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A difficult birth
by Jean-François Berger

Dili general hospital was built in 1983 under the Indonesians.

East Timor broke away from Indonesia in September 1999 at the cost of great suffering. It is in full transition with considerable support from the international community. How does a nation emerge from the ashes and rebuild its infrastructure? And how are the Timorese constructing their own National Society?

What does independence really mean for us Timorese?" asks Joao da Costa Freitas, as he looks over at the window of his small white-walled office. Joao has worked in a hospital environment for the past 30 years, first under the Portuguese colonizers, then under the Indonesians. Now he is the logistics coordinator at Dili general hospital, run for the first time by the Timorese themselves. His question is laden with significance and is one each and every Timorese will have to face from now on.

Eighteen months ago, a chain of events rocked the island of Timor, east of the Indonesian archipelago and north of Australia. On 30 August 1999, two-thirds of the population, about 300,000 people, voted for independence, with the remaining third voting to remain under Indonesian rule. Shortly after, a surge of hatred and violence spread like wildfire through the eastern half of the island. Pro-Indonesian militias went on the rampage, looting and destroying homes and the territory's main infrastructure. Their vindictive message was clear: if you want independence, you can build it yourselves from scratch. The toll: more than 500 people killed, numerous towns and villages gutted and a mass exodus towards the western half of the island, the Indonesian province of West Timor.

The winds have calmed since those tragic events. A multinational military operation with substantial help from humanitarian organizations succeeded in restoring security and responding to people's immediate needs. Now, the task of administering the territory is in the hands of UNTAET, the United Nations Transitional Administration for East Timor. Created on 25 October 1999 by UN Security Council Resolution 1272, UNTAET is ultimately responsible for establishing a viable state, which will be handed over to the Timorese before being officially recognized and admitted to the big family of independent states. This is a particular challenge, since there is no precedent or model to follow.
"The Timorese have rediscovered the meaning of freedom," says Xanana Gusmao (see interview), president of the Council for National Resistance of Timor (CNRT). It is true that most of the inhabitants no longer have to answer to an occupier and are therefore less fearful. But freedom alone does not put food on the table, especially in the current transitional phase which for many still represents a leap into the great unknown. Many civic institutions have yet to be created on the island; the Timorese executive and legislative structures, for example, whose existence depend largely on the electoral time-table still being worked out. For the time being, executive power is in the hands of UNTAET - headed by the Brazilian Sergio Vieira de Mello - who liaises with the CNRT and with a provisional government structure grouping four UNTAET representatives and five Timorese ministers. Severely disrupted since the Indonesian withdrawal, the economic, judicial, education and health systems are still in the early stages of development.

The Timorese leader Xanana Gusmao.

Xanana Gusmao, former leader of the Timorese resistance, spent 16 years in the bush. Viewed as the "father" of the nascent Timorese nation, he is now head of the Council for National Resistance of Timor. He talks to Red Cross, Red Crescent.

What is the most significant achievement since your return to East Timor in October 1999?
For me, it is the restoration of security, so that the population can prepare its future.

What are your priorities for 2001?
The first priority is the so-called "Timorization", meaning the gradual increase in the presence of Timorese nationals in the administration of their new country. The second is to move the political process forward, which entails building various democratic institutions: political parties, electoral law, a constituent assembly to form the basis of a national parliament, and a constitution.

The Timorese people are not all back in the fold, as some 100,000 of them are still in West Timor, in Indonesia. Is progress being made towards reconciliation?
Yes. I believe in reconciliation. I believe in it because we have been practising it for 25 years. It will take time, for there are wounds and deep-seated fears to overcome. Nevertheless, we are making headway. We will doubtless not achieve full reconciliation, but a number of key people opposed to independence are coming round and would like to return to East Timor in a spirit of reconciliation.

In future, the Timorese Red Cross must develop and form a humanitarian auxiliary to the future state of East Timor.
Through its operations during the difficult years of the conflict - since 1979 - the ICRC helped us to survive, especially in remote villages. It also played a crucial role in assisting detainees, including people like myself detained in Jakarta, who benefited from family visits twice a year. Today, we welcome the work of the Red Cross, in particular in the Dili hospital. In the future, we are counting on continued support from the Red Cross and Red Crescent Movement so that the Timorese Red Cross can function in the long term, especially in the health sphere.

A country of interpreters

The international community has invested enormously in its efforts to structure this little nation in the making, but a rapport still needs to be built with the Timorese. Change of any kind, even in the best of circumstances, can be considered threatening. Introducing change in the wake of chaos can be particularly so. The difficulties are compounded when those who have come to help and those they are there to serve do not speak the same language. For today in the sultry heat of the capital, Dili, among the expatriates no one speaks Tetum, the local language; almost no one speaks Indonesian, a language widely spoken by the Timorese; a mere few speak Portuguese, with which the Timorese are slightly familiar; and almost all speak English, generally unknown among the Timorese whom the expatriates have come to help. As a result, for the Timorese, learning languages has essentially become a pre-requisite for any kind of development. With this in mind, Timor Aid - a sizeable non-governmental organization (NGO) founded by the Timorese diaspora - has set up intensive English and Portuguese courses in Dili.

The array of nationalities among the expatriates in East Timor - more than 50 - has had a noticeable influence on the local environment. With the outside presence comes new behaviour; flash cars, mobile phones and bulging wallets, stuffed mainly with US and Australian dollars, the two new official currencies alongside the Indonesian rupiah. The imported wealth elicits admiration and emulation, but also irritation and envy - especially when the multinational presence triggers a marked rise in prices. "This situation creates
an artificial economy," says Manuel Abrantes, who heads the Catholic Church's Justice and Peace Commission. "It is a source of social discontent and must be resolved by a much greater involvement of the Timorese in the affairs of the territory." The goal of becoming more involved in the running of their own affairs is known as "Timorization". After years of external intrusion, the call for "Timorization" resonates like a distant promise across the island, even though the extent of its implementation varies considerably from one sphere of activity to another.

The balance between tradition and modernity is a challenge for East Timor.

Precarious health situation

What is happening in the field of health is an indicator of the many challenges of achieving "Timorization".
Now that the emergency phase is over, a transitional administration has been created with the aim of developing a viable national health system. The new administration, the Division of Health Services (DHS), is the fledgling Ministry of Health, currently made up of Timorese and international representatives. Supported by the World Health Organization, the DHS has ambitious goals: to define a health policy as well as to plan, implement and coordinate health services at the national level. In the absence of sufficient resources, the DHS is currently unable to provide these services, which NGOs have stepped in to deliver for more than a year. Dr. Sergio Lobo, in charge of the health services for East Timor, is well aware of the major difficulty of designing a health system, putting it into place, while also taking into account the realities of the country: "We are trying to unite and regulate the main players in the health system: the governmental services, humanitarian organizations - including the church's health network - and private medicine, which still needs to be developed." However, it is not easy to set priorities in a context where proper medical facilities are virtually non-existent. "The first objective is to respond to basic health-care needs and to ensure free access to care, especially in hospitals," comments Dr. Lobo.
The general hospital in Dili provides a good illustration of the health situation in East Timor as a whole. Since the hasty withdrawal of the Indonesians at the beginning of September 1999, the ICRC has taken over running the hospital. Today, the 210-bed facility is fully functioning with more than 350 staff members, of whom 26 are expatriates seconded mainly by national Red Cross or Red Crescent societies. The most common diseases treated are malaria, tuberculosis and gastro-enteritis. Obstetric complications and traffic accidents are on the rise and need urgent attention. Although many nurses are Timorese, there are few local doctors - only three of them in the Dili hospital. On average there are only two for every 100,000 inhabitants, about 20 in all across East Timor.

A sign of new times. Since May 2000, East Timor has its own stamps and postal service.

The United Nations is helping construct a new nation from the ground up.

The right to training

What is the impact of the profound upheavals under way in East Timor on the only general hospital in the territory? And how is the transition from an Indonesian hospital regime - in which middle management was negligible - to a Western-style system of organization going?

The general view is that the transition is not a simple one, nor was it likely to be. The needs are clearly vast, particularly in terms of the training required in basic physiology and in nursing care. "We need to train doctors, promote preventive medicine, develop laboratory work and radiology," says Dr. David Schnadower, the ICRC medical coordinator. Hiroshi Furukawa, a radiologist from the Japanese Red Cross, believes that the main objective is the autonomy of the Timorese staff: "He must show the way for the next generation!" he says, referring to Alberto dos Santos, a Timorese radiology assistant. But caution is needed: training may be perceived as questioning existing skills and elicit resistance, which is why the term "refresher course" is preferable to "training".
"We have to support the Timorese in the change process," says Jenny Allen, the hospital manager seconded by the Australian Red Cross.

Recently, a New Zealand Red Cross nurse set up a programme for nursing staff which revealed significant shortcomings in management techniques. "What has changed for me is that there are now rules and discipline," says one Timorese nurse assigned to emergencies. "It's all happening a bit fast, but we have to adapt and follow," he adds.

Indeed, the biggest change introduced by the expatriates aims to encourage the Timorese staff to take greater responsibility and to place them at the heart of the decision-making process. It is too early to say if this approach will bear fruit. In the view of several expatriates, the majority of staff has already made a great leap forward in its way of doing things, leading now and then to welcome individual initiatives. It's been a long road to the progress made so far and the language barrier remains a serious impediment to mutual understanding. Above all, the frequent turnover of expatriate staff has led to chronic changes of method which can be the source of confusion. Still, as Dr. Sergio Lobo points out, "There is only one road to take. The Timorese must assume full responsibility for themselves." His words sum up the whole challenge of "Timorization" and, ultimately, that of East Timorese independence.

Emergency room, Dili general hospital.

Margareta Wahlström visited East Timor last year on behalf of the International Federation to assess the potential for a future national Red Cross society.

East Timor is pulling itself out of a long, painful period in its history. Why is it important that it have a National Society?
A national Red Cross or Red Crescent society constitutes an important part of civil society in any country. A young nation that, as is the case of East Timor, is starting to build its institutions on the basis of a long history of mixed colonial influences needs to assert its identity and needs to ensure a broad base of national service providers.

A national Red Cross society in East Timor contributes to the construction of the country, to ease the suffering of grinding poverty and to help build a national capacity for preparedness to act in case of disasters - natural and man-made. And it has the advantage of support from a large international network of National Societies in the Red Cross and Red Crescent Movement.

What kind of historical connection does East Timor have with the Red Cross Red Crescent Movement?
East Timor has been a colony for hundreds of years. The Portuguese Red Cross had a branch in East Timor. The Indonesian Red Cross had a branch in Dili. It worked in blood-donor mobilization and first-aid training. The memory and experiences of these periods is certainly both positive and negative. However for the future, the East Timor Red Cross will cooperate with all sister societies within the International Federation and can count on support by all. During the past 20 years, the ICRC has ensured a continuous presence in East Timor which has been an important contribution to create positive expectations on the role of the Red Cross. This means that there are a number of people linked to the Red Cross as professional workers, as well as people who may have been volunteers in the past.

What are the particular challenges that the future National Society of East Timor may face?
The challenges involve mobilizing resources, identifying short-term and longer-term objectives and making it possible for people who wish to work with the Red Cross to do so. Attracting volunteers and leadership will not be easy because of the high demand on the educated and experienced groups that is created by the presence of international agencies.
However, there is every reason to be very positive about the development of the East Timor Red Cross. The willingness is high, the volunteers are there, the knowledge is good and the environment is positive.

W. B

Taking charge

The road to independence includes the creation of a national Red Cross society. Although still in its infancy, the Cruz Vermelha Timor Lorosa'e (CVTL) now comprises a core of 15 dedicated members intent on advancing towards the goal of recognition as a National Society and admission to the Movement (see box).

Its guiding force is Jose da Conceicao, who at the age of 36 already has 20 years of Red Cross experience behind him. He first saw the Red Cross in action when he was himself a refugee in Atambua in 1975, following the Indonesian intervention. Jose, an unassuming young man, started as a volunteer for the Indonesian Red Cross (PMI), then became a translator, logistics officer, coordinator, and leader of a water and sanitation team on various joint operations of the PMI and ICRC. Currently employed by the ICRC as a dissemination officer, he also devotes his time to building East Timor's new National Society. The future Cruz Vermelha Timor Lorosa'e should rest on four main pillars: logistics, education, health and finances. The International Federation, which carried out an initial evaluation mission in July 2000, will assist with the progressive emergence of the CVTL, by basing a delegate in Dili to oversee the society's structural development. In the meantime, Jose and his preparatory committee are busying themselves making contacts and making their presence felt by keeping the founding group motivated. The CVTL participates as an observer in the working group on disaster preparedness set up by UNTAET. "We would like to play a central role in first-aid training, which is also a good way of recruiting volunteers," stresses Jose.

Tackling tomorrow today: the emerging East Timor Red Cross discusses ways of providing clean sanitation.


There is no doubt that the emergence of a Timorese Red Cross Society is fundamental, all the more so since its mission reflects a basic public health concern - the treatment of medical problems at their source, in the villages. It is particularly important to achieve this, since most Timorese, more than 80 per cent, live in rural areas. As a result, health education in the villages is an absolute priority, one the future Timorese Red Cross could usefully contribute to through its extensive network of volunteers. In the past volunteers have been mobilized to install drinking water systems and locate members of dispersed families. Luis Freitas, responsible for logistics at the CVTL, sums up the challenge ahead in his own way: "We must instil a Red Cross spirit in our territory!"

The ten conditions for recognition of a National Society and admission to the International Red Cross and Red Crescent Movement are:

1. Be constituted on the territory of an independent State where the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field is in force.
2. Be the only National Red Cross or Red Crescent Society of the said State and be directed by a central body which shall alone be competent to represent it in its dealings with other components of the Movement.
3. Be duly recognized by the legal government of its country on the basis of the Geneva Conventions and of the national legislation as a voluntary aid society, auxiliary to the public authorities in the humanitarian field.
4. Have an autonomous status which allows it to operate in conformity with the Fundamental Principles of the Movement.
5. Use the name and emblem of the Red Cross or Red Crescent in conformity with the Geneva Conventions.
6. Be so organized as to be able to fulfil the tasks defined in its own statutes, including the preparation in peace time for its statutory tasks in case of armed conflict.
7. Extend its activities to the entire territory of the State.
8. Recruit its voluntary members and its staff without consideration of race, sex, class, religion or political opinions.
9. Adhere to the present Statutes, share in the fellowship which unites the components of the Movement and co-operate with them.
10. Respect the Fundamental Principles of the Movement and be guided in its work by the principles of international humanitarian law.

Jean-François Berger
ICRC editor of Red Cross, Red Crescent.

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