So Much Need, So Little Help for the Deathly Ill in Myanmar

A growing humanitarian emergency has sparked fears that thousands could die of disease and malnutrition in Myanmar, whose repressive military regime has drawn international condemnation and punishing U.S. trade sanctions.

Myanmar faces one of Asia’s worst AIDS epidemics and suffers 60% of all malaria deaths on the continent, U.N. officials say, but it receives little foreign aid.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, which is financing worldwide efforts to combat the three diseases, cut off $87 million in funding for Myanmar this year, citing a lack of cooperation from the ruling junta, which continues four decades of military control.

If other major donors don’t come forward, U.N. officials say, thousands of people will die, including as many as 5,000 AIDS patients who were supposed to receive antiretroviral drugs under the five-year Global Fund program.

“The Global Fund was never given a chance to function,” said Charles Petrie, the chief U.N. official in Myanmar. “Without exaggeration, people are going to die because of this decision. People who survived the regime are going to die because we are not able to provide the humanitarian aid to help them survive the disease.”

The looming health crisis in Myanmar, also known as Burma, has sparked debate among aid workers here and pro-democracy advocates outside the country over which should be the highest priority: preventing a humanitarian disaster or bringing down the regime.

One Washington-based advocate who insisted on anonymity said that blame for the lack of aid should be placed squarely on the regime and that the international community’s focus should be on bringing about political change in Myanmar.

“It’s not like people get up in the morning in Washington and decide they want to make people in Burma suffer more,” she said. “It needs to be recognized who causes suffering in that country. It’s not the Global Fund, it’s not the U.N., it’s not the Congress. It’s the regime.”

But Brian Williams, the UNAIDS country coordinator for Myanmar, likened the cutoff of medical aid to withholding food from people at a refugee camp.

“If there were refugee camps and you stopped feeding people, you would be accused of murder,” he said. “Here, if you are able to provide aid to people in need, then you should do so. If you need to reach people, you have to work with the authorities who are in place.”

Neither U.S. sanctions nor efforts by neighboring Asian countries to engage the regime have succeeded in winning concessions, particularly the release of Nobel Peace Prize winner Aung San Suu Kyi.

Suu Kyi’s opposition party, the National League for Democracy, won 80% of the vote in the country’s last election, in 1990, but the military refused to hand over power. She has been under house arrest or imprisoned for 10 of the last 16 years.

When Suu Kyi was last free, in 2003, pro-government thugs attacked her motorcade, killing dozens of her followers in what U.S. officials say was an attempt to assassinate her. In response, the Bush administration imposed trade sanctions that prohibit U.S. companies from doing business here. The sanctions put an estimated 20,000 people out of work, a U.N. official said, and have contributed to the steady deterioration of the economy.

The regime, headed by Sr. Gen. Than Shwe, 74, seems impervious to outside political pressure and appears content to remain cut off from the West. Apparently following the advice of astrologers, the government isolated itself further last month by abruptly moving its capital from Yangon, also known as Rangoon, to the remote town of Pyinmana 200 miles north.

The regime’s actions have been costly. Despite its overwhelming poverty, multiple epidemics and dearth of social services, Myanmar receives less international humanitarian aid per capita than almost any country in the world, including others with repressive governments.

Neighboring Laos, for example, which is ruled by a Communist regime, receives more than 20 times as much humanitarian aid per capita as Myanmar, according to 2003 figures compiled by the Organization for Economic Cooperation and Development. Vietnam receives nine times as much aid per capita as Myanmar, the figures show. Even Cuba, which also is subject to U.S. trade sanctions, receives more than twice as much aid per person.

“What I deplore is the low levels of international assistance,” said Guy Stallworthy, Myanmar country director of Population Services International, which would have received a share of the Global Fund money to finance its AIDS prevention program. “When you put that together with the military regime, it’s a horrendous situation.”

With the lack of action by the government and the shortage of aid funds to nongovernmental organizations, all three diseases targeted by the Global Fund have become epidemic in Myanmar and pose a threat to neighboring countries China, India and Thailand.

HIV has spread from drug users and sex workers into the general population, and its prevalence is estimated to be as high as 2.3%. Towns on the border with China that are popular with truckers are among the hardest hit.

Myanmar’s tuberculosis rate is one of the highest in the world, with 97,000 new cases detected annually. Multi-drug-resistant strains of tuberculosis are spreading within the country and across the border. About 600,000 cases of malaria are reported annually in Myanmar, with 3,000 deaths. Malaria is the leading cause of death for children under 5.

In cutting off aid, the Global Fund acknowledged that the health situation in Myanmar was “extremely precarious” and said, “These diseases could soon reach catastrophic proportions, affecting the entire region.”

The Global Fund initially granted $98 million for healthcare programs in Myanmar, which is almost the size of Texas. In May, however, security officials became concerned about foreign aid workers traveling around the country and imposed strict travel restrictions. The Global Fund concluded that the aid could not be distributed properly and, in August, cut off $87 million in funds that had not been disbursed.

The travel restrictions were lifted soon after.

Suu Kyi, who is held incommunicado by the government, has in the past advocated sanctions against the regime. But other leading opposition figures in Myanmar expressed disappointment over the Global Fund’s decision to withdraw assistance.

“We need international aid to solve the health crisis,” said Min Ko Naing, a prominent student leader of 1988 democracy protests freed last year after nearly 16 years in prison. “We need any form of donations and cooperation on this issue. We cannot wait for a political settlement.”

Some foreign aid workers here contend that the Global Fund’s decision to withdraw from Myanmar was the result of political pressure from the United States and hard-line democracy advocates in Washington who have the ear of key members of Congress.

Global Fund spokesman Jon Liden, however, denied that politics played any part in the decision and said the program was terminated because Myanmar had reneged on its commitment to let aid workers travel.

“The claim that political pressure was building on us and that we were looking for an excuse to get out is totally unfounded,” Liden said.

Congress has warned it will withhold part of its contribution to the United Nations Development Program if the aid it administers appears to be helping the military government.

Some aid workers here question what they contend is a strategy of withholding assistance from Myanmar in the hope of bringing down the regime.

“The idea of grinding them down so they will rise up is morally suspect, even if it could work,” said one foreign aid worker who asked not to be identified. “The idea that an impoverished, downtrodden population is more likely to rise up is not true. They spend all their working hours trying to find their next grain of rice.”