Ruled by a military junta for decades, Burma/Myanmar (hereafter referred to as Myanmar) held elections in November 2010, and the nominally civilian parliamentary government that took power in March 2011 has overseen a dramatic increase in humanitarian assistance and business investment. Accurate information related to health and human rights conditions under the old governance structure will allow the current government and the international community to monitor the health impact of these policy changes, and to track the progressive realization of the right to health.
National health statistics reported by UNICEF suggest that the health situation is worse in Myanmar than in neighboring countries. For example, in 2009, the infant mortality rate (IMR) was reported to be 54 per 1,000 live births in Myanmar, more than four times the rate in Thailand (12 per 1,000 live births)
. However, national figures do not include data from substantial portions of the country, including areas that are conflict-affected or controlled by non-state actors along Myanmar’s borders with Thailand and China.
The health information gap prior to the elections was partly due to the under-developed health research capacity in the country as a whole: Myanmar recently ranked 218th out of 224 countries in number of publications in medicine per capita (0.4 per 100,000 people)
. Prior to 2010, over four decades of conflict had produced widespread internal displacement, erosion of health systems, and limited access to health care and information. Over 446,000 internally displaced people were living in heavily militarized areas of eastern Myanmar
 where access for international humanitarian workers was severely constrained
Community based organizations (CBOs) with unique access to these areas have filled health information gaps by conducting population-based surveys that have estimated rates of death and disability higher than rates reported for the country as a whole. For example, in 2004, CBOs conducted retrospective mortality surveys in Kayin (Karen) and Kayah (Karenni)
 that found under-5 mortality rates of 218 per 1,000 live births, higher than the nationally reported rate of 105 per 1000 live births
Rural poverty and a paucity of health care services contributed to poor health outcomes prior to elections in 2010
. However, evidence suggests that economic and healthcare factors alone did not explain the elevated risk of disease and mortality in Myanmar’s border regions, where exposure to human rights violations (HRVs) also contributed to poor health. For example, loss of food security has been associated with anemia (hemoglobin < =11.0; odds ratio (OR) = 7.47)
 and child malnutrition (OR = 1.94)
. Forced displacement has been also associated with unmet need for contraception (OR = 1.68)
, child death (OR = 2.80), and child malnutrition (OR = 3.22)
. In Karen State, households that experienced assault during 2011 had 9 times the odds of moderate to severe household hunger. Forced labor was also associated with increased odds of night blindness (OR = 1.53) and diarrhea (OR = 2.98)
Although widespread HRVs likely contributed to poor health outcomes in eastern Myanmar in 2004, evidence is lacking to illuminate the health and human rights conditions immediately prior to the 2010 elections. Since 2010, new cease-fire agreements have been signed with several non-state actors and qualitative reports suggest a relative decline in fighting in eastern Myanmar
. In order to provide a pre-election baseline from which the expected positive health-related benefits of political and economic change can be measured, this manuscript presents results of a large population-based survey of health and human rights conducted in eastern Myanmar, shortly before the recent transition. These data aim to estimate the burden of mortality and morbidity, the prevalence of HRVs, and the association between HRVs and poor health.
The present survey differs from previous studies in the region in several ways. As it was conducted via a joint effort of several CBOs working in partnership, the geographical scope and target population size are considerably larger. In addition, this survey was conducted across a variety of political contexts throughout eastern Myanmar, ranging from areas of ceasefire to ongoing conflict and fluctuating control.