Humanitarian assistance and Burma

There’s a thought-provoking commentary in the latest edition of The Lancet on the challenges for rendering international humanitarian assistance in Burma.

Chris Beyrer of the Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, writes that, although the recent ‘Saffron Revolution’ was ostensibly sparked by the junta’s imposition in August of substantial price increases for petroleum fuel products, the outlook for ordinary Burmese had already been quite desperate:

In 2000, Burma’s health-care system was ranked 190th out of 191 nations by WHO. UNICEF estimates that close to a third of children nationwide were malnourished in 2006, real wages were being devoured by inflation, and HIV/AIDS, tuberculosis, malaria, and a range of other health threats were taking terrible tolls on ordinary Burmese. UNICEF reported that Government spending on health care in Burma amounted to US$0•40 per citizen per year in 2005, compared with $61 in neighbouring Thailand. Childhood (aged under 5 years) mortality was 106 per 1000 livebirths in 2006, compared with 21 per 1000 in Thailand.

The price increases were especially inflammatory for two reasons. First, they affected an already impoverished majority. One estimate is that for an average worker in Rangoon, 50–75% of daily wages would now be spent on travel alone—and fuel-price increases immediately raised the cost of basic commodities, including food. Second, the junta under General Than Shwe made the energy sector one of its principal supports and one of its show pieces, selling oil and gas reserves to Thailand, India, China, and others. And the junta was spending these revenues lavishly: an estimated $3•4 billion on arms in 2006 (mainly from China, Russia, and Ukraine), and running costs for the so-called City of Kings, the new capital Naypyidaw, costed by the International Monetary Fund at $120–240 million a year. All that in a country where the total national budget for HIV/AIDS in 2005 was $137000.

Beyrer therefore notes that the need for substantial international humanitarian assistance will be ongoing for the foreseeable future. Delivery of such assistance, however, is hampered by restrictions already imposed by the junta, with conditions exacerbated by the recent crackdown.

Beyrer sketches the dilemmas attendant upon provision of humanitarian assistance by international donors:

Some people might call for a depoliticising of aid efforts and for increased direct collaboration with the junta, its Ministries, and its affiliates. It would be heartless to deny the people of Burma any assistance the international community can provide. But it would be equally heartless to allow aid to be manipulated so as to prolong the junta’s rule or provide preferential relief for the junta’s supporters. Burma’s people have shown again that they want freedom and they have been willing, again, to die for their beliefs. All due diligence must be paid, as health and humanitarian efforts are ramped up, that such efforts do not prolong the cause of the very suffering they seek to alleviate: the military regime, which has proven such a threat to health, wellbeing, and prosperity.

There are certainly no easy answers to all this, and Beyrer doesn’t pretend to offer any. Rather, it suggests the need for an approach that is both creative and cautious, with a focus on maximising the benefit for the affected population, while minimising any advantage conferred upon an abysmally illegitimate regime.

• The Lancet, Volume 370 , Number 9597, pp. 1465-1467 (subscription only)