Professor Amartya Sen, recipient of the 1998 Nobel Prize in Economics, has written extensively on hunger, famine and its causes. He has observed that: "People in economic need also need a political voice....no substantial famine has ever occurred in any country with a democratic form of government and a relatively free press." Burma, a country of 48 million people, has an extraordinarily undemocratic government, an unfree press and not uncoincidentally, its population is facing what a confidential UNICEF report termed a "silent emergency."

Given the complexity of Burma's political situation, assistance on the basis of compassion alone is insufficient. Donors must understand the underlying causes of the crisis and ensure that humanitarian assistance, born of compassionate intentions, neither prolongs nor reinforces the causes of Burma's humanitarian crisis. Attempts to alleviate suffering should not have unintended consequences for either donors or recipients.

The Asian Wall Street Journal described the poverty in rural Burma in an article on April 16, 1999, after visiting some villages in the Southern Shan State. The writer confirmed the findings of a UN Working Group report on Burma published in July, 1998, which stated:

The military authorities have foreclosed all opportunities for the development of civil institutions and have nationalized or co-opted all existing non governmental organizations (NGOs) in Burma. Local professional organizations, such as the Burma Medical Association and the Burma Red Cross have been co-opted by the state. The Myanmar Maternal and Child Welfare Association, under the direction of Gen. Khin Nyunt's wife, has been presented to the international community as a legitimate NGO. At the same time, the military has set up a nationwide mass organization, the Union Solidarity and Development Association (USDA), with the mandate to conduct socio-economic development activities-sometimes with international assistance--while its members are routinely organized to attack the National League for Democracy and other democratic forces.

The results of the ongoing political repression in Burma on human development are plain to see. The living standards of the majority are falling while that of a small but visible elite is insulated from the general suffering. More children are suffering from diseases due to malnutrition and some people are starving. Hospitals, when they exist at all, have no medicines and private clinics are unaffordable to all but an affluent few. The universities are closed and the schools are increasingly impoverished. Non-attendance and drop out rates increase while budgets waste away. The government’s failure to address the pressing needs of the population affects many sectors, but particularly food security, health care, education, the environment, and women and children.

Food security:

The regime, in asserting its' control over all aspects of Burmese society, including the distribution of food, routinely prevent the National League for Democracy from providing rice donations to the impoverished.

Health care:

The health care system in Burma has been in decline for a number of years, and this process has accelerated since 1995. While data are poor and incomplete, there is little question that Burma has lagged sharply as compared to her ASEAN partners in health investment, programs, and outcomes. While public health programs cover approximately 90% of the populations of Vietnam and Thailand, they reach under 60% of Burmese. In Asia, only Cambodia now reaches fewer citizens. In 1996, maternal mortality was 580/100,000, roughly a third of which were attributed to complications of abortions, which are illegal in Burma, but widely used for family planning, since only 16% of women, according to UNFPA, have any access to family planning services.

According to Myanmar Health Facts, published by the junta, the annual expenditure on health per person in 1995 was 62 kyats, at actual exchange rates this is about U.S.D. 0.50$, and is among the world's lowest. Haiti, for example, is doing better, as is Ethiopia, at 0.80$ per citizen. Health expenditures under the junta, using their figures, accounted for 0.45% of GDP in 1995, a gross level of under investment in health. Since the economic collapse of the last two years, this figure is likely to be even lower. Life expectancy at birth in 1995 was 59 years, but UNAIDS estimates that this has fallen at least 2 years due to the uncontrolled spread of HIV, and probably reflects only those areas for which health data are available. As is true for many ministries under S.P.D.C., the Health Minister, Maj. Gen. Kit Sein, is a junta member with no medical or health training background.

Infectious diseases remain a serious and markedly under-addressed health problem. Multi-drug resistant malaria appears to be spreading rapidly, due to inadequate control and treatment programs. Donated drug supplies have subsequently appeared for sale in markets, and there are repeated examples of failed distribution programs in essential agents, including childhood vaccines. Polio, leprosy, filariasis, tuberculosis, diarrheal diseases, cholera, and parasites remain poorly controlled, surveyed, and treated. With

higher educated suspended for 8 of the last 10 years under the junta, the corp of health professionals to address these crises is actually shrinking. Donor aid will be difficult to use if in-country partners cannot be educated and trained.

While NGOs in developing countries have played important roles in filling government health program gaps, Burma's NGO's have been unable to do so. Since 1995, staff and members of local NGOs such as the Myanmar Medical Association, Myanmar Red Cross, and Myanmar Maternal Child Welfare Association, have been fired for having any affiliation with the NLD and its member parties. Staff of these organizations have been forced to join the junta's civilian militia organization, the Union Solidarity and Development Association or to resign. Thus, these are no longer non-governmental entities, and are viewed with widespread fear and mistrust by the bulk of the Burmese people, severely affecting their ability to implement programs. Donor support to these organizations is proxy support of the junta, not support of independent NGOs, and lends legitimacy to the attempt to further undermine the elected leadership.

HIV/AIDS:

According to an April, 1999 statement by Dr. Peter Piot, executive director of the UNAIDS Programme, "Burma has the second worst AIDS epidemic in Asia." UNAIDS estimated there were at least 440,000 cases of people infected by HIV/AIDS in Myanmar, where intravenous drug use is widespread and there is an active cross-border sex and heroin trading with neighboring Thailand, India, and China. The Myanmar junta, however, claims to have only 21,503 confirmed HIV cases and 2,854 AIDS cases. "The big challenge is the recognition of the problem by the government," said Dr. Piot, addressing a press conference in Bangkok.

The junta continues to deny not only the HIV/AIDS problem, which now affects as many as 1 in 25 Burmese, but also the risk factors for HIV infection and spread. A statement by the junta reported in The Nation (Bangkok, 10 April, 1999) was that "Myanmar has no sex industry." And that ". . . the number of drug users compared to other countries is very much less." In fact, the junta's own National AIDS Program, in collaboration with UNDCP, investigated the prevalence of drug use in a large study in 1995, reported in abstract form to the 11th International Congress on AIDS in Vancouver: prevalence of injecting drug use ranged from 2% of adults to 25% of adults across 36 townships, the highest rate for such drug reported anywhere in the world.

Despite the involvement of numerous UN agencies in the AIDS problem in Burma, including UNFPA, UNICEF, UNDP, and UNDCP, the junta continues to deny what are now widespread and well documented facts. This level of denial is matched by inefficiency. In 1997 less half of the 1.2 million condoms donated to the country by UNICEF were successfully distributed, or roughly 600,000 condoms. In the same year, Thailand, with only a slightly larger population, distributed 60 million free condoms. HIV/AIDS remains out of control in Burma, and the junta has responded thus far with denial, inaction, and inefficiency--a poor prognosis for further donor aid in this arena.

Education:

Burma was once considered one of the most literate countries in the world. Today, however, the education system at all levels in Burma is decaying–and along with it the futures of Burma’s next generations. The authorities have all but stopped funding education in Burma. And so the burden falls on the children and their families. Approximately 40% of children never enter school and of these and only 25-35% will complete the 5 years of primary education. These abysmal enrolment and completion rates are falling, as is the quality of education: "Against [a] backdrop of conflict and economic decline, education standards have plummeted throughout Burma." The military regime spends over 222% more on its army than on health and education services combined.

The Environment:

Until such time as there is a change to a more open and accountable political system in Burma, there is little that environmental and conservation organizations can do effectively inside the country. Following a nearly two year investigation on forest management, World Resources International found that "under the current political circumstances, there is no scope for direct engagement by the international community" and therefore recommended that the international community "should support projects that shed light on what is happening on the ground." This form of engagement would allow NGOs and others in the international community to increase international pressure on the regime to move toward the kind of accountable political system that is the only way to end the unsustainable, and often illegal, logging practices occurring in the border areas.

The NLD has pointed out that projects implemented through the authorities are inevitably done without the consent of those who live on the land. For a project to be effective, it must involve the people who live on the land by educating them and engender their support by making it in their economic interest to conserve the land. The authorities in Burma thus far refuse to allow conservation organizations free access to the people or their habitats most affected.

Women and Children:

Burma’s women and children endure some of the worse hardships in the day-to-day struggles of living under a military dictatorship. Women and children often forced to work as military porters under harsh conditions and child soldiers as young as 14 year old are not unusual.

The country’s women, though, face special problems, and especially young ethnic women are often the target of particular abuse. Rape by soldiers is common, and the military has been implicated in the trafficking of Burmese women into prostitution in neighboring Thailand and other neighboring countries. As many as 40,000 Burmese women, most of them from minority ethnic groups, are believed to be employed in Thai brothels. Some are abducted, others lured with false promises of legitimate employment, scarce in their impoverished home areas. Many contract AIDS or other serious diseases. It is certain that the large-scale trafficking of Burmese women, some of whom have been sold into prostitution for as little as $35-40, could not continue without the consent and cooperation of Burmese security forces and their Thai counterparts along Burma’s frontiers.

The International Labour Organization (ILO) recently reported that: "In violation of the absolute prohibition in Article 11, paragraph 1, of the Convention, forced or compulsory labour is widely imposed on women including pregnant women and nursing mothers, children below the age of 18 who may be as young as 12 or 10 years of age and who would otherwise be at school and persons above the age of 45 as well as persons otherwise unfit for work, for portering, messenger service, camp building sweeping roads to detect mines, sentry duty, building roads and railways and other infrastructure works.

Less than 40% of Burmese have access to safe water and sanitation. The few health services available are often rudimentary and have deteriorated seriously over the last decade. Even new foreign investment can create difficulties. For example, many foreign-financed garment factories employ mostly women and children who would not ordinarily be working under such harsh conditions if they were not so desperately poor.

Women are not at all or under-represented in positions of genuine power and governance. Burma ranks lowest among the world’s countries in terms of women’s participation in government. Especially among the dictatorship’s self-selected ranks, women are not represented. The UNDP’s 1997 figures show that Burma joins only ten other countries in the world, including Libya, Saudi Arabia, and the Solomon Islands, in which women hold no significant government posts.

Consecutive UN General Assembly resolutions recognizing the right of Burma's citizens to participate freely in the political process implies that donor aid should not be provided in such a way as to impede or frustrate this right. And this responsibility of UN agencies not to frustrate the political rights of Burma's people extends to those NGOs selected as grantees to implement UN projects. The difficulty here is that donors are currently strongly discouraged from consultation with the NLD, and that indigenous NGOs have been politicized by the military regime through purges of all members with NLD associations. The regime has thus politicized the humanitarian aid process.

There are many other examples of this kind of programmatic failure under the current regime.

The health, vital indicators, educational levels, development status, and human rights situation of the people of Burma have deteriorated over the last eleven years of military rule. This regime’s efforts at development have failed. While the inclination to redress the humanitarian crises created by the regime’s policies with donor aid, such aid channeled into a system that created the crisis is unlikely to solve it. The regime’s development policy failures are many and there is little indication that they are learning from their mistakes.

Among the mistakes made by the authorities is their under-investment in development and excessive spending on the military and police forces. The SPDC reports that 60% of its operating budget goes to the military. The actual level may be higher. Further mistakes include declining expenditures for health care on a per capita basis. In 1995 health care expenditures were 62 kyats/person, among the lowest in the world. Other mistakes are crippling the ability of the economy to provide the kind of growth that would alleviate suffering.

According to a recent report by the United Nation’s Working Group on Burma, the SPDC's efforts to reform the economy do "not have the underpinnings of sustainable long-term growth. The agriculture sector, which accounts for the greatest part of Burma’s economy, is under strict input and out-put price restrictions that have impoverished the 60 per cent of the population who are small farmers. Foreign investment in capital-intensive areas is promoted, but there is little investment in productive and labor-intensive sectors; investment-led growth potential is minimal. Rising budget deficits are causing sharp inflationary pressures.

Corruption, mismanagement, and the expanding narcotics economy pose equally severe threats to the development of a legitimate economy. Opium poppy cultivation, measured in acreage under poppy cultivation, has more than doubled since 1988.

Long-term development goals are also neglected. This best evidenced of which is the closure of the universities for 8 of the last 10 years. Efforts to control political expression and information flows, as well as the inclination of the authorities to cover up serious human emergencies for political reasons prevent the feedback necessary to redress complex emergency situations. For example, information on AIDS epidemiology, natural disasters, forced migration, and refugee repatriation is repressed. Burma has the world’s most severe Internet censorship law and information technology (e-mail and Internet) is restricted to 200 carefully screened licensees. The restrictions are not only legal, but also financial. The costs of 1,000 USD/license, leaves the Internet out of the range of virtually all Burmese civilians.

A number of international NGO and UN organizations now maintain humanitarian assistance programs in Burma. Their experience provides useful case-studies to assess the impact of aid to relieve the humanitarian crisis.

Among the problems aid providers are encountering are bureaucratic inefficiencies and delays. All NGOs require a Memorandum of Understanding (MOU) from the respective government ministries to operate in the country. Currently, about one-third of NGOs based in the country are waiting for government permission for their proposed activities. Some have waited over a year for permission to begin activity--others have waited over 15 months only to be denied. Even an MOU does not guarantee NGOs independence in selection of project sites, hiring and other issues related to project implementation and evaluation.

Another risk entailed by providing humanitarian aid in Burma is that by privileging populations favored by the authorities, NGOs risk funding the regime’s pacification campaigns. Finally, the presence of humanitarian and relief agencies has been used by the junta to counter charges of human rights violations and convey an impression of international legitimacy. Indeed, given the limited scope and lengthy delays encountered by NGOs seeking to operate in Burma, it is plausible that an appearance of legitimacy is the junta's principal reason for allowing NGOs entry at all.

6.1. cross-border assistance programs to expand the existing relief parameters in the border areas;

6.2. an emphasis on capacity-building and training in relief delivery thus strengthening the capability for sustainable self help and long term development;

7. The development of independent religious and community based NGOs in operating humanitarian projects should be a conditionality of aid.
8. The international community must increase its activities, through the United Nations, ASEAN and with Burma's trading partners to push for a resolution of the political crisis. Without such a resolution, the policies of the current authorities will continue to both cause immense suffering and to prevent its relief.