Myanmar: Health System

Lord Alton of Liverpool Excerpts

Thursday 29th February 2024 Grand Committee

[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.

--- Later in 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.