SITTWE, Myanmar (Reuters) - A 16-year-old Muslim boy lay dying on a thin metal table. Bitten by a rabid dog a month ago, he convulsed and drooled as his parents wedged a stick between his teeth to stop him from biting off his tongue.
Swift treatment might have saved Waadulae. But there are no doctors, painkillers or vaccines in this primitive hospital near Sittwe, capital of Rakhine State in western Myanmar. It is a lonely medical outpost that serves about 85,300 displaced people, almost all of them Muslims who lost their homes in fighting with Buddhist mobs last year.
"All we can give him is sedatives," said Maung Maung Hla, a former health ministry official who, despite lacking a medical degree, treats about 150 patients a day. The two doctors who once worked there haven't been seen in a month. Medical supplies stopped when they left, said Maung Maung Hla, a Muslim.
These trash-strewn camps represent the dark side of Myanmar's celebrated transition to democracy: apartheid-like policies segregating minority Muslims from the Buddhist majority. As communal violence spreads, nowhere are these practices more brutally enforced than around Sittwe.
In an echo of what happened in the Balkans after the fall of communist Yugoslavia, the loosening of authoritarian control in Myanmar is giving freer rein to ethnic hatred.
President Thein Sein, a former general, said in a May 6 televised speech his government was committed to creating "a peaceful and harmonious society in Rakhine State."
But the sand dunes and barren paddy fields outside Sittwe hold a different story. Here, emergency shelters set up for Rohingya Muslims last year have become permanent, prison-like ghettos. Muslims are stopped from leaving at gunpoint. Aid workers are threatened. Camps seethe with anger and disease.
In central Sittwe, ethnic Rakhine Buddhists and local officials exult in what they regard as a hard-won triumph: streets almost devoid of Muslims. Before last year's violence, the city's Muslims numbered about 73,000, nearly half its population. Today, there are fewer than 5,000 left.
Myanmar's transformation from global pariah to budding democracy once seemed remarkably smooth. After nearly half a century of military dictatorship, the quasi-civilian government that took power in March 2011 astonished the world by releasing dissidents, relaxing censorship and re-engaging with the West.
Then came the worst sectarian violence for decades. Clashes between Rakhine Buddhists and stateless Rohingya Muslims in June and October 2012 killed at least 192 people and displaced 140,000. Most of the dead and homeless were Muslims.
"Rakhine State is going through a profound crisis" that "has the potential to undermine the entire reform process," said Tomás Ojea Quintana, U.N. special rapporteur on human rights in Myanmar.
Life here, he said, resembles junta-era Myanmar, with rampant human-rights abuses and a pervasive security apparatus. "What is happening in Rakhine State is following the pattern of what has happened in Myanmar during the military government," he said in an interview.
The crisis poses the biggest domestic challenge yet for the reformist leaders of one of Asia's most ethnically diverse countries. Muslims make up about 5 percent of its 60 million people. Minorities, such as the Kachin and the Shan, are watching closely after enduring persecution under the former junta.
As the first powerful storm of the monsoon season approached western Myanmar this week, the government and U.N. agencies began a chaotic evacuation from the camps, urging thousands of Rohingya Muslims to move to safer areas on higher ground across Rakhine State.
Some resisted, fearing they would lose all they had left: their tarpaulin tents and makeshift huts. More than 50 are believed to have drowned in a botched evacuation by sea.
Sittwe's last remaining Muslim-dominated quarter, Aung Mingalar, is locked down by police and soldiers who patrol all streets leading in and out. Muslims can't leave without written permission from Buddhist local authorities, which Muslims say is almost impossible to secure.
Metal barricades, topped with razor wire, are opened only for Buddhist Rakhines. Despite a ban against foreign journalists, Reuters was able to enter Aung Mingalar. Near-deserted streets were flanked by shuttered shops. Some Muslims peered from doors or windows.
On the other side of the barricades, Rakhine Buddhists revel in the segregation.
"I don't trust them. They are not honest," said Khin Mya, 63, who owns a general store on Sittwe's main street. "Muslims are hot-headed; they like to fight, either with us or among themselves."
Ei Mon Kyaw, 19, who sells betel nut and chewing tobacco, said Muslims are "really dirty. It is better we live apart."
State spokesman Win Myaing, a Buddhist, explained why Aung Mingalar's besieged Muslims were forbidden from speaking to the media. "It's because they all tell lies," he said. He also denied the government had engaged in ethnic cleansing, a charge leveled most recently by Human Rights Watch in an April 22 report.
"How can it be ethnic cleansing? They are not an ethnic group," he said from an office on Sittwe's main street, overlooking an empty mosque guarded by soldiers and police.
His comments reflect a historic dispute over the origins of the country's estimated 800,000 Rohingya Muslims, who claim a centuries-old lineage in Rakhine State.
The government says they are Muslim migrants from northern neighbor Bangladesh who arrived during British rule from 1824. After independence in 1948, Myanmar's new rulers tried to limit citizenship to those whose roots in the country predated British rule. A 1982 Citizenship Act excluded Rohingya from the country's 135 recognized ethnic groups, denying them citizenship and rendering them stateless. Bangladesh also disowns them and has refused to grant them refugee status since 1992.
The United Nations calls them "virtually friendless" and among the world's most persecuted people.
The state government has shelved any plan to return the Rohingya Muslims to their villages on a technicality: for defying a state requirement that they identify themselves as "Bengali," a term that suggests they are illegal immigrants from Bangladesh.
All these factors are accelerating an exodus of Rohingya boat people emigrating in rickety fishing vessels to other Southeast Asian countries.
From October to March, between the monsoons, about 25,000 Rohingya left Myanmar on boats, according to new data from Arakan Project, a Rohingya advocacy group. That was double the previous year, turning a Rakhine problem into a region-wide one.
The cost of the one-way ticket is steep for an impoverished people - usually about 200,000 kyat, or $220, often paid for by remittances from family members who have already left.
Many who survive the perilous journeys wind up in majority-Muslim Malaysia. Some end up in U.N. camps, where they are denied permanent asylum. Others find illegal work on construction sites or other subsistence jobs. Tens of thousands are held in camps in Thailand. Growing numbers have been detained in Indonesia.
Rakhine State, one of the poorest regions of Southeast Asia's poorest country, had high hopes for the reform era.
In Sittwe's harbor, India is funding a $214 million port, river and road network that will carve a trade route into India's landlocked northeast. From Kyaukphyu, a city 65 miles southeast of Sittwe, gas and oil pipelines stretch to China's energy-hungry northwest. Both projects capitalize on Myanmar's growing importance at Asia's crossroads.
That promise has been interrupted by communal tensions that flared into the open after the rape and murder of a Buddhist woman by Muslim men in May last year. Six days later, in retribution, a Buddhist mob beat 10 Muslims to death. Violence then swept Maungdaw, one of the three Rohingya-majority districts bordering Bangladesh, on June 8. Rohingya mobs destroyed homes and killed an unknown number of Rakhines.
The clashes spread to Sittwe. More than 2,500 homes and buildings went up in flames, as Rohingya and Rakhine mobs rampaged. When the smoke cleared, both suffered losses, though the official death toll for Rohingya - 57 - was nearly double that for Buddhist Rakhines. Entire Muslim districts were razed.
October saw more violence. This time, Buddhist mobs attacked Muslim villages across the state over five days, led in some cases by Rakhine nationalists tied to a powerful political party, incited by Buddhist monks and abetted at times by local security forces..
U.S. President Barack Obama, on a groundbreaking visit in November, urged reconciliation. "The Rohingya ... hold within themselves the same dignity as you do, and I do," he said. The week he visited, Thein Sein vowed to forge ethnic unity in a letter to the United Nations.
But the violence kept spreading. Anti-Muslim unrest, whipped up by Buddhist monks, killed at least 44 people in the central city of Meikhtila in March. In April and May, Buddhist mobs destroyed mosques and hundreds of Muslim homes just a few hours' drive from Yangon, the country's largest city.
Thein Sein responded by sending troops to volatile areas and setting up an independent commission into the Rakhine violence. Its recommendations, released April 27, urged meetings of Muslim and Buddhist leaders to foster tolerance, Muslims to be moved to safer ground ahead of the storm season, and the continued segregation of the two communities "until the overt emotions subside."
It sent a strong message, calling the Rohingya "Bengalis," a term that suggests they belong in Bangladesh, and backing the 1982 citizenship law that rendered stateless even those Rohingya who had lived in Myanmar for generations.
The Rohingya's rapid population growth had fueled the clashes with Buddhists, it said, recommending voluntary family-planning education programs for them. It suggested doubling the number of soldiers and police in the region.
Rohingya responded angrily. "We completely reject this report," said Fukan Ahmed, 54, a Rohingya elder who lost his home in Sittwe.
Local government officials, however, were already moving to impose policies in line with the report.
On the morning of April 26, a group of state officials entered the Theak Kae Pyin refugee camp. With them were three policemen and several Border Administration Force officers, known as the Nasaka, a word derived from the initials of its Burmese name. Unique to the region, the Nasaka consists of officers from the police, military, customs and immigration. They control every aspect of Rohingya life, and are much feared.
Documented human-rights abuses blamed on the Nasaka include rape, forced labor and extortion. Rohingya cannot travel or marry without the Nasaka's permission, which is never secured without paying bribes, activists allege.
State spokesman Win Myaing said the Nasaka's mission was to compile a list identifying where people had lived before the violence, a precondition for resettlement. They wanted to know who was from Sittwe and who was from more remote townships such as Pauktaw and Kyaukphyu, areas that saw a near-total expulsion of Muslims in October.
Many fled for what Win Myaing said were unregistered camps outside Sittwe, often in flood-prone areas. "We would like to move them back to where they came from in the next two months," said Win Myaing. The list was the first step towards doing that.
The list, however, also required Muslims to identify themselves as Bengali. For Fukan Ahmed and other Rohingya leaders, it sent a chilling message: If they want to be resettled, they must deny their identity.
Agitated crowds gathered as the officials tried to compile the list, witnesses said. Women and children chanted "Rohingya! Rohingya!" As the police officers were leaving, one tumbled to the ground, struck by a stone to his head, according to Win Myaing. Rohingya witnesses said the officer tripped. Seven Rohingya were arrested and charged with causing grievous hurt to a public servant, criminal intimidation and rioting.
Compiling the list is on hold, said Win Myaing. So, too, is resettlement.
"If they trust us, then (resettlement) can happen immediately. If you won't even accept us making a list, then how can we try and do other things?" he asked. The crisis could be defused if Rohingya accepted the 1982 Citizenship Law, he said.
But doing so would effectively confirm their statelessness. Official discrimination and lack of documentation meant many Rohingya have no hope of fulfilling the requirements.
Boshi Raman, 40, said he and other Rohingya would never sign a document calling themselves Bengali. "We would rather die," he said.
Win Myaing blamed the Rohingya for their misfortune. "If you look back at the events that occurred, it wasn't because the Rakhines were extreme. The problems were all started by them," the Muslims, he said.
In Theak Kae Pyin camp, a sea of tarpaulin tents and fragile huts built of straw from the last rice harvest, there is an air of growing permanence. More than 11,000 live in this camp alone, according to U.N. data. Naked children bathe in a murky-brown pond and play on sewage-lined pathways.
A year ago, before the unrest, Haleda Somisian lived in Narzi, a Sittwe district of more than 10,000 people. Today, it is rubble and scorched earth. Somisian, 20, wants to return and rebuild. Her husband, she says, has started to beat her. In Narzi, he worked. Now he is jobless, restless and despondent.
"I want to leave this place," she said.
Some of those confined to the camps are Kaman Muslims, who are recognized as one of Myanmar's 135 official ethnic groups; they usually hold citizenship and can be hard to tell apart from Rakhine Buddhists. They fled after October's violence when their homes were destroyed by Rakhine mobs in remote townships such as Kyaukphyu. They, too, are prevented from leaving.
Beyond Sittwe, another 50,000 people, mostly Rohingya, live in similar camps in other parts of the state destroyed in last year's sectarian violence.
Across the state, the U.N relief agency has provided about 4,000 tents and built about 300 bamboo homes, each of which can hold eight families. Another 500 bamboo homes are planned by year-end. None are designed to be permanent, said agency spokeswoman Vivian Tan. Tents can last six months to a year; bamboo homes about two years.
The agency wants to provide the temporary shelter that is badly needed. "But we don't want in any way to create permanent shelters and to condone any kind of segregation," Tan said.
Aid group Doctors Without Borders has accused hardline nationalists of threatening its staff, impairing its ability to deliver care. Mobile clinics have appeared in some camps, but a U.N. report describes most as "insufficient."
Waadulae, suffering from rabies, was treated at Dar Paing hospital, whose lone worker, Maung Maung Hla, was overwhelmed. "We have run out of antibiotics," he said. "There is no malaria medicine. There's no medicine for tuberculosis or diabetes. No vaccines. There's no equipment to check peoples' condition. There are no drips for people suffering from acute diarrhea."
State spokesman Win Myaing said Rakhine doctors feared entering the camps. "It's reached a stage where they say they'd quit their jobs before they would go to these places," he said.
The treatment of the Rohingya contrasts with that of some 4,080 displaced ethnic Rakhine Buddhists in central Sittwe. They can leave their camps freely, work in the city, move in with relatives in nearby villages and rebuild, helped by an outpouring of aid from Burmese business leaders.
Hset Hlaing, 33, who survives on handouts from aid agencies at Thae Chaung camp, recalls how he earned 10,000 kyat ($11 a day) from a general-goods stall in Sittwe before his business and home went up in flames last June. Like other Muslims, he refuses to accept the term Bengali.
"I don't want to go to another country. I was born here," he says, sipping tea in a bamboo shack. "But if the government won't accept us, we will leave. We'll go by boat. We'll go to a country that can accept us."
Edited by Andrew R.C. Marshall and Bill Tarrant.