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Bhutan is an ethnically diverse country: it is comprised of the Ngalong in the west, the "central Bhutanese," the Sharchop in the east and the Lhotshampas or Nepali-Bhutanese in the south.
Lhotshampas is a term that other Bhutanese use to refer to Nepali-Bhutanese, the refugees which Canada has been accepting from Bhutan. The refugees do not prefer this term; rather, they like to be recognized as either Nepali-Bhutanese or Bhutanese.
Map: US Central Intelligence Agency
Bhutanese refugees are ethnic Nepalese whose origins trace to the eastern part of Nepal. In the late 1980s, with the formation of pro-Nepali-Bhutanese political parties, the Bhutan government perceived the Nepali-Bhutanese people as a growing threat. The Bhutan government introduced a series of repressive citizenship laws and "Bhutanization" policies which led to the political, economic, and cultural exclusion of the Nepali-Bhutanese people. This included denationalization of ethnic Nepalese as well as tightened requirements for obtaining and retaining their citizenship.
Additionally, in 1989, the government introduced a "one nation, one people" policy which restricted the practice of Nepali-Bhutanese culture by requiring Bhutanese to adopt a national dress code of Drukpa culture, and to terminate the use of Nepali language instruction in schools. Before this policy, Nepali-Bhutanese were allowed to wear their ethnic clothes, which are saris for women and daura suruwal for men. When the Nepali-Bhutanese revolted against the government for such encroachments on their civil rights, the government responded harshly to protests and public demonstrations by suspending public services such as schools and health services in the southern region. By 1992, only a small population of the Nepali-Bhutanese people remained in Bhutan.
Bhutanese refugees were not permitted to set up permanent refugee camps in India and were transferred en masse to Nepal. In Nepal, the refugees were divided into seven United Nations High Commissioner for Refugees (UNHCR) camps in Jhapa and Ilam districts in the southeastern region. Neither Nepal nor Bhutan were willing to give legalization/citizenship to this population, resulting in the refugees living in this state of liminality for over two decades.
Most of the refugees from Bhutan who arrived in Nepal between 1990 and 1993 were recognized on a prima facie basis by Nepal. With the large resettlement programme initiated in 2007 (see Resettlement of Refugees in Canada for further details), the dynamics of refugee camps changed significantly. The following are current challenges faced by the UNHCR operations at the refugee camps:
Maintaining services due to the departure of many skilled refugees
Various types of long-standing psychosocial issues due to the marginalization of this population
Questions of child custody and divorce need to be addressed prior to the departure of refugees for resettlement
Sexual and gender-based violence in the camps remain ongoing
The presence of the refugees from Bhutan in the seven camps has at times been perceived as harmful to the environment and the economic prospects of the host community.
The perception that services available in the camps are better than those for nationals has also led to resentment from refugee host communities
Political instability and sporadic violence throughout the eastern region continue to interfere with UNHCR operations
A large-scale resettlement program was initiated in 2007 with the aid of seven countries, including Canada. When the resettlement movement first started, there were 108,000 Bhutanese refugees in the camps. As of August 2011, this population has grown to over 113,000 due to births. The seven countries have agreed to resettle 70,000 people.
In May 2007, the Government of Canada announced that it would resettle up to 5,000 Bhutanese refugees over the next 3-5 years. As of March 31, 2011, nearly 2,600 Bhutanese refugees had already arrived in Canada with additional arrivals continuing throughout 2011-2012.
Found in 27-64% of Bhutanese refugees. From the NIH factsheet: clinical signs and symptoms include megaloblastic anemia, fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue. The neurological symptoms of vitamin B12 deficiency can occur without anemia, and can be irreversible.
The Cdn Guidelines on Immigrant Health do not recommend routine screening for the Bhutanese, as they are not from Southeast Asia, but South Asia. However, serology should be done if eosinophilia or symptoms (abdominal pain, diarrhea, pulmonary symptoms, urticarial rashes to buttocks/waist) are present (Pat Walker MD - Centre for Int'l Health, Minnesota)
Per the BCCDC, the estimated incidence of sputum-smear positive TB in camp is 242/100,000. (Recall that high incidence is >15/100,000). If Canada committed to accepting ~5,000 of the refugees over 5 years beginning 2009, we can expect to see about 12 cases of active TB across the country (excludes latent cases).
Several cases were diagnosed on pre-departure screening.
Also see the CDC Bhutanese Refugee Health Profile.
The following is some general information on Bhutanese refugees' culture and traditions, which may be followed to varying degrees by the individuals settling in Canada.
60% Indian-and Nepalese-influenced Hinduism; 27% Buddhist; 10% Kirat and 1-7% Christians
Women - saris. Men - daura suruwal.
Nepali; 35% have functional knowledge of English
Birth and Wedding Traditions
|Children named on 11th day after birth
Hindu boys perform “Bratabandha” (symbolic representation that a boy is mature enough to perform his duties) starting at the age of 8
Polygamy is not common but is practiced
Women move to husband’s house after marriage
Cultural practice related to Death
Cremation is practiced
Hindus mourn for 13 days and avoid salt, turmeric and oils in food. Only ghee (clarified butter) is used
Sons shave heads and wife and son wear white for 1 year. Woman does not wear red after the death of her husband
No festivals, no weddings, no social events during this year.
Remarriage is not common among widows.
Many are vegetarian
Mainly rice along with legumes, vegetables
Eat twice a day (10am and 7pm) and tea (with a lot of sugar) during the day
Fasting for religious purpose is common
Packets of noodle soup (high in sodium) are common in refugee camps
Patriarchal society: men earn the money and makes decisions
Women are responsible for household work
Women and daughters eat last and men and male children eat first
Men and women don’t touch in public
Shaking hands between men and women is not common (but is not restricted)
Women are considered untouchables during their menstrual period and after given birth.
Central Intelligence Agency. The World Factback – Bhutan. Date modified: September 27, 2011
Citizenship and Immigration Canada. Backgrounder – Bhutanese refugees. Date modified: May 22, 2007.
Citizenship and Immigration Canada. Resettling Bhutanese Refugees – Update on Canada’s Commitment. Date modified: August 23, 2011.
Great Brook Valley Health Center. Bhutanese Refugees. http://www.umassmed.edu/uploadedFiles/fmch/Community_Health/Community_Health_Toolkit_Draft1/Bhutanese%20Cultural%20Presentation%20%205_10_2010%20SS.pdf
International Rescue Committee. The health of refugees from Bhutan. February 2009.
Shrestha, C. New Issues in Refugee Research. Power and politics in resettlement: a case study of Bhutanese refugees in the USA. The UN Refugee Agency, Policy Development and Evaluation Service. May 2011. http://www.unhcr.org/4dca7f129.html
The United Nations Refugee Agency. Bhutan. 2010 UNHCR country operations profile --Nepal.
Translated educational handouts on health issues.
Dentists, physiotherapists and other community resources who speak other languages, accept IFH or offer reduced fees.