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AAA calls upon the Brazilian government to fulfill its obligation to protect the health and human rights of its Indigenous Peoples during the COVID-19, pandemic which is causing clearly avoidable misery and deaths. The below letter was delivered to the following individuals:
Sr. Jair Bolsonaro
Praça dos Três Poderes, Palácio do Planalto
Sr. Eduardo Pazuello
Acting Minister of Health, Esplanada dos Ministérios,
Sr. André Luiz de Almeida Mendonça
Minister of Justice, Esplanada dos Ministérios
Antônio Augusto Brandão de Aras
Procurador Geral da República, Federal Public Ministry
Sr. Gustavo Freire Borges
FUNAI Regional Coordinator
Sr. Marcelo, Augusto Xavier da Silva
President of FUNAI
Sr. Robson Santos da Silva
Secretaria Especial de Saúde Indígena
Ministério da Saúde
Sr. Rodrigo Maia
President of the Chamber of Deputies
Dear Senhor Presidente and Distinguished Gentlemen,
On behalf of the American Anthropological Association, a US-based organization of researchers and policy experts with close ties to colleagues and communities in Brazil, we join Cultural Survival and the Society for the Anthropology of Lowland South America to express our concern about the situation among Indigenous Peoples and communities, as well as Quilombolas and other traditional groups, during the Covid-19 pandemic. We believe that it is urgent to take immediate and substantial measures to protect their health and safety.
According to reliable reports we have received, the situation is growing worse by the hour, requiring the implementation of measures that fully conform to WHO guidelines and recommendations. These include providing resources and protocols to ensure that all SESAI (Special Indian Health Service of the Ministry of Health) districts and facilities implement procedures that guarantee the proper tracking and treatment of infected individuals as well as the proper isolation of positive Covid-19 cases and patients undergoing treatment. Failure to isolate infected individuals puts others at high risk and compromises the health of other individuals and communities.
We also urge you to immediately cease the administration of hydroxychloroquine to Indigenous patients, either as a prophylactic agent or in treatment of Covid-19, unless it is closely monitored in hospital settings and with patients’ fully informed consent, as required by international law. Indigenous patients must never be used as research subjects in clinical trials without such consent. According to the International Covenant for Civil and Political Rights (1966), which Brazil ratified in 1992, “No one shall be subjected without his free consent to medical or scientific experimentation” (Part III, Article 7).
Brazil has a special responsibility to protect and ensure the health and safety of its Indigenous populations, including inhabitants in remote areas of the Amazon and those who live in impoverished regions, such as the Northeast and urban areas where poverty makes Indigenous peoples particularly vulnerable. Failure to do so is irresponsible and grossly negligent.
The current procedures and protocols outlined in SESAI Covid-19 Contingency Plans do not conform to WHO Guidelines and Recommendations. They may violate Article 231 of the 1988 Constitution, ILO Convention 169 and the United Nations Declaration on the Rights of Indigenous Peoples, of which Brazil is a signatory. Brazil’s current policies concerning the health and protection of its Indigenous citizens are nothing less than genocidal.
Brazil’s first reported Indigenous COVID-19 case was a 20-year old female Kokama healthcare worker who contracted the virus in early April from a non-indigenous physician. SESAI did not take proper steps to prevent the virus’s transmission. It spread rapidly in Parque das Tribos on the outskirts of Manaus, which is home to many Indigenous Peoples, including the Tikuna, who have been exceptionally affected. Despite the courageous work of front-line health care professionals -- including technical specialists, nurses, dentists, physicians and Indigenous health monitors who are working in dangerous conditions -- more than 70 Kokama have died of COVID-19 since the first case was reported in April.
The virus quickly traveled up the Rio Negro to São Gabriel da Cachoeira, also located in Amazonas state, where it has decimated the region’s Indigenous inhabitants. On April 3, 2020, the Secretary of Indigenous Health, Robson Santos da Silva, declared that the Special Indigenous Health Service (SESAI) will no longer serve Indigenous people who reside in urban areas. This leaves Indigenous residents of the town of São Gabriel da Cachoeira, where the majority of residents are Indigenous, as well as other Indigenous urbanites, without the health services to which they are entitled.
Indigenous people do not “become white,” as Mr. da Silva insinuates, simply by residing in cities and towns. By taking this position, SESAI abrogates its responsibility to care for and ensure the health and safety of Brazil’s Indigenous peoples. SESAI must serve and care for all Indigenous people, regardless of their place of residence. Failing to do so is a severe breach of the Ministry of Health’s constitutional mandate to provide health care to the nation’s Indigenous Peoples. Article 196 of the 1988 Constitution and Federal Law nº 9.836/99 specify that SESAI must offer a network of services to Indigenous people according to cultural, demographic, and geographic criteria. Therefore SESAI is obliged to carry out its responsibility to provide healthcare to Brazil’s urban Indigenous citizens.
Covid-19 is spreading rampantly through Brazil’s Indigenous populations. According to the Boletim Epidemiológico SESAI/MA, dated 1 July 2020, there are 6,846 confirmed Indigenous COVID-19 cases, 156 deaths, and 776 suspected cases. APIB, the Articulação dos Povos Indígenas do Brasil, reports higher numbers. As of 7 July 2020, its National Committee for Indigenous Life and Memory reports 12 048 infections and 444 COVID-19 related Indigenous deaths in more than 122 Indigenous groups across 14 states. The highest concentration of Indigenous COVID-19 deaths is in Amazonas state. According to APIB, the Indigenous Covid-19 mortality rate is more than twice that of the national population. This is unacceptable. This high rate of mortality among Brazil’s Indigenous population is the result of negligence and failure to protect the health and safety of the nation’s Indigenous Peoples.
A recently diagnosed COVID-19 case among the Xavante of Mato Grosso illustrates SESAI’s failure to ensure proper isolation of infected Covid-19 cases, guaranteeing that the virus will spread unchecked. WHO guidelines and recommendations for the treatment of confirmed COVID-19 cases are to Track, Test, and Treat. Treatment includes isolation to protect co-residents and communities. On May 28 health officials in São Felix do Araguaia returned a COVID-19-infected man to the Xavante village of Marawãitsédé, where health and sanitation are precarious, in violation of FUNAI policy to ensure that domestic environments are adequate to isolate confirmed COVID-19 cases. Hospital officials discharged the infected man with some medications to be overseen by a local Indian Health Service worker and instructions to remain in “domestic isolation.”
SESAI’s special COVID-19 guidelines are misleading, vague and inadequate for the current situation. Its standard COVID-19 protocol --- “Test and Return Home for domestic isolation”-- as outlined in March 2020 Contingency Plan for Human Infection by the new Coronavirus (COVID-19) in Indigenous Peoples within the Xavante Special Sanitation District -- is inconsistent with Indigenous realities because isolation is impossible. The policy guarantees that many Indigenous people will be exposed to infection, and many
will die prematurely.
In most Indigenous communities multiple families live together in multigenerational houses that often have no fixed walls, are poorly ventilated and frequently have no inside sanitation or running water. In many Indigenous communities, people share and congregate around a common water source, which makes regular hand washing and social distancing difficult. Returning infected individuals to communities where living conditions and sanitation are precarious guarantees that infection will spread from household to household.
Family members and people in Indigenous communities who will inevitably bear the responsibility to care for infected individuals are untrained and ill-equipped. The few local health professionals (and many communities have none) lack Personal Protective Equipment (PPE). There are no gloves or shields and few face masks in the majority of Indigenous communities in Brazil. Household members cannot protect themselves from contagion while living under the same roof as a COVID-19 patient, not to mention while caring for a sick and infected individual in the same home. Local health professionals are often Indigenous health monitors, who have little training and lack resources to cope with any serious illness. They are likely to become easy targets for blame when disaster hits. It is unconscionable and inexcusable to put Indigenous health monitors in situations where they lack proper protective equipment and will be blamed for the government’s lack of attention.
Indigenous people are particularly at risk, given high rates of diabetes, tuberculosis, malnutrition, and other health conditions, many of which result from sustained lack of adequate medical attention and preventive health care in their communities. These communities lack adequate health care resources. Local health care facilities are poorly equipped and often staffed with minimally trained health care workers. Many communities have no Basic Indigenous Health Units (UBSI), and existing UBSIs are often severely understaffed.
In many cases, Indigenous people must travel great distances to obtain medical attention. For example, according to Xavante PC-DSEI (COVID-19 Contingency Plan for the Xavante Special Indigenous Sanitary District ), only 8.5 percent of Xavante communities have UBSIs. OPAN’s recently released Technical Report on the Vulnerability of Xavante to the COVID-19 Pandemic shows 670 Xavante for each UBSI, compared to the Xingu, where each UBSI is responsible for almost half that number (348). The DSEI of Cuiabá –which serves Boe Bororo, Balatiponé Umutina, Kurã Bakari, Miki, Manoki, Enawene Nawe, Nmbikwara, Guaté, Chiquitano and Hailit Paresi - has an even lower ratio: 170 people per UBSI. This means that more than 90 percent of the Xavante population has extremely limited access to health monitoring and minimal care.
Brazil’s current COVID-19 policies and protocols for Indigenous People undermine all institutions (FUNAI, SESAI, IBAMA - Brazil’s Institute of Environmental and Renewable Natural Resources) whose responsibility is to respect, protect, and fulfill the rights of Indigenous Peoples. Brazil’s policies also violate Indigenous Peoples’ rights to health and safety as guaranteed by the national Constitution, ILO Convention 169, the United Nations Declaration on the Rights of Indigenous Peoples and other international agreements.
Our Association urges that Brazil immediately implement protocols that conform to WHO guidelines and recommendations. Brazil must provide SESAI with resources so that it can:
In addition, with the consent of Indigenous communities, FUNAI must block entrances and exits to and from Indigenous Territories, criminalize and prosecute the entry of unauthorized or infected persons into Indigenous Territories, while providing appropriate medical attention in Indigenous communities.
These measures are urgent and necessary to halt the spread of this lethal virus and protect the lives of Brazil’s Indigenous Peoples. We look forward to receiving your prompt reply.
Cc: Cultural Survival
Society for the Anthropology of Lowland South America