Myanmar: Health System
(8 months, 3 weeks ago)
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Lord Crisp
To ask His Majesty’s Government what assessment they have made of the role that the United Kingdom could play in supporting health workers in Myanmar and contributing to the reconstruction of the country’s health system.
Lord Crisp (CB)
My Lords, I start by thanking noble Lords taking part in this debate, many of whom know Myanmar much better than I do. I also thank the people who produced briefings for us, because we got some very good briefings from a number of different sources.
My locus in this is my interest in global health. I am also patron of THET, which I ought to declare as an interest and which I will refer to later. I want the debate to raise the profile of the health crisis in Myanmar, to discuss what can be done to support health workers now and to contribute to the reconstruction of the country’s health system, which has been very largely destroyed over the last few years.
I will not dwell on the wider situation: the coup just over three years ago, the extraordinary repression and violence, the attacks on citizens, and the persecution of the Rohingya and other minorities, with the Gambia’s referral, supported by the UK, to the International Court of Justice on the basis of genocide. For the purpose of this debate, my focus is on the way that health workers and health facilities have been targeted.
To give just a few figures, health workers were among the first people to object and create the civil disobedience movement in Myanmar. Some 50% of health workers in the country were or are part of that movement. As a result, they have been targeted. Since the coup, there is documented evidence of at least 104 being killed and at least 870 being detained, and of 1,127 attacks on health facilities. These figures will be at a lower level, because these are the documented cases. I am sure that there will be others.
That is accompanied by the declining health of the population. In the World Health Organization’s estimate, a third of the population is in need and 12 million will need humanitarian health assistance in 2024. Some 2.6 million people are internally displaced within the country. Just as an indicator, perinatal deaths have been going up and vaccination rates are down by about 50% for children. This is a dire health emergency, which is affecting health workers as well as the health of the people in the nation.
A month ago, I had the privilege to be one of a number of parliamentarians from both Houses, including the noble Baroness, Lady Finlay, and the noble Earl, Lord Sandwich, who had a Zoom meeting with four nurses in different parts of northern Myanmar. It was deeply impressive: these people were essentially in hiding but providing support to their local communities —not in proper facilities, but in whatever facilities they could find. They were really impressive. It was incredibly moving and horrifying, and they were incredibly brave. I think all of us came away asking what we could do to help.
Part of what I want to do is relay what the nurses said to us was needed. First, they were very grateful to the UK. They recognised what the UK has been doing. Indeed, I have seen the replies to the Parliamentary Questions from Fiona Bruce MP, which have just come out, and can see that the Government are indeed taking this very seriously.
The nurses were also very grateful to the Myanmar clinicians who were supporting them from this country through the internet and through training. Part of this is being co-ordinated through THET, the organisation I mentioned earlier. It does impressive work. THET loosely co-ordinates 20 health organisations in the UK and a number of individuals who, between them, have supported training of health workers in the country, because the medical and nursing facilities have been destroyed in a number of places, and with telehealth consultations.
The numbers here are impressive. Something like 2,000 medical students have been supported through their training, and 59 clinicians have gone through training for faculty development to increase the ability to train people outside the traditional medical schools, if you like. Some 280 GPs have been supported in 50 townships. On the telemedicine side, THET regularly runs 24 specialist and four general clinics, and has seen 158,000 patients over the three years. Clinicians in the UK, some of whom are from Myanmar and some are UK citizens, have been making this contribution; it is a big contribution, and they are very grateful to those people for that. There are other groups from the UK, particularly at the border and in the north, who are working on the ground. They represent the great links that there are between the UK and Myanmar.
The nurses, first, wanted their voices heard. In the circumstances where we have Gaza and Ukraine, it is not surprising that they feel that they have slipped off the agenda and want to be heard. They want the UK to do even more in international fora to raise the issues that they are facing and give this a much higher profile.
I shall ask the Minister some questions. First, what can the UK do to raise the profile more in international organisations and with international organisations? Secondly, the nurses are asking for humanitarian corridors to be set up so they can properly support the civilian population. I note that Thailand has reached an agreement with the junta and has taken the initiative about creating some humanitarian corridors, but I also note that there is some controversy about the safety of this. One question for us is how the UK can support the development of humanitarian corridors, and what the UK can do to monitor that they are actually safe and not, in some sense, a trap developed by the junta.
Thirdly, the nurses wanted more aid into the country. There are two questions here. I would be grateful if the Minister could explain why there was a cut in aid to Myanmar in the past year and what that was about. Furthermore, they were particularly asking about having more direct aid, not aid going through junta control—more aid reaching people in the increasingly large parts of the country where the junta is simply not in control. I expect that other noble Lords will raise this, but there is certainly demand for different methods of getting aid there. Is it time to relook at what is happening? A lot of the aid is going through international organisations and directly through the junta. Could the Minister provide some thoughts about why the aid was cut and how more aid could be provided directly to the people, without going through the junta?
Fifthly, they want more of the clinician-to-clinician help that I was talking about earlier, which is partly co-ordinated through THET, and some real recognition of the immense amount of work done by the four nurses. Their relationships with nurses in this country are incredibly important to them in terms of support and solidarity, but there are also very practical things that you can do through the internet today, which you cannot do in other ways. Will the Minister consider looking at what more support can be provided to these UK and Myanmar clinicians in this country, who are providing this direct clinical support to clinicians in Myanmar?
In summing up, the situation is appalling and is clearly deteriorating. The civil war is developing, which will have a very long-term impact on the country. At some point, there will presumably be a very long recovery programme. I hope that the UK can be part of that and play a leading role.
The UK is doing a lot at the moment, through the Government, and the nurses wanted us particularly to stress that and all the useful support of the individuals and institutions that are around and have been providing this direct support, clinician to clinician. In requesting this debate and, subsequently, a meeting with the Minister, I wanted to ask whether the UK Government could think about what more it could do—and, of course, for him to answer my five questions.
Lord Bruce of Bennachie (LD)
My Lords, I thank the noble Lord, Lord Crisp, very much for initiating this debate. I look forward to hearing the Minister’s answers to those very pertinent and direct questions.
I have been involved with Myanmar, one way or another, for about 15 years. The first time was when the junta were in charge before. Although I was not able to visit the country, the International Development Committee, of which I was chair, went to a camp on the Thai border where we got a very direct insight into the appalling way in which the junta and the generals were treating their own civilians, for whom they seem to have nothing but contempt. The UK Government at that time were supporting the delivery of medicines through a whole variety of routes, obviously by focusing on diseases such as malaria and TB, but also anything and everything else that they could get. It is probably better not to publicise how they managed it, but they did.
I then had the opportunity to return to Myanmar, after the generals had backed off and the reforms towards democracy were in place. Initially, I went with a cross-party group led by John Bercow, the Speaker, who had also been a very active campaigner on the Burma/Myanmar situation. We were part of that group, along with Fiona Bruce MP and Valerie Vaz MP, and we travelled extensively across the country at a time of hope.
Subsequently, as things improved, I was able to engage with committees in the Myanmar Parliament, under the auspices of the Westminster Foundation for Democracy, for which I should obviously declare an interest, having been supported by it to do that. Interestingly enough, my role at the time was in mentoring committees in how they could promote reform and deliver on policy. In particular, I engaged with two of the health committees, which were keenly focused on building up a service which would deliver for people across the country.
What was interesting was that these committees were chaired by medical practitioners who had been in exile and had come back, as they put it, to help the lady. That was how they expressed it. What was shocking was that when they arrived back, they found that the health system was pretty well non-existent. To the extent that there was any healthcare, it was provided only to support the mates of the generals. It was not really going to the people in need.
I have to express a little frustration there was at the time, because very good insights, reports and recommendations were produced by those MPs, but they were frustrated in getting any action from the Government there. I was really disappointed to hear that most of them said they had never met Aung San Suu Kyi, even though they were MPs in her party. They had real difficulty getting action. It is such a pity that things that could perhaps have been done were not done. The point, at the end of the day, was that they were beginning to build back a health service and focusing on how to do that in a fair and objective way. I was in the middle of an inquiry on trying to do just that. Obviously, we reached the situation where all that was swept aside as the generals came back and did what they are now doing.
That previous experience we had as DfID, operating for the UK through both Thailand and where we could within Myanmar, was really effective at reaching people. The situation has changed but there must be experiences there which are valid as to how we can get things through. Also, the junta are not having it all their own way. Unlike the way they were in control previously, it is a civil war now, and parts of the country are clearly not under the generals’ control where we can and should get access. We can support people there, and have to find ways of getting to people in areas where it is more difficult.
It is a matter of experience and ingenuity. We have done it in the past and should do it again. Clearly, it breaks anybody’s heart to see a Government, if you can call them that, who have such little interest in the welfare of their people. It is quite the reverse; they are hostile and the enemy of the people. Their interest in education and health is absolute zero, apart from for themselves, and they are literally destroying that infrastructure. We have got to do everything we can to help people. We can do it and have done it in the past. We could do it again and I hope that the Minister will be able to give us some positive replies.
Lord Alton of Liverpool (CB)
My Lords, I pay tribute to my noble friend Lord Crisp, both for securing this important Question for Short Debate and for his long and distinguished career in global healthcare and international development. Last year, at his instigation, I took part in a call with health workers and nurses from Myanmar—I will refer to it as Burma, during the debate. That meeting was dramatically interrupted by a cyberattack, which reinforced some of the issues that we were talking about and the fears and anxieties of some who were on the call. From what my noble friend has said to us, it is clear that the situation has not improved and has only worsened, in the meantime.
I declare an interest as vice-chair of the All-Party Parliamentary Groups on Burma and the Rohingya, and as patron of the Epiphany Trust, which supports humanitarian projects along the Burma/Thailand border.
I first visited Burma—illegally—in 1998, when I met the Karen refugees and internally displaced people on the border. It led to a subsequent letter to me from Lady Mountbatten of Burma, which touched me enormously. She talked about her father’s high regard for the Karen people, whom she described as “our forgotten allies”.
On subsequent visits, I met Aung San Suu Kyi, who is now incarcerated with thousands of other political prisoners. Reports of her poor health in prison, and the concerns that emerged last year that she was being denied proper medical attention, are deeply alarming. Until very recently her son, Kim Aris—I request of the Minister that the Foreign Secretary should meet him—had no contact with his mother and did not know whether his letters and parcels to her were reaching her. A recent letter to her son was, he said, the first confirmation that his mother is still alive.
Since the coup, over 26,000 people have been arrested and over 20,000 political prisoners remain in jail. Their conditions, including inadequate healthcare, are appalling. The humanitarian crisis in the ethnic states is even more shocking with, as we have heard from the noble Lord, Lord Bruce, the military engaged in a brutal campaign of air strikes, bombardment and ground attacks against civilians, with devastating consequences. At least 2 million people are internally displaced and thousands more have fled across borders to neighbouring countries.
This week, I received a letter from the UNHCR representative in Bangladesh, Sumbul Rizvi. She described the plight of Rohingya refugees from Burma who fled across the border and are in Cox’s Bazar, and said there had been a 179% increase in serious protection incidents, including 88 killings, torture, abductions and sexual-based violence. What impact will reduced humanitarian aid have on their protection and well-being?
The military is also committing barbaric atrocity crimes at a level of intensity not previously seen. Thousands have been killed. Hospitals and clinics, as well as schools and churches, have been bombed. Volker Türk, the UN High Commissioner for Human Rights, says that the junta’s crimes include
“burning them alive, dismembering, raping, beheading, bludgeoning, and using abducted villagers”
as human minesweepers. He says that it is
“inhumanity in its vilest form”.
According to the UN, at least 18 million people in Burma—one-third of the population—are now in urgent need of humanitarian assistance. The World Health Organization says that the entire population of 56 million are now facing some level of need, with at least 12 million people in need of humanitarian health assistance this year.
The military regime has directly and deliberately targeted the health system and health workers, as my noble friend described. New restrictive laws target NGOs and health providers. The Government have imposed sanctions, which I welcome, as do my noble friend and the noble Lord, Lord Bruce, but are we still trying to put Burma back on the Security Council agenda? Perhaps the Minister could tell us what discussions are being had with the UN Secretary-General about what more he could do to address the crisis.
We should increase efforts to seek the enforcement of a global arms embargo and, in particular, co-ordinate with like-minded countries on sanctions on aviation fuel, which would be a very practical and much-needed measure to impede the military’s ability to bomb civilians.
Lastly, will the Government urgently increase funding for humanitarian aid? Can the Minister tell us precisely what this year’s figures are, particularly for cross-border help for healthcare initiatives in the border areas to help internally displaced people and to provide much-needed healthcare for those displaced by conflict, including the Rohingya, who have been forced to flee the genocide unleashed upon them? If the Minister has not seen the letter that I received from the UNHCR this week, I would be very happy to share it with him. I have tabled Written Parliamentary Questions to him; if he is unable to give the answers today, I will look forward to reading them in due course.
Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure, as always, to follow the noble Lord, Lord Alton, and to very much agree with his points in terms of the need for more diplomatic action on sanctions on aviation fuel and small steps we can take to stop the flow of arms that are being used to repress the Burmese population. I also thank the noble Lord, Lord Crisp, for securing this debate. Unfortunately, I was not on that call with the nurses but, given what I heard today, I can only pay tribute to them. I have encountered other people in similar situations who can be utterly amazing.
My connection is that I was in Rakhine state in the late 1990s, up country in the amazing archaeological site of Mrauk-U, where the only other westerners in town were two Médecins Sans Frontières doctors. That was a testimony to the state of the medical system then in that poverty-stricken part of Burma.
I do not wish to repeat the points that others have made but will focus on two issues. One of them arises from what I was doing last night: I was with the High Commissioners of Barbados and Bangladesh, the Ineos Oxford Institute, the British Society for Antimicrobial Chemotherapy and the APPG on Antimicrobial Resistance. The meeting was preparing for the forthcoming high-level meeting in September of the General Assembly on the issue of antimicrobial resistance. I wish to cross-reference that with a couple of matters. One is the fact that there is increasing research coming mostly out of the Middle East that shows how AMR can be amplified by the impact of modern, heavy weapons, involving heavy metals going into the environment. That can induce resistance to antibiotics in microbes in the environment. There is also an increasingly amount of research that shows how AMR is strongly related to conflict. Obviously, that is partly due to the breakdown of medical systems, wounds that become infected for long periods, and so on. However, there is also increasing understanding about the impact of weapons.
As regards the issue of antimicrobial resistance, a figure that I suspect may shock even the knowledgeable noble Lords in this Committee is that about 50% of medical facilities in the world do not have running water. Wash water and sanitation are crucial. One would think that they are basic in 2024 but I have no doubt that these fundamental issues are enormous in Burma.
My direct question to the Minister—I will understand if he does not have an answer now—is: what are the Government doing as regards three key matters in the AMR area in terms of Burma? What is being done to support the provision of wash facilities, water and sanitation? What can be done to support provision of the appropriate antibiotics? Often in those situations, people just buy whatever antibiotics they can find, which may amplify problems. What can be done to increase the capacity for diagnostics that can operate at a small level, so that, crucially, one can test infections and find what antibiotics they are susceptible to and which they are resistant to? Then one can use the correct antibiotics. So, either now or later, perhaps the Minister can tell me of any work being done in that AMR space, which is getting much global focus this year, in terms of Burma.
I want to look at that, too, in the broader sense. I was in Burma many years ago with the World Health Organization, looking at the process of writing a report on women’s health. One of my more unusual claims to fame is that I appeared on the front page of the New Light of Myanmar shaking hands with the Health Minister. One might say that that was the previous junta’s propaganda rag. I did not have any choice in that. However, seriously, my question is about focus on women’s health and the efforts being made. We know that that issue is crucial to the health of whole communities but it often gets ignored. Rather more broadly, the focus on women’s education and the provision of support for women in those conflict zones and circumstances can be tremendously difficult.
Just as an example, some women from Afghanistan who I have heard from recently were working very hard to provide education—where girls are being denied it—by Zoom. Those technological means are open practically anywhere now. Is any work being done to support women’s education in Burma?
The Lord Bishop of Chelmsford
My Lords, I thank the noble Lord, Lord Crisp, for securing this important debate and for his commitment to raising the profile of this important issue. This time nearly a year ago, the noble Lord asked an Oral Question about health workers in Myanmar in your Lordships’ House. The picture then was stark, but NGOs agree that in the intervening year, the situation has deteriorated further.
As we have heard, 104 health workers have lost their lives and many more have been detained in the three years since the coup. Although I certainly echo the congratulations to the UK Government on a number of impactful training and partnership programmes, it is clear that more needs to be done. We have heard about the appalling attacks on health workers, which have rightly been thoroughly condemned. However, it is important too to consider the broader humanitarian situation and its impact on the country’s health system. I do not personally have any specific connection with Myanmar but, like many others, I have a concern for how this country can play a positive part in places in the world that are suffering humanitarian disasters and injustice.
To emphasise what other noble Lords have said, we know that where there is internal displacement and humanitarian need, it can become all but impossible to access reliable and high-quality healthcare. The Royal College of Paediatrics and Child Health describes Myanmar’s health system as having all but collapsed, while the number of internally displaced people has now risen to over 2.5 million. In such situations, how is it possible for adequate healthcare provision to be made?
Communicable diseases are on the rise and progress that had been made against diseases such as malaria and tuberculosis has been reversed. Infectious diseases invariably spike in times of humanitarian crisis. Between 2019 and 2022, there was a sevenfold increase in malaria cases in the country, which can primarily be attributed to unrest and a weakened health system. This is having a knock-on effect on neighbouring Thailand, where cases more than doubled over the same period. Displaced people are crossing the border to seek the medical treatment that they cannot access in their own country.
The UK is a significant funder of the Global Fund to Fight AIDS, Tuberculosis and Malaria. What steps, then, does the Minister think can be taken to ensure that interventions from multilateral organisations such as the Global Fund can be accessed by those who need them in Myanmar? What other interventions, multilateral or bilateral, might effectively be offered by the UK to alleviate the pressing medical need?
The long-term effects of depriving anyone of healthcare, particularly children—I am not sure that they have been mentioned yet—cannot be overstated. Children are not receiving vaccines; that could have an impact on them for the rest of their lives. The WHO has described Myanmar as having one of the lowest health worker availability levels in the whole region. I echo the calls from noble Lords for increased humanitarian aid to tackle immediate need, but might the Minister also be able to report on how the Government might support efforts to build up a larger healthcare workforce in the country for the longer-term?
The Earl of Sandwich (CB)
My Lords, the right reverend Prelate gave me an idea and I was about to write something down, but it is too late.
There are wars we follow on television every day and there are hidden wars, as in Myanmar. We owe a huge debt to my noble friend for focusing on the plight of the health services there. Knowing him quite well, I am sure he will not let this subject go.
I have some nostalgia joining this debate as it takes me back to two visits on behalf of Christian Aid in the 1980s. One was to the Thai border to see how the UN and NGOs managed to successfully reach the ethnic minorities, which they still do with great difficulty. The second visit was to Mandalay, where my host was a famous Karen soldier called Saw Lader. He fought with the British on two expeditions with the Chindits and won the MC. Later, I came to learn of the extraordinary courage and endurance of the people of Myanmar, personified by people such as Aung San Suu Kyi. Now, as we have heard, since the 2021 coup, innocent people, including doctors and nurses, have had to face an onslaught from their own Government.
What we have been watching daily in Gaza is the politicisation of health and education—the destruction of services which were already of a high standard. Something similar is happening in Sudan. In Myanmar, it is an outright attack on the very people charged with the physical and mental care of their compatriots. They are seen by the army as legitimate targets simply because these workers, many of whom are from ethnic minorities, are protecting their own patients and institutions. Then there is conscription, which is finally being enforced and causing a lot of distress to families.
The world needs to protest louder if the people of Myanmar are going to be heard. Thankfully, the FCDO has been quite active. Anne-Marie Trevelyan sounded the alarm a year ago when she said that the 2021 coup had led to millions needing assistance—16 million after two years. These numbers are going up. OCHA now estimates that 18.6 million are in need, about one-third of the population. Millions are displaced, and about 6 million children are cut off from education and healthcare. This also directly hits the national immunisation campaign. Then there is the problem of training, which has fallen away.
We have already heard the shocking figures for the number of outright attacks on health workers. Of course, the numbers are impossible to verify, but there can be no doubt that nurses and doctors, whether or not they protest openly, are being targeted like armed forces. Many have now left institutions for fear of being attacked, and they have to work through much smaller teams.
Despite the ravages of the pandemic, which is also an important factor, health workers are professionally well organised and have set up a shadow health service—a network of volunteers who were part of the National Unity Government, before they were closed down. They have also been skilled fundraisers through NGOs—I know that, like me, the noble Lord, Lord Collins, values the weight of NGOs in development—and international contacts, even recruiting staff to work behind the lines.
However, the army is resorting to brutal methods. Our own medical teams are risking their lives. We must do all we can to raise this issue in Parliament. Internal protest and resistance in any country may be perceived as insurrection. The same is happening in Gaza. As outsiders, we should never be deceived by this idea ourselves.
Baroness Finlay of Llandaff (CB)
My Lords, I appreciate being allowed to speak briefly in the gap. Some of us will have had the pleasure—indeed, the overwhelming experience—of hearing Aung San Suu Kyi when she addressed both Houses of Parliament in Westminster Hall. A gentle light of hope emanated. Now, we see a country that is almost in freefall, with so much collapsing. There has been a collapse in health care, maternal mortality has increased to a level that one could not have imagined, and there has been such a drop in immunisation, as has been said, that infections are rife.
I was privileged to be on the call that has been referred to, and prior to that had been on a call with doctors from that country. They were risking their lives simply to tell us what was going on. They knew that if they were traced, they would be no more. They knew that their families were at risk. Many of them leave their families to go to provide health care to others, because they cannot bear to see their country’s collapse.
The attacks against hospitals are appalling. The Royal College of Paediatrics and Child Health is providing support through its global mechanisms, as other organisations are. I hope the BMA will raise this with the World Medical Association. We cannot just leave this. The journalists cannot get the images out, so we have quite a problem, because people do not realise just how terrible the situation is.
Even drivers transporting medicines are arrested, so trying to move supplies around is really difficult. It all has to be done subtly and underhand. If any of these people are caught, I am afraid that families sometimes find their family member delivered to their front door the next morning, dead. It is awful.
We cannot not intervene somehow. Many of the hospitals that are being bombed could do with early warning systems to detect aircraft, so that people can at least seek shelter. At the moment, they cannot.
Baroness Northover (LD)
My Lords, I too thank the noble Lord, Lord Crisp, for securing this debate and pay tribute to him for all his work on global health. I am a former trustee of THET and am very glad to hear that it is playing a major part.
As we have heard, the situation in Myanmar is very worrying. Various noble Lords, including my noble friend Lord Bruce, the noble Lord, Lord Alton, the noble Baroness, Lady Bennett, and the noble Earl, Lord Sandwich, have demonstrated their personal knowledge of that country. Health workers should be protected under international law. We have seen that in the debates on Gaza. Certainly in Myanmar, health workers and health facilities, far from being protected, have become a particular target. As the noble Lord, Lord Crisp, said, many health workers resisted military rule, but most have sought to assist those who have been wounded by the military. Burma Campaign UK notes that they faced beatings, arrest, torture and death.
It is therefore not surprising that many health workers have sought to escape to areas beyond the control of ethnic armed organisations. We hear that, once there, some health workers have joined existing health networks, some have established new clinics and others may have joined new armed forces set up by the resistance. We have heard today how the military has targeted clinics and hospitals in areas not under their control with deliberate and repeated attacks. We just heard from the noble Baroness, Lady Finlay, about the effects of this.
The health service was not strong before the military action, although I know that the noble Lord, Lord Darzi, had been working to strengthen it over a period of years. Having been asked to set up a hospital, he recognised the need for a whole health service, which he worked on delivering. My noble friend Lord Bruce spoke of those who returned to Myanmar to help rebuild the country. It is desperately sad that this has come to absolutely nothing.
As in other countries, the pandemic affected medical and allied health professional universities and training schools in Myanmar. This resulted in the closure of all training institutions in 2020, with no graduation of the health workforce. Since the coup, Myanmar’s health provision has been further severely damaged. The BMA and the Royal College of Paediatrics and Child Health—we have heard about their efforts—are working in Myanmar and note that, since the military coup in February 2021, the health service has largely collapsed, as the right reverend Prelate the Bishop of Chelmsford said. The number of skilled birth attendants has fallen, infant mortality has risen, and acute malnutrition has shot up. As the noble Lord, Lord Crisp, and others have said, vaccination rates have fallen dramatically—below 50% of the relevant population in 2021—leaving Myanmar open to large-scale disease outbreaks and unprotected against potential new pandemic diseases. Does the Minister see this as undermining global health security? How might it be tackled? I note the warning that the noble Baroness, Lady Bennett, just issued.
There has been an increase in violence, including against women and girls. Is the FCDO monitoring this, and what is being done to ensure that women and girls have access to family planning? Noble Lords detailed the kinds of attacks, and I see that 385 attacks were recorded against healthcare infrastructure or personnel, in direct contravention of international humanitarian law. The WHO said that the number of people in need of humanitarian health assistance was estimated at 10 million in 2023. The noble Lord, Lord Alton, has updated this to 12 million this year—four times the previous rate.
Routine disease surveillance systems have become dilapidated, raising the risk of Myanmar becoming an ungoverned source of potential new pandemic emergence, threatening economic recovery in the region and globally. But the UK’s long engagement in Myanmar has been hit by a 70% decrease in funding. Could the Minister say whether this will be reversed?
Civil society organisations have proposed bans on aviation fuel, as the noble Baroness, Lady Bennett, just mentioned, which would hinder the military’s campaign. Could the Minister comment? It is difficult to get aid into conflict areas; it is always a problem. Could the Minister comment on how this is being tackled? I look forward to his replies.
Lord Collins of Highbury (Lab)
My Lords, I, too, thank the noble Lord, Lord Crisp, for initiating this debate on an area which we often take our eyes off. The situation is pretty dire. I also welcome the Government’s continued support for NHS partners through the Tropical Health and Education Trust. As the noble Lord said, many of those clinicians are Burmese, and are helping their friends and colleagues there—they do a tremendous job—but also serving the NHS. We should not forget that.
The military are widely opposed by the public and have been accused of war crimes against their own people. Two-thirds of the country is gripped by conflict. The military now appears to have lost control of the country. Of course, the Covid pandemic and military coup left in ruins the already minimal healthcare system in the country. As we have heard in the debate, following the post-coup crackdown on peaceful protests, health workers created informal networks to help to treat those injured by the military. They then become the targets and face beatings, arrest and torture. Fleeing those military-controlled towns and cities, they work with other organisations—some join new armed forces set up by the resistance and civil society organisations.
However, as we have heard, most aid, including for healthcare, is channelled via the military-controlled Yangon and then to international and UN agencies. As was highlighted by the noble Lord, Lord Bruce, I ask the Minister what assessment the FCDO has made of the effectiveness of aid going through the ever-shrinking areas of Myanmar that are still under military control. While there is now some welcome flexibility in the way that aid is being delivered, there is a case for a complete review of how it reaches those most in need. They are very often not in those military-controlled areas.
I want to touch on another issue. Despite UN Resolution 2669, the Myanmar military has been targeting clinics and hospitals in areas that are not under its control, with deliberate and repeated air strikes and artillery attacks. As the noble Baroness, Lady Northover, said, many civil society organisations in Myanmar have repeatedly called for sectoral sanctions to limit deliveries of aviation fuel to Myanmar. I know what the Minister will say when we ask for additional sanctions—that we do not normally announce these in advance. However, I hope that he will address the issue of what we are doing with our allies to reduce the Myanmar military’s access to aviation fuel. What other support can we give those health centres in terms of an advance warning system? With those few comments, I hope that the Minister is able to respond to the questions in the debate.
The Minister of State, Department for Environment, Food and Rural Affairs, and Foreign, Commonwealth and Development Office (Lord Benyon) (Con)
My Lords, I thank the noble Lord, Lord Crisp, whom I have known for many years, for tabling this debate. I know his commitment to this cause, among many others, and I thank him for his dedication to healthcare provision in his role as co-chair of the All-Party Parliamentary Group on Global Health. I also thank all noble Lords for their insightful contributions.
As the humanitarian situation in Myanmar continues to deteriorate and the Myanmar military commit more and more atrocities against innocent civilians, this debate is timely. A number of noble Lords asked how we can give voice to the healthcare workers doing incredibly courageous work, despite the regime. In a small way, this debate does just that, but we want to give much more voice to what they are doing. I pay tribute to those health workers, who continue to demonstrate true heroism in hugely challenging circumstances.
I too commend our partners in the UK, including THET, with which the noble Lord, Lord Crisp, works closely, as we know, for working tirelessly to support Myanmar’s fragile health system. Its work makes it possible for doctors and nurses to provide life-saving assistance to vulnerable adults and children, and we are proud to support it. We have to appreciate the benefit of technology, despite the cyberattack that was mentioned, and the diagnostics that are now available online. We hope that we can continue to support THET. I also recognise the work of the Royal College of Paediatrics and Child Health to support nurses in Myanmar, which is enormously important. This addresses some of the points that have been raised about women and girls, sexual health and paediatrics. It is so important that those are supported.
The Government remain deeply concerned about healthcare provision in Myanmar. Since the coup in February 2021, the healthcare system has collapsed and many are unable to access even the most basic services. Child immunisation has fallen significantly, creating the potential for a regional health crisis, and there is limited support for pregnant women, increasing the risks to them and their children. Humanitarian access is challenging, with many parts of the country cut off to the UN and international NGOs.
The noble Baronesses, Lady Finlay and Lady Northover, made a key point: on top of this, the military continue to target healthcare workers and undertake air attacks, striking hospitals and demoralising the civilian population, as well as injuring and killing healthcare workers. Indeed, according to the World Health Organization, there were 385 attacks against healthcare infrastructure between February 2021 and August last year.
The UK is a leading donor in the response to the humanitarian situation in Myanmar. Despite the substantial operational challenges, that includes work to support the healthcare system. Since the coup, we have provided approximately £125 million in life-saving assistance, supporting those affected by conflict and displacement and providing emergency healthcare and education. The UK is working with local partners to access remote and conflict-affected areas of the country and respond to the Myanmar people’s most pressing health needs.
The UK is the largest funder of the multilateral Access to Health Fund, which we also chair. In answer to the key point made by the noble Lord, Lord Bruce, over 80% of the funding goes directly to local healthcare providers within Myanmar, providing assistance and training to help increase their resilience. These programmes have provided essential health services to approximately 3.3 million vulnerable individuals in 154 townships in Myanmar over the last five years. More than half a million women and children have received maternal, newborn and child health services—a key point made by the noble Baroness, Lady Bennett.
Over a million people have received education and health services promoting the well-being and rights of women. Some 36,000 children under five and over 6,000 pregnant women in opposition-held areas have received vaccinations. In the wake of the coup, we have had to alter our approach in Myanmar. We shifted away from working with the authorities and created new partnerships with local civil society organisations. The UK has been a pioneer in working with local organisations in Myanmar, allowing us to serve the most vulnerable in areas that other donors simply cannot reach and to respond rapidly to emerging crises by empowering first responders.
In October last year, when new conflicts broke out in the north-east, our pre-existing relationships with local partners enabled us to make a difference immediately. In the first week alone, UK government support reached 18,000 people affected by the conflict. As well as responding to immediate needs, our work with local organisations is designed to support the construction of a much more comprehensive healthcare system for the future of Myanmar—a key point made by a number of noble Lords. Many of our programmes provide supplies and funding to organisations employing doctors and nurses who do not want to support the regime but are committed to serving the people of Myanmar. Our assistance makes it possible for them to continue to respond to the substantial needs of their communities, even when access is constrained. All that sits alongside the training we offer to improve their skills, expertise and capacity.
The UK Health Partnership Scheme, which is delivered through our excellent partner, the Tropical Health and Education Trust, leverages British expertise to address healthcare workforce challenges. The noble Lord, Lord Crisp, is a patron of that. We have improved the quality of healthcare provision in Myanmar by offering training to 3,000 nurses and by providing healthcare workers with access to learning materials online. We have supplied direct medical services to some of the most vulnerable people, including migrants, and women and girls in volatile areas, through telemedicine services and digital healthcare. This has provided 94% of the population with access to some type of qualified health professional.
A point was raised about the Thailand corridors. We are looking closely at that and will seek to use them as and when they are available but there is some doubt, as was said, about how that agreement will work.
The groups that we support champion a peaceful, inclusive and democratic vision for Myanmar that reflects the aspirations of its people. By assisting them, we are helping to build organisations that will become the backbone of a future healthcare system in that country. Indeed, the UK plays a crucial role on the international stage, encouraging international partners to channel more funding through local organisations, and sharing lessons from our work in order to create a strong, co-ordinated international effort to reconstruct Myanmar’s health system.
The noble Lord, Lord Alton, talked about Aung San Suu Kyi and her son. Her imprisonment is an affront to all who believe in the rights and freedoms that we expect around the world. Her son is as courageous as her but she is just one of a great many people who have been held by that Government quite illegally.
Lord Alton of Liverpool (CB)
Before the Minister leaves that point, will he respond to the request from Kim Aris that he should have a meeting with the Foreign Secretary at some stage? Will the Minister at least relay that back to the noble Lord, Lord Cameron?
Lord Benyon (Con)
I will certainly do that. A number of noble Lords asked about the support that we give. Spend in 2021-22 was reduced following the coup. The UK ceased providing funding for policy and capacity development to the Myanmar Government and prioritised humanitarian assistance, and direct support for healthcare and education. Spend rose in 2022, as the number of those in need of humanitarian assistance increased from around 1 million to 17.6 million as a result of the conflict and insecurity.
ODA spend in Myanmar decreased again in 2023-24 due to broader fiscal constraints but, given the unprecedented global humanitarian need, the UK has adjusted annual allocations for specific crises, including that in Myanmar. During 2023-24, the UK will have provided over £40 million in ODA support. This will increase as we return to 0.7% of GNI in, I hope, the near future. The UK is one of the leading donors to the country, having provided approximately £125 million in healthcare support.
A number of noble Lords asked about the diplomatic work that we are doing multilaterally. The UK is the penholder in the UN Security Council on this, and we have consistently demonstrated our ability to use the Security Council to keep the spotlight on the situation in Myanmar, particularly talking about the health of its population in the context of the insecurity created by this wicked regime.
A number of noble Lords asked about the Rohingya. The UK has continued to call for an end to the crisis, including through the UN Human Rights Council and UN Security Council. Earlier this month, we held a Security Council meeting calling for an end to violence in Myanmar and stressing the need to address the root causes of the crisis in Rakhine state and to ensure the conditions necessary for the voluntary, safe, dignified and sustainable return of Rohingya refugees. We have done a lot more, and I do not have time to go through it today, but am very happy to talk to noble Lords more about this.
The UK is continuing to support women and girls through our efforts—and I wish that I had more time to go into that. However, the UK welcomes the Thai Government’s commitment to providing humanitarian assistance, and we are working through them to try to reach regime-controlled parts of the country.
On aviation fuel, we are looking to see how we can provide sanctions. We have sanctions against individuals and a great many members of the regime. If we can stop aviation fuel getting to the Myanmar regime’s air force, we will work with partners to achieve that.
There is a long tradition of Myanmar and British healthcare workers collaborating to bring benefits to both our countries. Indeed, 800 members of the Burmese diaspora in the UK work for the NHS, making an immeasurable contribution to our national life. Healthcare needs in Myanmar are increasing and healthcare professionals still face unacceptable threats. Yet in spite of all these challenges, we continue to leverage the UK’s substantial healthcare expertise to train doctors and nurses in Myanmar.
Our work alongside the Tropical Health and Education Trust enables UK health institutions to support medium and longer-term health workforce planning and the development of the ethnic health system. This is improving the quality of healthcare and is making a crucial step towards universal health coverage in Myanmar. When peace returns to that country, the UK will work with local healthcare organisations because we will have laid the foundations for a future healthcare system in Myanmar which can respond to all its people’s needs.