A hammock of dark cloth envelops the tiny frame of a girl so thin that her skin is stretched tight over her ribs. She weighs just 12.5 kilograms, whereas the average weight for a child of her age is closer to 20. This photograph of the eight-year-old, a member of the Yanomami indigenous people who inhabit the Amazon rainforest, was taken in the village of Maimasi, in Roraima state in northern Brazil, and lays bare the chronic problem of poor healthcare facing indigenous people in the heart of the Amazon.
The child is suffering from malaria, pneumonia, malnutrition and worms in a region where there are no regular visits from healthcare workers and which is 11 hours on foot from the nearest clinic. The image was captured on April 23, a few days before she was airlifted to a hospital in the regional capital of Boa Vista, where she has now recovered from malaria but continues to be treated for other diseases. The picture has become a symbol of Brazil’s historical abandonment of the Yanomami, who are fighting for their survival amid various crises: the escalation of violence by illegal miners, environmental issues that have caused hunger in some areas and the scarcity of access to medical attention.
There are areas where people have not received the Covid-19 vaccine because there are no health professionalsJúnior Yanomami, a member of the Indigenous District Health Council
Indigenous leader Darío Kopenawa, who authorized the use of the image for this report, explains: “In the Yanomami culture we cannot display the image of a frail, unwell child. But it is very important [to do so] because of the crisis we are going through.” For the Yanomami, images of a person are an important part of their existence and they believe allowing them to be viewed when someone is unwell can weaken them further. When a member of the Yanomami dies, all memories of the deceased must be burned to preserve their spirit in the afterlife, but the community decided to publish this photograph when the child was awaiting treatment to draw the attention of the napëpë - the Yanomami word for non-indigenous people – to their suffering in the midst of the healthcare emergency that is threatening their way of life.
“This photograph is a response to the violation of the rights of the indigenous peoples,” says Kopenawa. While malaria and the coronavirus move through the villages, community leaders report that healthcare teams have been reduced with medical professionals out of action due to the pandemic and other illnesses. Healthcare centers have been temporarily closed and there are no helicopters available to transport patients in remote areas. “We have been suffering for a long time, without a proper structure, without the professionals to assist us. With the pandemic, the situation has gotten worse,” Kopenawa says.
These issues affect the most isolated communities in particular, where people depend on the sporadic visits of the medical teams. Júnior Yanomami, a member of the Indigenous District Health Council, adds: “There are areas where people have not received the Covid-19 vaccine because there are no health professionals. These are communities that are far away from the clinics and there is no way for people to get to them.” In Brazil, ethnic groups are at the end of the line for the Covid-19 vaccine.
Malaria and malnutrition
“The health of the Yanomami is being neglected. Everything is lacking,” continues Júnior Yanomami. According to the community leader the village of Maimasi, which is in the grip of a malaria outbreak and where several children are suffering from malnutrition and verminosis, had not been visited by healthcare teams in six months when they treated the girl in the picture (which was circulated by a Catholic missionary and published in Folha de São Paulo), at the end of April. The team that did make it there did not have enough medication for all those that needed it, he adds.
The Secretariat of Indigenous Health (Sesai), the government department responsible for the care of ethnic groups, gives a different version: they say that the team provided assistance on March 19 “but the family did not give its authorization for transfer to a hospital.” Sesai also says it has sufficient reserves of medicines and medical professionals under contract, but it did not state how often the teams visit Maimasi. Sesai also failed to inform EL PAÍS of the number of incidences of malaria, malnutrition and infant mortality to give an idea of the spread of illnesses in the region.
These healthcare problems do not extend across the entirety of the Yanomami’s lands – roughly the size of Portugal – but they are present in several communities. A study published last year by the Oswaldo Cruz Foundation (Fiocruz) in two areas, Auaris and Maturaká, provides some clues to the magnitude of the problem: 80% of children up to the age of five were suffering from chronic malnutrition and 50% from acute malnutrition in these locations.
Factors contributing to the problem include the scarcity of drinking water and a lack of nutritional guidance and prenatal attention during pregnancy, in addition to the frequency of cases of malaria, diarrhea and verminosis among communities. “We have been explaining our needs and asking the government for help since 2019,” says Júnior Yanomami. “Now the situation is worse. Malnutrition has increased greatly. Where there is illegal mining, there is also the problem of hunger. And during the pandemic incursions have been more frequent. How can the hunger of the Yanomami be explained? They [the miners] pollute the rivers, they destroy the forest, they kill all the animals for hunting. We live off nature.”
The residents of Maimasi are descendants of one of the groups that has been most affected by the opening of the BR-210 north perimeter federal highway in the 1970s, during the military dictatorship. During that time, a large part of the group died amid outbreaks of measles and other diseases transmitted by construction workers. They have been asking the government for a local clinic for years, but for now, the Yanomami in Maimasi are reliant on the occasional visits of healthcare teams.
The threat of illegal mining
If the situation wasn’t already precarious enough, since last year it has gotten considerably worse. As the visits of the medical teams have dropped off, the activities of the illegal miners have increased, leading to a greater possibility of contagious diseases being passed on, and more violence. Cases of malaria, which have afflicted indigenous peoples for decades and which Sesai considers “endemic,” continue to rise. According to Júnior Yanomami, this year alone 10,000 cases have been reported, which corresponds to a third of the entire Yanomami population of around 29,000 people. “The girl in the picture is probably an expression of the sum of these tragedies,” says the monitoring network Red Pro-Yanomami y Ye’kwana in a statement.
The diverse sanitary, environmental and social problems the Yanomami face are not unrelated. Deforestation in the Amazon last April was at its highest rate over the past six years, according to the Brazilian National Institute for Space Research. Forest clearing has increased year-on-year and the resulting environmental imbalance and impact on biodiversity affect the diet of the peoples that inhabit the Amazon, who live on what they farm, fish and hunt.
In several areas, the presence of illegal miners and loggers also leads to the contamination of rivers with mercury, which contributes to malnutrition, dehydration and diarrhea. Faced with the reduction of resources in the forest and a subsequent lack of food, some indigenous people have started to look for work with the napëpë and adopted an industrialized and less nutritious diet. “You can’t generalize and say that children are dying of malnutrition and hunger,” says Kopenawa. “There is a problem where there are illegal miners. Where there are none, the children are healthy, eat well and go about their activities. What is lacking is medical attention. The way of life of the Yanomami is under threat. Our lands are vulnerable against so many problems at once.”
In addition to health and environmental problems, violence has escalated in some areas such as the indigenous community of Palimiu, in Roraima. Earlier this month, the inhabitants were subjected to a sustained attack by illegal miners who aimed shots, bombs and tear gas at them. A week ago, the miners exchanged gunfire with the federal police while they were looking into the complaints about attacks on the village. Júnior Yanomami, who was visiting the community at the time, says the scale of the violence was unprecedented. “I had never seen so many gunshots. Only in the movies. There were a lot of them [illegal miners] and they had heavy weapons.”
The way of life of the Yanomami is under threat. Our lands are vulnerable against so many problems at onceIndigenous leader Darío Kopenawa
Last year, the Yanomami set up a sanitary barricade to stop the illegal miners from entering their lands and to try and prevent the spread of the coronavirus. But the Uraricoera river, where the barrier was set up, is one of the main thoroughfares of activity for miners. On April 24, the Yanomami prevented a group from passing through. They attempted to negotiate to stop them from returning. The response to their request, according to Júnior Yanomami, came half an hour later with shots fired in the direction of the village. The Yanomami defended themselves with arrows and rifles.
The various conflicts during the past week, according to the indigenous people, left three miners and a Yanomami wounded. Two children drowned while fleeing from the firing, say community leaders. The last attack reported took place last Sunday. “It’s a very serious situation. Everybody there is very afraid. I stayed behind,” says Júnior Yanomami. “There are Yanomami in danger. I fear there could be a massacre at any moment. The federal government has to do something.”
Indigenous organizations say the stance of Brazilian President Jair Bolsonaro, who has spoken out against the demarcation of the Yanomami’s lands and expressed his support for the regularization of mining on indigenous territories, is stoking the conflict. On May 12, the army deployed soldiers in Palimiu, but they were withdrawn just hours later. The 1st Infantry Brigade, based in Boa Vista, did not respond to a request to clarify if they would dispatch units again and what the reasons were for their standing down.
In the meantime, the Yanomami remain in a state of alert and fear, say community leaders. Until the panorama changes, they will also be without medical services after the Sesai withdrew their workers due to the seriousness of the situation. “The active service unit will be re-established as soon as it is possible to operate in safety,” says the Secretariat of Indigenous Health, adding that emergency care will be carried out as and when possible in the indigenous health care district that is outside the territory. For its part, the governmental National Indian Foundation did not respond to El PAÍS for this report.
“The atmosphere is one of fear. A lot of fear,” says Júnior Yanomami. “At the moment they are on their own, without the federal police, without the army, and without medical aid. They are alone to defend their homes.”
English version by Rob Train.