Myanmar: Health System

Lord Crisp Excerpts

Thursday 29th February 2024 Grand Committee

Asked by

[Lord Crisp]

To ask His Majesty’s Government what assessment they have made of the role that the United Kingdom could play in supporting health workers in Myanmar and contributing to the reconstruction of the country’s health system.

[Lord Crisp (CB)]

My Lords, I start by thanking noble Lords taking part in this debate, many of whom know Myanmar much better than I do. I also thank the people who produced briefings for us, because we got some very good briefings from a number of different sources.

My locus in this is my interest in global health. I am also patron of THET, which I ought to declare as an interest and which I will refer to later. I want the debate to raise the profile of the health crisis in Myanmar, to discuss what can be done to support health workers now and to contribute to the reconstruction of the country’s health system, which has been very largely destroyed over the last few years.

I will not dwell on the wider situation: the coup just over three years ago, the extraordinary repression and violence, the attacks on citizens, and the persecution of the Rohingya and other minorities, with the Gambia’s referral, supported by the UK, to the International Court of Justice on the basis of genocide. For the purpose of this debate, my focus is on the way that health workers and health facilities have been targeted.

To give just a few figures, health workers were among the first people to object and create the civil disobedience movement in Myanmar. Some 50% of health workers in the country were or are part of that movement. As a result, they have been targeted. Since the coup, there is documented evidence of at least 104 being killed and at least 870 being detained, and of 1,127 attacks on health facilities. These figures will be at a lower level, because these are the documented cases. I am sure that there will be others.

That is accompanied by the declining health of the population. In the World Health Organization’s estimate, a third of the population is in need and 12 million will need humanitarian health assistance in 2024. Some 2.6 million people are internally displaced within the country. Just as an indicator, perinatal deaths have been going up and vaccination rates are down by about 50% for children. This is a dire health emergency, which is affecting health workers as well as the health of the people in the nation.

A month ago, I had the privilege to be one of a number of parliamentarians from both Houses, including the noble Baroness, Lady Finlay, and the noble Earl, Lord Sandwich, who had a Zoom meeting with four nurses in different parts of northern Myanmar. It was deeply impressive: these people were essentially in hiding but providing support to their local communities —not in proper facilities, but in whatever facilities they could find. They were really impressive. It was incredibly moving and horrifying, and they were incredibly brave. I think all of us came away asking what we could do to help.

Part of what I want to do is relay what the nurses said to us was needed. First, they were very grateful to the UK. They recognised what the UK has been doing. Indeed, I have seen the replies to the Parliamentary Questions from Fiona Bruce MP, which have just come out, and can see that the Government are indeed taking this very seriously.

The nurses were also very grateful to the Myanmar clinicians who were supporting them from this country through the internet and through training. Part of this is being co-ordinated through THET, the organisation I mentioned earlier. It does impressive work. THET loosely co-ordinates 20 health organisations in the UK and a number of individuals who, between them, have supported training of health workers in the country, because the medical and nursing facilities have been destroyed in a number of places, and with telehealth consultations.

The numbers here are impressive. Something like 2,000 medical students have been supported through their training, and 59 clinicians have gone through training for faculty development to increase the ability to train people outside the traditional medical schools, if you like. Some 280 GPs have been supported in 50 townships. On the telemedicine side, THET regularly runs 24 specialist and four general clinics, and has seen 158,000 patients over the three years. Clinicians in the UK, some of whom are from Myanmar and some are UK citizens, have been making this contribution; it is a big contribution, and they are very grateful to those people for that. There are other groups from the UK, particularly at the border and in the north, who are working on the ground. They represent the great links that there are between the UK and Myanmar.

The nurses, first, wanted their voices heard. In the circumstances where we have Gaza and Ukraine, it is not surprising that they feel that they have slipped off the agenda and want to be heard. They want the UK to do even more in international fora to raise the issues that they are facing and give this a much higher profile.

I shall ask the Minister some questions. First, what can the UK do to raise the profile more in international organisations and with international organisations? Secondly, the nurses are asking for humanitarian corridors to be set up so they can properly support the civilian population. I note that Thailand has reached an agreement with the junta and has taken the initiative about creating some humanitarian corridors, but I also note that there is some controversy about the safety of this. One question for us is how the UK can support the development of humanitarian corridors, and what the UK can do to monitor that they are actually safe and not, in some sense, a trap developed by the junta.

Thirdly, the nurses wanted more aid into the country. There are two questions here. I would be grateful if the Minister could explain why there was a cut in aid to Myanmar in the past year and what that was about. Furthermore, they were particularly asking about having more direct aid, not aid going through junta control—more aid reaching people in the increasingly large parts of the country where the junta is simply not in control. I expect that other noble Lords will raise this, but there is certainly demand for different methods of getting aid there. Is it time to relook at what is happening? A lot of the aid is going through international organisations and directly through the junta. Could the Minister provide some thoughts about why the aid was cut and how more aid could be provided directly to the people, without going through the junta?

Fifthly, they want more of the clinician-to-clinician help that I was talking about earlier, which is partly co-ordinated through THET, and some real recognition of the immense amount of work done by the four nurses. Their relationships with nurses in this country are incredibly important to them in terms of support and solidarity, but there are also very practical things that you can do through the internet today, which you cannot do in other ways. Will the Minister consider looking at what more support can be provided to these UK and Myanmar clinicians in this country, who are providing this direct clinical support to clinicians in Myanmar?

In summing up, the situation is appalling and is clearly deteriorating. The civil war is developing, which will have a very long-term impact on the country. At some point, there will presumably be a very long recovery programme. I hope that the UK can be part of that and play a leading role.

The UK is doing a lot at the moment, through the Government, and the nurses wanted us particularly to stress that and all the useful support of the individuals and institutions that are around and have been providing this direct support, clinician to clinician. In requesting this debate and, subsequently, a meeting with the Minister, I wanted to ask whether the UK Government could think about what more it could do—and, of course, for him to answer my five questions.

Myanmar: Health Workers

Lord Crisp Excerpts

Tuesday 7th March 2023 Lords Chamber

Asked by

[Lord Crisp]

To ask His Majesty’s Government what support they are providing for health workers in Myanmar who are caring for patients outside the areas controlled by the military government of that country.

[Lord Crisp (CB)]

I beg leave to ask the Question standing in my name on the Order Paper and, in doing so, I declare an interest as patron of THET, the Tropical Health and Education Trust.

[The Minister of State, Foreign, Commonwealth and Development Office (Lord Goldsmith of Richmond Park) (Con)]

My Lords, Myanmar’s public healthcare system has been in crisis since the coup. We are concerned about Myanmar’s level of basic healthcare services and childhood immunisation rates. The UK is a leading donor on supporting healthcare needs in that country. This financial year, the UK has provided £13.95 million for healthcare in Myanmar, which is being delivered by the UN, by civil society and by ethnic healthcare organisations. This support is saving the lives of vulnerable women and children.

[Lord Crisp (CB)]

I thank the Minister for that response. I agree that the situation in Myanmar two years after the coup is truly appalling. I pay tribute to the UK Government’s efforts, including their efforts at the Security Council to keep up pressure on the country. There are many courageous health workers in the parts of the country that are not controlled by the military who are providing health services where and how they can from makeshift facilities, and they are being targeted by the military as a result. They are being excellently supported by UK and UK-based Burmese clinicians with education, training, advice, some supplies and more, largely over the internet. However, this is problematic because it is very largely controlled by the Government.

I have two immediate questions. I understand that Professor Zaw Wai Soe, the Health Minister of the National Unity Government, has asked the noble Lord, Lord Ahmad, if the UK can help by providing access to satellites. Can the Minister tell the House what progress is being made with this and when a response can be expected? Would he be willing to meet representatives of the UK and the UK-based Burmese clinicians in this country to discuss the situation, and what further practical action can be taken?

[Lord Goldsmith of Richmond Park (Con)]

My Lords, for obvious reasons, humanitarian access is extremely challenging, with many areas cut off completely to the UN and international NGOs. That is why our approach has been targeted at using and working with domestic organisations of the sort that the noble Lord has cited. The problem with that, as he knows, is that healthcare workers affiliated in any way with the civil disobedience movement are targeted. According to the World Health Organization, at least 51 healthcare workers have been killed and 352 attacked since the coup, and the Tropical Health and Education Trust, which the noble Lord is part of, reports that 624 healthcare workers remain in arbitrary detention. I am afraid I do not know the answer about progress on satellites, but I will ask my noble friend Lord Ahmad, in whose portfolio this sits, and if he is not able to meet representatives then I will certainly happily do so.

Social Security (Up-rating of Benefits) Bill

Lord Crisp Excerpts

Committee stage
Tuesday 26th October 2021 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, I remember being in the Chamber just under five years ago when your Lordships’ House was united in paying tribute to my noble friend Lord Freud on the occasion of his final speech as Minister for Welfare Reform. Hansard cols. 1697 to 1720 of 21 December 2016 paid testament to the esteem in which my noble friend is held. I join other noble Lords in thanking him and my noble friend Lady Stroud for their courage and tenacity both in their previous, pivotal positions in driving welfare reform and also for tabling what I regard as a crucial amendment, which we are considering this evening. So the question that I would be grateful if my noble friend the Minister would answer is: if we listened to my noble friend Lord Freud when he was a Minister, why should we not listen to him today? What has changed?

I shall briefly address this from the perspective of a disabled person. Disabled people have been disproportionately hit by the pandemic. Perhaps the biggest change since has been the recent significant and growing increase in the cost of living, to which other noble Lords have alluded. For those disabled people in particular who cannot work, the calamitous impact of the removal of the universal credit uplift, just as their need for support is growing, could hardly have been worse timed. For them, the impact of Covid—for which the uplift was introduced—not only endures but has increased considerably. It is completely fatuous to pretend otherwise.

Of course, I do not blame the Government for increases in the cost of living. It is not the Government’s fault that heating bills have risen by 12% and are expected to continue rising as we head into winter. Nor is it their fault that petrol now costs £1.43 per litre—an all-time high—and that prices at the pump are also predicted to increase further. But that does not mean that the Government can deny their responsibility to mitigate the real hardship faced by those disabled people who are unable to work and need the universal credit uplift now more than ever.

As a Conservative, I of course support efforts to bring the deficit under control but, as a disabled person, I suggest that that Conservative principle needs to go hand in hand with pragmatism. In conclusion, only MPs can fully appreciate the implications of ignoring the universal credit uplift crisis, for the simple reason that it is their severely disabled constituents and their families who are being hardest hit. They deserve the opportunity to vote to protect their most vulnerable constituents. As we have heard, this amendment would simply give them the chance to choose whether they want to take that opportunity. I urge the Government to think again and thereby make this amendment unnecessary. That is in the Government’s gift.

[Lord Crisp (CB)]

My Lords, I, too, congratulate the noble Baroness, Lady Stroud, for bringing this amendment to the House, together with the noble Lord, Lord Freud, and other noble Lords. They have done it in entirely the appropriate way, in recognition that there is a Budget tomorrow and other opportunities to take this whole debate forward. I have been very struck by the arguments on both sides and how well they were balanced and expressed. But I take the point of the noble Lord, Lord Hodgson, that the rules may not be quite as clear cut as they appear to be, that people will bend, expand or do something with the envelope as they see fit, and that this area needs much more discussion. I particularly agree with him on the planning laws, for example.

I want to make one substantive point which I do not think has been made yet, about the effect of this cut on health. I spent a lot of time recently in some of the poorer communities in the country working on health. In doing so, I have recognised, as we all have, the fragility of some people’s lives and the balances they need to strike to make things work. This may well knock many people on into poverty, as the noble Baroness has said. It will have an impact on physical and mental health and on other public services, and it will be damaging in the long term for society, not just for the people involved.

We have already heard one great paradox: how costly it is to be poor, and how you pay more. There is another great paradox, which is that quite a lot of cost-saving measures end up costing other budgets rather more.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise to make three brief points. I wish first to join other noble Lords in paying tribute to the noble Baroness, Lady Stroud, who has shown real bravery and great leadership this evening in moving these amendments from the Government Benches, and to the noble Lord, Lord Freud, for doing likewise. I commend the others who have supported them.

My second point is constitutional and builds on what the noble Lord, Lord Hodgson, said. Noble Lords may know from history that there has been a real shift in attitudes towards innovation. In the Middle Ages, innovation was a slur, a way of attacking people, whereas in the modern world we think of it as being a wonderful thing. The Government like to celebrate innovations. We have seen lots of innovations in our constitution from the Government, but they do not seem to like what they see as other people’s innovations— even though the noble Baroness, Lady Stroud, clearly set out a number of precedents to show that what she and others are doing here is not an innovation at all.

I want to go back a considerable number of hours to the Environment Bill. Noble Lords who have covered both Bills may have seen the noble Duke, the Duke of Wellington, a Cross-Bencher and hereditary Peer, lead a very cross-party charge, to the point where the Government eventually reversed their position—crucially, after there had been a huge public outcry about water treatment and water companies dumping sewage into our rivers and oceans.

This is a weird situation arising from our dysfunctional constitution and centuries of historical accident; but it was the House of Lords that enabled the people to speak and express their views in a way that eventually changed the minds of MPs. Were your Lordships’ House to go forward from this point and enable these debates, I have no doubt that the people of this country, the voters, would speak loudly and clearly through social media, letters and phone calls to their MPs about their very strong views on the £20 universal credit uplift. Your Lordships’ House could have the opportunity to make that happen. That, I would argue, would be intensely democratic.

My third point is very brief. The Minister, sitting beside the Leader of the House, knows that the circumstances of universal credit, its inadequacy, low wages, insecure employment and zero-hours contracts have given me many opportunities to plague her by talking about a universal basic income. The noble Baroness, Lady Lister, and many others have made hugely powerful points about the dreadful human impacts of the cut to universal credit, but I ask your Lordships to consider whether you believe in the human right to life. The right to life implies access to food, shelter, heating in winter and the basics of security, and that is what this amendment is about. We are talking about basic universal human rights, and that surely has to be a matter for your Lordships’ House.

Health Partnership Schemes: Funding

Lord Crisp Excerpts

Monday 7th June 2021 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government why they have reduced funding to health partnership schemes used by United Kingdom clinicians to support doctors and nurses abroad with training in (1) infection control, (2) pandemic management, and (3) the care of COVID-19 patients.

[Lord Crisp (CB) [V]]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare my interest as patron of THET, the Tropical Health and Education Trust.

[The Minister of State, Foreign, Commonwealth and Development Office (Lord Ahmad of Wimbledon) (Con)]

My Lords, UK health professionals have made a substantial contribution to achieving global health goals in developing countries by giving their time voluntarily through health partnership schemes. However, the UK is facing its worst economic contraction in over 300 years and a budget deficit of close to £400 billion. Given the impact of the global pandemic on the economy, the Government have been forced to take tough but necessary decisions, including to close our UK Partnerships for Health Systems programme.

[Lord Crisp (CB) [V]]

I thank the noble Lord for that Answer. As he says, hundreds and maybe thousands of health professionals every year, voluntarily and in their own time, support their colleagues in low and middle-income countries with Covid and in all other kinds of areas. It is good for those countries and good for the NHS, because it provides training and development as well as learning; we learned so much during the Ebola epidemic. For the last 10 years Her Majesty’s Government have supported these schemes in some areas such as transport, and so on. They have been very positive but, as the noble Lord says, they have been cut completely. So I have two specific questions. In February, Her Majesty’s Government agreed or committed themselves to continue to support the partnership scheme in Myanmar, which is dealing with Covid but also the dreadful emergency. Will the Government honour that commitment? Secondly, how will the Government continue to support UK volunteers, who give and gain so much and who are great ambassadors for the UK, given the withdrawal of this scheme?

[Lord Ahmad of Wimbledon (Con)]

My Lords, on the noble Lord’s second point, I agree that our medical professionals play an incredible role around the world. Certainly, I am keen to explore with the noble Lord and key Ministers, including my colleague Minister Morton, to see how through the contributions we make to health through institutions such as the World Health Organization we can continue to leverage that expertise. On Myanmar specifically, of course with the coup the situation has been extremely difficult. The noble Lord is correct in saying that we are cancelling future activity on this particular programme, but we will fund a round of grants to support voluntary health partnerships working in Myanmar.

Integrated Review: Development Aid

Lord Crisp Excerpts

Wednesday 28th April 2021 Grand Committee

[Lord Crisp (CB) [V]]

My Lords, I shall speak about a specific that illustrates the bigger problem. On Monday I chaired a meeting of clinicians in Myanmar and the UK, attended by the Health Minister of the national unity Government. British clinicians are providing vital support to their counterparts in Myanmar. The situation is desperate, with many doctors and nurses unable to access their hospitals and clinics and having to treat people in homes and the community without specialist support, equipment and knowledge. Some have been targeted for assassination. Services have deteriorated and Covid-19 is spreading fast.

British clinicians are actively supporting clinicians in Myanmar by establishing websites with treatment protocols in Burmese, providing training, being available for advice and consultation at short notice—setting up rotas to do so—and helping to record the atrocities. In March the Government committed to support this activity. Can the Minister confirm that the Government will indeed provide financial and other support for this vital work?

More generally, this is just one example of international health partnerships. Many hundreds of volunteers and doctors in training work overseas every year. I declare an interest as patron of THET, which organises such schemes. They bring benefits to the NHS as well as to other countries. Every one of those doctors, nurses and others is a fine ambassador for global Britain—through their actions, not their words. During Covid they have provided vital expertise in infection, prevention and control, treatment of Covid patients and the use of personal protective equipment. Do the Government really want to stop this essential work and crush the enthusiasm and passion of these clinicians by cutting these schemes? Are they prepared to meet THET, royal colleges and others to consider how to provide continuing support for these vital partnerships?

Covid-19: Surplus Vaccine Doses

Lord Crisp Excerpts

Monday 22nd February 2021 Lords Chamber

[Lord Ahmad of Wimbledon (Con)]

My Lords, on the noble Baroness’s second point, the Government have made their position clear. It was a difficult decision, but a necessary one. Nevertheless, it still guarantees £10 billion of support this year. On support to Oxford University, our commitment to UK science has been a major contribution to being where we are on the global stage when it comes to vaccine distribution and research.

[Lord Crisp (CB) [V]]

My Lords, I congratulate the Government on this initiative and on their positive support for COVAX. I note that other countries are making their own unilateral offers. Will the Government, with their influence as president of the G7, take two further initiatives? Will they seek a commitment from G7 countries, and others if possible, to offer a vaccination to all vulnerable people and health and care workers in those 92 countries by a target date of, say, July 2022? Will they seek an agreement to waive parts of the TRIPS agreement on intellectual property so that there are no barriers restricting access to Covid-19 medicines, tools, devices and vaccines?

[Lord Ahmad of Wimbledon (Con)]

My Lords, on the noble Lord’s second point, Oxford and AstraZeneca have worked very closely on intellectual property. Indeed, close collaboration with the Serum Institute of India has allowed it to produce exactly the same vaccine in India. On his earlier point about COVAX and other countries, he will have noted that UK leadership—we used the first G7 summit led by the Prime Minister—resulted in major contributions to COVAX, not least $4 billion from the United States as well as from the European Commission and Germany.

Official Development Assistance

Lord Crisp Excerpts

Thursday 26th November 2020 Lords Chamber

[Lord Ahmad of Wimbledon (Con)]

My Lords, my noble friend is right: we will remain one of the most generous G7 donors, spending more of our national income, in percentage terms, than the United States, Japan, Canada or Italy. I further assure my noble friend that we stand very firmly in ensuring that, when we look at poverty alleviation, fighting famine, our commitment through the various vaccine summits we have held and the importance of our COP 26 presidency —with the commitment we have made on climate finance —we stand ready to continue to meet our obligations both domestically and internationally.

[Lord Crisp (CB) [V]]

My Lords, this cut is short-sighted and mean-spirited; it will damage our national interests and scar the lives of millions. Disturbingly, there is no end point. We are all aware of the financial situation, but what other options were considered? The UK will spend billions on vaccines from its aid budget and elsewhere for people in low and middle incomes as well as its own citizens. Could it not have made a virtue of this by using the aid budget to commit to vaccinations for all, not just making a cut but demonstrating UK leadership on the protection of the world’s health and providing a welcome boost for UK science and technology? Was this considered, and why was it not done? If the Minister does not know the answer, I would be grateful for a letter.

[Lord Ahmad of Wimbledon (Con)]

I do not agree with the noble Lord. On the specific issue of the vaccine, he will recall that, when my right honourable friend the Prime Minister returned from his own challenge with Covid-19, the first summit he chaired was the Gavi summit, which committed £330 million per year to other vaccines. As the Minister responsible for south Asia, I know that issues of polio still impact vulnerable communities in places such as Afghanistan and Pakistan. Equally, we have led from the front on the importance of the Covid-19 vaccine, with a commitment of £571 million to the COVAX Facility. The Covid-19 challenge, along with climate finance, are arguably the two biggest challenges facing the world today and through 2021, and we have shown leadership on both and will continue to do so.

Nagorno-Karabakh

Lord Crisp Excerpts

Wednesday 30th September 2020 Lords Chamber

[Baroness Sugg (Con)]

My Lords, Russia of course has long historical links with both Armenia and Azerbaijan. We do not consider that the co-chairmanship of the Minsk Group conflicts with its political interests. A peaceful settlement to the conflict should be in Russia’s interest and we continue to support the Russians in their role as co-chairs.

[Lord Crisp (CB) [V]]

My Lords, I know from Armenian friends how tragic this is and I understand the potential for this conflict to increase regional instability, and I am therefore pleased with the steps that the Government are taking. However, what discussions have Her Majesty’s Government had with the Turkish Government and what pressure do they believe that our Government and the international community can bring to bear to prevent Turkey’s further intervention in this conflict?

[Baroness Sugg (Con)]

The noble Lord rightly highlights the situation in which many civilians find themselves in this conflict, which is why we are keen to do everything we can to de-escalate it. On relations with Turkey, on 28 September, the Prime Minister spoke to President Erdoğan. They agreed on the importance of a return to dialogue. As I have said, we will do all that we can to urge the parties to avoid any external interference.