Proceedings of the Standing Senate Committee on
Foreign Affairs and International Trade
Issue 13 - Evidence - Meeting of June 5, 2014
OTTAWA, Thursday, June 5, 2014
The Standing Senate Committee on Foreign Affairs and International Trade met this day at 11:05 a.m. to study security conditions and economic developments in the Asia-Pacific region, the implications for Canadian policy and interests in the region, and other related matters.
Senator A. Raynell Andreychuk (Chair) in the chair.
[English]
The Chair: Honourable senators, we are ready to start but before I do, I am mindful of an event that is occurring in Moncton, which all of us are aware of. I want to express on behalf of this committee our condolences to the families of the three fallen officers and those that have been wounded. It is something that it touches me having taught at the RCMP Depot. They are fine trained officers doing duty on our behalf, and we express our sincere condolences to the family with our prayers that the suspect is apprehended without any further incident. I trust that will be noted in the record and passed on.
On your behalf, I express that sentiment, and we trust that the community will come together and help those families, and I'm sure they are.
We are now on to the study. Today we are continuing our study on security conditions and economic developments in the Asia-Pacific region, the implications for Canadian policy and interests in the region, and other related matters.
In this session we're pleased to welcome Rebecca Wolsak, Program Manager with Inter Pares. She is accompanied by a delegation visiting Canada from Burma. The delegates include: Dr. Cynthia Maung, Director, Mae Tao Clinic; Saw Nay Htoo, Program Director, Burma Medical Association; Nang Snow, Deputy Director, Back Pack Health Worker Team; Nai Ley Ye Mon, Director, Mon National Health Committee; and Gary Rozema, Program Coordinator, Burma Relief Centre.
We're very pleased that you're here to update us on your work and any issues that you wish to present to us with respect to Burma. I understand that there will be introductory comments by Ms. Wolsak, Dr. Maung and Mr. Htoo, after which we will turn to questions from senators. Welcome to the committee.
Rebecca Wolsak, Program Manager, Inter Pares: I work at Inter Pares, which is a small Canadian social justice organization based in Ottawa. Our name means "among equals" and this essentially describes how we like to work.
We have programmed in Burma for over 20 years, and in our current program we collaborate with over 60 community-based organizations, which work on human rights documentation, the promotion of free media, essential support for refugees living in refugee camps, women's empowerment and health care provisions. We currently have financial support from the Government of Canada through the Department of Foreign Affairs, Trade and Development for this work.
Before passing the floor to my colleagues from Burma who work in health care, I would like to take a few minutes to attempt to summarize the history and the current context and critical considerations for moving forward.
I often describe Burma as a country of two struggles, the struggle for democracy and the struggle for ethnic rights. The struggle for democracy is the one that we hear about in our media. This is the one that is led by Aung San Suu Kyi. I'm sure many of you have heard of her. In the last three to four years we can definitely say that we've seen some progress in this struggle in the transition from a military dictatorship towards democracy, although I would describe the current government in Burma as quasi-civilian, given that 25 per cent of parliamentary seats are constitutionally saved for active duty military officers and the fact that most other seats are held by men who took off their uniforms just prior to election.
But the second struggle is at the heart of the 60 years of conflict and it's all too often overlooked. It's the struggle for respect and some form of self-government for the ethnic peoples of Burma. Ethnic people comprise 40 per cent or more of the population, so it's a considerable part of the country. General Aung San, who is Aung San Suu Kyi's father, realized that this nation that had been cobbled together by the British colonies, would only survive if the non-Burman ethnic groups agreed to be part of it as a nation.
In 1947, just before independence, General Aung San held a conference, brought people together and an agreement was reached on a federal structure for this new nation. However, months later he and several other leaders were assassinated. Therefore, upon independence, Burma was born a centralized state dominated by the Burman ethnicity.
Since that time, various regimes have justified military rule as the only way to hold this country together. They have used brutal campaigns in an attempt to extend sovereignty all the way to the borders. Ethnic villages were seen as needing to be conquered and controlled. Their populations needed to be subjugated and what's called "Burmanized," meaning an assimilation plan with the goal of everyone speaking Burmese and preferably becoming Buddhist.
Military campaigns have faced both non-violent and armed resistance. As military offensives became more brutal, the resistance has only become more determined. Villagers hid in the hills rather than submit to military control, while ethnic groups carved out large territories for themselves and ran their own regional governments, with social services and an active civil society. Over the years there have been many ceasefires but without political dialogue, so therefore these ceasefires have failed.
In Burma today there is active war still in Kachin State and in Shan State, and there are ceasefires in place elsewhere. There has been a rapid rise in anti-Muslim sentiment, which has also led to violence. A quarter of a million people have been displaced by conflict in the last three years. I'm going to repeat that because I think it's really important. We think of the last three years in Burma as some kind of Burma spring with this transition to democracy, but a quarter of a million people have been displaced in the last three years. This is in addition to the hundreds of thousands of internally displaced people and people who have fled the country.
However, there is hope, absolutely, that the current ceasefire talks will lead to a nationwide ceasefire, and in turn that that will lead to political dialogue. But it's pretty hard for villagers to hope that these talks will be any different from the ones they've had before, especially when they see government troops using this time to stockpile, reinforce and expand their bases.
Civil society is not waiting to see how these talks will progress. The groups we work with are actively engaging in policy development and a process of envisioning practically and strategically the steps that will be needed to nurture an inclusive democracy.
I hope this has given you some perspective on why it is so critical when we talk about Burma that we talk about ethnic people and about including them in all hopes for sustainable peace and democracy in Burma. Canada should be proud of the role that we have played. It's a critical role in supporting civil society within and between ethnic communities. In moving forward, we believe that this conflict analysis must continue to be integral to Canada's evolving foreign policy on Burma.
Dr. Cynthia Maung, Director, Mae Tao Clinic, as an individual: I am Dr. Cynthia Maung. I am a health professional working with Burmese ethnic groups in the different ethnic states and displaced and conflict-affected population over the past 20 years. A centralized health system, armed conflicts and discrimination has caused Burma to have one of the worst health and human rights records in the region. When I started working on the border 20 years ago, almost 90 per cent of women delivered at home by untrained midwives. Since we arrived at the border, we train health workers from the community, we train community midwives, and we continue to deliver service for the people, otherwise they cannot access health service from the government.
The conflict is ongoing, but we can bring many diverse ethnic groups to come together to access better health services, as well as to improve the coordination and networking among the diverse ethnic communities.
In 2000, we established a network of ethnic health organizations to develop the health system. The Health Information System Working Group was formed, so since that time we can do more standardization and coordination on the health service delivery and we can monitor the impact of our health services. We train health workers at different levels to provide different levels of care. The Backpack Health Worker Team is working in the most remote conflict areas in mostly village-level care. The Burma Medical Association provides technical support, ongoing training and monitors the impact of the health outcomes.
Different ethnic groups are leading the policies, so since that time coordination and standardization for health will help develop future health policy, as well as make space for more understanding of a culturally, socially and economically appropriate delivery health system on the border area.
Prior to 2012 there was no connection between the Burmese government health system and the ethnic health system, so over the past 20 years we trained more than 4,000 health workers who have accessed over half a million people for better maternal and child care services. We provide maternity care as well as public health promotion activities like school health promotion and water and sanitation. Also, we continue to address the community needs and designs to assist basic health services.
Over the past 20 years the building of partnerships has brought better opportunities for us. Since 2012, with the ceasefire between the Burmese government and the ethnic groups, we have had the opportunity to have more meetings and some connection with the government health services or health officials, but the centralized government system could not make decisions at the state level government. The ethnic health organizations met with the state governments several times to discuss the future health policy and health system. However, the highly centralized system prevents them from making more decisions and, at the same time, there are more international communities with access to the border, but without consultation with the ethnic health organizations or recognizing the existing health facility it made it more difficult with overlapping services and many vertical programs that are not appropriate for our situation.
We will continue working on standardization coordination among us as well as consultations with different communities and diverse ethnic groups to bring better opportunities. It will act as a bridge for peace and help to strengthen ownership and empower civil society organizations. Canadian support for us over the last 15 years has been crucial for us. It has built the capacity of health workers, improved access to quality health services, and made a more neutral and comprehensive approach to promoting health care for people.
Saw Nay Htoo, Program Director, Burma Medical Association, as an individual: Good morning, everyone. I am honoured to be here today to present our policy development process. I am Saw Nay Htoo, Program Director, Burma Medical Association. We are a member of the Health Convergence Core Group represented here today.
As already mentioned, Burma has a centralized health system mainly based in central and urban areas. It is ranked one of the worst in the world. Currently, we ethnic health organizations are jointly developing our policy on how to integrate our local health systems into a future federal union of Burma.
Even though there is political dialogue to address the root cause of civil war, ethnic autonomy has not yet begun. We ethnic health organizations from Burma have been studying other federal countries to develop our own solution. Our proposed solution for the convergence of our health system into a national structure is based totally on decentralization. The main reason we are here is to study your health system in Canada and how health powers are decentralized to the provincial and regional levels.
Until political agreement can be reached in Burma and all peoples and social structures can be represented under one government, we are asking that international development aid supports social structures on both sides of the conflict. This can help with confidence and trust on both sides during the convergence process toward a long-lasting peace in Burma. This will also support the most effective and sustainable health care.
We appreciate Canada's support for our system development in the past. We hope that Canada will continue to support the path toward sustainable peace and health care. Thank you.
[Translation]
Senator Fortin-Duplessis: Welcome to our committee and thank you for your presentations. My question is for Dr. Maung and Mr. Saw Nay Htoo. I want to ask you about the precarious medical conditions in Burma.
Earlier, Ms. Wolsak mentioned that some progress has been made in terms of deliveries, as midwives have been trained. Did you know that Burmese authorities expelled Doctors Without Borders a few weeks ago and that Red Cross had to pull out 300 members of its staff? How much does that complicate health service delivery to local populations in desperate need?
[English]
Dr. Maung: As I mentioned earlier, we have trained 4,000 health workers, who are all from the community — the midwives and the community health workers. They have been trained and we continue to monitor and supervise their services. This strengthens the community health care system. We explained to the international community, INGOs and government, that there has been an existing health infrastructure and health system, and this is a continuing empowering process. Also, there is no language barrier working in the community, and since they have been living in the community for a long time this is more geographically or economically sustainable. This is a good opportunity for us to work together with the Burmese health care system. The primary health care services and also the training of health workers need to be appropriate to the local needs.
We are happy to coordinate with many international NGOs and health workers to recognize the existing health service system, which was built over the past 20 years. This is very crucial for us because health workers who were trained have made significant impacts on health in the community. As I mentioned earlier, we train midwives. Many women access health care through community midwives, and almost 70 per cent of women now deliver with trained midwives. We still need to refer patients to the hospital when they need a higher level of care, so we need to work on strengthening the referral system and upgrading the knowledge and skills. This is a good opportunity for us to bring health workers together to do more standardization and coordination regarding the health system. We need to sustain these health services in the community.
[Translation]
Senator Fortin-Duplessis: From what I understand, you no longer needed Doctors Without Borders or Red Cross. So you have other international and government organizations that are helping you. I would like to know if there are any regions where health care services are still not available. You have trained a lot of midwives for deliveries, but there is more to health care than that. Who handles surgeries or very serious diseases — such as dengue? Surely, not only midwives are available to provide such services?
[English]
Gary Rozema, Program Coordinator, Burma Relief Centre, as an individual: The withdrawal of MSF and ICRC was mainly in the Rakhine State. The groups represented today are working basically in eastern Burma, and Rakhine State is on the western side next to Bangladesh. The areas where those INGOs were working are government controlled. Support for them is needed in those areas. It is significant, but those areas are different from the ones Dr. Maung was talking about.
Senator Oh: My question is for Dr. Maung. Of the large number of people coming to your clinic every day, I would imagine that people of ethnic minorities are the most vulnerable and affected by the social unrest, the Kachin, the Rohingya Muslims, the Shan, the Karen and Lahu. Can you comment on the statistics on the backgrounds of patients entering your clinic? Do you see this situation improving or worsening as time goes on?
Dr. Maung: In the ethnic state, the ethnic health organization or Back Pack Health Worker Team provide services, so we continue to monitor the services, as well as continuing to monitor the impact of health programs. As I mentioned earlier, in the past, women delivered at home by untrained midwives. Now women can access emergency obstetric care and basic maternal and child health care services. At the clinic, we do both primary and secondary-level care, but, for the tertiary-level care, we still need to refer to the hospital those who require caesarean sections or more intensive services. This is an opportunity for us to strengthen our partnership with the government on both sides of the border because, in Eastern Burma, we have a long border with Thailand. Many referrals currently go to Thailand because women can access emergency obstetric services in Thailand. What we would like to see is that we can refer more women to government health facilities, which can take care of emergency obstetric and neonatal care services. We regularly do client surveys, and there are still a lot of issues with accessing the government facility currently because of the language barrier, the costs and the transportation issue. That's why we need to continue to provide or to expand the existing health facility, which can be accessible and affordable for the local population.
Senator Oh: So are the United Nations or any other countries helping you out? I know you see so many patients every day. You need the funding and so forth.
Dr. Maung: Over the past year, we trained health workers. We had more than 4,000 health workers. On the Thai side of the border, we delivered more than 3,000 babies. In the ethic states, we recorded that more than 8,000 babies were delivered by trained midwives in 2013. So we need to continue to provide these essential services, otherwise women cannot access basic maternal and child care services, and we need to have growing support and a growing monitoring system and to strengthen the existing health network, like information management, pharmacy and essential drugs, as well as continued training for health workers. So we need to continue getting support.
Senator Oh: Where are you getting your funding? Who is helping you?
Dr. Maung: We were supported by the Canadian and U.S. governments, as well as some international NGOs from the Netherlands and other European countries. In 2015, the contracts with many international donors will be finished, so we would like to continue support to these essential basic services.
Senator Downe: In your opening comment, you spoke about the Parliament and reserved seats for the military and ex-military who took off their uniforms to serve and so on.
I'm just wondering, overall, how much freedom do civil society groups have? Is there much pressure on them, more pressure or less pressure under the changes in the last three years? Has there been any noticeable change?
Mr. Rozema: I think there has been a kind of increase in freedom of civil society, especially media. However that's really been in Yangon, or Rangoon, the ex-capital. Some people call that more of a bubble effect. The quasi-civilian government is using that as the show place to show where these freedoms are.
However, when you travel to other parts of the country, like the capital cities of the ethnic states, the situation can be quite different. Then, you will see less civilian control and more military control. Of course, in the areas where the conflict is still continuing, it's purely military control.
This is also reflected in the media. For example, the Burmese media are quite free to write on many issues in Yangon, including government corruption or some issues like that. However, in the ethic states, the ethnic media, the Karen media or the Shan media, are quite a bit more restricted. So it's a little bit different situation.
Recently, even in Yangon, there has been a bit of backsliding even amongst the media there. Some journalists have been arrested recently. Some foreign journalists were expelled from the country. So there is concern about some backsliding on this.
Senator Downe: Is this media that you referred to independently owned or owned by corporations? Are they just one-person operations? How extensive is the ownership of them?
Mr. Rozema: The media, before the 2010 election and the new civilian government, mainly was the government media. Since then, they've allowed the formation of a lot more private media. What happened, over the last three years, is that there was quite a liberalization of media, especially in Yangon. They allowed, for example, even daily newspapers, and there was a lot of competition. Many of the private ones failed. Then, what's happened is that the government has kind of beefed up its own government media with extra funds, and a big issue and a word you'll hear in Burma a lot is "cronies." These are businessmen who have been linked to the government or previous generals and who have a lot of business opportunities. These so-called cronies end up buying up a lot of the private media. They are beginning to dominate the media from Yangon. In the ethnic areas, this is not really happening yet.
Senator Ataullahjan: When we speak of Burma, invariably the plight of the Rohingya Muslims comes up; the severe human rights abuses that they have faced. Our Foreign Affairs Minister has been vocal about the plight of the Rohingya Muslims. Burma has recently created a human rights commission. Do you know of this institution and how effective they will be?
Ms. Wolsak: I could answer that or attempt to start to answer that. Just to quickly note, we would echo the horror at what is going on for the Rohingya Muslims and want to make sure to emphasize that it's actually broader than that. It has broadened to be an anti-Muslim sentiment altogether and is broadening beyond Rakhine state. It's a symptom of what we are seeing and have seen in Burma for many years, which is policies of discrimination and oppression. So it is yet another group being targeted at this particular time.
In terms of the human rights commission, we have partners who have attempted to engage this commission and ask them to investigate human rights abuses, and it has not gotten very far. It is being led by the same people who used to defend the actions of the military at the UN, the exact same staff. So there is not a lot of hope in the institution as it stands right now, but people are trying to engage with it and trying to shift.
Senator Ataullahjan: I wanted to ask about the Mae Tao Clinic. You have a reproductive in-patient ward, and it seems that a lot of the patients you deal with are migrant workers. How many cases do you typically deal with per year? How long do the patients stay at the clinic?
Dr. Maung: Almost 50 per cent of our caseload is migrant workers, but the other 50 per cent cross the border from Burma into Thailand. That means the services on the Burma side are not available and accessible to them, so they cross the border. When we do the annual client survey, it is a big challenge for them to access health services in other places because of language barriers, the cost and transportation. Those are the three main barriers to accessing other services, so they cross the border from Burma and stay there.
Mostly the people who cross the border from Burma into Thailand to access health care are in-patient because for out-patient, many people go to private clinics. For in-patient, they cannot access government health facilities.
There is a 50-bed hospital on the Burma side. On the Thai side, the government hospital has 400 beds. At Mae Tao Clinic, we have a 200-bed facility. We treat more than 150,000 cases a year, and we admit more than 12,000 a year. The clinic has become like a bridge between the Thailand hospital and the Burmese hospital. Even the Burmese government hospital refers some patients, especially neonatal cases or emergency obstetrics, to the Mae Tao Clinic, and then if they require further advanced treatment, we refer them to the hospital on the Thai side.
[Translation]
Senator Demers: Thank you for being here today. It is a pleasure to hear from you. In 2015, Burma will hold elections.
[English]
Elections there will be free and fair elections. What steps are being taken right now so there will not be any kind of electoral fraud? Have any steps been taken? 2015 is coming quickly now.
Mr. Htoo: Thank you for the question. In 2015, Burma will have a national election. They don't have much time from now to the end of the year 2014; we have only six months left. During this time, most of the political parties, especially the National League for Democracy, which is led by Aung San Suu Kyi, will try to do constitutional reform. This is very crucial to the whole of Burma. I believe without constitutional reform, Burma will remain the same because in the constitution, 25 per cent is military, by law; they don't have to be elected. They are already there by law in the constitution.
So whatever you do with the constitution in Parliament, it's quite difficult to move things around. I think the political parties have a big challenge with constitutional reform. They have to focus on that first. Even the time frame for the national election for 2015 is not yet confirmed, we don't really know yet.
Senator Demers: Thank you.
The Chair: Ms. Wolsak, I would like to go back to your comment that there is a problem with minorities, not just in one area. There is a pervasive opinion about minorities and how to treat them.
Do you think that has any sociological basis? Or is it because it was a closed society that controlled information? Is there a role now, therefore, to try to expose Burmese society to where the human rights community and the international community have moved in a facilitation mode?
Ms. Wolsak: I would very much agree with what you're saying, which is the fact that information throughout the country has been very heavily controlled by the military regime for such a long time, that it has perpetuated and in some cases inspired discrimination. Because of the decades of this work, it's going to take quite a long time to start breaking down those entrenched prejudices, and it will take a long time to build trust, which is an issue that many people here have been mentioning over time.
A lot of the work we're doing is in various sectors, as I've mentioned, but one of the key methodologies we're using is trying to bring people together to work in coalitions across different ethnic groups to try to build this trust and understanding. It will be slow work.
The Chair: I ask that because often we say that a country who wants to merge or join a democratic society should adhere to international standards, the UN declaration. But it would seem to me that with Burma, which has had a fairly educated class of people but has been closed in talking to each other, perhaps our strategies on human rights should be different towards Burma and build into this that there needs to be some information, some bringing up to speed about the current options to live in a more diverse society.
Ms. Wolsak: I would agree with you. There is a need to practically emphasize what it is like to live in a country that is very diverse. There are lessons that could be learned from Canada.
I think that there can be, unfortunately, a tendency to do a bit of a technical fix by coming in and giving human rights training to people, particularly Burman people, in the centre of the country. That is of some benefit, but really, it will take a lot more time and collaboration before we'll see an impact.
The Chair: Am I reading from what you're saying, then, that human rights training may be helpful, but it is really to start working at governance issues, et cetera, that look at how to give services to the full communities? Also, how do you involve people in the governance structures?
Ms. Wolsak: I would agree with that for sure. I think Gary would like to add something.
Mr. Rozema: Yes, just to repeat what Saw Nay Htoo said in his opening speech, that in Burma with these two populations, the ethnic groups make up around 40 per cent of the population. They have developed their own social structures, such as health, education, human rights organizations and women's organizations. I think whatever Canada or other countries are going to do in Burma, they really have to work with both communities on both sides of the conflict to help them, as they have mentioned the word, to converge and narrow the gaps. If the international communities were to work with only one side, it perpetuates the feeling from the other group that they're trying to dominate us again, so it will not build peace and create trust.
[Translation]
Senator Robichaud: I see on my iPad that Buddhist monks are very active. Do they have a lot of influence over the government? Do they influence your work? Do they help you or are they just tolerating your presence? What kind of a role do they play?
[English]
Mr. Rozema: I'm Canadian, so I'm giving my perspective on this. Looking at Burma, Buddhist monks are traditionally quite influential and have leadership positions in Buddhist communities. Teachers have often been involved in political struggles in the past, so that's happening all over the country where there is Buddhist religion. Burma also has a significant Christian and Muslim population.
In Burma there is also the Rohingya population, which is mainly in that western state of Rakhine. Initially, people thought the conflict was really about Rohingya and status of citizenship; however, we can see that this kind of conflict has spread around the country and is actually kind of an anti-Muslim issue. There has been a group set up called the 969 movement, and it seems to be a more radical form of monks and really spreading a very nationalist message, not just religious, but basically we Burman are Buddhists; we have only one language, one race, one nationality. So this is dangerous for all ethnic groups.
The question is: How would this group could operate nationally? How could it be allowed to operate nationally? Who could give them the resources to operate nationally? And there are only two organizations in Burma that have that capacity, and that's the military and the government.
A lot of speculation is going on and the President of Myanmar recently praised the 969 leader who said he was a beacon of Buddhist leaders. There is a lot of speculation that this 969 movement is perhaps being used for political purposes and perhaps in the lead up to the 2015 election to solidify their voting base, perhaps even to be able to defeat the rival NLD party led by Aung San Suu Kyi. There is lots of speculation on this.
The Chair: Final question from Senator Fortin-Duplessis.
[Translation]
Senator Fortin-Duplessis: What can the Government of Canada do to promote human rights in Burma?
[English]
Dr. Maung: Since Burma has multi-ethnic groups with different religions and in different geographic areas, the social services and infrastructure needs must be appropriately addressed, as well as health and education as basic human rights. The communities need to continue to be empowered to address the health needs of the people.
As well as for the human rights issue, there are many areas we have identified. Over the past 20 years of human rights being violated, there has been forced relocation, forced labour and food destruction, it is widespread through the country, as well as political prisoners. We need reconciliation because people have lived long under oppression and the mistrust among each other as well as trauma. So we need a lot of psychosocial counselling integrated into the education system, as well as human rights education in the school, in the health facilities, the media groups, as well as to strengthen the network of civil society organizations to promote human rights.
[Translation]
Senator Fortin-Duplessis: Ms. Wolsak, would you like to add anything?
[English]
Ms. Wolsak: Thank you, yes. I wanted to note something that hasn't come up, which is the fact that the majority of natural resources in the country, which of course would give some hope for economic development in the future, lie in the ethnic areas and have been a major source of conflict. The development of resources tends to come with human rights abuses, so the word "development" for most people we work with tends to be a bad word and is very closely associated with land mine contamination and human rights abuses.
Again, there will be a real need to promote peace within the ethnic areas and between ethnic areas in the central area for there to be hope for this kind of transformation.
The Chair: We've come to the end of our time.
Thank you for coming before us as we are studying the Asia-Pacific with a concentration on Burma/Myanmar. I want to thank Dr. Maung and all those that are working on the ground in the medical community. We often hear about the politics and the economy, but you've brought to us the very valuable work you do on the ground, working with all the people whom you need to serve. I very much appreciated your comments about the fact that those who come through your doors for service are there because of need and that's what you look at and that's extremely important.
Thank you for putting this dimension of Burma before us, and I appreciate that you were here in a timely way so we could hear from you personally in our study.
Senators, we're adjourned until next week.
(The committee adjourned.)