Myanmar: Health System

Lord Crisp Excerpts

Thursday 29th February 2024 Grand Committee

Asked by

[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.