According to the ECLAC, 68.7 per cent of Panama's population are urban dwellers. With a per capita GDP of US$7,265 in 2011, of which 8.1 per cent was spent on health, Panama ranks among the most developed societies in Latin America.

However, Panama's wealth is concentrated in the main urban areas. The urban poverty rate in 2011 was 15.5 per cent with 4.7 per cent in extreme poverty. In contrast, the rural poverty figure was 43.6 per cent with 26.8 per cent in an extreme condition. The majority of Panama's indigenous people live in the under-served peripheral rural zones of the country.

Indigenous groups

The three main indigenous groups are Ngöbe-Buglé (sometimes called Guaymís), Kuna and Embera-Wounan (Darienitas or Chocós). Of these Ngöbe-Buglé account for almost two-thirds of the 200,000 indigenous population, with Kuna being the second largest group.

Half of all indigenous children suffer from malnutrition, while only 10 per cent of non-indigenous children are undernourished, according to the PAHO. Infant mortality among Panama's indigenous population is approximately 40 to 50 children for every 1,000 live births. In stark contrast the national average is 19, which is considered a very positive ratio for Latin American countries. The huge difference is another expression both of income concentration and the public policy towards the country's indigenous population.

Housing problems and lack of basic services such as potable water and sanitation promote diseases including diarrhoea, typhus and other health problems. These affect mostly indigenous children, and are directly connected to the social, economic and political marginalization of the respective populations.

In addition, access to formal health services and institutions by the majority of the rural indigenous population in Panama is limited. This is partly due to the dispersed nature of the population and the distance between their communities and the nearest medical services. In some areas, indigenous people need to walk between three and five days to get to a health centre and there is no guarantee there will be personnel or medicines on hand. Language is also a significant factor. Many poor indigenous families are headed by monolingual non-Spanish-speaking parents who are also non-literate.

Health care initiative

In September 2011 Panama received a loan of about US$50 million from the Inter-American Development Bank (IDB) to reorganize its primary health care system and improve maternal, neonatal and chronic disease care.

The loan is aimed at improving services in nutrition, reproductive health and dental care. It is intended to help reduce maternal and infant mortality rates as well as the prevalence of chronic malnutrition among children under the age of 5. It remains to be seen what effect this investment will eventually have in improving health conditions of rural indigenous communities.

Privatization moves

In an effort to raise revenue to repay international debts and stimulate development, during the past two decades Panama has been engaged in an aggressive programme of privatizations. In October 2012, the government put into effect a plan to sell off state-owned lands in the Free Trade Zone of Colón, which has a large Afro-Panamanian population.

Free Trade Zone businesses are a major source of employment in the otherwise depressed area, and during 2012 Colón residents picketed and street-marched for months to protest the planned sale. They argued that the land sale in the biggest duty-free zone in Latin America would cost jobs, cut incomes and deconstruct the largely Afro-Panamanian community.

The actual passage of the new law in October led to a sharp escalation of marches, and street blockages. Security forces answered with tear gas, bird shot and rubber bullets. According to local media sources, three people were killed in the clashes.

Protesters argued that the land sale was an inadequate solution to raising additional revenue to pay for large national projects whose economic benefits largely bypass Colón's economically depressed and marginalized Afro-Panamanian and indigenous populations.

Among residents' complaints during the protest were that some Colón communities had not had access to water facilities for months, thereby raising the risk of gastrointestinal and other infections. Following the adverse international publicity and the protesters' refusal to enter a dialogue unless the new legislation was repealed, in October Panama's President Ricardo Martinelli said he would scrap the land sale plans. Instead, according to BBC News, commercial rents would be increased and the money reinvested in the area, as protesters had been demanding.

The protest and deaths in Colón were just one in a string of incidents across Panama during 2012 where police were accused of using excessive force to disperse demonstrations over social and economic policies that have a potentially negative effect on the health and well-being of minority and indigenous communities.

Over the past year and a half, indigenous Ngöbe-Buglé have also relentlessly fought for their right to free, prior and informed consent concerning the growing number of mining and hydroelectric projects on their lands. They too have been met with serious force from the police.

Opposition to governments plans first prompted blockades of the Pan-American Highway during February 2012. These cost several lives, but forced an agreement that prohibited mining and hydroelectric power projects in their territory (comarca) located on the north-west coast, bordering Costa Rica.

However – in what critics see as a familiar pattern – the government backtracked and in February 2012 the Ngöbe-Buglé community resumed their protests to again force the government to negotiate. Two people were killed by security forces, dozens injured and many detained.

Finally, in March 2012, elected Ngöbe-Buglé leaders and Panama government officials reached a new agreement. All mining was banned in Ngöbe-Buglé territory. The agreement also requires community consent for any hydro-electric projects via referendum vote.

Nevertheless, a dissenting group of Ngöbe-Buglé resumed street protests in opposition to the agreement, particularly regarding permits for hydroelectric projects. According to AFP wire service, the Ngöbe-Buglé General Congress, which represents the traditional indigenous leadership, does not recognize indigenous leaders formally elected under government rules. Ngöbe-Buglé traditionalists continue to reject all hydro-electric projects in their territory for economic and cultural as well as health reasons.

They argue that the Barro Blanco hydro-electric dam, when completed, will flood Ngöbé communities along the Tabasara River. Places at risk include schools, cemeteries, cultural sites and rich fertile farmlands. They also cite health risks. The president of the Indigenous M-10 (Movimento 10 de Abril) protest movement especially argues the project will change the currently fast-flowing fish-filled Tabasara River into an expanse of still water ideal for breeding disease-carrying mosquitoes in a country long noted for a high incidence of malaria and yellow fever and in an area with inadequate health services.

According to a UN report, some of the sites to be flooded are of significant cultural and religious value. This includes ancient boulders carved with petroglyphs that were the key to recreating the Buglé written language, and led to a revival of indigenous culture in the area. Indigenous activists across the Americas argue that such religious and cultural disruptions, which have now continued for several generations, are among the main contributors to the ongoing mental health issues that continue to affect aboriginal communities from Alaska to Argentina.

Disclaimer: © Minority Rights Group International. All rights reserved.

This is not a UNHCR publication. UNHCR is not responsible for, nor does it necessarily endorse, its content. Any views expressed are solely those of the author or publisher and do not necessarily reflect those of UNHCR, the United Nations or its Member States.