Displacement and disease: The Shan exodus and infectious disease implications for Thailand

As I left the hospital, Sai Harn struggled to prop himself up from the bed, his emaciated arms upraised, his palms pressed together in a traditional goodbye. I never saw him again. Sai Harn, an ethnic Shan from southern Shan State, Burma, fled his home for Chiang Mai about a decade ago. He last worked in agriculture, finally stopping after losing weight and becoming too tired. He was diagnosed with AIDS and tuberculosis. As a migrant worker, he was ineligible for the Thai government's anti-retroviral treatment programs, and died soon thereafter. His funeral, at a local Shan temple, was attended by only a handful of people, almost all staff of a migrant safe-house where he spent his final days. His worldly possessions, including his life-savings of about 500 baht, were given away. In death, he was as invisible as he was in life, yet another tragedy in the catastrophe of Shan State.Burma, particularly the frontiers of the country, is ethnically diverse, and perhaps a third of her peoples are non-Burman (the last census detailing ethnic makeup was done in 1931). The country has fourteen administrative divisions, of which seven are ethnic states, named after the largest ethnic group inhabiting it [1]. Shan State, bordering Thailand, Laos, and China, is the largest, covering 20% of the country's land mass. Much of it has been ravaged by five decades of continuous, low-intensity civil conflict as armed groups vied for autonomy, ideology, and business interests, including the narcotics trade. Starting in 1996, the Burmese military or Tatmadaw, in an attempt to expand central control, intensified its counter-insurgency strategy, the Four Cuts Policy, in central and southern Shan State [2]. The cornerstone of this policy was the forced relocation of civilians from contested areas to "relocation centers" more firmly under Rangoon's control, and destroying rice fields and food storage facilities [2,3]. Between 1996–1998 alone, over 1,400 villages in a 7,000 square mile area of