A difficult birth
by Jean-François Berger
Dili general hospital was built in 1983
under the Indonesians.
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
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.
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
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
"We have to support the Timorese in the change process,"
says Jenny Allen, the hospital manager seconded by the Australian
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
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
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
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.
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
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
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
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
10. Respect the Fundamental Principles of the Movement
and be guided in its work by the principles of international
ICRC editor of Red Cross, Red Crescent.
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