Dispatches from Burma
A look at the crisis along the Thailand-Burma border

Trudging through Burma’s troubled Karen state, Cho Ma faced malarial jungles, landmine-laden fields, and the realities of the world’s longest-running civil war in search of a safe place to deliver her child.  After four days, she arrived at the Mae Tao Clinic in Mae Sot, Thailand.

Sitting on a bench near the Outpatient Department, Cho Ma said, “I was scared to come here because of the gunfire and fighting. I hid in a friend’s basement for two days to avoid soldiers. But [my] pregnancy was not going well. I knew I had to keep going to get help at the clinic.”

Photo courtesy of Reuben Steains

As she breastfeeds her newborn baby, a banner that reads, “From the American People: A Gift of USAID” dangles overhead.

When Burma’s military junta began cracking down on the 1988 pro-democracy uprising, Dr. Cynthia Maung—universally known as “Dr. Cynthia”—stuffed a few medical instruments into her shoulder bag and, along with thousands of other student activists, fled to Thailand to avoid government retribution. “At first, we hoped to regroup in the jungle and continue the protests,” Dr. Cynthia explained. “It soon became clear the revolutionary moment had passed, and we had to keep moving.”

Many of the exiled students required medical attention, so Dr. Cynthia and a dozen volunteers began treating patients informally. “Gradually,” she said, “we found out that there were many others, especially women and children, who could not [obtain] access to health services in Burma or Thailand.”

Starting with just a few instruments from her bag, Dr. Cynthia’s operations have mushroomed into a renowned, multipurpose operation. Originally occupying a rickety house on the outskirts of Mae Sot, the clinic has evolved into a small village of humble buildings, covered outdoor waiting rooms, and numerous medical, psychological, and educational departments. In 1989, the clinic treated 2,000 patients—by 2010, that figure soared to 140,000, despite Dr. Cynthia’s undocumented status and limited resources.

A land with a rich ancient history and abundant natural resources, Burma has yet to reach its full potential. Today, half of the population drops out of elementary school, primarily due to financial constraints; the World Health Organization ranks its health care system second to last (just above Sierra Leone); and, according to Human Rights Watch, “Burma has the largest number of child soldiers in the world.”  These crises, coupled with longstanding internal conflict, contribute to the porous nature of the Thailand-Burma border.

Roughly 150,000 stateless Burmese nationals live in Thailand under the auspices of the United Nations, although they do so without official refugee status. Approximately two million more work in Thailand as undocumented workers, often in squalid conditions.

“Sweatshops in Thailand offer a comparative advantage since there’s no way to improve conditions back home, [thus keeping the workers in Thailand] … Since Burmese people can be deported anytime, bribing Thai authorities has become routine,” explained Saw Aung Than Wai, director of research at Mae Tao Clinic.  “But it still beats life in Burma.”

With an estimated budget of $2.9 million, the clinic sees over 100,000 patients annually; operates weekly cross-border jungle clinics; runs over a dozen migrant schools; and feeds 2,000 school children, patients, staff, and their families every day. There is a constant bustle to the whole place, but also a system to manage the flow of patients. Just over half of the treated  come from the local Burmese communit,y while the rest travel from inside Burma via secret routes. With the country’s deteriorating economic and political conditions, the clinic’s caseload increases by about 20 percent every year.

Today, the Mae Tao Clinic and its community partners are grappling with two major challenges, one political, the other, financial.

While international headlines regularly pay attention to Burma’s pro-democracy icon Aung San Suu Kyi, they rarely mention the ongoing conflict in Burma’s Karen State.  In the immediate aftermath of Burma’s first election in twenty years, armed conflict between the Burmese Army and the Democratic Karen Buddhist Army in Eastern Burma led to the largest single influx of displaced people into Thailand since 1988.

After heavy fighting broke out in Myawaddy—a Burmese town just a few miles from Mae Sot— more than 25,000 civilians fled to Mae Sot and the surrounding area. Others have gone underground in 31 hiding sites across Karen State. These internally displaced persons rely on Mae Tao Clinic and its partner, Backpack Health Worker Teams, for social services.

The Mae Tao Clinic, the Backpack Health Worker Team, and other community partners rely heavily on USAID to serve a population of over 100,000 people.

“We go to the hiding sites to check up on people and record how they’re doing,” said Mahn Mahn, director of BHWT. “We bring in medical supplies, toys for the kids, educational materials, and food. This work is important since no one at the hiding sites can leave until the fighting stops.”

“Really, their work is what the U.N. should be doing,” a Mae Tao Clinic staff member added. “With the crisis, we need more advocacy but hardly anyone is reaching people on the ground.”

Apart from the surge in conflict and displacement, the Mae Tao Clinic has also been hit hard by the global recession. With existing donors unable to maintain funding levels and the rising costs of food, medicine, and other basic commodities worldwide, the clinic is in financial crisis.

“This year we estimate a shortfall of about $650,000,” Dr. Cynthia said. “Staff members have suffered financially and we are relying on donations from the local community—but it won’t be enough. It is likely we will have to scale back many of our services during our greatest time of need.”

Michelle Katics, fundraising and advocacy adviser at the Mae Tao Clinic, said international money is available but largely out of reach due to the clinic’s cross-border projects and tenuous legal position.

“INGOs have inherent advantages we can’t compete with, like infrastructure and knowledge of the auditing process that community-based groups won’t ever have,” she said. “There’s a real tension between [international organization’s] approach to the issue and how they fund initiatives on the border.”

Unlike other donors, USAID has not yet cut funding to Thailand-Burma border. Here, it is common knowledge that Mae Tao Clinic, the Backpack Health Worker Team, and other community partners rely heavily on USAID to serve a population of over 100,000 people. However, given the political climate in Washington, it remains to be seen how much longer this support will last.

For over two decades, U.S. lawmakers have denounced Burma’s military regime and demanded the release of pro-democracy icon Aung San Suu Kyi from house arrest. According to Georgetown Government Professor David Steinberg, members of Congress have mentioned the Nobel Peace Laureate’s name over 1,600 times between 1990 and January 2010.

“The statistically strongest supporter has been Republican Senator Mitch McConnell (R-Tenn.) who had done so 340 times,” Steinberg said.

When Cyclone Nargis tore through Burma in May 2008, Senate Minority Leader McConnell blasted Burma’s military junta for delaying international aid amid the country’s worst natural disaster in recorded history.

“No one can say with certainty what the full toll of death and destruction is from the storm,” McConnell stated. “But we do know the junta greatly compounded matters through inaction and its utter disregard for the Burmese people.”

But nearly three years after vilifying the junta for resisting U.S. aid, the Minority Leader’s party has placed similar humanitarian relief on the chopping block. H.R. 1, the Republican budget proposal, aimed to cut $100 billion in non-defense spending, including a 19 percent cut to international programs.

Just as partisan impasse over the budget threatened a federal shutdown, President Obama and congressional leaders reached a compromise to cut $38 billion for the remaining fiscal year.  International aid, and poverty-reduction programs in particular, suffered drastic cutbacks. Compared to the 2010 budget, refugee assistance and international food aid were reduced by 10 and 17 percent, respectively; United Nations contributions were cut by $377 million; disease-prevention programs, by $1 billion; and USAID funding, by $39 million.

“This is a huge problem,” said Myra Dah of the U.S. Campaign for Burma. “Honestly, refugee programs on the Thai border might reach the point of closing down since the U.S. gives the most money.”

Two days after the United States reduced funding to international programs, Thawil Pliensri, Thailand’s National Security Council chief, announced plans to close the nine camps along the border. Pliensri claimed that plans to repatriate the 140,000 refugees were discussed between the Thai and Burmese governments, but no deadlines had been made. A recent Bangkok Post editorial speculated, “It is unclear why authorities picked this week to [make the announcement],” but some see a connection between the U.S. budget cuts and Pliensri’s statements.

“Thailand did not sign the 1951 U.N.  Refugee Convention and doesn’t legally have to take in people from Burma,” Than Wai said. “Personally, I think Thailand wants to show the world they have a good human rights record, but they’re also thinking economically … not only in terms of labor, but also the Western money financing the camps as well.”

Whether or not a causal link exists between budget cuts in the U.S. and the calls for repatriation in Thailand, it is clear that Western dollars are vital to programs on the ground and have long-term implications.

So why is it that international aid is such a uniquely popular candidate for elimination? Polls by Gallup and CNN have found this is the only area that a majority of Americans consistently favor cutting. The same polls, however, indicate that Americans drastically overestimate international aid’s status. On average, most people believe it constitutes anywhere from 10 to 25 percent of the overall budget when, in reality, the figure is 0.7 percent. As James Lindsay, director of studies at the Council on Foreign Relations, recently told PBS, “The public’s inflated sense of international aid spending helps explain why so many politicians are quick to volunteer aid programs for the budget axe.”

In some policy circles, aid to poor countries is unpopular because it is poorly used and can, on occasion, do more harm than good.

While the public’s misunderstanding of America’s foreign aid budget contributes to the urge to cut, it is not always the direct root of aid skepticism.  In some policy circles, aid to poor countries is unpopular because it is poorly used and can, on occasion, do more harm than good.

For example, Egypt has been a major recipient of USAID funds since 1975, receiving $1.3 billion annually. According to Isobel Coleman of the Council on Foreign Relations, “[Egypt’s] rising income inequality and a failure to address root poverty have given rise to widespread economic grievance. Gains from structural reforms and increased growth [since 1990] have not trickled down to the population at large.” Furthermore, when Egyptians rose up against social inequality earlier this year, protesters were notoriously met with waves of tear gas manufactured in Jamestown, Pennsylvania.

In her book, The Shock Doctrine, Naomi Klein exposes more skeletons from USAID’s closet, arguing that the agency historically advances U.S. interests at the expense of democracy and human rights. For example, USAID funded “Los Chicago Boys,” the architects of Chilean dictator Augosto Pinochet’s economic policies. Moreover, Klein contends the program’s politicized nature continues despite USAID’s post-Cold War transition from anti-communism efforts to ostensibly humanitarian aid.

“[During the Bush Administration], NGOs had to do a better job of linking their humanitarian assistance to U.S. foreign policy and making it clear that they are an arm of the U.S. government,” Klein writes. “If they didn’t, [USAID Director Andrew] Natsios threatened to personally tear up their contracts and find new partners.”

Rick Marshall of USAID Asia countered the criticism that USAID is primarily a mechanism for extending American influence by arguing that the organization is moving away from its traditionally business-oriented approach.  The organization is now making an effort to support more community-based organizations like Mae Tao Clinic.

Rep. Sam Farr (D-Calif.) echoed this sentiment on the House Floor last month. “USAID is helping to create strong local capacity so that development assistance is no longer necessary,” Farr said. “Already, USAID has launched efforts to increase efficiency [and has] dramatically reduced contracting … Budget slashing now cuts these reforms off at the knees.”

While the 2011 budget cuts are not as deep as anticipated, international aid will likely face more cuts in the looming 2012 budget debate. The most recent proposal put forward by Rep. Paul Ryan (R-Wisc.) calls for an additional 29 percent reduction in non-defense international aid for 2012 and a 44 percent cut by 2016. At the same time, Ryan proposes a 14 percent increase in military spending.

Fiscal conservatives, often the most vocal advocates on behalf of Aung San Suu Kyi, are neglecting America’s commitments to people who are struggling to create meaningful social change in Burma. USAID’s growing collaboration with community-based organizations deserves not only recognition, but also a chance to thrive. Through this approach, the U.S. actively supports the self-empowerment of displaced people in an effective and multilateral way. Projects like the Mae Tao Clinic fill empty stomachs, ensure safe home environments, facilitate basic public health, provide free education and job training, and help build the civil society necessary for a functioning democracy.

Unfortunately, future prospects look grim.  “With the $40 million loss and more budget cuts to come,” Marshall said. “I don’t see how USAID-funded projects on the border won’t be affected.”

Editor’s note: The author’s name has not been included in the online edition of this article because further research will be conducted inside Burma. The print edition of Counterpoint includes the author’s full name.