The rate of coronavirus deaths among indigenous people in Brazil's Amazon is nearly 250% higher than in the general population, for reasons ranging from a lack of access to healthcare to invasions of indigenous land, researchers said.
The fatality rate among Covid-19-infected indigenous Amazonians had soared by early August, up from the 150% higher than the broader population found in a study in June by IPAM, the Amazon Environmental Research Institute.
"The situation has worsened. It is clear that we did not learn from the first few months," said Martha Fellows, one of the IPAM researchers who worked on the June study and on an upcoming update.
In particular, the virus "exploded" in indigenous health districts that until mid-June had seen no cases of the virus, she said.
The rate of deaths among indigenous residents of the Amazon, based on data collected through August 7, was 247% higher than in the general population, she said.
The data, from the Coordination of the Indigenous Organizations of the Brazilian Amazon (COAIB), shows 559 coronavirus deaths among indigenous people in Brazil's Amazonian states since the start of the pandemic.
According to COIAB data, the Kokama people, in Amazonas state, have the highest losses in the region with 57 deaths followed by the Xavante people, in Mato Grosso, with 51 deaths.
'A situation of vulnerability'
Angela Kaxuyana, a member of COAIB's executive team, said she did not believe the higher death rate was because indigenous people had immune systems more vulnerable to the virus.
Instead "we are placed in a situation of vulnerability," she said, particularly with ongoing entry into indigenous land by illegal miners, loggers and others carrying the virus.
"We are talking about the invasion of territories, contamination of rivers, psychological pressures caused by invasions of miners and loggers, and by insecurity in indigenous territories," she said.
She said lack of access to adequate healthcare in indigenous areas of the Amazon was another reason for the higher death rate there compared to cities in Brazil.
"Imagine (the virus) in an indigenous village, which has no health centre, no doctor. There isn't anyone there to act quickly and isolate people. That's why it spreads so intensely," she said.
On Kaxuyana-Tunayana indigenous land - where Angela Kaxayuna is from, in the north of the state of Para - 574 people living on four river systems have access to just one state health centre, along one of the rivers, she said.
Brazil's Special Secretariat for Indigenous Health (SESAI), the federal agency responsible for assuring access to healthcare for indigenous people living within indigenous territories, has been criticized for not including in its COVID-19 death toll indigenous people who live in or contracted the disease in urban areas.
SESAI's figures, through August 7, show 263 indigenous people dead from Covid-19 in the Amazon region - less than half the number of deaths recorded by COIAB.
Angela Kaxuyana said it made no sense to count indigenous deaths only in reserves when there are 487 indigenous territories recognized by Brazil's government but another 237 still waiting for recognition.
"It's totally contradictory to say that the indigenous healthcare policy will only serve those in the indigenous territories," Kaxuyana said.
Territories not yet recognised do not receive health services aimed at indigenous people, as provided for in Brazil's constitution. Brazil's Ministry of Health in 2004 restricted SESAI's services to indigenous villages.
A SESAI spokeswoman confirmed that its legal mandate is to provide health services to indigenous people resident in indigenous villages.
"Indigenous people living in urban regions are served by the state and municipal public health system," the spokeswoman told the Thomson Reuters Foundation via email.
Angela Kaxuyana said the rules effectively deny many indigenous people adequate healthcare.
"It is a prejudiced division that diminishes indigenous people who are in the city without choosing to be there," she said.
Many indigenous families have been displaced to cities by illegal mining, logging, farming and other activity by outsiders in their territories, she said.
Fellows, of IPAM, said SESAI's count of indigenous coronavirus deaths overlooks data from about 100,000 indigenous people in the Amazon living outside reserves, based on the last Brazilian census in 2010.
Existing Health Risks:
Paulo Basta, a doctor and epidemiologist specialising in indigenous health, said indigenous communities, as a result of limited access to healthcare and exposure to untreated water, often had higher rates of everything from tuberculosis and malnutrition to parasites and diarrhoea.
Those existing vulnerabilities could also contribute to a higher death rate from Covid-19, said Basta, of the Oswaldo Cruz Foundation (Fiocruz), a leading public health research institute in Brazil.
He attributed poor health in the Amazon to factors including "institutional racism, territorial vulnerability (and) territories invaded by land grabbers, loggers and every type of explorer interested in the richness of the Amazon".
IPAM's Fellows said indigenous people in the Amazon have also become more vulnerable to the virus because many, as a result of destruction in their territories, now need to travel to towns to buy food.
Indigenous territories have a higher rate of malnutrition than the national average, she said.
"It is the perfect storm," in terms of indigenous vulnerability to the coronavirus, she said. "All the possible factors are there."
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