Poverty in Underdeveloped Countries—The Poorest of the Poor - Least Developed Countries Of Asia And The Pacific

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In Voices of the Least Developed Countries of Asia and the Pacific: Achieving the Millennium Development Goals through a Global Partnership (Elsevier, 2005), the United Nations Development Program (UNDP) reported that the least developed Asia/Pacific countries—Afghanistan, Bangladesh, Bhutan, Cambodia, Kiribati, Lao People's Democratic Republic, Maldives, Myanmar, Nepal, Samoa, Solomon Islands, Timor-Leste, Tuvalu, and Vanuatu—together account for 37% of the total population of all LDCs. These countries range in size from Bangladesh, which has 130 million people, to Tuvalu with 11,000. Between 1990 and 2000 Asia/Pacific LDCs saw overall improvement in some areas: average per capita gross domestic product increased, the total adult literacy rate increased from 60% to 71%, life expectancy went from fifty-eight years to sixty-two years, and the infant mortality rate dropped from seventy-seven to fifty-five deaths per 1,000 live births.

While Asia as a whole has experienced much growth and the very large Asian economies of China and India have expanded in the early twenty-first century and reduced their rates of overall poverty, the least developed countries of the Asia/Pacific region are in general not on track to meet the Millennium Development Goals—in particular the first goal of halving extreme poverty by 2015. (See Table 3.3.) According to the UNDP, 22% of the population of developing countries in Asia live on less then one dollar a day, but 38% of the population of Asia/Pacific LDCs live on less than a dollar a day. So although Asia/Pacific least developed countries account for 7% of the total population of the region, they account for 12% of the region's extremely poor. Furthermore, 46.8% of the Asia/Pacific LDC population live below the region's individual country poverty lines. In individual least developed countries in the region, according to UNDP estimates, the national poverty rates range from 34% in Cambodia to 56% in Afghanistan.

As in Asia/Pacific countries such as China and India that are experiencing unprecedented economic growth but a wider poverty gap, least developed countries in the region have seen increasing disparities in income, wealth, and consumption: Cambodia's consumption rose by 18% among the country's wealthiest segment but only 1% among the poorest. However, even among a single economic category of countries in a region, such as the LDCs of Asia/Pacific, great differences exist in levels of poverty and human development indicators.

Afghanistan

About a year after signing the 1978 Treaty of Friendship, Cooperation, and Good Neighborliness with Afghanistan, the Soviet Union invaded the country and deposed the Afghan president, sparking a bloody civil war between Soviet supporters and anticommunist rebels. By the time the Soviets withdrew in 1989, more than five million Afghans had fled to refugee camps in Pakistan and Iran. The civil war, however, continued after the Soviet withdrawal, creating a state of chaos between competing warlords and eventually giving rise in 1996 to the Taliban, an extreme Islamic nationalist movement that stabilized the country to a degree but also controlled nearly every aspect of Afghan citizens' lives. The Taliban were responsible for massive human rights abuses, including torturing and killing thousands of Afghan civilians. Devastating earthquakes hit the country in 1998 and 1999, further displacing tens of thousands of Afghans. When terrorists associated with the Islamic fundamentalist group al-Qaeda struck the United States on September 11, 2001, the U.S. retaliated militarily against the Taliban—and therefore against Afghanistan—for sheltering al-Qaeda leader Osama bin Laden. Afghanistan was again torn by war.

Afghanistan is considered the least developed country in the world. According to the United Nations Development Program's Afghanistan National Human Development Report 2004, more than two decades of near-constant war and natural disasters have left Afghanistan with one of the worst human development indexes (HDI) in the world, at 0.346, ranking 171 out of 177 countries. As a comparison, Norway had the world's highest human development ranking in 2003 at 0.963; the United States ranked tenth at 0.944. Niger, with the lowest HDI in the world, had a score

TABLE 3.3 Progress toward attainment of the MDGs (Millennium Development Goals) in Asia-Pacific least developed countries, 2005

TABLE 3.3
Progress toward attainment of the MDGs (Millennium Development Goals) in Asia-Pacific least developed countries, 2005
Country Goal 1, target 1, indicator 1: proportion of population below poverty line Goal 1, target 2, indicator 4: prevalence of underweight children under 5 years of age (UNICEFa-WHOb) Goal 1, target 2, indicator 5: proportion of population below minimum level of dietary energy consumption (FAOc) Goal 2, target 3, indicator 6: net enrollment ratio in primary education (UNESCOc) Goal 2, target 3, indicator 8: literacy rate of 16- to 24-year-olds (UNESCOc) Goal 4, target 5, indicator 13: under-5 mortality rate (UNICEFa-WHOb) Goal 4, target 5, indicator 14; infant mortality rate (UNICEFa-WHOb) Goal 7, target 10, indicator 30: proportion of population with sustainable access to an improved water source, rural (UNICEFa-WHOb) Goal 7, target 10, indicator 30: proportion of population with sustainable access to an improved water source, rural (UNICEFa-WHOb) Goal 7, target 10, indicator 31: proportion of population with access to improved sanitation, rural (UNICEFa-WHOb) Goal 7, target 10, indicator 31: proportion of population with access to improved sanitation, urban (UNICEFa-WHOb)
Afghanistan n/a n/a Underachiever, deteriorating trend Underachiever, slow pace of achievement n/a Underachiever, slow pace of achievement Underachiever, slow pace of achievement n/a n/a n/a n/a
Bangladesh Underachieves slow pace of achievement On track Underachiever, slow pace of achievement On track Underachiever, slow pace of achievement On track On track Underachiever, slow pace of achievement Underachiever, deteriorating trend On track Underachiever, slow pace of achievement
Bhutan n/a On track n/a Underachiever, slow pace of achievement n/a On track Underachiever, slow pace of achievement n/a n/a n/a n/a
Cambodia On track Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track Underachiever, slow pace of achievement Underachiever, deteriorating trend Underachiever, deteriorating trend n/a n/a n/a n/a
Lao People's Democratic Republic On track Underachiever, slow pace of achievement On track On track Underachiever, slow pace of achievement On track Underachiever, slow pace of achievement n/a n/a n/a n/a
Maldives n/a On track n/a On track On track On track Underachiever, slow pace of achievement Underachiever, deteriorating trend Underachiever, deteriorating trend n/a On track
Myanmar n/a Underachiever, deteriorating trend On track Underachiever, deteriorating trend Underachiever, slow pace of achievement Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track On track On track On track
Timor-Leste n/a n/a n/a n/a n/a Underachiever, slow pace of achievement Underachiever, slow pace of achievement n/a On track n/a n/a
Nepal Underachiever, slow pace of achievement n/a Underachiever, slow pace of achievement Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track On track On track Underachiever, deteriorating trend Underachiever, slow pace of achievement Underachiever, slow pace of achievement
Kiribati n/a n/a n/a n/a n/a Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track
Samoa n/a n/a n/a Underachiever, deteriorating trend On track On track On track Underachiever, deteriorating trend Underachiever, deteriorating trend On track On track
Solomon Islands n/a n/a n/a n/a n/a On track On track n/a n/a Underachiever, slow pace of achievement No improvement

TABLE 3.3 Progress toward attainment of the MDGs (Millennium Development Goals) in Asia-Pacific least developed countries, 2005 [CONTINUED] "Box 2. Progress toward Attainment of the MDGs in Asia-Pacific Least Developed Countries," in Voices of the Least Developed Countries of Asia and the Pacific: Achieving the Millennium Development Goals through a Global Partnership, United Nations Development Programme, Elsevier, 2005, http://www.undp.org.in/events/LDC/LDC-MDGAsiaP.pdf (accessed April 10, 2006). Information compiled and estimated on the basis of latest available data from the United Nations Millennium Database and national Millennium Development Goal (MDG) Progress Reports for Afghanistan, Bangladesh, Bhutan, Cambodia, Lao People's Democratic Republic, Nepal and Timor-Leste.

TABLE 3.3
Progress toward attainment of the MDGs (Millennium Development Goals) in Asia-Pacific least developed countries, 2005 [CONTINUED]
Country Goal 1, target 1, indicator 1: proportion of population below poverty line Goal 1, target 2, indicator 4: prevalence of underweight children under 5 years of age (UNICEFa-WHOb) Goal 1, target 2, indicator 5: proportion of population below minimum level of dietary energy consumption (FAOc) Goal 2, target 3, indicator 6: net enrollment ratio in primary education (UNESCOc) Goal 2, target 3, indicator 8: literacy rate of 16- to 24-year-olds (UNESCOc) Goal 4, target 5, indicator 13: under-5 mortality rate (UNICEFa-WHOb) Goal 4, target 5, indicator 14; infant mortality rate (UNICEFa-WHOb) Goal 7, target 10, indicator 30: proportion of population with sustainable access to an improved water source, rural (UNICEFa-WHOb) Goal 7, target 10, indicator 30: proportion of population with sustainable access to an improved water source, rural (UNICEFa-WHOb) Goal 7, target 10, indicator 31: proportion of population with access to improved sanitation, rural (UNICEFa-WHOb) Goal 7, target 10, indicator 31: proportion of population with access to improved sanitation, urban (UNICEFa-WHOb)
aUnited Nations Children's Fund.
bWorld Health Organization.
cFood and Agriculture Organization.
dUnited Nations Educational, Scientific and Cultural Organization.
eAsia-Pacific least developed country. These estimates refer to various points of time and are based on population-weighted averages of countries for which data were available.
Note: "n/a" indicates data not available.
SOURCE: "Box 2. Progress toward Attainment of the MDGs in Asia-Pacific Least Developed Countries," in Voices of the Least Developed Countries of Asia and the Pacific: Achieving the Millennium Development Goals through a Global Partnership, United Nations Development Programme, Elsevier, 2005, http://www.undp.org.in/events/LDC/LDC-MDGAsiaP.pdf (accessed April 10, 2006). Information compiled and estimated on the basis of latest available data from the United Nations Millennium Database and national Millennium Development Goal (MDG) Progress Reports for Afghanistan, Bangladesh, Bhutan, Cambodia, Lao People's Democratic Republic, Nepal and Timor-Leste.
Tuvalu n/a n/a n/a n/a n/a Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track On track On track On track
Vanuatu n/a n/a n/a On track n/a On track On track Underachiever, deteriorating trend Underachiever, deteriorating trend n/a n/a
APLDCse (weighted averages) Underachiever, slow pace of achievement On track Underachiever, slow pace of achievement Underachiever, slow pace of achievement Underachiever, slow pace of achievement On track Underachiever, slow pace of achievement On track On track On track On track

TABLE 3.4 Selected indicators for poverty, vulnerability, and risk in Afghanistan, 2003 "Table 2.2. Selected Indicators for Poverty, Vulnerability, and Risk in Afghanistan," in Afghanistan National Human Development Report 2004: Security with a Human Face, United Nations Development Programme, 2004, http://www.undp.org/dpa/nhdr/af-files/afnhdr2004-ch2.pdf (accessed April 10, 2006). Data from UNDP global Human Development Report 2004, UNICEF/CSO MICS 2003 and CSO Statistical Yearbook 2003.

TABLE 3.4
Selected indicators for poverty, vulnerability, and risk in Afghanistan, 2003
GDPa per capita (US$) (2002) Life expectancy at birth (years) (2002) Infant mortality rate per 1,000 live births (2002) Population without sustainable access to an improved water source (percent) (2000)
aGross domestic product.
bFigures for 2003.
SOURCE: "Table 2.2. Selected Indicators for Poverty, Vulnerability, and Risk in Afghanistan," in Afghanistan National Human Development Report 2004: Security with a Human Face, United Nations Development Programme, 2004, http://www.undp.org/dpa/nhdr/af-files/afnhdr2004-ch2.pdf (accessed April 10, 2006). Data from UNDP global Human Development Report 2004, UNICEF/CSO MICS 2003 and CSO Statistical Yearbook 2003.
Afghanistan 190 44.5 115b 60b
Iran 1,652 70.1 35 8
Pakistan 408 60.8 83 10
Tajikistan 193 68.6 53 40
Turkmenistan 1,601 66.9 76
Uzbekistán 314 69.5 52 15
Least developed countries 298 50.6 99 38
South Asia 516 63.2 69 15
Low human Development countries 322 49.1 104 38
Low-income countries 451 59.1 80 24
World 5,174 66.9 56 18

of 0.281. Afghanistan's gender-related development index (GDI) was 0.300. The gender development index examines basic quality of life but is adjusted for inequalities between men and women. Norway again ranked first in the world, with a GDI rating of 0.960; the United States was eighth at 0.942. Of the 140 countries ranked using the GDI, Niger was again last at 0.271.

Individual poverty indicators are equally low, especially compared with those of Afghanistan's neighboring countries. Per capita gross domestic product in 2002 was $190—the lowest in the region—and only 23% of Afghans have access to safe drinking water. All of the country's poverty indicator numbers were the worst in the region: As indicated in Table 3.4, Afghanistan's per capita GDP was lower, its life expectancy at birth was lower, its infant mortality rate was higher, and its population without access to an improved water source was higher than other countries in the region, than the average of countries with low human development, and than the average of low-income countries.

Because of the constant wartime conditions in Afghanistan, the idea of poverty encompasses more than income and human deprivation as they are discussed in Chapter 1. Overall "human security" includes not only security in the physical sense of safety from armed violence but also security that allows for economic development and even access to safe water, sanitation services, and farmable land. In Human Security and Livelihoods of Rural Afghans, 2002–2003 (June 2004), the Feinstein International Famine Center at Tufts University used data collected by the United Nations Food Program and the Ministry of Rural Rehabilitation and Development's Nationwide Risk and Vulnerability Assessment (NRVA) of 2003, which found that Afghans living in rural provinces who were asked about their physical and economic conditions overwhelmingly reported a lack of access to safe water sources, health care, education, and economic opportunities and said that this lack of essential services posed as much of a threat to their security as the ongoing armed conflict. As in most developing and underdeveloped countries, women and children are the most vulnerable members of Afghan society.

The Tufts study revealed that Afghan people by and large have a very different idea of their country's biggest challenges than do those in the international community:

Rural people throughout Badghis, Herat, Kabul, Kandahar, and Nangarhar provinces defined security as having access to health care, education, employment, clean drinking water, reproductive choices, political participation, good governance, and housing. This conception of security illustrates a marked difference from the understanding of security on the part of the international community (i.e., a lack of armed attacks and fighting). It also more accurately reflects the reality of "security issues" in the lives of rural Afghans.

Regarding the differing perceptions of men and women, the report notes: "In contrast to men's overwhelming concerns regarding physical security, women consistently ranked poverty as their top concern."

Eighty-five percent of Afghans live in rural areas. The UNDP identifies seven critical factors that influence the country's high poverty level in addition to chronic violent conflict:

  • Lack of income
  • Lack of access to basic necessities
  • Social, political, and economic exclusion and isolation
  • Lack of marketable skills and exposure to technologies; lack of assets such as tools, livestock, and machinery
  • Lack of property ownership rights and access to credit
  • Vulnerability to environmental risks, natural disasters, and other poverty risk factors
  • Erosion of indigenous cultures, values, and social support networks

HEALTH AND MORTALITY IN AFGHANISTAN

According to the UNDP report, life expectancy in Afghanistan is 44.5 years; healthy life expectancy (the number of years a newborn can expect to live in full health) is just 33.4 years. Afghans live about twenty fewer years than those in their neighboring countries and about 18.7 fewer than the average of South Asia overall. Mortality rates of infants, children, and mothers are some of the highest in the world: UNICEF's State of the World's Children 2006 reports that 257 out every 1,000 children—one out of every five and the fourth worst rate in the world—die before reaching the age of five (85,000 children annually die from diarrhea); and a woman dies of pregnancy-related causes every thirty minutes. An estimated 50% of the population suffers from chronic malnutrition, as do 50% of children under five. Fewer than 15% of pregnant women receive medical attention during labor and delivery; only eleven of the country's thirty-one provinces have obstetric care available, and Afghan women report that the care they do receive is inadequate.

The Afghan population suffers from high rates of malaria infection—an estimated two to three million per year. Afghanistan also has a high number of tuberculosis cases, with 72,000 new cases annually and about 15,000 deaths (at least 12,000 to 13,000 of which are women). Because fewer than 40% of Afghan children receive preventative vaccinations, diseases such as measles and polio—which have been largely eradicated in developed countries—continue to afflict Afghans; there are approximately 35,000 cases of measles every year, and in 2001 the country had eleven cases of polio. (Afghanistan is one of only six countries where polio still exists.) State of the World's Children 2006 reports that 54% of Afghan children under age five suffer from stunted growth, and 39% are moderately or severely underweight. The main causes of death for children under five are diarrhea disease (accounting for 25% of under-five deaths), respiratory tract infections (19%), and measles (16%).

Additionally, the UNDP reports that most Afghans suffer from some degree of mental illness or stress disorder due to the country's almost chronic state of war since 1978. The World Health Organization estimates that as many as one in five Afghans have some form of mental disorder related to stress, including severe anxiety, depression, insomnia, and post-traumatic stress disorder. A large percentage of Afghans is also believed to have serious health problems related to drug use, although exact figures are unavailable. Health officials fear that, as heroin injection increases among drug users, rates of HIV/AIDS and hepatitis infection will also increase, although, again, numbers are not available.

EDUCATION AND LITERACY

As a result of the country's longstanding military engagements, about 80% of its schools have been seriously damaged or destroyed, according to the UNDP. So although Afghanistan's constitution of 1964 guaranteed free and compulsory (required) education for all citizens, by 1999 almost 70% of Afghans (85% of women) were illiterate and its education system was considered one of the worst in the world. In the Tufts study fewer than 10% of women in rural areas reported having attended any school at all. After the American invasion in late 2001 and the subsequent fall of the Taliban, which had outlawed education for girls, pressure from the international community led to the enrollment of nearly four million children in grades one through twelve in 2002—a higher enrollment than the country had ever experienced.

Nonetheless, access to education is limited and schools remain substandard. Most classes are held in tents or the open air, with few materials available. Disparities exist between urban and rural areas as well, with only about one-third of schools located in rural provinces (2,233 out of 6,870 total). In more remote areas schools often are located inside mosques, where girls and women are not allowed. In areas where gender segregation is enforced, schools must either hold separate sessions for girls and boys, or there must be separate schools altogether. With teachers earning only about $30 a month, there is little incentive to work double the hours to educate both boys and girls equally. Many parents continue to resist sending their daughters to school as well because of cultural beliefs. In a country where most girls have no options for higher education or careers, educating them seems like a waste of time and money that could be better spent elsewhere. Additionally, traditional beliefs hold that girls have lesser capabilities and will never have to support their families financially. In 2002 more than twice as many Afghan boys attended school as girls (2,533,272 boys versus 1,171,963 girls).

ACCESS TO NATURAL RESOURCES

The ongoing military conflict in Afghanistan is another example of a cyclical situation that is both a cause and a consequence of poverty. On the one hand, it has caused environmental destruction that prevents many Afghans from earning a good living. On the other hand, because they cannot earn a living wage, Afghans continue to join militias and fight, thus causing more damage to natural resources and preventing other Afghans from getting out of poverty. In addition to the environmental affects of war, Afghanistan has suffered from natural soil erosion and drought, which make agricultural work extremely difficult. A rapidly diminishing water table due to drought and infrastructure mismanagement has made safe water and sanitation rare in Afghanistan.

In fact, water scarcity is considered one of the greatest threats to human development in Afghanistan, according to the UNDP. Wetlands in the country have disappeared, along with the wildlife they housed and the agriculture they supported. Overall, a lack of reliable water supplies has caused widespread loss of income. The UNDP reports that many families reduce their food intake, take out loans, and sell possessions to cope with the inadequate water supply. The quality of water in Afghanistan is also a danger to the poor, causing water-borne illnesses such as cholera outbreaks. Only 8.5% of Afghans had access to indoor piped water in 2003—23.8% of urban residents and 2% of those living in rural areas. The rest of population relied on surface water and wells for drinking, bathing, and cleaning. Sanitation causes equally serious problems for the poor. In six provinces less than 20% of households had access to a flush or pit toilet. Only one province had near 100% toilet access. Open sewers spread communicable diseases that can cause severe illness or death, especially in children.

Access to farmable land also threatens the health and livelihoods of impoverished Afghans. Just 12% of Afghanistan's land can be used as farmland, but about 80% of Afghans rely on farming for food; 85% of the population lives in rural areas. Competition among rural farmers over land and water often leads to outbreaks of violence, and families can become displaced—forced to move to urban areas to survive—when they lose valuable land on which to farm or let their livestock graze, leaving them even more vulnerable to malnutrition and disease. One survey cited by the UNDP found that 37% of Afghan households have become displaced due to the shrinking supply of arable land. Such competition increases both the rate and the depth of poverty by pitting the relatively well off against those who are already poor.

Timor-Leste

While Afghanistan is the world's least developed country in terms of social and human development indicators, Timor-Leste (formerly known as East Timor) is commonly cited as the world's poorest in terms of income poverty. As with many extremely poor countries, Timor-Leste has experienced violent conflict that has in many respects truncated its potential for economic development and kept much of the population in poverty.

A TURBULENT HISTORY

Timor-Leste makes up half of the island of Timor in Oceania, surrounded by the Banda Sea to the north and the Timor Sea to the south. Portugal colonized the island in the mid-sixteenth century, but a treaty in 1859 ceded the western half of the island to the Dutch. During World War II Imperial Japan occupied Timor-Leste, but Japan's defeat in the war in 1945 returned colonial rule to Portugal. A military coup in Portugal in 1974 led to a decolonization process in all of Portugal's territories, including Timor-Leste. In August 1975 the Timorese Democratic Union Party launched a coup, which was followed by a short civil war with the Revolutionary Front for an Independent Timor-Leste. The Democratic Union Party was forced into West Timor (the other half of the island), which was under Indonesian rule. Indonesian forces began entering Timor-Leste in September 1975. In November 1975 the Revolutionary Front declared Timor-Leste an independent state; in December Indonesia launched a full-scale military attack.

Although Indonesia's takeover of Timor-Leste was never recognized by the United Nations, its insistence that the Revolutionary Front was a communist organization incited fear—many Western countries, including the United States, supported Indonesia's brutal regime in Timor-Leste to prevent the spread of communism, even though an estimated 100,000 to 250,000 Timorese died because of the violence and starvation caused by the Indonesian occupation. Finally, in January 1999 the Indonesian government allowed the Timorese to vote to choose between remaining under the rule of Indonesia and establishing an independent state. In August 1999, 75% percent of Timorese voters chose independence, but in September an anti-independence front of militias rampaged through the country, burning three-quarters of the houses and destroying most of the infrastructure, schools, and utility systems. More than a thousand Timorese were killed, a thousand Timorese women raped, and another 250,000 to 300,000 people were forced into West Timor to live as refugees. Late in September peacekeeping forces from Australia entered Timor-Leste to end the violence. In August 2001 the United Nations supervised elections, and in May 2002 Timor-Leste officially became an independent republic recognized by the global community. In April 2005 Indonesia and Timor-Leste signed an agreement to demarcate their borders.

Timor-Leste has continued to experience phases of violence and unrest. According to the Office of the United Nations High Commissioner for Refugees (UNHCR) 2006 "Country Operations Plan" for Timor-Leste (September 1, 2005), further violence is expected during the scheduled 2006 elections.

ECONOMIC CONDITIONS SINCE INDEPENDENCE

Timor-Leste has valuable natural resources, particularly petroleum reserves. However, the political unrest over the second half of the twentieth century caused such disruption in essential services, food production, and livelihoods in general that extreme poverty became the norm. The joint publication by the World Bank, Asian Development Bank, Japanese International Cooperation Agency, United Nations Development Program, UNICEF, United Nations Mission of Support in Timor-Leste, and the Government of Timor-Leste, titled Timor-Leste. Poverty in a New Nation: Analysis for Action (May 2003), reports that in 1999—the year Timorese citizens voted in favor of independence, followed by the violent militia crackdown—Timor-Leste's gross domestic product fell 38.5% and its agricultural output fell 48.4%. In 2000 and 2001 recovery began in earnest, with GDP increasing 15% in 2000 and 18% in 2001, and food production increased 15% in 2000. Reconstruction of roads and residential and commercial buildings also began shortly after the UN-supervised elections—almost 70% of damaged or destroyed houses have been or are being rebuilt. Utilities, however, have not been fully restored: electricity in particular remains unavailable in much of the country, especially rural areas.

As of the publication of the World Bank's joint report in 2003, the poverty line in Timor-Leste was US$15.44 per capita a month, or about fifty cents per day. Just less than 40% of the population lives below this poverty line. About 75% of Timorese live in rural areas; six out of seven poor people in the country are rural dwellers.

HEALTH

According to the International Monetary Fund's July 2005 Country Report on Timor-Leste, Timor-Leste's rate of maternal mortality is one of the highest in the region, at about 800 per 100,000 live births. The rate of infant mortality is also high, at seventy to ninety-five per 1,000 live births. The mortality rate of children under age five is 126 per 1,000 live births. The World Health Organization (WHO) reports that life expectancy was fifty-five years for males and sixty-one years for females in 2003; healthy life expectancy was 47.9 years for males and 51.8 years for females. In 2002, 23.6% of births were attended by skilled practitioners.

The WHO reports in Health Profile: Democratic Republic of Timor-Leste (October 2002) that 80% of Timorese had access to health care as of 2002, but distance is a problem: on average, people must walk about seventy minutes to reach one of the country's four hospitals, sixty-five community health centers, or eighty-two health posts. Timor-Leste has had a serious shortage of doctors since the violence of 1999, when many health care professionals fled to Indonesia. The lack of technical services, clean water, reliable electricity, and communications systems adds to the inadequacy of the medical system.

Common childhood diseases include acute respiratory and diarrheal diseases, malaria, and dengue fever. Additionally, as many as 80% of Timorese children suffer from intestinal parasites, which can lead to severe malnutrition. In fact, hunger and its consequences are major health problems in Timor-Leste. In March 2000 the WHO estimated that 45% of children ages six months to five years were underweight, and 41% had stunted growth. About 35% of mothers were also found to be underweight. According to the WHO, several deadly and/or communicable diseases are prevalent in Timor-Leste, including malaria, leprosy, lymphatic filariasis (an infection of the lymph system by parasitic worms), Japanese encephalitis, yaws (a bacterial infection of the skin), and tuberculosis. In 2002 communicable diseases were responsible for about 60% of deaths in Timor-Leste. Although the immunization program was revived in 2000, in 2002 fewer than 50% of children five years and younger had received basic immunizations.

ACCESS TO ESSENTIAL SERVICES

As in Afghanistan, access to essential services such as water and sanitation is a strong indicator of poverty in Timor-Leste, especially among those living in rural areas. Only 4% of the rural population has access to safe water, sanitation, and electricity, versus almost 50% of urban dwellers. According to the Health Profile of Timor Leste prepared by the World Health Organization, of the country's 850,000 citizens, 620,000 have no electricity and 560,000 have no radios, making daily conveniences and communication across even short distances almost nonexistent.

EDUCATION

Before the 1999 vote for independence, 80% of sixteen- to eighteen-year-olds in Timor-Leste had completed grades one, two, and three of primary school, compared with nearly 100% of Indonesians in the same age group. During the violence that followed the independence referendum, 95% of schools were destroyed, and 20% of primary school teachers and 80% of secondary school teachers fled the country. By 2001, however, about 86% of schools had been rebuilt at least to the point of being usable, with overall enrollment in primary school increased from 65% in 1998–99 to 75% in 2000–01—girls made up 45% of those enrolled. Among adults, however, literacy and educational attainment are very low, with 57% reporting little or no formal schooling. Less than 40% of Timor-Leste's wealthiest adults age thirty and older are literate; in the poorest group only about 15% are literate. This poses a problem for the development of the country's education system because it means the pool of potential teachers is extremely small.

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