Burundi

Debate between Jim Shannon and Jeremy Lefroy

Thursday 10th December 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

Thank you, Madam Deputy Speaker. It is a great honour to raise the subject of the political situation in Burundi under your chairmanship, particularly on international human rights day.

Last week we spent 10 and a half hours discussing Syria, the subject of United Nations resolution 2249, but I shall refer to United Nations resolution 2248, which relates to Burundi. Perhaps we in this House ought to pay more attention to resolutions of the Security Council, of which the United Kingdom is a permanent member, because they often highlight crises around the world.

Everyone I have met who has been to Burundi has returned with a love for the country and its people. I had the privilege of going there for the first time in 2011 with the International Development Committee and have returned several times since. I declare an interest in that I help to lead the Conservative party’s social action project Umubano in Burundi with my hon. Friend the Member for Congleton (Fiona Bruce), whom I am glad to see in her place. We worked in Burundi in 2013 and 2014. We had planned to go this year, but unfortunately the political situation there made that impossible.

All those who care deeply about Burundi have been greatly concerned by the violence of the past few months, which started before the presidential and parliamentary elections. We all long for it to come to an end and for stability to prevail. We also wish to see a return to the greater freedom of expression for which Burundi has rightly been commended in recent years, following the turbulent first 40 years after independence.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way. I asked his permission earlier to intervene. I understand that the UN says that since April this year 240 people have been killed. Just yesterday five people were taken away, beaten, shot and disappeared. Their only crime, if it is a crime, was that they spoke out against the president. It is clear to me that the vigilantes think they can do what they like. Does the hon. Gentleman think it is time the vigilantes were restricted and the Government took control?

[Jeremy Lefroy]

I totally agree. There are still killings almost every day in Burundi. I will come to that later.

I was talking about the first 40 years after independence, which saw several ethnically based mass killings, in particular during 1972, when between 150,000 and 300,000 people were murdered, mainly by Government or Government-inspired forces, including the elimination of almost the entire Hutu elite. I shall spend a little time going through history because it is so relevant to what is happening today. Whereas April 1994 is remembered as the beginning of Rwanda’s terrible genocide, it is often forgotten that the shooting down of the presidential plane that killed the Rwandan President Habyarimana and marked the start of the genocide also brought about the death of Burundi’s President, Cyprien Ntaryamira. He was the second Burundian leader to meet a violent end within six months, as the democratically elected Melchior Ndadaye had been murdered the previous September.

Violence escalated in 1995 and 1996 and there followed several years of civil conflict. A series of peace talks took place, sponsored by the regional peace initiative in Burundi, mediated by former Tanzanian President Julius Nyerere and held in Arusha, but not much progress was made. Some of the main political parties, including CNDD-FDD—the current governing party—were not involved at this point. In August 2000 a peace agreement, known as the Arusha accord, was signed by the Government, the National Assembly and a range of Hutu and Tutsi groups. This provided for the establishment of a transitional Government for three years, the creation for the first time of a genuinely mixed army, and a return to political power sharing. Neither the CNDD-FDD, nor the FNL—an armed wing of another political party—was involved in the agreement and military activity increased in 2001.

The CNDD-FDD eventually agreed to a ceasefire in December 2002, which came properly into effect in October 2003, when final agreement was reached on the terms of power sharing. The soldiers of the CNDD-FDD, led by Pierre Nkurunziza, the current President, were to be integrated into the national armed forces and given 40% of army officer posts. Negotiations in South Africa to agree a new constitution met with success in November 2004. It provided for a 60:40 power-sharing agreement and both Hutu and Tutsi Vice-Presidents. A minimum of 30% of the Government had to be women.

In 2005 elections were held under the new constitution, resulting in a decisive win for the CNDD-FDD, led by Nkurunziza. He was elected President indirectly, as the new constitution provided, by the National Assembly and Senate. The indirect election is the source of the controversy surrounding the 2015 elections.

This still left the FNL. Rwasa, its leader, announced in March 2006 that he would enter unconditional negotiations to end hostilities and a ceasefire agreement was signed in September 2006. However, talks on points of disagreement broke down and a formal end to the conflict did not come about until 2009. We can see how long the people of Burundi have suffered under various forms of civil conflict.

The presidential election in 2010 saw Nkurunziza returned with 91.6% of the votes cast. International observers believed that the election met international standards, but they expressed concern at the worsening political climate. Between the 2010 election and 2015, low-intensity violence—if there can ever be such a thing—continued. Rwasa had fled in June 2010 and was reported to have moved to the Democratic Republic of the Congo, where he was recruiting fighters. There were killings by rebels and by Government forces. In December 2011 UN Security Council resolution 2027 called on the Government to halt extrajudicial killings.

Amid all this there was real progress. The integration of the Burundian army was generally a great success. It began to take part in many peacekeeping operations, where its skills and discipline were respected. Most notably, it has played a huge role in AMISOM—the African Union Mission to Somalia—alongside the Ugandan and Sierra Leonean armies, and latterly the Kenyan army, in bringing stability to Mogadishu and other parts of Somalia. That cost the lives of more than 450 Burundian soldiers, and great credit and honour must be paid to them. Burundian press and civil society were generally free and active for some of that time. A national human rights commission was established, although the Government delayed setting up the truth and reconciliation commission and the special tribunal to prosecute crimes against humanity committed during the civil war.

With elections due in 2015, the question of President Nkurunziza’s eligibility for another term came sharply into focus. His supporters claimed that, due to an ambiguity in the constitution, his election in 2005 was by Parliament and not by the people, and therefore his election in 2010 marked the beginning of his first term, not his second. Opponents said that the Arusha agreement, on which the constitution was based, stipulated a maximum of two presidential terms, which he has completed this year.

The National Assembly narrowly defeated a proposal to revise the constitution in 2014. However, President Nkurunziza was officially announced as a candidate in April 2015 and the constitutional court validated that on 4 May. The vice-president of the court fled to Rwanda, maintaining that the decision had been made under duress and intimidation. Mass protests followed the decision and were met with very strong force by the police, which was condemned by regional and international figures. Election aid was suspended by the EU and Belgium.

On 13 May there was an attempted coup while President Nkurunziza was in Tanzania to discuss the crisis. It was led by the former head of Burundi’s army and, more recently, its intelligence service, who had been sacked earlier in the year. He specifically cited the President’s candidacy at the forthcoming election, which he blamed for instability. The coup attempt was unsuccessful.

The parliamentary elections were eventually held on 29 June and the presidential election on 21 July. Both were largely boycotted by the opposition parties and both resulted in the CNDD-FDD receiving just under 75% of the vote. According to the United Nations electoral mission, this time the elections were not free or fair. The electoral commission declared a victory for President Nkurunziza.

Since the election, as the hon. Member for Strangford (Jim Shannon) has pointed out, violence has continued, with killings of unarmed civilians as well as armed opposition and Government security forces. This has sometimes been accompanied by rhetoric from political leaders that can only inflame the situation. In one speech on 29 October, a senior politician is reported to have said in respect of action against armed opposition members—this is translated from the Kirundi—

“you tell those who want to execute mission: on this issue, you have to pulverize, you have to exterminate—these people are only good for dying. I give you this order, go!”

The United Nations is rightly alarmed. In its resolution 2248, to which I have referred and which was adopted on 12 November, the Security Council expressed its

“deep concern about the ongoing escalation of insecurity and the continued rise in violence in Burundi, as well as the persisting political impasse in the country, marked by the lack of dialogue among Burundian stakeholders.”

Tropical Diseases

Debate between Jim Shannon and Jeremy Lefroy

Tuesday 27th October 2015 Westminster Hall

[Jeremy Lefroy]

My hon. Friend is exactly right, and we have seen the consequences of taking our foot off the pedal in the past. In Zanzibar, malaria was almost eliminated in the 1950s, but it came back with a vengeance. There was another programme in the 1980s, and the foot was taken off the pedal and it came back with a vengeance. The same has happened in Sudan and many other places, so we must deal with that. I think the figures she quoted are accurate, but if we manage to tackle malaria and get to virtual elimination, it will add more than $4 trillion dollars to world GDP, so it is a hugely important investment to make.

Improving health systems is another reason why we have seen progress in many developing countries, with increasing local funding, although some countries really need to step up to their pledges—for instance, the Abuja declaration of committing 15% of budgets to health, which only a few sub-Saharan countries do at the moment, along with unprecedented co-operation, which I have described. We will need all these and more as we face the challenge of the next 15 years, which is to meet the WHO’s global technical strategy for malaria 2016 to 2030.

On top of that, we face two forms of serious resistance: by the malaria parasite to artemisinin-based combination therapies in the Mekong region in south-east Asia, from where resistance to both chloroquine and sulfadoxine-pyrimethamine started and spread to sub-Saharan Africa, which is why it is vital to get on top of this; and by mosquitoes to the insecticides on bed nets, which are becoming resistant to pyrethroids. We also see serious outbreaks where bed net distribution has failed and health systems are weak. I believe my hon. Friend the Member for Mid Derbyshire (Pauline Latham) is going to describe one such instance later in this debate.

The UK is heavily involved in work to counter both those threats, through the Department for International Development’s work and the global fund supported by DFID in Myanmar, working alongside the Government there, and through the work of the Innovative Vector Control Consortium, based in the Liverpool school, in searching for and testing new insecticides for bed nets. The UK has therefore been at the forefront in so many different ways, whether through funding or research—from the London school, the Liverpool school, Dundee, York, Imperial, Keele and other universities, or from business, NGOs, or, above all, people. There are so many I would like to mention, but I will not because of time constraints, but the UK has fantastic scientists in this field at all levels.

Given the effectiveness of UK support for tackling malaria over the last 15 years, will the Minister undertake to do his utmost to maintain that for the future? I am asking the UK not to increase the level of funding, but to maintain current levels. Reaching £500 million a year is a great achievement and others need to come forward to support the UK in this, not least the countries in which malaria is endemic.

The WHO’s roll back malaria framework states that malaria interventions are very good value for money:

“Immunisation is the only public health intervention that has been shown to be more effective than malaria interventions. Beyond the financial return, investments in fighting malaria will have enormous positive effects on agriculture, education and women’s empowerment. They will also contribute significantly to reductions in poverty and the alleviation of inequality.”

Almost exactly the same can be said about the work on neglected tropical diseases. They affect 1.4 billion people—possibly an underestimate—bringing disability and sometimes death. They have a devastating economic impact, yet treating them is cheap and entirely possible. Co-operation plays a vital role, and host Governments have a vital role to play. Many of these diseases can be treated in parallel through local health systems. It makes sense to work together rather than in silos. We saw that when we visited the NTD control programme in Mkuranga district in Tanzania—I went with two other hon. Members in the all-party group on malaria and neglected tropical diseases—where they were tackling lymphatic filariasis, schistosomiasis, soil-transmitted helminth and trachoma all together. Universities also have a vital role to play. In the case of Mkuranga, an important partner was the schistosomiasis control initiative, based in the UK’s Imperial College London. Other universities are very important partners.

In the private sector, we have seen extraordinarily generous donations of drugs. I will list them because it is important that hon. Members understand the scale. Merck and Co. will donate Mectizan—ivermectin—for onchocerciasis and lymphatic filariasis in Africa for as long as it is needed, with no limit. GSK has already donated nearly 2 billion tablets of albendazole for lymphatic filariasis and will continue until elimination, and has also donated 1 billion per annum to de-worm school-aged children. Johnson & Johnson has donated 200 million tablets of mebendazole a year. Pfizer donated 70 million doses of azithromycin for trachoma in 2012 alone. Novartis has donated drugs for leprosy. Eisai, the Japanese company, has donated 2 billion tablets of Diethylcarbamazine for lymphatic filariasis, and E. Merck has donated 20 million doses of praziquantel a year, going up to 250 million tablets a year from 2016 for schistosomiasis. These are huge figures that will substantially reduce the costs of treatment in countries where those diseases are endemic.

There are also product development partnerships. As well as the Medicines for Malaria Venture and the Malaria Vaccine Initiative, we have the Drugs for Neglected Diseases initiative, which focuses on developing new treatments for the most neglected patients suffering from diseases such as human Africa trypanosomiasis, Chagas disease and lymphatic filariasis, as well as paediatric HIV. Again, the UK has taken a leading role. On top of the £50 million committed by the previous Labour Government, a further £195 million was pledged by the coalition. The UK is also the second largest funder of the Drugs for Neglected Diseases initiative, with £64 million donated, second to Gates, who has given $126 million. The one other donor with more than €20 million of donations is Médecins sans Frontières, which has donated €66 million.

The UK has also played a leading role by hosting the London conference—a big conference that set the path for the next few years; we need to find out where we have got to with that—and the declaration on neglected tropical diseases, an important declaration that I want to quote from:

“Inspired by the World Health Organization’s 2020 Roadmap on NTDs, we believe there is a tremendous opportunity to control or eliminate at least 10 of these devastating diseases by the end of the decade”—

that is just over four years away.

“But no one company, organization or government can do it alone. With the right commitment, coordination and collaboration, the public and private sectors will work together to enable the more than a billion people suffering from NTDs to lead healthier and more productive lives—helping the world's poorest build self-sufficiency.”

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving me a chance to speak in this debate. Obviously the issue is very important. The number of Members present is an indication of that. I have not yet heard—although I am sure he is coming to it—about the vast contributions that faith groups, churches and missionaries make throughout the world to eliminate poverty and help people to work their farms and so on. Almost every church in my constituency of Strangford has a project to give help directly to an area in Africa, the middle east and the far east. Does he recognise the good work that those churches and faith groups do?

[Jeremy Lefroy]

I do indeed. I am most grateful to the hon. Gentleman for that intervention. I recognise the huge amount of work done by faith groups and missions around the world. They often run remote hospitals, which even the state health system cannot afford to maintain. I have seen the work that they do. Indeed, my wife ran a public health education programme for 11 years in Tanzania and saw at first hand the work that was done when she worked for the Lutheran Church there.

I will not go through the London declaration in detail, because I want other hon. Members to speak, but I will quote the final words:

“We believe that, working together, we can meet our goals by 2020 and chart a new course toward health and sustainability among the world’s poorest communities to a stronger, healthier future.”

Real progress has been made in the past few years. To take one example of many highlighted by the Overseas Development Institute last year, Sierra Leone made great strides in preventing four of the five diseases that make up 90% of the world’s NTD burden: onchocerciasis, lymphatic filariasis, soil-transmitted helminth and schistosomiasis. In particular, on schistosomiasis, which can lead to death through liver disease and bladder cancer, 562,000 people in Sierra Leone received preventative treatment in 2009. By 2012, that figure had reached 1.4 million, which was 99% of those needing treatment. We have heard of the tragic trials of Sierra Leone in the past year and a half, but it is important that we also recognise the huge amount of work that Sierra Leoneans have done to treat many of these other diseases.

Health Services in Staffordshire

Debate between Jim Shannon and Jeremy Lefroy

Wednesday 3rd June 2015 Commons Chamber

[Jeremy Lefroy]

I entirely agree with my hon. Friend and reiterate his remarks about the excellent work done in my constituency by staff at the County hospital to recover the situation, which a few years ago was extremely difficult, to one where the quality of care offered is of a very high standard.

To return to cancer and end-of-life services, the real concern has been over the method being used. To quote Macmillan:

“We think a procurement process is the best way to integrate the fragmented cancer and end of life services we have in Staffordshire. A procurement process is needed because at the moment there is no one organisation with overall control of cancer or end of life services.”

My argument has always been: in that case, what are CCGs for? They are there to commission, so why can they not commission? In the last Parliament, we gave them the ability to work together to procure services, so why cannot the four CCGs involved, together with Macmillan, simply make that happen? The answer I was given at the time was that the constraints on CCGs’ own administration costs—a reducing amount of funding per head—meant that it was impossible. Sometimes I am puzzled. We see this all over Government and have done for many years and across many Departments: we constrain spending on so-called bureaucracy and then, in order to get necessary things done, pay large sums of money to consultants to do precisely the kind of bureaucratic work that we forbid the experts from doing—in this case the CCGs—but, because it is called consultancy or programme work rather than overheads, it is allowed. There is a problem that needs to be solved—I do not deny that—and it affects the lives of my constituents and those of other Members, so it must be solved.

Macmillan says about the first two years of the contract:

“The main responsibility of the integrator will be to address the current inadequate data about pathway activity and the real cost of this activity. Much increased investment over the last decade has arguably been wasted by poor contract accountability and a lack of reliable data and analytics.”

That is important, but it is a research and advisory role. I have no problem with the CCGs calling in experts to offer them such research and advice, whether it is a private company, university or, indeed, another arm of the NHS. A fee will be paid for that work. Again, I have no problem with that, but I would like the Minister to say how much it is likely to be. As local MPs, we have a right to know, on behalf of our constituents, or at least have a rough idea.

According to Macmillan, after 18 months the integrator —I would say consultant—will be expected to

“present a more detailed strategy as to how they expect to achieve improved service outcomes. If the evidence is robust, arrangements will be made for all contracts to be transferred to the Service Integrator from the beginning of year 3. If not, the contract with the Integrator could be terminated and the Service integrator will be required to repay all (or a significant part) of their fee to date.”

That is where I do not see the logic. What makes an organisation that is good at research and advice the right body to run cancer services for our constituents? Why can it not simply be thanked for its advice and that advice, if it is good, be followed by the CCGs, working in co-operation with the providers? The risk is that the vital work that patients, the CCGs and Macmillan have done, with the very best of intentions, will be damaged by contractual arrangements that do not make sense and may put a private organisation with a somewhat different ethos in charge of commissioning NHS providers for services, rather than the other way round.

I have no problem at all with a private organisation producing a much better plan for cancer and end-of-life services, nor do I have a problem with social enterprises or private providers being involved in delivering certain elements of that plan, as they do now and have done under Labour, coalition and Conservative Governments. However, I do not see the logic in the organisation producing that plan becoming another bureaucratic tier between the CCGs, providers and patients. I therefore ask the Minister to take up the proposed contract with the CCGs.

The state of general practice is gradually becoming critical in our area. Many GPs are retiring or approaching retirement. I welcome the Government’s plans to train more GPs, but we will also have to train more medical students or rely on recruiting from overseas.

[Jim Shannon (Strangford) (DUP)]

In Health questions this week, an issue close to my heart was raised about GP numbers and how many doctors are choosing to become GPs. We have similar issues in Northern Ireland. The difficulties in Staffordshire have been outlined, but they are mirrored across the whole of the United Kingdom, and particularly in Northern Ireland. Could any steps be taken to encourage more doctors to become GPs, thus dealing with the problem of the massive number of patients that each doctor has, because we are getting to the stage where doctors will not be able to cope?

[Jeremy Lefroy]

I am grateful to the hon. Gentleman, who hits the nail on the head. It is vital to increase the number of medical students and those training as GPs. I know that the Government want to do that and are committed to it, but I believe they need to expand the number of medical school places.

What plans do the Government have for expanding the number of medical school places and ensuring that those trained stay and work in the NHS, particularly in those areas that are running short of GPs? A seven-day personalised service is an ideal, but those GPs who take the care of their patients extremely seriously—and that is the vast majority of them—are already working extraordinarily hard. The European working time directive most certainly does not apply to GPs, even if it does to the rest of the NHS, and if it were to apply, our family doctor service would fall apart.

Finally, I wish to address the financing of the NHS in Staffordshire. All parts of it are under strain. The KPMG report showed, although some of its solutions have rightly not been accepted, that there is a serious problem. The answer is not to be found in short-term fixes, whether they be in Staffordshire or elsewhere. The NHS England 2020 plan—tough though it is—gives us the opportunity to think long term. Yesterday, I argued in this place for a cross-party commission, including the medical professions, on the future of health and social care and its provision and financing for the 20 or 30 years beyond 2020. I repeat that call today, and I urge the Minister and his colleagues to take up the challenge.