did the Bali authorities warn tourists that swimming there for over 30 minutes could cause skin infections? The lifeguard tenderly strokes his girlfriend’s naked leg. “I guess some people just have sensitive skin,” he says.

Itchy ocean? Just add it to Bali’s growing list of seemingly intractable problems: water shortages, rolling blackouts, uncollected trash, overflowing sewage-treatment plants and traffic so bad that parts of the island resemble Indonesia’s gridlocked capital Jakarta. And don’t forget crime. In January, amid a spate of violent robberies against foreigners, Bali police chief Hadiatmoko reportedly ordered his officers to shoot criminals on sight. You’ve heard of the Julia Roberts movie Eat Pray Love, which was partly filmed in Bali? Now get ready for its grim sequel: Eat Pray Duck.

Most of Bali’s woes stem from a problem that rival resorts would love to have: too many tourists. In 2001, the island welcomed about 1.3 million foreign visitors. Ten years later — and despite bombings by Islamic extremists in 2002 and 2005 that killed 222 people, mostly Australian tourists — the island expects almost twice that number. And there are millions of Indonesian visitors too.

Hotels, shopping centers and restaurants are springing up everywhere to accommodate them. The cranes looming over Kuta are building at least three malls and a five-star hotel. But the less glamorous stuff — roads, power lines, sewers, parking spaces — often remains an afterthought. “The infrastructure is not keeping up with the development,” says Ron Nomura, marketing director at the Bali Hotels Association. The island’s lack of reservoirs, he says, is a case in point. “Can you believe there is this much rain and we don’t have enough water?”

When it comes to Bali, newspaper editors have a seemingly bottomless stock of “Paradise Lost?” headlines. Its rich Hindu culture is so distinctive that many people mistake the island for a separate country rather than a province of the world’s most populous Muslim nation. That Bali’s tourism industry has survived terrorism attacks and a global recession is a cause for pride. But amid unchecked growth and a creaking infrastructure, it is also a source of complacency. “It’s like Bali is slowly committing suicide,” says local journalist Wayan Juniarta.

Bali’s Governor I Made Mangku Pastika knows it. In January, he issued a moratorium on new construction in certain built-up areas, and later warned that his lush birthplace might turn into a “dry land full of concrete buildings.” Pastika is popular — he investigated the bombings as Bali’s then police chief — but his moratorium isn’t. “Some people says he’s trying to slow down Bali’s growth,” says Nomura. “That’s not necessarily true. What he’s looking for is more responsible growth.”

He probably won’t find it. Nobody I talked to reckoned that Pastika’s measures would influence who built what where. Bali’s spiritualism might be a bewildering blend of Hinduism, Buddhism and animism, but the island’s planning code is simple: if you build it, they will come.

And on the way, they’ll get stuck in traffic. Complaining about the congestion around the airport or in tourist areas like Kuta is now one of Bali’s newest pastimes. Even in Ubud, the seat of the island’s art and culture, once sleepy streets are clogged with buses carrying Chinese tourists, who visit the island in ever greater numbers. Vehicle ownership on Bali is rising at an annual rate (12.42%) that far outstrips the growth in new roads (2.28%), according to government statistics. “Traffic will get worse and worse,” I Made Santha, Bali’s traffic chief, predicted in February.

Equally damaging to Bali’s prestige is the perception among some expatriates that the island is increasingly unsafe. Lusiana Burgess, the 46-year-old Indonesian wife of a retired British pilot, was robbed and killed in her North Kuta home earlier this year and her murderer remains at large. An Australian woman awoke in her villa to be gagged and assaulted by four thieves. Then an American man was stabbed during another robbery attempt in Kuta. A week after that, police arrested and — following an apparent escape attempt — shot dead 34-year-old M. Syahri, from the neighboring island of Lombok, who was suspected of robbing a number of foreigners.

The statistics actually show a slight decrease in serious crime from 2009 to ’10. But Chris Wilkin, a former oil-company executive from the U.K. who retired in Bali six years ago, remains uneasy. “It was very quiet when I moved here,” he says. “It wasn’t a big attraction for the criminal classes. Now, with the boom, word has got round that there are easy pickings to be had.”

Wilkin, whose Indonesian wife rents villas to expats and knew Burgess, believes the threat of violent robbery will discourage foreigners from leasing properties in remote places. Investing in CCTV, intrusion alarms and bedside panic buttons may only “give a false sense of security,” he says. Recently, Wilkin accidentally set off his burglar alarm. Nobody went to investigate, not even the private security guards in his own complex.

Expat anxiety hasn’t dented Bali’s popularity among its core visitors, the Australians. And why should it? Officially, the Australian government still advises its citizens to “reconsider your need to travel” to Bali due to a “very high threat of terrorist attack,” yet more than a hundred flights arrive from Australia every week. The dangers to new arrivals are those commonly faced by tourists everywhere: dodgy food, motorbike accidents, and — as a sign at my Kuta hotel suggests (“No Jumping from Any Balcony into Pool Is Permitted”) — beer-fueled misadventure.

A new terminal at Bali’s shabby airport is due for completion in 2013. But unless other infrastructure is improved, this will serve only to channel yet more tourists onto a critically overburdened island. For now, however, such doubts are largely forgotten in the rush to cash in on the Bali boom. “Goodness shouts, evil whispers,” runs an overused Balinese proverb. But money talks.

For the Balinese reaction to this story, please see Read With For Not Laughing

Cholera kills 120,000 people every year, estimates the World Health Organization. Could mass vaccination—now being tested in Bangladesh’s cholera-prone capital—prove a new weapon against an old disease?

By Andrew Marshall

DHAKA — Anita Ashfaqunnesa skips over a ditch oozing with raw sewage, her spotless white shawl trailing behind her like a superhero’s cape, then squeezes between shacks built on an old rubbish dump. Three years ago, she explains, this slum in northern Dhaka didn’t exist. But with hundreds of thousands of rural job-seekers pouring into Bangladesh’s capital every year, it now teems with families, and the water they use for drinking, cooking and bathing comes from pipes that run alongside, and often through, the sewage ditches. That’s why the area’s oldest living resident is not a person, but a disease. “Cholera is a common ordeal here,” says Anita, 33. “People don’t fear it, but they are happy to hear there’s a vaccine coming to prevent it.”

Anita is one of a small army of field workers collecting household data for the biggest oral cholera vaccination program in history. It starts on Feb. 17 and will involve 240,000 residents in Mirpur, the district that reports most of Dhaka’s cholera cases. Two-thirds of them will receive two oral doses of a cheap new Indian-made vaccine. “We think of it as a demonstration project rather than a trial,” says Dr. Stephen Luby, Bangladesh country director for the U.S. Centers for Disease Control (CDC). “We don’t have a big question in our minds over whether this vaccine is going to prevent cholera. What we’re trying to do is illustrate the feasibility of using it as a public health intervention.”

Mass vaccination could be a new weapon against an old disease. In Zimbabwe, where cholera claimed 5,000 lives in 2008 and 2009, a swift vaccination program could have cut the death toll by 40%, calculated the authors of a study published in Jan by PLoS Neglected Tropical Diseases. Such results are avidly followed in Haiti, where cholera has killed about 3,800 people and sickened 189,000 since October. A committee that includes experts from the CDC and the World Health Organization (WHO) recently recommended a small-scale cholera vaccination project. This rankled Haitian health officials, who want millions to be protected against a disease that foreign peacekeepers almost certainly brought with them after last year’s earthquake.

Anita Ashfaqunnesa in Mirpur

Nobody in Bangladesh disputes the origins of the disease. The Ganges delta, which India and Bangladesh straddle, is cholera’s homeland. Six of the seven pandemics since the 19th century have originated here. Every year, WHO estimates, there are 3-5 million cholera cases and up to 120,000 deaths worldwide. Dhaka’s dilapidated water and sanitation systems provide ideal conditions. Bounded by rivers that are too filthy to purify, the city pumps up nearly all its water from hundreds of deep wells. It is never enough, especially when those pumps need electricity to run, and Bangladesh is plagued by power shortages too. With no positive pressure in the water pipes, sewage and other contaminants easily leak in.

The only thing Dhaka doesn’t lack is people. With 13 million residents and counting, it is a fast-growing megacity in the world’s most densely populated large country. New arrivals squeeze into already overflowing slums, or squat on wasteland with zero infrastructure. “Wherever there is human misery you will find cholera,” says Dr. Mark Pietroni, Medical Director of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Dhaka, which is implementing the vaccine project with the Bangladesh government. “It thrives on malnutrition, overcrowding and poor hygiene.”

Cholera outbreaks in Dhaka are as predictable as the seasons. There are two each year: roughly one before and one after the monsoon. Dhaka Hospital at the ICDDR,B treats thousands of cholera patients, who during outbreaks not only crowd its wards and hallways, but spill out into tents in the parking lot, forming what might be the world’s only hospital ward with speed bumps. Left untreated, cholera can kill in hours. But treat it promptly and properly, mainly with oral rehydration salts, and death rates are under 1%. At Dhaka Hospital, even the sickest patients make near-miraculous recoveries; arrive with just one breath, say locals, and you’ll leave alive.

But as Dhaka’s population grows, so does the hospital’s patient load. Every March and April, a thousand new patients a day is standard. “Cholera is a dreaded illness because of its rapid onset, severity and potential to cause outbreaks that easily overwhelm public health systems,” says Dr. Regina Rabinovich, director of Infectious Diseases at the Bill & Melinda Gates Foundation. “That’s why it’s important to invest in the development of new, more effective vaccines.”

Enter Shanchol, a two-dose vaccine produced by Shantha Biotechnics of Hyderabad and developed with funding from (among others) the Gates Foundation, which also gave $16.5 million to the ICDDR,B for the cholera vaccine project. Shanchol is safe and efficacious: a trial in the Indian city of Kolkata involving nearly 70,000 people showed that the drug gave 67% protection for at least 2 years. Just as importantly for mass vaccinations, it is cheap: its two doses cost about $3, or about a tenth the price of its only rival, the Dutch-made drug Dukoral. Shanchol is expected to get WHO approval this year.

Bangladesh’s state-run immunization programs are widely trusted, so persuading a cholera-weary populace to take the vaccine shouldn’t be hard. Some 80,000 adults and children will receive it; another 80,000 will receive the vaccine, plus active encouragement to treat household water and wash their hands with soap. But assuaging those who don’t get it might be trickier. This includes 80,000 people who will unknowingly receive a placebo, forming a control group that helps validate the project’s results. “That’s what we perceive is going to be our biggest problem: not everybody gets it,” says Luby, who was seconded from the CDC to head the ICDDRB’s Program on Infectious Diseases and Vaccine Sciences.

One of the project’s broader aims is to get a better idea of cholera’s mortality rate. “Right now most of the estimates that people throw around are quite speculative,” says Luby. Mortality at the ICDDR,B’s hospital may be less than 1%, but some patients are dead on arrival — negotiating this vast city’s gridlocked streets can use up precious hours — and others expire at home.

Mass vaccination has its critics. Today’s drugs do not offer long-term coverage or protect against every cholera strain. And even a cheap vaccine, in high quantities, is expensive and could divert resources from the only thing proven to eradicate cholera: improved water and sanitation infrastructure. (London suffered centuries of cholera epidemics until the Victorians built sewers.) Improving Dhaka’s infrastructure is vital, agrees Luby, but the task could take decades. The same is true for hundreds of cities in our rapidly urbanizing world, and indeed for disaster zones such as Haiti. While that infrastructure is being built or rebuilt, how do you protect a vulnerable population from cholera? Mass vaccination is one answer. “What we’re trying to do is generate some evidence on what’s feasible and cost-effective,” he says.

Participants in the Mirpur project will be monitored for years. But the vaccine’s impact could be felt as early as March or April, when the more severe of Dhaka’s biannual epidemics strikes. “That’s why we’re aiming to have this community immunized by the time that worst peak comes,” says Luby. Haiti — and the rest of the world — will be watching.

Correction: The people in the control group will not receive a placebo, knowingly or unknowingly. My apologies for the error.

Blog post: You’ve Got Cholera

In Indonesia, a military tribunal found three soldiers guilty of torturing Papuans. Horrific footage of this abuse was filmed and posted on YouTube last year. This compelled the Indonesian military to act; so, probably, did the U.S., which recently re-established military links with Kopassus, the special forces notorious for human rights abuses. (Orlando and I witnessed the aftermath of a Kopassus massacre in 2003; watch Orlando’s powerful film on it here.)

For what they did to their victims—they held a burning stick to one man’s genitals, a knife to another’s face (right)—the Indonesian soldiers got off lightly: the tribunal gave them 8 to 10 months in jail. But the sentences still represent a grudging acknowledgment that torture exists in the Indonesian armed forces and that those who commit it should be held accountable.

Now look at Thailand—specifically, at an article in today’s Bangkok Post. “Nothing the military has done has violated the rights of local people,” says Udomchai Thammasarorat, commander of the Fourth Army in southern Thailand. This is the same Udomchai who told me and Orlando, “We confirm we have never committed torture”—even as Amnesty International, Human Rights Watch and other groups continue to document its systematic use against the Malay-Muslim minority in southern Thailand.

Please watch “Thailand’s Tropical Gulag” and, if it moves you in any way, leave a comment below. I’m very interested to hear what you think.

Cholera bacteria

Haiti’s cholera epidemic took place some 10,000 miles from my home in Thailand, but I watched it unfold with more than just academic interest. I recently woke up feeling too nauseous to even sip water. Then diarrhea struck. A few hours later, weak and dehydrated, I was being wheeled into a Bangkok hospital, my blood pressure so low I couldn’t stand up without blacking out. I spent four days on an IV drip, cradling my aching guts.

I was treated for acute gastroenteritis caused by bacteria which the hospital failed to identify. But when I later described my symptoms and their alarmingly sudden onset to a British expert in diarrheal disease, he gave a different diagnosis: cholera.

I was shocked. Left untreated, cholera can kill within hours. Many governments under-report the disease, and not just because its name alone terrifies people. Cholera is a byword for backwardness and neglect. The World Health Organization (WHO) calls it “a key indicator of lack of social development.”

That certainly rings true of the place where I had fallen ill. Pattani is one of Thailand’s three southernmost provinces, a Muslim-majority region in an otherwise largely Buddhist nation. There, a brutal conflict between shadowy militants and government troops has killed more than 4,400 people. On 4 January 2011, this ill-reported war enters its eighth year, with no end in sight.

Statistically speaking, Pattani is a great place to catch cholera. Hundreds of people were infected during an outbreak in fishing communities along the Pattani River in late 2009. Most of the 982 cases reported by Thailand in the first six months of 2010 occurred in the south.

It is easy to blame the conflict. This region was annexed by Thailand a century ago and its Malay-speaking people have chafed under Bangkok’s rule ever since. Since the current hostilities erupted, insurgents have torched clinics and killed dozens of health workers, who are government employees and therefore considered legitimate targets. In the past, military intelligence agents have posed as health workers, endangering them further.

But the chief cause of the south’s health crisis is not years of conflict, but the decades of government neglect that preceded them. Take maternal deaths, another key indicator of the quality of a healthcare system. The maternal mortality ratio in the three southernmost provinces is double the national average of about 12 per 100,000 live births, reports the United Nations Development Programme. In one province, Yala, it is three times the national average.

Or look at polio vaccine coverage. The rallying cry of the Polio Global Eradication Initiative is “every last child,” but in Pattani province it’s more like every third child. Dr Piyanit Tharmaphornpilas, who runs the national immunization programme, has described southern Thailand as a “high-risk area” for the disease’s re-emergence.

That the region’s health system hasn’t collapsed entirely is credit to the bravery and dedication of its members. Despite being targets, health workers still enter southern villages more often than any other government officials and, after religious leaders and teachers, remain the most trusted.

The Thai government has offered them better pay and perks. But conditions won’t really improve until the violence does—and that’s unlikely for now. “Prime Minister Abhisit Vejjajiva has made little effort to tackle the political grievances that drive the insurgency,” reported the International Crisis Group in November. Amid continued conflict, only cholera and its attendant health miseries are guaranteed a safe refuge.

Watch “Thailand’s Tropical Gulag,” a film by Orlando de Guzman and Andrew Marshall, on Al Jazeera’s “People & Power” programme.

IS THE THAI MILITARY TORTURING DETAINEES?
Thai soldiers have adopted the worst practices of the only military they admire more than their own: America’s.

By Andrew Marshall

There is one way the latest WikiLeaks deluge could help beleaguered U.S. officials. It might encourage an Iraq-weary American public to forget the last WikiLeaks deluge: war logs suggesting that the U.S. military had ignored torture by its Iraqi allies. But those allegations still resonate in Thailand, and not just because this staunch U.S. ally is fighting an insurgency of its own. Since 2004, more than 4,400 people have been killed in southern Thailand in a bloody conflict between government security forces and shadowy separatist militants. Most Thais are Buddhists, but the southern provinces of Pattani, Yala and Narathiwat are largely populated by Malay-speaking Muslims, who have chafed under rule from faraway Bangkok for a century.

I recently visited the region with director Orlando de Guzman to co-produce an al-Jazeera documentary on the death of a 25-year-old militant suspect called Sulaiman Naesa. He was detained in May at Pattani’s vast Ingkhayutthabariharn army camp. The Thai army says Sulaiman confessed to his part in nine killings, then later tied a towel to the bars of his cell and hanged himself. Sulaiman’s parents say their son was a semi-literate villager, not a militant, and that the blood and bruising on his corpse proves that soldiers tortured him to death.

What really happened? We’ll probably never know. His parents saw no point in an autopsy. “How could we fight the government?” asked his mother Maetsoh. But Sulaiman’s case should refocus international attention on human-rights violations in southern Thailand — specifically, on an ever growing body of evidence that suggests that the military routinely tortures Muslim detainees. It is also worth asking why the U.S. is remaining quiet about it.

The Thai army was keen to show our crew a human face. Lieut. General Pichet Visaijorn, then the regional commander, gave us a personal tour of his pet projects. They included free dental surgery for local people at his headquarters in Yala. We watched an army dentist fit an elderly Muslim with a set of false teeth. The man grinned. “Are they beautiful?” urged Pichet, grinning back. “Do you like them?” Then the smiles faded. Our next stop was Ingkhayutthabariharn, home to the military’s main detention and interrogation facility. It is called the Reconciliation Promotion Centre — an Orwellian touch, considering the camp’s notoriety. For Muslims, Ingkhayutthabariharn is a “terrifying word,” says Sunai Phasuk of New York City–based Human Rights Watch. “They know anything could happen to them in there.”

Sulaiman Naesa

Sulaiman was found dead in a one-story cell-block that soldiers call “the resort.” (His cell door is pictured above.) “Everyone was scared there,” a former inmate told us. The inmate said he spoke briefly with Sulaiman, who said that soldiers had kicked him so hard in the stomach that he hadn’t eaten for four days. He said he saw detainees beaten and plastic bags put over their heads to simulate suffocation. So many detainees have complained of torture in southern Thailand, and for so many years, that it is amazing the world hasn’t paid more attention. Abuses reported by detainees include severe beatings, electric shocks, forced nudity, exposure to extreme cold or heat, needles inserted into open wounds and holding detainees’ family members hostage — including, in one case, a 6-year-old boy.

The army has not called these allegations isolated incidents or blamed rotten apples; it has flat-out denied them. “We have never committed torture,” Lieut. General Udomchai Thamsarorat, the regional commander, told me. “We’re here to help people, not hurt them.” Blanket denials don’t impress the experts. “The security forces continue to use torture even though senior commanders claim to have prohibited it,” the Brussels-based International Crisis Group said in November. In the two months leading up to Sulaiman’s death, Amnesty International received eight reports of torture — six from Ingkhayutthabariharn.

Denials don’t fool the locals either. In Pattani, I know a teacher of Malay who, as an exercise, asked his students — all Muslims — to write a newspaper-style report. A dozen of them turned in stories about relatives or friends who had been detained or tortured. When I asked a Muslim paralegal why more people don’t speak out about such abuses, he replied, “We hate the army, but we fear them also. The fear is stronger than the hate.” Such views seemed to barely register with the officers I spoke to. Lieut. General Udomchai said he was “100% confident” that his troops were winning Muslim hearts and minds. A civil affairs officer told me that local people “trust us more and more,” before explaining that Thailand was one big loving family in which Muslims were “naughty teenagers.”

Torture is illegal and morally repugnant. It’s also counterproductive: stories of abuse by security forces are potent recruiting tools for insurgents. Though torture is well proven to produce unreliable intelligence, the military still evidently regards it as an acceptable and effective weapon against a ruthless enemy. Sometimes, torture is used not to extract information but to exact revenge for murdered colleagues. Insurgents regularly burn, behead or mutilate the corpses of soldiers they have killed.

Who can hold the Thai military to account? Not the courts: an emergency law in southern Thailand grants the security forces immunity from prosecution. And not Prime Minister Abhisit Vejjajiva, who is beholden to the army for crushing the anti-government Red Shirt protests in May. The U.S. should have more luck. Its security ties with Thailand go back more than half a century, and it has trained more Thais under its International Military Education and Training program than any other nationality. But there’s a problem. On the subject of torture, the U.S. has no moral high ground left to occupy — especially in Thailand.

After the Sept. 11, 2001, terrorism attacks on the U.S., the Central Intelligence Agency set up a global network of secret prisons where terrorism suspects were subjected to waterboarding, or simulated drowning, and other forms of torture. The system’s first two detainees were brutally interrogated at a prison in Thailand in 2002. In November, the U.S. Justice Department decided that CIA officials would not face criminal charges for destroying videotapes that showed the torture.

The CIA never revealed the exact location of its secret prison, reportedly closed in 2003. And Thailand denied all knowledge of it. Yet many of the so-called enhanced interrogation techniques refined at these facilities — prolonged stress positions, sleep deprivation, use of dogs — keep resurfacing in detainee testimony to international human-rights groups. This is not proof that Americans are teaching Thais how to torture, but it isn’t a coincidence either. The Thai army seems to have adopted the worst practices of the only military it knows and admires more than itself.

In January 2011, Thailand’s insurgency entered its eighth year. Peace doesn’t stand a chance until Thailand’s generals see torture for what it is: a cancer in their ranks. Want to win the hearts and minds of Muslims? Then investigate and prosecute the soldiers who abuse them. What people really want is justice, not free dentures.

Watch “Thailand’s Tropical Gulag,” a film by Orlando de Guzman and Andrew Marshall, on Al Jazeera’s “People & Power” programme.

I’ve just heard that Chiranuch Premchaiporn, editor of the news site Prachatai, has been arrested at Bangkok’s main international airport, apparently on charges of insulting the Thai monarchy. In March, Chiranuch (left) spent nearly four hours in a cage beneath a Bangkok courtroom while her bail was approved on previous charges under Thailand’s Cyber Crimes Act. I first met her the following month, after the deadly “Black Saturday” clashes on 10 April between government troops and Red Shirt protesters in Bangkok. Here’s what I wrote then:

Not long after Black Saturday, I met a Thai woman so dangerous that the Thai state is trying to put her behind bars for the rest of her natural life. We met on Silom Road, near the Rajaprasong protest site. A few nights before, I had watched a mob hurl rocks, bottles and abuse at Red Shirt barricades. Then five M-79 grenades had exploded amid the crowd. One person was killed and dozens injured. The government and the Red Shirts blamed each other, and the perpetrators were never found.

Chiranuch Premchaiporn doesn’t look very dangerous. She is a short, slightly plump woman of 43 who runs an independent news website called Prachatai. She is also one of first Thais to be prosecuted under the Cyber Crimes Act. Her offence? Someone made an oblique but unflattering comment about a member of the Thai royal family on Prachatai’s webboard, and Chiranuch didn’t remove it quickly enough. If convicted of all ten counts against her, she faces 50 years in jail. Prachatai — the name means “free people” — has been shut down.

“The internet is about openness,” says Chiranuch. “It opens minds. That’s what democracies need. But in Thailand the internet has become a battleground, just like the streets.” Chiranuch’s trial began the following month. She says she’s nervous, but doesn’t seem so. “Thailand has to admit that it’s not a real democracy,” she says quietly. “We cannot talk freely about many things.”

Meanwhile, chaos spreads. As I write, there are more clashes, more deaths, more injuries. Elsewhere in Thailand, Red Shirts shut down city halls and obstruct military personnel and equipment bound for the capital. The Yellow Shirts have reappeared to demand the army declare martial law. In Bangkok, grenade attacks and drive-by shootings — usually at night, on government or military buildings — are now so frequent I barely register them. There is talk of civil war, rumors of another military coup.

Is Thailand growing up or falling apart? It is too early to tell. But the old stereotype of Thais — simple, fun-loving, apolitical, as loyal as Labradors — is shattered forever. Chiranuch is relieved. “We’ve woken up from a fairytale,” she says. Then we walk together down Silom Road, past coils of razor wire and shuttered shops and soldiers with assault rifles, towards whatever kind of Thailand comes next.

Many thanks to Nick Nostitz for the photo of Chiranuch. Nick’s latest book ,”Red vs. Yellow, Volume 1: Thailand’s crisis of identity,” is available from all good bookstores.