Mobile Army Surgical Hospital

Jim Shannon Excerpts

Wednesday 9th October 2013 Commons Chamber

[Dr Phillip Lee (Bracknell) (Con)]

I never thought I would see the day when the words “Mobile Army Surgical Hospital” would be the title of a debate of mine. I grew up watching the television series “MASH”, which partly inspired me to become a doctor. I want to make a serious proposal about a capability that this country should be able to deploy abroad. I started thinking about the issue following the Syria vote in August. I voted against both motions before the House that day. After that, I thought that I should come forward with a constructive suggestion for our engagement with the crisis in Syria. This is my suggestion.

I will present a history of field hospitals in general—just a brief one; don’t worry—and discuss the humanitarian response capability that we need. I shall then mention the challenges of bringing that about and, perhaps more importantly, the details of the facility.

I became a doctor for a number of reasons, but a couple of things spring to mind. One is a book called “The Red and Green Life Machine” written by a commander in the Royal Navy, a chap called Rick Jolly. The title refers to a field hospital in the Falklands war, set up in a disused abattoir in San Carlos bay. I read the book when I was about 13. I watched every single episode of “MASH” and developed desire and ambition—initially, to become a trauma orthopaedic surgeon. I subsequently went to medical school and decided that I would be a GP. What inspired me was the desire to do something to help people in distress.

However, I stress that I am no pacifist. I did not vote in August against the intervention lightly; in fact, I am in favour of quite significant intervention if it is well thought through, coherent and backed up with a strategy for the region. However, I am against the wilful, somewhat reckless destruction of assets in a small way because that can breed more problems going forward.

We are experiencing the ongoing crisis in Syria through our TV screens. I first visited the country in 1998 and I went back as vice-chairman of the Conservative middle east council in February 2011, about three weeks before the civil war started. I have a sense of association with the country. I enjoyed both my visits—particularly the first one, when I was backpacking around as a medical student. I visited Homs, Hama and the beautiful parts of Aleppo that I fear are no longer intact. When I came back from my second visit, I was gripped with a sense of foreboding that trouble was about to start, although not as quickly as it did. I also felt the sense that Britain’s engagement with the country in its crisis should be constructive and trying desperately to bring about a peaceful end to the war.

The problem is that since then there have been more than 100,000 deaths and more than 2 million people have migrated away from the chaos. There has been one public use of chemical weapons, and it has been suggested that there have been others. We have all had to endure some pretty appalling footage of death and destruction, primarily affecting innocent civilians—women and children. It is pretty shocking to have to endure it.

Our response should be multi-pronged. We could foresee a situation in which hard power is wielded, but soft power should also be considered. This is where I come to the MASH or mobile surgical hospital facility that I envisage for Britain. The history of field hospitals goes back to the Napoleonic wars and the gentleman called the father of combat medicine, Baron Dominique Jean Larrey. From that concept of forward surgical hospitals bringing medical support to combatants at the front line, things developed slowly. I guess that the fastest development took place during the Korean war in the early 1950s; the “MASH” TV series is based on that war, although it was always associated with the Vietnam war because of when it was made. During the Korean war, major developments were made in pushing field hospitals closer to the front line. There was the famous image of a Bell helicopter with two casualties strapped into stretchers on either side, with the purpose of bringing people back to be treated very quickly. The dictum was, “Life takes precedence over limb, function over anatomical defects.”

Since then, there have been massive advances. I have not yet visited the hospital at Camp Bastion in Afghanistan, but I am told that it is a remarkable facility delivering the very best trauma care. Of particular note to Britain is our experience in Kosovo in 1999, where the British Army managed to create, in effect, a tented village for a load of refugees as well as medical facilities. It was a fantastic success, and proof of what our military are capable of.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this innovative idea to the House for consideration. I have a Territorial Army ambulance unit in my constituency and they are renowned for the good work that they have done and can do. Does he see the MASH unit being staffed by regular soldiers or TA soldiers, because I believe that both could do the job equally well?

[Dr Lee]

I was going to come to that. I see it as being a reserve force, not part of the regular Army, although I suspect that there will be some logistics staff maintaining the kit and the facility.

--- Later in debate ---

[Dr Lee]

Yes, I was going to come to that. There should be a DFID-funded capability.

The capability needs to be constructive. A friend of mine has talked about having blue overalls, not blue helmets. In other words, we have a United Nations force with blue helmets, so why do we not have a force of people in blue overalls? Our intervention should not necessarily be military in appearance—we can also intervene in other ways. The capability should be resourceful. We are good at this stuff. We can draw on our experiences in the Balkans and the Falklands—I mentioned Rick Jolly’s field hospital—and prior to that. We are very good at this; we have the clinical expertise, in particular. The capability should be able to be expeditionary—that is, to go abroad. In the case of Syria, I foresee a situation where it could be located in a friendly country such as Jordan. It should also have a domestic application. God forbid that there is ever a chemical attack in this country, but the facility could also be deployed here.

The core goal should be to try to develop a stable world that we all appreciate, and that can be brought about by making friends and influencing people. The Arab street is not necessarily with the British or the Americans. We need to persuade civilians on the ground that we do not always have a malign, vested interest—a sense that we are just doing it for ourselves—in our approach to the middle east, but that we are there to do constructive and good things and to genuinely help people.

Turning to details and capacity, as a result of the conversations I have had I envisage a facility with at least 50 beds, perhaps more. If it is as successful as I think it will be I suspect we will extend it, but 50 beds is a good starting point. I think it should include a CT scanner, which is often not available in more rural areas and far-flung destinations. It is possible to put CT scanners in containers and companies such as Marshall Land Systems in Cambridge make container hospitals. There is no reason why we cannot do this. We need to consider whether the facility should also have paediatric and obstetric services, because it is not just soldiers such as those in the “MASH” television series who will be coming in, but children who have been affected by a neurological agent—such as those we saw in that dreadful footage—and pregnant women who have sustained injuries.

Cost is always relevant when it comes to Government spending and there are some figures available. Apparently the Finns purchased a hospital for deployment for about £5 million. I envisage that my proposal will probably cost between £5 million and £10 million. I think it should be a military asset, because the military is best placed to run it, but it should be staffed primarily with reservists, not regulars. Military logistics are important: the army are the best people to get this facility quickly into the field, and Kosovo is an example of that. The army’s command and control systems are relevant.

My hon. Friend the Member for Beckenham (Bob Stewart) has rightly referred to the facility’s security, which is of paramount importance. I think it would be a target. The facility would focus on hearts and minds and on delivering care on the ground, and if I were an Islamist jihadist I would think, “We need to knock that out, because it’s going to start changing minds and attitudes.” The facility’s security would need some thought. For example, RAF Akrotiri is stationed close to Syria and the deployment of troops may need to be considered in exceptional circumstances.

Clarity of funding is clearly important, as my hon. Friend the Member for Woking (Jonathan Lord) has said. The politics of international aid are tough on the doorsteps of Bracknell—trust me: I experience it quite often. This proposal would be one way of using DFID funds for something that is demonstrably humanitarian and of leveraging in some funds to a defence asset that would be used primarily for humanitarian purposes, but—this would always be at the back of my mind—that could also be deployed if we ever go to war.

[Jim Shannon]

We are discussing examples of armed conflict in places such as Syria and Kosovo. Does the hon. Gentleman also see this MASH unit playing a role in responding to humanitarian crises or disasters?

[Dr Lee]

Yes, I do. In fact, the last American MASH unit was deployed in response to the 2006 earthquake in Pakistan and it was then given to the Pakistanis. I would hope that the facility would be used less for military purposes. There are likely to be future crises and I think it should be used in response to them.

Oral Answers to Questions

Jim Shannon Excerpts

Wednesday 12th June 2013 Commons Chamber

[Justine Greening]

My hon. Friend is right to raise the issue, as the International Development Committee did. The incoming Government have a clear-cut manifesto commitment to increase the proportion of GDP from tax collected. We support that, and we hope and expect that they will get on with it.

[Jim Shannon (Strangford) (DUP)]

There have been reports from Pakistan of Christian groups who say they have not had access to the aid coming from the United Kingdom Government. What steps have the Government taken to address that issue directly with the Pakistani Government to ensure that Christian groups get the aid that they should get?

[Justine Greening]

We intend to make sure that our aid reaches all the people who need it, irrespective of ethnic background or anything else. We raised all such issues with the Pakistani Government in the past and will continue to do so with the new Government, now that they are in place. I hope I can do that when I visit Pakistan in the coming weeks.

Drug-resistant Tuberculosis (Developing Countries)

Jim Shannon Excerpts

Tuesday 4th June 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this important issue to Westminster Hall for debate. A group of children and young people from Swaziland were recently in my constituency. They were a Christian choir, and every one of those children had AIDS. In Swaziland, 40% of people have AIDS. Does he feel that we need to address such issues at the highest level? That choir is an example of what can happen when medication is available; if they can survive AIDS and TB, they can make a contribution to their country and ultimately across the world.

[Jim Fitzpatrick]

I agree with the hon. Gentleman, and I am sure that the Minister will repeat that agreement on the positive outcomes that result from appropriate treatment.

First, the report recommends that we strengthen the global fund by doubling the UK’s contribution. International donor funding, including the majority of the UK’s response to TB in developing countries, comes almost entirely through the global fund. In 22 high-TB-burden countries, six are totally reliant on the fund and in another 15 it accounts for two thirds of their budget. To scale up access and treatment for DR-TB, which remain woefully low, the resources the global fund has at its disposal need to increase. The Government have a key role to play in the replenishment of the fund, having been a key driving force behind the recent reforms it undertook. I commend the Government for that policy. What are their thoughts on our contribution to the fund to address the threat of TB and DR-TB? A lead from the UK should happen as soon as possible, to help leverage more from other donor Governments in this important replenishment year.

Secondly, the report recommends investment in innovation through TB REACH and continued investment in research and development. The Government have already shown leadership in support of developing new, badly needed tools to tackle TB—a policy of successive Governments that I hope will continue. Some of those tools have come to market, specifically new rapid diagnostics, but despite that, 3 million people each year still fail to access diagnosis and treatment for TB, which includes a large portion of people with drug-resistant strains. We need to accelerate our efforts to diagnose TB by rolling out new technologies, and it is clear that we need to think outside the box. TB REACH is one way to do that.

As the Minister knows, TB REACH is a Stop TB Partnership-hosted initiative that gives small grants of up to $1 million to find and treat those who do not have access to TB diagnosis or treatment. It is an incubator for innovation and pushes the frontiers of technology. It works closely with DFID-funded UNITAID. In short, TB REACH goes where others cannot and shows Governments and donors how to reach the unreachable. Critically, it often demonstrates with data what projects could be scaled up. The Minister may wish to express a view on whether she agrees with that assessment. Beyond their contribution of core funding to the Stop TB Partnership, which does not cover TB REACH, I ask that the Government become a donor to TB REACH, to maximise their investments in UNITAID and support the expansion of new diagnostic tools to detect and ultimately treat cases of TB, in addition to the work of the global fund. The funding allocated should be directed by the evaluation of the Stop TB Partnership later this year. I will be interested to hear her view on that recommendation.

Thirdly and finally, I want to mention a national strategy for TB in the UK and the importance of a global target within that. A national strategy for TB has never been developed, despite the public health risk the disease presents. The UK has seen rising rates of TB since the 1980s and DR-TB increased by 26% in the past year alone. I welcome that the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) indicated that her Department is supporting Public Health England to develop a strategy. I bumped into her before the Division and thanked her for her leadership on the matter, in which I have a constituency as well as a personal interest. I was recently invited to a seminar, organised by the Barts and Royal London TB unit, by Dr Veronica White, the consultant in respiratory medicine. Unsurprisingly, it is the biggest TB team in the UK and does sterling work locally and nationally.

With all that in mind and given the clear link between global and UK rates, will the Government set a specific target on their contribution internationally to tackling DR-TB as part of a comprehensive TB strategy, led by Public Health England?

HIV (Developing Countries)

Jim Shannon Excerpts

Wednesday 19th December 2012 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on bringing this important issue before the House. Some people know about it and others have acquired knowledge of it, as I have through my office and the organisations that I deal with.

The topic is worthy. Many of us cannot fail to be touched by the scenes on television from Africa and other parts of the world, and we often think, “If only the children had more food.” However, looking more deeply at the issues, they need not only more food, but more medication and, in many cases, HIV medication. The hon. Lady referred to the statistics. Some 1.7 million people died of AIDS in the past year, and there have been 2.5 million new infections this year, so there has been an increase to about 38 million people with HIV infections across the whole world. Those figures put the issue into perspective, and bring into focus where we are on this.

Every year, one of the girls in my office takes a two-week summer holiday in a small country called Swaziland. I will speak specifically about that country, because I have some knowledge of the area. She does it through the Elim Church’s international missions; the headquarters are in Newtownards in my constituency. The missions do marvellous work in Swaziland, in schools, education, and health, and in trying to build lives and give people more quality of life and opportunity. Two years ago, we had the youth choir over from Swaziland. What put the issue into perspective for me, perhaps for the first time, was meeting some of those young people, who were in their teens or early 20s. I did not know this until they had returned home, but the girl in my office said, “Jim, many of those people you met have AIDS—not by choice, but from birth.” That puts the issue into perspective; it certainly did for me.

In Swaziland, the people are very similar to those in Northern Ireland—they have the same friendliness that we have, and that the Scots also have, and which we are renowned for—and it is also about the same size as Northern Ireland, but there is one big difference: 40% of Swaziland’s population has HIV/AIDS. The perspective is that nearly half the population has it, and the difficulty is that no one talks about it. I agree with what the hon. Lady said about educating people better to address the key issues that affect them.

When someone goes into an overcrowded hospital in Swaziland, they find two people on each bed and another lying beneath each bed. That is the nature of their hospitalisation. They are probably there for tuberculosis, cancer or some other problem, but they will never admit that the underlying issue is HIV/AIDS, and we must address that. Those lovely young people from Swaziland whom I met had what I would call heavenly voices, but that belied the undercurrent of their health issues.

In Swaziland, to use that country as an example, people do not protect themselves against HIV. They do not use the condoms that are given out for free, because that would be an acknowledgment that they were already ill or could become ill. We have to get past the barrier that seems to exist. In Swaziland, as in many other African countries, male circumcision is also available as a method of trying to reduce the number of people with HIV/AIDS. Will the Minister give us details, if she has them—if not, I am happy for her to reply in writing—on how much the use of condoms and male circumcision has reduced HIV/AIDS in Swaziland, in which I am particularly interested, and across the world? For every one starting treatment, two become infected, which gives us an idea of the massive mountain that we have to climb.

My office sponsors a child in Africa. It is not big money; every week £1 goes into a box to sponsor a young orphan in Swaziland. Through the Elim missions, that money gives orphans clothing, school fees, school books, food and, most importantly, the HIV medication that they need to allow them to live a full, normal life—small moneys, but big dividends and big returns. The kids live on a farm and are sponsored by people from all over the world who understand their illness and how to treat it. The orphanage has a hospice, with a nurse who picks up the first signs of infection. They have hope and a future, but unfortunately the same cannot be said of most people with AIDS in Swaziland, not because of ignorance, but because they just do not want to face the key issues.

An entire generation is missing due to this disease. Grandmothers look after toddlers because the parents have died of AIDS. The grandparents who concentrate on the children perhaps do not want to talk about it. They do not talk about it to their grandchildren, because they do not want them to know that their mums and dads died from it. Again, we can see the dangers for that third generation. A middle generation is missing because of the epidemic, and the older generation is keeping that from their grandchildren, so another generation is being raised not to talk about this unspoken illness.

The scenario is replicated across Africa and the whole world; we have statistics and information relating to places such as Indonesia. Will the Minister respond about the educational drive that we need? It has to be an educational drive that people will respond to, not one that sounds good on a piece of paper that can be sent off without our knowing how the drive works or whether it will be successful. We need to know that it will ensure that we can put an end to losing entire generations. I have looked through the statistics on India. It has had an AIDS campaign since 2001, and it has reduced new infections by 50% in 10 years. The statistics illustrate that; there were 270,000 infections in 2001, and 120,000 in 2012. However, there are still 2.1 million people in India with AIDS, which gives us an idea of the magnitude of the problem.

There have been many pharmaceutical developments, and some of the costs are fantastically different. In America, one dose of medication would cost $12,000, but the same medication can be produced in India, where there are pharmaceutical companies, for $300. Again, we must focus on that. With the wonders of modern medicine, HIV/AIDS no longer has to be a death sentence; medication and care can allow people to have a long life. That life will not be as long as ours in this Chamber, because the disease reduces people’s length of life and their time on this earth, but it will be longer than if they were under the threat of the disease without any medication.

Medication is not always readily available, and given the cost implications, it is clear to many that change must come from stopping the spread by educating people and changing their mindset. If that needs the help and support of those of us in the western world, I believe that we should give it.

[Sir Tony Cunningham (Workington) (Lab)]

Does the hon. Gentleman agree that, in many African countries, for education to be successful, it needs political leadership behind it? Without that, we will struggle.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I absolutely agree that we need leadership at the very top in all countries, and that we need to make the necessary commitment.

The pupils who came over here as part of the choir from Swaziland were young, and although they were AIDS carriers, they were clearly focused on what they had to do for the future. If we can keep young girls at school, or give them an improved livelihood, so that their focus is on the good things of life, we can reduce the number who can be infected by AIDS. I support the efforts of the hon. Member for Mid Derbyshire to highlight this issue in the hope of securing attention and help for people who are so much in need, in Swaziland and many other countries across the world.

--- Later in debate ---

[Lynne Featherstone]

The hon. Gentleman raises an important point. He may be aware that the Prime Minister raised the issue at the Commonwealth Heads of Government meeting. I have spoken to Foreign and Commonwealth Office Ministers about the issue, and in my international champion role I have developed key messages. Three of those messages are on women, and they address: leadership; rights and laws; and impunity, access, justice and enforcement. There are two messages on homosexuality, and it has been agreed that all travelling Ministers will raise the issue when appropriate. That must be done appropriately as it is easy to raise feelings that the issue is a western construct. The issue, therefore, has to be worked out with the countries not in a preaching way, but in a way in which we can discuss our differences and move the agenda forwards. Human rights are a priority, and we have all made that clear on many occasions. Nevertheless, we work across many countries that come from a different place from us.

In parallel, the UK Government complement grass-roots demand for change through our diplomacy on human rights overseas. We are committed to ending religious intolerance and persecution and discrimination against individuals on the basis of their sexuality. We regularly review the commitment to and respect for all human rights in other countries, including the likely direction of travel over the coming years. Where we have specific concerns about a Government’s failure to protect their citizens’ rights, we raise those concerns directly at the highest levels of the Government concerned.

I will now answer some of the other points that were raised by Members and try to finish ahead of time—we are running over because of the Division.

The hon. Member for Airdrie and Shotts (Pamela Nash) asked about direct budget support payments to Uganda and the condition of renewed payments. Aid to the Government of Uganda is predicated on fundamental commitments and agreed principles, so any renewal of general budget support depends on those conditions being met. The route is always open, and there is nothing we would wish more than for countries to want to come back to the same table as us. I am hopeful that that will be the case one day, but it is very early days as we try to address the diplomacy and geopolitics on the Democratic Republic of the Congo, Rwanda and Uganda.

We support Ugandan civil society groups, including the Civil Society Coalition on Human Rights and Constitutional Law, which trains in advocacy and covers the costs of legal cases to protect LGBT communities. That is just one example. Where we cannot give directly to Governments, we find other ways to help people in countries where possible.

My hon. Friend the Member for Mid Derbyshire specifically raised a number of points. Under the global fund’s new funding model, there will be a targeted band for countries, such as Ukraine, with higher incomes and a lower disease burden that remain at risk from rising epidemics. That allocation band includes countries that should focus resources on most-at-risk populations, which are the groups that we have discussed. The UK has consistently argued that such groups should be prioritised in that context. That was the argument I used in Ethiopia when then Prime Minister Meles and I discussed public health, transmission and other such issues.

My hon. Friend is right that Gilead has shown leadership in joining the medicines patent pool, which we strongly support. We are encouraging other companies with patents for new first-line treatments for HIV/AIDS to consider beginning formal negotiations to enter that pool.

On the G8 and the post-millennium development goals, we will use our influence with the international system to deliver our global commitments. As part of our G8 presidency, we will be reporting on progress against existing commitments and holding members to account. There is definitely a view that we need to finish the job. As exciting as it is to think about post-2015 MDGs, there is still much work to be done on the goals we are in the middle of right now.

Several Members raised the issue of the Why Stop Now? UK blueprint, which is where we slightly part company. Our review of progress on the UK’s position paper will happen in the early part of next year, and it is there that we will make our next decisions based on evidence. We think that just spending a lot of our resources to create another blueprint will be just that—using a lot of our resources—when we basically know what we need to do. We want to get on with working with international partners on implementation, rather than having to stop and bring all our resources back to create another plan. We want to work with stakeholders to ensure a robust and accountable analysis of DFID’s HIV results. We are still discussing the time frame because our review of our position paper needs to align with a number of other international processes. I am aware of the call for a blueprint, but I do not think it is necessarily the way we want to go. I apologise if that disappoints anyone. Indeed, I see the AIDS Consortium sitting in the Public Gallery, and I think I have shown my commitment. My first speech as a Minister was an address to the annual general meeting of the AIDS Consortium, which I have since met to discuss all the issues.

I must be quick, but a number of Members raised the issue of the relationship between HIV and tuberculosis. My right hon. Friend the Member for Arundel and South Downs (Nick Herbert), whom I used to work with at the Home Office, specifically raised that issue. TB is the leading cause of death for people living with HIV. DFID supports leadership among countries on integrated responses rooted in knowledge of local epidemics, with donor support harmonised in line with national plans to deliver quality integrated HIV, TB and reproductive health services, which was a call across the Chamber.

I acknowledge the two issues raised by my right hon. Friend on the TB REACH programme and on vaccination, both of which I will consider further. At the moment, DFID’s support for TB research includes £205 million to the Global Alliance for TB Drug Development and £14 million to the tropical disease research programme.

The hon. Member for Strangford (Jim Shannon) mentioned how condom use and circumcision have helped HIV prevention work in Swaziland and the rest of the world. I thank him for highlighting the challenges in Swaziland, and DFID agrees that a combination prevention approach, including condoms, male circumcision and education, is essential to an effective response.

[Jim Shannon]

I also mentioned how pharmaceutical companies in India are able to produce the same anti-HIV drugs more cheaply than companies in America. Without promoting any company over any other, does the Minister agree that, if cheap medication is available in India that is every bit as effective as other medication, we should be sourcing medication from India, given our DFID contribution to countries across the world?

[Lynne Featherstone]

I thank the hon. Gentleman. We have heard the point that he has made so well.

I thank all hon. Members who have spoken, particularly my hon. Friend the Member for Mid Derbyshire, who secured this important debate. It is heartening to see so many Members who genuinely hold HIV as a priority and will pursue the wonderful goal of zero infections.

Oral Answers to Questions

Jim Shannon Excerpts

Wednesday 31st October 2012 Commons Chamber

[The Prime Minister]

My hon. Friend is entirely right. Last week’s news was welcome. The economy is growing, unemployment is coming down, inflation is coming down, the rate of small business creation is going up and a million more people are employed in the private sector than there were two years ago. The one absolute certainty is that the worst approach—Michael Heseltine confirms this in his report—would be to see more spending, more borrowing and more debt, because that is what got us into the mess in the first place. The Labour party has only one growth plan: the plan to grow the deficit.

[Jim Shannon (Strangford) (DUP)]

I thank the Prime Minister for his condolences on the death of my constituent, Corporal Channing Day. She was a courageous young lady. She always wanted to join the Army and for eight years served as a medic. Her job was to save lives—to run the line of fire in order to give aid. Imagine what it meant to a wounded soldier to see someone running to help them when all hell was bursting around them and to know that they were not alone. Corporal Channing Day is not alone today. She will soon return to the bosom of her family, to her mother, father, sisters, brothers, friends and family, who loved her dearly, and to the community, which is immensely proud of her achievements. This House and this great nation of the United Kingdom of Great Britain and Northern Ireland salute her courage, bravery and heroism.

Prime Minister, will you agree with me that Army medics are often the unsung heroes of conflict, and will you agree to meet me and my colleagues to discuss the implementation of the military covenant in Northern Ireland?

[The Prime Minister]

I would be very happy to meet the hon. Gentleman and his colleagues to talk about the implementation of the covenant in Northern Ireland. It is something I have spoken about with the First Minister and Deputy First Minister in Northern Ireland. I know that there are issues about its implementation, but I hope that it can be done, and I would be happy to have that meeting.

The hon. Gentleman spoke very strongly and movingly about Corporal Channing Day. I think he is absolutely right that those in the Royal Army Medical Corp do a fantastic job. It has been a huge honour and privilege for me to meet some of them, including in Afghanistan. When you see the service they provide, you really can put your hand on your heart and know that British military personnel in theatre are getting medical care that is as good as that which anyone in history ever got. What they do is truly remarkable.

Water and Sanitation

Jim Shannon Excerpts

Wednesday 21st March 2012 Westminster Hall

[Naomi Long]

I agree entirely with the hon. Lady. It is hugely important to maximise the benefit of our investment.

Lack of access to clean water, sanitation and hygiene also carries with it significant gender implications that can, in turn, impact more widely on communities.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Naomi Long]

I would like to make a little progress first.

In developing countries, women and girls still shoulder most of the responsibility for the collection of clean drinking water from wells, which may involve long and arduous daily journeys. The provision of simple village standpipes could therefore improve not only health, but education outcomes for women and girls in particular, because, freed from that daily chore, they would have time to attend school. The provision of proper and private sanitation facilities in schools has also been shown to reduce education drop-out rates for girls reaching puberty. Women are more likely to bear the burden of caring for those who contract diseases as a result of poor access to water, sanitation and hygiene, and that significantly restricts the degree to which they can be economically active and independent. Most disturbingly, lack of access to water and sanitation can leave women and girls more vulnerable to violence and sexual assault, either as they travel long distances to collect water, or as they wait until nightfall before defecating in the open.

By investing in water and sanitation, we can improve the health and education of millions of people around the world and tackle gender inequality. Access to water and sanitation transforms lives, improves health outcomes and lifts people out of poverty. With every penny of public expenditure under scrutiny, it is important that the resources available for international development are invested in ways that will have maximum impact and are sustainable. Investment in water, sanitation and hygiene meets that economic test.

The UN human development report estimates that for every pound invested in water and sanitation, £8 is returned in saved time, increased productivity and reduced health costs. It is therefore a prudent as well as a necessary investment. Lack of access to clean water and sanitation is estimated to cost sub-Saharan Africa 5% of its gross domestic product—an amount equivalent to the aid received by the region. That fact demonstrates the link between long-term sustainable development, and the specific direction of aid towards water, sanitation and hygiene projects. The impact of such investment could be multiplied if we collaborate with other Governments and with non-governmental organisations and charities that can assist by providing education to local communities through Church and community networks, and by supporting increased capacity among state and non-state players in the field.

The provision of water and sanitation is a fundamental part of the foundations on which our progress on other millennium development goals will be built. It is also an area that delivers significant economic and social returns. One would imagine, therefore, that it would be the aid investment of choice, but sadly that is not the case. Speaking of water and sanitation, Kofi Annan stated:

“No other issue suffers such disparity between its human importance and its political priority.”

In 2010, the UN-Water global annual assessment of sanitation and drinking water looked at the amount spent by donor countries on aid for that sector. It found that although levels of international aid have been rising since the mid-‘90s, the proportion spent on water and sanitation has declined. In the mid-‘90s, the proportion of aid spent on water, sanitation and hygiene was more than 8%, but that has now fallen to less than 5.5%. The UK’s bilateral aid to the WASH sector made up less than 2% of our total aid budget in 2010, and less than 50% of the average reported by other donors.

[Jim Shannon]

I congratulate the hon. Lady on bringing this subject before the House. She has mentioned the importance of water for sanitation, but it is used for other things such as watering crops, or the work done by the churches. Water is also used to make bricks for industry, so it is important for employment, health and food. Does the hon. Lady agree that sanitation is one part of the need for wider water provision?

Education Projects (Nigeria)

Jim Shannon Excerpts

Tuesday 20th March 2012 Commons Chamber

[Bob Blackman]

I thank my hon. Friend for that intervention. Clearly, not only enabling young girls to go into education but supporting them while they are there is crucial. That is one of the key elements of DFID funding that I strongly support and I trust it will continue well into the future.

Most schools do not have proper sanitation or even fresh water, and that is a considerable barrier preventing girls from being educated. DFID funding is being used to provide these basic facilities, and I warmly welcome that. No mention of Nigeria can be complete without referring to the security situation. The attacks orchestrated by Boko Haram have created problems, particularly in the north of Nigeria, and we should all express sincere condolences to the family of Chris McManus who, sadly, was murdered by his kidnappers recently.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue to the House tonight. He has talked about DFID and about all the other groups that are helping. Is he aware of the many churches that do tremendous work in Nigeria through their educational projects? In particular, I am thinking of the Elim missions in my constituency, which, through Kingsway International, run an educational project that provides teachers and teaching, food and meals for the day and the books for the schools. It is not Government-funded; it is done through the churches themselves. Such projects also do tremendously good work in Nigeria, alongside all the other people who do likewise.

[Bob Blackman]

I thank the hon. Gentleman for his intervention. Clearly the work of churches, charities, Comic Relief and other organisations is extremely valuable in promoting the educational opportunities that are required in these areas.

On our visit, we had the opportunity to visit schools in Abuja and Lagos. We saw at first hand that DFID funding can make a big difference on providing toilets and new classrooms. In Abuja, we saw a school where thieves had stolen the water pump that provided fresh water for the children. One can imagine spending all day in school without access to fresh water or even basic toilet facilities. In Lagos, we saw a school that had had a new toilet block installed with DFID funding. However, we expressed concern that the cost of that—£37,000—seemed excessive compared with the cost of building generally in Nigeria.

It is important to recognise that the overwhelming majority of the population earn less than a £1 a day. We inquired about that project, particularly the procurement costs and the process that had been followed. We believe that DFID should carefully consider how best to ensure value for money in such a country as Nigeria. The tendering process seems fraught with problems and might not be the best way of obtaining good value for money. Surely we should be negotiating down these prices to make our money go further.

On our school visits we met the school-based management committees, which are equivalent to our school governing bodies. The main problem they face is training members and developing their powers. We heard at first hand how one SBMC had used its power to embarrass local politicians to release much-needed funding for a project. It used Facebook to threaten the governor that it would refuse to support his re-election bid unless funding was released for new classrooms. The governor released the money in a matter of days. DFID money is channelled via the education sector support programme in Nigeria and the girls’ education project. DFID will assist more than 800,000 children to enter education, including 600,000 girls, over the next four years. There can be no doubt that the ministerial team at DFID has ensured that proper targets and value for money are at the heart of the Department’s work. They have truly been the wind of change required for the projects in Africa.

We also had the opportunity to meet many politicians and officials, which helped to promote the relationship between the UK and Nigeria. In my opinion, this type of bilateral relationship is crucial as we increase the UK’s influence in the world. Anyone visiting Nigeria will be shocked at the wide disparity in levels of wealth and income. They will also be surprised, if not frightened, when being driven by car. The normal behaviour of car drivers in Nigeria is to sound their horn and point the car where they want to go irrespective of who or what is in the way. I should also report that my name became the subject of much hilarity for many of the officials I met. I would be a very rich man indeed if I had £1 for every time someone said “Mr Blackman? But you are a white man.”

Nigerians have a great love of the UK. They love premier league football, they universally love the Queen, they are staunch allies of the UK and they are a key member of the Commonwealth. China and other countries have seen the opportunities for investment there and we need to ensure that we retain and improve our relationship with Nigeria. There can be little doubt that Nigeria will become the key economy in Africa very soon, so it is in our vital national interest to continue to invest in infrastructure projects in Nigeria and particularly to invest in education.

Oral Answers to Questions

Jim Shannon Excerpts

Wednesday 26th October 2011 Commons Chamber

[Mr O'Brien]

I am delighted to note that excellent meeting—the Secretary of State found it extremely enjoyable and helpful. Those many nations and our country are working to strengthen and develop our relationships, particularly on climate change and trade.

[Jim Shannon (Strangford) (DUP)]

The people of the UK are very generous, but it is estimated that some 30% of humanitarian aid is removed at the harbour at which it arrives. Will the Minister give an assurance that he will have discussions with the countries that receive humanitarian aid to ensure that all of it gets to the people for whom it is intended?

[Mr O'Brien]

The hon. Gentleman raises an important point about ensuring that the money reaches the destination and serves the purpose for which it is intended. That is absolutely central to the redirection of the Department for International Development’s aid effort in the past year. We are ensuring that we align every effort to results, to ensure that the money reaches the purposes intended.

Great Lakes (Africa)

Jim Shannon Excerpts

Tuesday 5th July 2011 Westminster Hall

[Eric Joyce (Falkirk) (Lab)]

I want to say a few words, in opening, about the nature of the debate. It is a little unorthodox, in the sense that normally there would not be several hon. Members speaking in such a short debate; however, there was great interest in the subject. The all-party group on the great lakes region of Africa went to the Congo recently. I was not on that trip. There is a great deal going on there, of course, and I am sure that the Minister will say more.

Although most hon. Members who are present are aware of the broad context and much of the detail, it is worth setting out some of the things that are happening. Some things that are happening in the Democratic Republic of the Congo are very important, one of which is that very soon, we hope, there will be an election. That is planned for November, which is a little later than it might have taken place. Nevertheless, it is a good sign. The UK was very involved the last time round, and sent several official observers. Members of this place and the other House went with non-governmental organisations to observe the elections. It was a very successful election process for the region, all things considered. There was a good, high turnout at the last presidential and prime ministerial elections in the DRC, and an independent commission ran things. International observers from all sorts of NGOs, UK bodies and Governments thought it went pretty well. There was a pretty good tick in most of the boxes.

Some years later, there is a rather different backdrop to the elections. The cost of the elections last time was about $225 million. One assumes that the cost is similar this time, but the international community was more reluctant, understandably, to find the large amount of money needed to run such a large-scale election in a place as difficult as the DRC, which is the size of western Europe but covered in tropical rain forest, making the logistics very complex. The election was well run last time, but this time there are one or two question marks. That is not to say that the election will not be legitimate. However, political development in the country over the past five years has been modest.

I have met Mr Tshisekedi, the person who would probably be considered the leader of the opposition, in so far as one can be considered to exist. He is an important figure in Congolese politics, and he is capable of putting together an alternative platform in the presidential re-election campaign. At root, however, it seems to be a fairly basic offer. One assumes that unless the elections are run tidily and independently, there will be questions about the process.

The elections have been put back a bit, and the constitution has been changed to take out the second round in the presidential elections. That is significant, as some think that President Kabila may not win a second round. Nevertheless, he will certainly get the majority of votes in the first round; so many people stand as presidential candidates that it is hard to prevent that, but who knows? What gave the last election considerable legitimacy was the fact that it was a tightly run process; the result was 57% to 43% in the second round, which was a clear result for everyone. It was clear that there was a genuine opposition, albeit the chap who was the opposition is now banged up in The Hague. That is a pity, but there it is.

This time round, the electoral commission is being run by an ally of the President, which is cause for concern. This is primarily a Foreign and Commonwealth Office issue, but although the Minister may have a view, my instinct is that he will want to wait and see how it goes. It is fair to say that we should let the processes take place and express our judgment after the elections. The elections are important, because they change other things that are happening at the same time.

[Jim Shannon (Strangford) (DUP)]

Does the hon. Gentleman agree that the formation of an integrated and professional army that does not abuse the people, but gives them the chance to express themselves, is important? It is essential that people can use the ballot box unhindered.

[Eric Joyce]

I thank the hon. Gentleman for making that profound point. We cannot do anything in countries such as the DRC unless we have security. We cannot have justice, effective infrastructure, hospitals and schools if people are too frightened to leave their houses or move around the place safely. In parts of the east—not only there, but significantly in the east—that is very much a fact of life for many. They live in dour conditions, and security is of the first order.

The FARDC, the army, has a history of having some competently trained people—trained in conjunction with the UK and the French. I do not want to say anything pejorative, but it does not have a high capacity, if I could put it like that. It has one or two people who are perfectly competent, and a large number of people who are not. First and foremost, the DRC needs a proper security regime, but in a good way; in effect, the country needs the army function, rather than a policing function. At a different stage of development, we would be talking about police, but it is a case of the army trying to maintain law and order.

There are some programmes, particularly from the United States, and there is a common European effort to assist in building capacity, but it is a long-running process. One of the early things that has to be done is to get the army to behave decently towards its own people. Poor discipline—it often breaks down, particularly in the east, where deployment of the army is coincidental to the mining operations—is a matter that should be scrutinised by us and international authorities, but the hon. Gentleman makes a profound point.

I turn to the question of minerals. The DRC is enormous, and its mineral reserves are unbelievably huge. One thing that prevents their full exploitation is that many companies are still concerned about the environment and corruption, and the damage that that does to their brand. The DRC produces about 18% of the world’s diamonds, but mainly in an artisanal manner; they are not produced industrially, as one might imagine it being done in South Africa, because the big companies are reluctant to play in the DRC. Some companies have invested in proper infrastructure—they have built proper mining operations—but they find things quite unstable at the moment.

I have waxed rhapsodic endlessly in the main Chamber, and in Westminster Hall, about a deal that involved First Quantum Minerals. It is a quite famous case that also involved ENRC, a FTSE 100 company, but I do not want to bang on too much about it and bore all who have heard me talk about it before. The essence of the case is that if there is an unstable trading environment, a company’s reputation could be damaged by one or two decisions that a Government may make in places such as the Congo, which may make it difficult for companies to invest properly.

First Quantum was the largest taxpayer in the Congo, which collects very little corporate tax and almost no income tax per annum. At the time, First Quantum was employing several thousand people at a mine in Kolwezi near the Zambian border. The mine was effectively expropriated by the Government, sold on for a small amount and then sold on again for a large sum. The question is where the bit in the middle went. No one knows, but we can guess. That, of course, makes it hard for other mining organisations, who saw that mine being expropriated, to invest in DRC. Sadly, that mine is an exemplar of what can happen; it sits empty, basically rotting, with no work going on there. There are no jobs. Companies that can provide several thousand jobs are a rarity all over the Congo, but particularly in the east and south, where jobs are a lifeline for the extended family. Those jobs have gone; there are no operations, and of course no tax is being paid.

As other Members wish to speak, I shall conclude by mentioning PROMINES. I am speaking without notes, so I am not sure whether I have mentioned it already, but ProMines is an excellent effort by the British Government, working in conjunction with other Governments, to increase transparency in the mining industry, and to make it legit so that people can invest with confidence. I understand that things were held up briefly at the time of the First Quantum deal, because the World Bank was concerned about that expropriation. The project stalled as a result, but I believe that it is on the go again. It is an essential developmental issue and a super idea. I hope that Minister will speak about it when the debate concludes.

--- Later in debate ---

[Mr O'Brien]

The hon. Gentleman is entirely right to make that observation. There are various estimates about the DRC, but what he has just said is broadly what we all understand to be the case. Part of the answer lies with what the hon. Member for Falkirk hinted at earlier. He suggested that the lack of confidence among foreign direct investors—confidence they can take the risk of going into the DRC and using their world-class skills to extract the unique assets that the DRC is particularly blessed with—means that 80% or more of all the gold that is mined in the DRC is extracted by artisan extraction, as is the case with the other valuable minerals found in the DRC that are sought on world markets. Of course, that makes it almost impossible to capture the revenue from that activity within any kind of regulatory environment.

That is why we are putting such emphasis in the design of the DFID programme on considering what will create the conditions for private sector development. By that, I mean not just foreign direct investment, which is important, but measures that will help regional economic integration. That economic integration is important not only in the east of the region, which we discussed extensively in the International Development Committee this morning, but across the various corridors in the region, particularly the north-south corridor that includes the copper belt in Zambia and the Katanga region of the DRC. That corridor will be vital for the future of many countries in southern and eastern Africa as trade passes up and down it.

The hon. Member for Glasgow Central (Anas Sarwar) referred to the extractive industries transparency initiative. As he knows, we are a strong supporter of that initiative for resource-rich countries. It is absolutely the right way to ensure that, as part of the measures to build confidence and credibility, people are genuine in both countries—both the UK and the country from which the materials are being extracted—and companies must sign up to it. Both the hon. Gentleman and I welcome the DRC’s efforts fully to implement the EITI.

On the Dodd-Frank issue, I hope that the hon. Gentleman knows that my right hon. Friend the Chancellor made it clear at the G20 Finance Ministers meeting in February that the British Government support the development of new international rules that, to some degree, are prompted by the Dodd-Frank Act in the US. Such rules would require oil, gas and mining companies to report payments that they make to Governments. The UK seeks to make progress on that issue in both the G20 and, very importantly, within the EU. This process will work if we move together, so that both a combined, common purpose and combined, common standards and values are reflected in the way those reporting mechanisms are developed.

While I am discussing minerals, perhaps I should talk about PROMINES, which the hon. Member for Falkirk referred to. As he knows, the British Government are co-funding that project with the World Bank, and I was grateful for his complimentary remarks about it. It is a major minerals sector reform programme. A PROMINES agreement is about to be signed with the DRC Government, and it will tighten up regulation in the DRC’s minerals sector. Obviously, we hope that it will improve conditions for mine workers and increase tax revenues from mining, which is another issue that we have discussed. That agreement has been cleared by the World Bank’s executive board, and we expect the DRC Government to sign it within the next few weeks. That is progress.

If the hon. Gentleman will forgive me, I will not comment on the particular case of First Quantum Minerals, because it is the subject of an ongoing dispute.

In recent years, we have gathered a lot of evidence about how to work effectively in war-torn and fragile states, and the key issue is ensuring that we learn from that evidence. Learning from such evidence, alongside a renewed emphasis on results and value for money, has helped us to develop the new country programme that we have now put in place for the DRC. Through that programme, we believe that we can deliver fantastic results in what is, by any test, one of the world’s most difficult aid environments. We believe that we can combine major improvements in basic services, which are much needed, with new efforts to promote trade and investment and, of course, new efforts to create wealth. If we can find ways to create wealth for the broader population, that would be the biggest reliever of poverty.

Over the four-year period of the spending review, we have a total aid budget for the DRC. For the two inner years of that four-year period, we have settled on a budget of about £147 million and £165 million respectively. We will review the progress that is made in the DRC, because we want to ensure that milestones are being identified and that we are achieving results. If progress is made, we have signalled that we want to have a total aid budget for the DRC over the four-year period of about £790 million. That would obviously mean a significant increase in the two outer years of that four-year period.

Without wanting in any sense to undo the absolutely essential element of being in a partnership with the DRC Government in this work, the modalities of delivery have to take place. Often that means that we are unable to use Government systems—for no other reason than that the Government systems do not exist. We must ensure that there is a sense of “earned increase” because progress has been banked and secured, because it is real and sustainable, because it is pro-poor and because it does not benefit those for whom aid might be regarded as being unjustified.

That aid programme will allow us to address the point that was made very forcefully by my hon. Friend the Member for Wolverhampton South West (Paul Uppal) about women in the DRC who are subject to appalling violence, including sexual violence such as rape and female genital mutilation, and who lack access to economic opportunities, including any form of land registration, which would give them the incentive to move into the economic sphere. We hope that we learn the lessons about all those factors.

[Jim Shannon]

Does the Minister have any concern about the influence of China in the region at present? I believe that there is great concern about it among a great many people in this Parliament and indeed in other countries, too.

[Mr O'Brien]

The issue is how we all operate in the various countries of Africa. The essence of that is partnership and recognising that we can make a great contribution through development spend, giving aid where appropriate but also having a programme whereby over time we can graduate away from giving aid. Equally, China has an enormous interest in terms of capital expenditure and infrastructure development. Instead of seeing that as a form of competition, there is a real opportunity, which we hope to develop, of having more of a consortium approach, whereby we can partner and perhaps use some of our technical assistance skills allied to the resources of what is unquestionably the world’s greatest capital investor. We must also ensure that the benefits of such investment are truly mutual, because nobody enters into a contract without mutuality. Moreover, mutuality must include the poor people of the countries in which the operations take place. Those are ideas that we want to take forward.

I am very conscious that this debate is not only about the DRC but about Rwanda and Burundi, too. Although the neighbourhood issues, not least those affecting areas across the border from Rwanda, are still not sufficiently calm, settled and satisfactory, there has been enormous progress given the cycles of conflict that have played out over recent decades, both in the post-colonial period and more recently. I am pleased to see the hon. Member for Liverpool, West Derby in Westminster Hall today, because I know myself, having been to Rwanda, the great work that the Aegis Trust has done to find a fitting and indeed deeply moving memorial to the events in Rwanda in the 1990s—it defies belief that those events were taking place in our lifetime.

The future progress of Rwanda cannot be taken for granted. There is still an awful lot that needs to be done to build upon the successes that have been achieved so far. There must be strong and legitimate institutions, security and the rule of law to ensure that there is a more open political space, an ability to tolerate media plurality and a lessening of the strains with neighbouring countries. As is widely known, we have a plan to increase our commitment to Rwanda in the future.

I will touch on Burundi briefly. Burundi was discussed extensively in the International Development Committee this morning, but in the last half-minute of this debate I hope that I can at least summarise matters and say that we have thought very carefully about the appropriate modality of delivering continuing aid to Burundi. In particular, we can work through TradeMark East Africa, which is the operating end of the East African Community, and Burundi stands to benefit enormously from the improvements in infrastructure and lowering of costs that are necessary to participate in economic development, while other donors—particularly multilateral donors—fill the gaps.

Humanitarian Emergency Response Review

Jim Shannon Excerpts

Wednesday 15th June 2011 Commons Chamber

[Mr Mitchell]

The answer is that I will and I have. I commend to the hon. Lady the 35-page report, which should now be on the internet, and I urge her to have a look at it and respond if she has any additional comments—as I urge all hon. Members to do.

[Jim Shannon (Strangford) (DUP)]

All the humanitarian aid we give for natural disasters, such as that in Pakistan, or to countries with civil unrest, such as Syria, Egypt and Sudan, is good news. However, the feedback from some of those countries is that those of a Christian faith and in evangelical Churches are at the back of the queue and ignored when it comes to humanitarian aid. What steps will the Minister take to ensure that that two-tier system of assistance will not continue to disadvantage those of that faith in those countries?

[Mr Mitchell]

I hear those allegations from time to time and I always ensure that they are investigated with the seriousness and rigour that such allegations obviously deserve. We have set up a working party with all the faith communities, which will commence work shortly. That will be quite a good issue for the faith communities to address and advise on. On the hon. Gentleman’s specific point, we take all such matters extremely seriously and investigate them immediately.