Military regimes have ruled Burma for most of the past 45 years. The current regime took power in 1988. In Burma’s last election in 1990, Burmese citizens voted to oust the regime in favor of the National League for Democracy. The regime confined the League’s leader (Aung San Suu Kyi) and many of the League’s members, and continued to rule Burma despite international condemnation. As of September 2006, the regime was holding more than 1,100 political prisoners under conditions that State has described as “harsh.” Amnesty International reported that the regime has subjected Burmese political prisoners to torture and ill-treatment that has resulted in the deaths of some prisoners. The regime has also condoned the use of forced labor and taken military action against ethnic groups living in areas within Burma. According to the U.S. government, Burmese campaigns against ethnic minorities in conflict regions may have displaced as many as 500,000 persons. Due in part to the country’s widespread violations of human rights, The Fund for Peace ranked Burma among the world’s top 20 most unstable countries, while Transparency International ranked Burma 1.9 on a corruption scale ranging from 0 (highly corrupt) to 10 (highly clean). Burma is also one of the world’s most impoverished countries. In 2006, the UN Development Program (UNDP) ranked Burma 130 out of 177 countries in its annual human development index based on economic and social indicators. The U.S. government has ranked Burma’s per capita gross domestic product 186 out of 229 countries and territories—below those of neighboring Bangladesh and Laos. Both infant and maternal mortality rates are high in Burma. Humanitarian needs are particularly acute in the border areas that have been afflicted for many years by conflict and instability, according to the UN High Commissioner for Refugees. HIV/AIDS has become a generalized epidemic, with approximately 1.3 percent of the population suffering from the virus. According to UN officials, the quality of education in Burma has been declining from formerly high levels. Low educational attainment is depriving many Burmese children of a good start in life and significantly lowering their income opportunities and productivity as adults, according to the United Nations. The weak education system also has long-term implications for the country’s ability to develop. According to the most recent World Bank data available to the public, the regime spent less during 2001 and 2003 on health and education in terms of percentage of gross domestic product than Bangladesh, Cambodia, and Laos, which are other low-income nations in the region. Burma has also emerged as a leading opium and methamphetamine producer and a source of human trafficking, according to the U.S. government. The regime’s leadership and policies have undergone shifts since it took power. Beginning in 1989, the regime began signing cease-fire agreements with some of Burma’s ethnic groups. In 2002, it released the winner of the 1990 election. In 2003, Burma’s newly appointed Prime Minister began offering the United Nations expanded opportunities to address some of Burma’s problems. However, the regime subsequently renewed military activities against minorities along Burma’s border with Thailand, reconfined the winner of the 1990 election, and, after purging the Prime Minister from power in October 2004, issued new restrictions on international organizations in Burma. In November 2005, the regime announced that it was moving Burma’s capital from Rangoon to Nay Pyi Taw, which is more than 200 miles from the Rangoon headquarters offices of international organizations working in Burma (see fig. 1). The regime’s actions have prompted the United States to impose a variety of sanctions. The United States has banned the importation of Burmese goods, the export of financial services and arms by U.S. persons to Burma, and new U.S. investment in Burma. It has barred high-ranking Burmese officials from visiting the United States. The United States also proposed a UN Security Council resolution that would have called upon the regime to cease attacks on civilians in ethnic minority areas and begin a substantive political dialogue that would lead to a transition to democracy. In addition, it has supported UN resolutions on Burma, such as those passed by the UN General Assembly in response to the human rights situation in Burma. According to State, U.S. objectives for Burma include the release of political prisoners, the start of a credible and inclusive national reconciliation process, the ending of forced labor and attacks on civilians, and increased access for UN organizations and nongovernmental organizations. While several other nations have imposed sanctions on Burma, China has strengthened its ties with that country. Australia, Canada, and the European Union have joined the United States in imposing some form of sanctions against the regime, according to State. In contrast, China has increased its commercial presence in Burma, emerged as Burma’s largest single source of imports (about 30 percent in 2005), and become a strong market for Burmese exports. In addition, the current Burmese Prime Minister visited Beijing in February 2006 and signed agreements with Chinese officials that will provide Burma with grants and concessionary loans. Burma has also become increasingly isolated from the World Bank, the Asian Development Bank, and the International Monetary Fund. The World Bank reported that it has not approved any new loans to Burma since 1987 and has no plans to resume its program. Burma is currently in arrears to the World Bank and has not enacted economic and other reforms. The Asian Development Bank and the International Monetary Fund have not made new loans to Burma since the 1980s. The United Nations and several international organizations have become an important source of outside assistance to the country. UN entities informed us that they had spent about $218 million in Burma from 2002 through 2005. In 2005, more than 70 percent of these funds were spent by UNDP, the UN Children’s Fund (UNICEF) and the World Food Program (WFP), as shown in figure 2. Of the remaining agencies, the UN World Health Organization (WHO) informed us it spent about $4.9 million in Burma during 2005, while UNHCR and the UN Population Fund (UNFPA) informed us they had each spent about $4.3 million. The UN Office on Drugs and Crime (UNODC) and the Food and Agriculture Organization (FAO) reported they had spent about $3 million and about $2 million, respectively, in Burma during the same year. ILO informed us it spent about $321,000 in Burma during 2005, while UNAIDS reported it spent about $691,000. The United States has provided financial support for some UN programs in Burma. For example, it has helped fund programs conducted in Burma by UNICEF. U.S. law requires that the United States withhold a proportionate share of its voluntary contributions to most UN organizations in connection with their programs in Burma. For example, the United States has withheld a proportionate share of its voluntary contributions to UNDP because UNDP conducts programs in Burma. UNDP’s governing board has also limited the scope of UNDP’s mandate to conduct programs in Burma. UNDP’s governing board, which includes the United States, has directed UNDP to work directly with the Burmese people at the grass roots level and not through the regime. State has requested and obtained annual assurances from UNDP that UNDP’s Burma program is focused on the needs of the poor, does not provide any benefits to the regime, and works only through organizations that are independent of the regime. Other UN entities are not restricted from working with the Burmese regime by their mandates. The United Nations and other international organizations have undertaken numerous efforts to address some of Burma’s most pressing problems. These efforts include programs aimed at addressing prison conditions, forced labor, and conflicts in Burma’s ethnic areas. International organizations are also attempting to provide food security to vulnerable populations, promote local economic development, detect and treat HIV/AIDS and other diseases, and strengthen the educational system. ICRC and ILO are attempting to address issues involving prison and forced labor conditions in Burma. ICRC has attempted to monitor prison conditions in Burma, while ILO has sought to allow victims of forced labor to file complaints without interference from the regime. ICRC has sought to improve Burmese prison conditions by meeting with inmates unaccompanied by Burmese officials. In accordance with its international mandate of visiting prisoners during situations of internal violence and their consequences, ICRC began visiting Burmese prisons in 1999 following 13 years of negotiations with the regime. According to ICRC officials and documents, ICRC staff conducted about 450 prison visits between 1999 and 2005. ICRC staff informed us that while they do not allow regime officials to accompany them during prison visits, they have worked with regime ministries to improve prison health conditions and to help prisoners contact their families. According to ICRC, the prison visit program has helped improve prisoners’ physical and psychological well-being. To address the problem of forced labor in Burma, ILO has recently succeeded in establishing an independent mechanism to handle complaints from victims of this practice. ILO is charged with defining international labor standards, including an internationally recognized ban on the use of forced labor. In 1998, an ILO inquiry reported that it had found “abundant evidence” of the “pervasive use of forced labour imposed on the civilian population…by the authorities and the military” in Burma. Following negotiations with ILO, Burma agreed in 2002 to allow ILO to station a liaison officer for forced labor issues in Rangoon. In 2003, Burma agreed in principle to an ILO plan of action that called for the establishment of a non-Burmese facilitator for forced labor issues. This facilitator would receive and investigate complaints of forced labor provided in confidence and would then work with the regime to resolve the complaints while protecting the rights of the complainant. International organizations are also attempting to help populations in areas of Burma that have been marked by tension or conflict between regime forces and ethnic groups, according to officials of international organizations. These organizations include UNHCR and ICRC. UNHCR is currently working in two areas that have been subject to ethnic tensions. Near Burma’s border with Bangladesh, UNHCR is serving as the lead international agency in engaging the regime on protection issues affecting a large population of stateless Muslims, including more than 200,000 former refugees who began returning to Burma from Bangladesh in 1993. According to UNHCR, it is coordinating the work of several other international organizations in providing needed support to this population. UNHCR is also attempting to address the needs of persons living in three provinces near Burma’s southeastern border with Thailand, where military campaigns have displaced large numbers of villagers. As a result of these campaigns, many thousands of Karen, Karenni, and Mon ethnic groups have crossed the border into Thailand. A senior UNHCR official told us that UNHCR was granted access to these areas in 2004 as part of a contingency plan for the possible repatriation of these refugees. ICRC has also sought to assist and protect populations in conflict areas. ICRC officials informed us that ICRC teams travel to these areas to persuade fighting forces to avoid harming civilians and to help civilians who have already been harmed. The teams, which include medical personnel and interpreters, have operated from ICRC field offices. ICRC officials informed us that ICRC policy calls for the teams to travel freely in these areas without regime supervision. They stated that they do not notify authorities of each team’s activities, although they must ask for permission to establish field offices. UN and other international organizations have launched a wide range of assistance programs in Burma to address Burma’s many social and health problems. These problems include food shortages, poverty, threats to public health, and a deficient and declining educational system. International organizations have sought to address food shortages in Burma, including those affecting displaced populations along Burma’s borders as well as other areas where malnutrition is increasingly prevalent. WFP, the emergency food aid arm of the United Nations, has sought to provide food to vulnerable populations in Burma that suffer from hunger, malnutrition, and poverty and have been adversely affected by regime policies. WFP delivers food assistance to northwestern Burmese Muslim populations and to families from mostly ethnic minority groups who lost their main livelihood under a regime ban on opium cultivation. WFP implements food assistance programs for students and landless workers, and provides nutrition support for mothers and young children. WFP implements its programs with cooperating partners such as other UN entities or nongovernmental organizations rather than the regime. WFP has also provided emergency food assistance to families affected by the 2005 tsunami disaster and has responded to other localized food crises, such as floods and crop failures. FAO helps developing countries improve and modernize practices in agriculture, livestock and fisheries, and forestry by providing technical cooperation, expertise, and information, and by bringing knowledge to the field. For example, in northwest Burma, FAO works with foreign donors to provide support for agricultural resource management and promotes seed projects to improve food security for refugees returning from Bangladesh. FAO has also provided technical assistance to strengthen Burma’s emergency preparedness for avian influenza and to aid tsunami-affected areas. UNDP is currently operating several major programs at the grass roots level that seek to address poverty in Burma. These programs include projects aimed at strengthening the capacity of poor communities to address their basic needs, in part through the creation of community development groups. In 2005, UNDP expanded its operations to include a greater number of poor communities in selected remote townships. It was able to retain access to several formerly inaccessible townships after the ouster of the former Prime Minister who had invited UNDP to establish itself in them. It has also supported the creation of small banking networks that provide financial services to producers in selected poor villages, including the one pictured in figure 3. UNDP has also worked with other UN entities to secure funding from other international donors to establish a major campaign against the spread of AIDS and other infectious diseases in Burma. International organizations have also sought to address threats to public health in Burma. Several UN entities have provided assistance to combat HIV/AIDS, malaria, and tuberculosis; to support the country capacity in both the human and animal sectors for avian and human influenza pandemic preparedness and response; and to improve reproductive health and combat the manufacture and use of dangerous drugs. UNAIDS is a joint effort of 10 UN entities that aims to prevent new HIV infections, provide care for those already infected, and mitigate the impact of the epidemic. Using available data on HIV/AIDS prevalence, UN entities aim to promote condom usage; raise awareness on prevention methods; provide care, treatment, and support for people living with HIV/AIDS; and take other actions. WHO, the UN authority on international health, provides technical cooperation on health matters to Burma and other member states. WHO’s priorities for Burma include preventing and controlling diseases such as HIV/AIDS, malaria, and tuberculosis and vaccine-preventable diseases such as polio, measles, and neonatal tetanus and tuberculosis; strengthening health systems; improving child, adolescent, and reproductive health; and strengthening Burma’s ability to address avian and human influenza. UNFPA assists countries such as Burma in providing quality reproductive health and family planning services and formulates population policies that support sustainable development. UNFPA’s assistance to Burma has focused on reducing maternal mortality and preventing the spread of HIV/AIDS by improving reproductive health information and services and by providing reproductive health commodities. UNODC operates several programs in Burma, including efforts to reduce demand for injecting drugs and the transmission of HIV among and from users of injecting drugs. Implementation of these programs is concentrated in areas near certain border areas where the prevalence of HIV and drug abuse is high. According to UNODC, it has supported almost 2,400 individuals in accessing drug treatment and rehabilitation services, while about 12,000 youth accessed its youth development centers and more than 6,500 individuals accessed UNODC health care services. UNODC has other programs in Burma, including programs to help define alternative livelihoods for families who lost their main livelihood under a regime ban on opium cultivation. UNICEF also conducts a range of activities that include programs aimed at addressing deficiencies in Burma’s educational system and improving women and children’s health. Based on educational data to which it has access, UNICEF works with Burma’s Ministry of Education to promote comprehensive quality education in Burma. UNICEF has supported projects in early childhood development, quality basic education, life skills, and HIV/AIDS prevention education. It has also provided school supplies to children from poor families and supported local parent-teacher associations and teachers in improving the learning environment for children. According to officials of international organizations, Burma’s regime has blocked or impeded activities undertaken by many international organizations following its ouster of the former Prime Minister in 2004. It has blocked international efforts to monitor prison conditions, and, until recently, forced labor cases. The regime has also significantly restricted international assistance to populations living in conflict areas, and, to a lesser degree, impeded food, development, and health programs. Despite these actions, many of the international officials we spoke with told us that they are still able to achieve meaningful results in their efforts to mitigate some of Burma’s many problems. The Burmese military regime became more restrictive regarding activities of international organizations after it purged the former Prime Minister in October 2004, according to officials of international organizations now working in Burma. The regime formalized its restrictions on the international organizations in 2006 by publishing guidelines to govern their activities in Burma. The guidelines, if fully implemented, would further tighten regime controls over these activities and contain provisions that UN officials consider to be unacceptable. International organization officials informed us that the regime had become more restrictive of their activities since 2004. While the regime allowed UNDP to proceed with a previously agreed upon expansion of its programs into certain remote villages, international organization officials told us that the regime had otherwise increased restrictions on international access to conflict areas. The regime has also begun pressuring some international organizations to work more closely with regime-sponsored political mobilization groups, such as the Union Solidarity Development Association. A senior UN official in Burma told us that since 2004 the regime has made the operating environment for UN organizations far more difficult than before. He noted that the regime had distanced itself from international organizations. Other officials told us that their organizations were unable to make contact with regime officials for months after October 2004. International organization staff also reported that a lack of coordination and consistency between regime ministry staff and between local commanders led to delays in international programs and approvals of needed agreements. The effect of the regime’s withdrawal has been compounded by its decision to distance itself physically from the international organizations. In 2006, the regime moved its officials to the new capital, Nay Pyi Taw, which is more than 200 miles inland from Rangoon. As a result, Rangoon- based international organization officials must now spend several hours traveling by car and airplane to meet with government officials who were formerly located in Rangoon. The regime moved to formalize restrictions on the international organizations in February 2006, when the Burmese Ministry of National Planning and Economic Development published guidelines governing international organizations’ programs in Burma. A senior official of the Ministry of National Planning and Economic Development told us that the guidelines are intended to improve the efficiency and effectiveness of the international organizations’ programs by improving coordination and eliminating duplicative programs. The official also stated that the guidelines would help address the tendency of some international humanitarian entities to become involved in what she referred to as “political matters.” The ministry disseminated differing English and Burmese language versions of the guidelines. A UN-provided translation of the Burmese language version revealed that it contains several restrictions not included in the English language version. A senior ministry official told us that the Burmese language version is intended to help Burmese local officials better understand the English language version of the guidelines. The provisions in the two versions of the guidelines would restrict several aspects of international organizations’ activities in Burma. For example, the guidelines would require the international organizations to agree that their international staff may only travel within Burma with permission from the subject area ministry and with a regime representative; obtain prior approval of all international projects by subject area ministries and by the Ministry of National Planning and Economic Development; avoid conducting or distributing any surveys not mentioned and approved in the original project documentation; deposit all incoming funds in Burma’s national bank for subsequent withdrawal as “foreign exchange credits”; agree that their programs will “enhance and safeguard the national interest,” “prevent infringement of the sovereignty of the State,” and “be on the right track…to contributing to the socio-economic development of the Nation”; coordinate their work with local and state coordinating committees that include representatives of the Union Solidarity Development Association and similar groups; and select their Burmese national staff from government-prepared lists of individuals. The extent to which the regime will fully implement these guidelines is unclear. High-ranking officials of the Ministry of National Planning and Economic Development and the Ministry of Health told us that the guidelines are now in effect and are not being negotiated. UN officials, who have taken the lead in speaking for all international organizations regarding the guidelines, informed us that they continue to try to engage the regime in discussions regarding the guidelines. A senior UN official familiar with the full range of UN programs in Burma told us that the United Nations has informed regime officials that the last three of the above restrictions are not acceptable to the United Nations. According to this official, the United Nations cannot agree that its programs would support the regime’s definitions of the national interest because UN humanitarian assistance must be apolitical. For the same reason, he told us, the United Nations could not work with committees that include the Union Solidarity Development Association and similar organizations. Other international organization officials also informed us that they would not agree to allow the regime to select their Burmese staff members. According to ICRC officials, the regime has blocked ICRC monitoring of prison conditions. The regime has halted ICRC’s prison visit program by insisting that pro-regime staff observe ICRC meetings with prisoners. ICRC staff told us that the regime appeared to have reassessed its view of ICRC and other international organizations in 2004. According to ICRC officials, in September 2005 the Burmese Ministry of Home Affairs suddenly demanded that representatives of the Union Solidarity Development Association accompany ICRC staff on all prison visits. ICRC refused the ministry’s demand, given ICRC’s policy of protecting the confidentiality of its discussions with inmates. As a result, the ministry has denied ICRC access to Burmese prisons since the end of December 2005. The regime frustrated ILO efforts to conclude an agreement establishing an independent complaints process for forced labor victims for 4 years until signing an agreement with ILO in February 2007. In 2003, Burma agreed in principle to establish such a process. ILO relations with the regime deteriorated after October 2004. In the absence of a final agreement on the establishment of an independent complaints mechanism, the ILO liaison officer worked with regime officials to informally address complaints of forced labor. However, he stopped doing so after the regime began to arrest and prosecute complainants. Three individuals were sentenced to death for allegedly contacting ILO. In 2005, the Union Solidarity Development Association staged mass anti-ILO rallies, while the ILO liaison officer reported receiving 21 similarly worded death threats. Following ILO expressions of concern about the situation, the regime released the imprisoned complainants, agreed to not prosecute complainants for the next 6 months, and began negotiating a new “understanding” with ILO to protect complainant rights. These negotiations deadlocked in October 2006 after regime officials objected to language in the draft understanding that would have allowed the liaison officer to employ a sufficiently large staff with the diplomatic and travel rights needed to meet with complainants in a timely and confidential manner. ILO and the regime subsequently agreed that necessary adjustments to the liaison officer’s staff capacity would be made “after due consultation,” and ILO announced on February 26, 2007, that it had reached an agreement with Burma to establish a complaints mechanism for victims of forced labor. Prior to the signing of this agreement, ILO had no project activities under way in Burma because of the regime’s policies. According to officials of international organizations, the regime has impeded international efforts to address the needs of populations in conflict areas by restricting international access to those areas. It has limited UNHCR efforts along the Thai border, while halting or impeding efforts in conflict areas by ICRC and other organizations. A senior UN official familiar with the full range of UN activities in Burma informed us that the regime’s refusal to allow free access to conflict areas is one of the most important restrictions faced by international organizations in that country. The official contrasted the current regime’s policies with those of the former Prime Minister, who expanded opportunities for UNDP to work in previously closed parts of Burma. The current regime’s policies have particularly affected efforts by UNHCR to assist displaced persons in the southeast region near the border with Thailand. UNHCR officials told us that UNHCR operating conditions in the southeast region near the border had deteriorated sharply in 2005. Previously, according to UNHCR, the agency had been developing plans for the anticipated repatriation of thousands of refugees from the Thai side of the border, with the support of the Prime Minister in assessing the region’s capacity to support returning refugees. These conditions, along with the prospects for a political settlement between the regime and a Karen organization, changed after the Prime Minister’s removal. The regime’s Ministry of Interior initially ignored UNHCR’s efforts to restart discussions before reassigning UNHCR to a less influential ministry. More importantly, the resumption of military operations in the area convinced UNHCR that conditions were no longer conducive to the return of refugees. The regime has also resisted UNHCR’s subsequent efforts to assist communities on the Burmese side of the border that have been affected by the displacement of persons within the area. UNHCR officials told us that restrictions on UNHCR’s access to several areas have impeded the agency’s efforts to improve its fragmented understanding of the population’s needs and its capacity to address them. The regime, which denies that internally displaced persons are in the region, has not allowed UNHCR to access certain border areas that it does not control. While UNHCR has been allowed to implement certain “quick impact” projects (such as the building of schools and bridges) in some 300 villages, UNHCR considers these projects to be only a first step toward fulfilling its protection objectives. Because regime officials closely monitor these projects, UNHCR staff cannot easily meet with villagers to improve UNHCR’s understanding of the problems facing internally displaced persons. A senior UNHCR official in Burma told us that UNHCR does not want to jeopardize its already limited access to the region or to put the local population at risk by holding public meetings on protection issues. The regime has halted ICRC’s efforts to assist and protect civilians in conflict areas over the past 2-1/2 years. ICRC staff informed us that the regime began restricting ICRC’s access to conflict areas after October 2004. ICRC staff also told us that regime authorities had begun demanding that representatives of the Union Solidarity Development Association accompany ICRC teams in certain conflict areas. ICRC staff stated that allowing regime representatives to do so would compromise the independence of ICRC’s role in these areas. ICRC staff estimated that between 2002 and October 2006, regime actions reduced the scope of ICRC’s assistance and protection effort by 90 percent. The regime then ordered ICRC to close its five field offices in Burma, including those that served as bases for ICRC conflict area teams. ICRC stated that the closures will make it impossible for it to carry out most of its assistance and protection work for civilians in the conflict areas. According to State and ICRC officials, the regime has since allowed ICRC to reopen the field offices but has not allowed ICRC to resume humanitarian assistance programs out of the offices. The regime now insists that ICRC follow strict guidelines that do not allow space for independent movements by teams as in the past, according to a senior ICRC official in Burma. Several other international organizations reported similar difficulties in sensitive regions of Burma. FAO staff reported that local police had barred them from traveling to villages in Shan State to question people regarding food supplies. UNICEF staff stated that they had difficulties accessing parts of the country. WHO also lacks access to populations in certain areas. A representative of an international nongovernmental organization told us that the regime began strictly enforcing its ban on access to conflict areas after 2004. Officials of international organizations informed us that the regime has also impeded international food, development, and health programs. They stated that it has done so by restricting their ability to (1) move food and international personnel freely within Burma and (2) gather data needed to understand the scope and nature of Burma’s problems. The regime’s policies on travel have hindered international organizations’ efforts to ship food to vulnerable populations within the country. For example, delays in obtaining transport permits for food commodities from the current regime have hindered WFP efforts to deliver food to vulnerable populations. A senior WFP official told us that WFP has not always been able to deliver food on schedule because regime officials have required 3 to 5 months to approve food shipments and because regional military commanders have not always been available to approve food deliveries upon their arrival. As a result, he stated, WFP had been unable to deliver several months’ worth of food to students and their families in the northern parts of the Rakhine State during the 2005 school year. In addition, he informed us that WFP had been unable to deliver 20 percent to 30 percent of its planned food shipments during 2005. He added that the regime began to provide authorizations in a timelier manner in 2006. The regime’s time-consuming travel procedures have also impeded the ability of international staff to move freely within the country to ensure the timely provision of assistance. According to UN officials, the Burmese regime typically requires non-Burmese staff of UN entities and other international organizations to obtain travel permits to visit project sites. Officials of eight of the nine UN entities that provide humanitarian, health, and development assistance in Burma told us that the regime requires at least 3 to 4 weeks’ advance notice to authorize travel. An official of the remaining entity told us that it is required to provide 2 weeks’ notice. These officials said that the additional time it takes to apply for travel permits impedes the planning and monitoring of projects through field visits and reduces the scope of their activities. In August 2006, the acting UN Resident Coordinator informed the Minister of National Planning and Economic Development that with regard to internal travel, “Unnecessary and time-consuming procedures impede us from providing assistance in a timely manner.” Moreover, the regime’s internal travel restrictions contributed to a major setback to international efforts to fight three diseases in Burma. The Global Fund to Fight AIDS, Tuberculosis, and Malaria had agreed to provide $98.4 million over 5 years, beginning in 2005. However, in 2005 the fund terminated its program in Burma after the regime instituted new travel clearance procedures that would have impeded international staff travel to project sites. In announcing its decision to terminate the program, the fund cited the adverse impact that the new travel restrictions would have had on its ability to ensure that the program was properly managed. Some UN international staff also reported they have been hindered by the regime’s requirement that they be accompanied by their regime counterparts when they travel in Burma, although others noted that the requirement has some benefits. One official said that counterparts had prevented her from meeting with project beneficiaries in private. Another stated that his organization has faced the challenge of finding government counterparts to accompany international staff when they need to travel. However, four UN officials noted that Burmese technical experts had facilitated their travel and access and provided input to their work. In addition, officials of three UN entities reported difficulties in obtaining permission for experts located outside Burma to visit sites in that country. These experts had been sought out to provide technical expertise on agricultural, HIV/AIDS, and educational projects. One organization in Thailand also reported delays in obtaining visas as the primary reason that it did not have active programs in Burma. International organization officials told us that the regime’s informal restrictions on surveys and data sharing have impeded their efforts to address Burma’s problems. According to UN officials, regime data concerning health and education in Burma is incomplete and unreliable. UN officials noted that the regime has not conducted a census since 1983 and expressed concern that the regime’s collection of statistics has deteriorated since 2004. WHO has reported with concern that Burma’s deteriorating statistics on health are not reliable and that Burma lacks a plan to develop a nationwide health information system. Officials working for other UN entities in Burma’s health sector expressed similar concerns. UN officials also criticized Burmese statistics on education. One official told us that the lack of solid and evidence-based research on education in Burma significantly impedes efforts to address educational problems. UN officials also expressed concern that the regime is deliberately providing inaccurate data to the public. The United Nations has stated that these data weaknesses have impeded international organizations’ efforts to assess needs, conduct strategic planning, and implement programs in Burma. According to the United Nations, international organizations require a comprehensive understanding of the needs of the population to efficiently direct their resources. The United Nations has also noted that surveys would be valuable for identifying issues related to poverty alleviation, initiating activities that create longer-term benefits, and evaluating program performance. However, UN and other international officials told us that the Burmese regime has impeded their ability to conduct their own surveys and freely share the data they gather regarding the nature and scope of Burma’s problems. In its strategic framework for assistance to Burma, the United Nations has called upon the regime to allow a wider range of data to be collected, analyzed, and shared without alteration. According to one UN official, the regime has rejected project proposals that cite the terms “research” or “data collection.” UN health officials also told us that the regime had restricted the scope of their HIV/AIDS research and the health data that they could share with the public. A WFP official told us that while his organization has not encountered any problems carrying out surveys and assessments in the regions in which it has been operating, it has encountered difficulty in carrying out national surveys on food needs. Representatives of several international nongovernmental organizations working in Burma also expressed concerns about regime restrictions on research and surveys by their staff. International organization officials also noted that the guidelines for international organizations contain the regime’s first formal restriction on research. In commenting on a draft of this report, UNDP said it recently completed two major research projects without encountering significant difficulties with the government. According to UNDP, its survey of over 18,000 households represented a unique effort. Similarly, UNDP noted that its agricultural sector review provides an in-depth analysis of the inadequate growth of Burma’s agriculture in recent decades that has contributed to declining real incomes and growing poverty in rural areas. Several international organization officials stressed that their organizations are still able to achieve meaningful results in their efforts to address Burma’s development, humanitarian, and health problems, despite the regime’s post-2004 restrictions. For example, UNDP reported that its banking projects for small businesses in selected poor villages had over 180,000 active borrowers as of March 2006. UN officials working in the health sector told us that the Burmese regime had been increasingly cooperative in efforts to address HIV/AIDS prevalence and recently worked with several UN entities to develop a multisectoral plan that targets all victims of the disease in Burma. For example, UN officials told us that UN entities provided home-based or community-based care and support on HIV/AIDS to over 5,000 people in 2005, a 175 percent increase over service provision in this area in 2004. UN officials also noted that they launched a measles campaign after October 2006 after earlier government resistance. In addition, a WFP official told us that WFP operations have expanded over the last 3 years in Burma and have gained better access to certain areas. Programs that address health and development issues in Burma have generally been less constrained by the regime’s restrictions than the ILO and ICRC human rights efforts. Officials said that careful planning is the key to managing useful health and development projects within regime limits. Several officials also emphasized that restrictions have had the least effect on their organizations, which tend to work closely with the regime. For example, an FAO official told us that FAO generally has good relations with the technical ministries it cooperates with due to its close work with these ministries in providing technical assistance and supporting knowledge transfer. Due to restrictions imposed by the Burmese regime, international organizations are facing an increasingly uncertain future as they continue their efforts to address Burma’s assistance needs. The recent actions of the Burmese regime indicate that it is now seeking to exert a greater degree of control over international activities in Burma than before. While the regime appears to have accepted international efforts to relieve Burma’s development, health, and educational problems as necessary, it has also opted to regulate them more closely. The regime also appears to have become more insistent that international organizations cooperate with regime-sponsored political mobilization groups. Such actions can only further narrow the opportunities for international organizations to address Burma’s pressing human rights, humanitarian, and development problems. We requested comments on a draft of this report from the Secretary of State and cognizant officials at the United Nations and ICRC. We received written comments from State, the UN Country Team in Burma, and UNAIDS, which are reprinted in appendixes II, III, and IV, along with our responses to specific points. State said that the draft report presents the challenges and opportunities facing international nongovernmental organizations in Burma in a thorough, accurate, and balanced fashion. State added that it “will continue to encourage the Burmese regime, both directly and through various UN fora, to lift the unnecessary and unreasonable restrictions it has placed on organizations seeking to provide humanitarian assistance and to promote respect for human rights.” The UN Country Team said that it agreed with our analysis that UN and other international agencies are able to achieve meaningful results in Burma despite a difficult and complex environment. However, it expressed concern that our draft report did not note that a significant opening of humanitarian space on the ground has been achieved by the UN and its partners in the past decade. This statement is in contrast to information UN officials had provided earlier stating that conditions had deteriorated since the 2004 change in government. The team did not dispute our specific findings about restrictions faced. However, it noted a significant development for one organization—ILO. Following the completion of our draft report, ILO and Burma signed an agreement to establish a mechanism for victims of forced labor to file complaints on February 26, 2007. We have updated our report to reflect this change. The UN Country Team also said our report did not adequately reflect the nature of the UN entities’ work and the differences in their mandates. We believe we fairly describe the entities’ work in our first objective. While our draft report noted that UNDP has a restricted mandate prohibiting it from working with the government, we added language stating that other UN entities’ mandates do not have similar restrictions. UNAIDS commented that it appreciated our recognition of progress despite difficulties but added that the draft report could contain more evidence of this progress. We believe we fairly described UNAIDS’ work in our draft report. State, UN agencies, and ICRC submitted technical comments that we have incorporated into this report, as appropriate. As agreed with your offices, unless you publicly announce the contents of this report earlier, we plan no further distribution until 30 days from the report date. At that time, we will send copies to interested congressional committees, the Secretary of State, and other interested parties. We will also make copies available to others on request. In addition, this report will be available at no charge on the GAO Web site at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512-9601 or at melitot@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. Key contributors are listed in appendix V. To identify the principal efforts of United Nations (UN) and other international organizations in addressing Burma’s problems, we examined documents relating to programs conducted in Burma by the 10 UN entities located in that country. We also traveled to several locations in Burma, where we met with officials of the Food and Agriculture Organization, International Labor Organization, Joint United Nations Program on HIV/AIDS, UN Children’s Fund, UN Development Program, UN High Commissioner for Refugees, UN Office on Drugs and Crime, UN Population Fund, World Health Organization, World Food Program, and International Committee of the Red Cross. We also met with several international nongovernmental organizations (who asked that we not identify their organizations in this report). In addition, we met with Burmese staff working for the United Nations who are implementing three projects in or around Rangoon and two projects in villages a day’s travel by car and small boat outside of Rangoon and Bassein. In Thailand, we met with officials from the Inter-Agency Project on Human Trafficking in the Greater Mekong Sub-Region; UN Educational, Scientific, and Cultural Organization; UN High Commissioner for Refugees; UN Industrial Development Organization; and UN Office for Project Services. We conducted telephone interviews and videoconferences or exchanged e- mail correspondences with officials at the headquarters of the 10 UN entities and the respective U.S. missions in Geneva, New York, Rome, and Vienna. We met with additional U.S. Department of State officials in Washington, D.C., Burma, and Thailand. We did not assess UN data on UN expenditures in Burma because we only used these data as background information in our report. To describe the impact of the Burmese regime’s recent actions on the activities of international organizations in Burma, we reviewed the Guidelines for UN Agencies, International Organizations, and NGO/INGOs on Cooperation Programmes in Myanmar set forth by the Burmese Ministry of National Planning and Economic Development. We traveled to Nay Pyi Taw, the newly built Burmese capital, to discuss the regime’s restrictions on international organizations with senior officials from the Ministry of National Planning and Economic Development and the Ministry of Health. In addition, we met with officials of the U.S. embassy and of the leading democratic organization in Burma, as well as with local recipients of UN assistance. We also spoke with a UN official from the Department of Political Affairs and met with the Burmese UN mission in New York. In Thailand, we met with representatives of the British and Dutch embassies to discuss aspects of their nations’ aid to Burma. In Washington, D.C., we met with officials of the U.S. Departments of State and the Treasury, individuals from several international nongovernmental organizations, and individuals at the World Bank and International Monetary Fund. We conducted our work from May 2006 through February 2007 in accordance with generally accepted government auditing standards. The following are GAO’s comments on the UN Country Team’s letter dated March 5, 2007. 1. The UN Country Team (UNCT) noted that the International Labor Organization and Burma had concluded an agreement establishing a forced labor complaints mechanism after we had submitted our draft report for comments. We have updated the text and title of our report to reflect this recent development. 2. The UNCT commented that our draft report did not adequately reflect the differences in UN entities’ mandates, in that it did not clarify which entities are mandated to work with the regime and which are not. We disagree. Our draft report noted that UNDP’s governing board has restricted UNDP from working through the regime. We further clarified our report by adding a sentence noting that the mandates of other UN entities do not contain restrictions similar to those of UNDP. 3. The UNCT commented that our draft report did not describe a significant opening of humanitarian space in Burma. The UNCT’s letter is not consistent with the information and assessments provided to us by UNCT members and NGO officials during our October 2006 fieldwork in Burma. At the time, UNCT and NGO officials provided numerous examples of how Burmese restrictions had impeded their activities (including UNHCR’s recent efforts in the Thai border region) and a senior UN official in Burma informed us that the “humanitarian space” in Burma was dwindling. UNCT members reconfirmed much of this information in February 2007, when we asked them to review excerpts from our working draft report for accuracy and sensitivity. We then reflected many of their suggestions in our draft report, which we subsequently submitted to UN entities for official review and comment. The UNCT comments do not take issue with our findings concerning the range and nature of the regime’s restrictions (with the exception of the recent agreement reached between the government and the ILO). Moreover, they do not explain how those restrictions might have eased following our field work. 4. The UNCT commented that our draft report did not address human rights activities by agencies other than ILO and ICRC. In assessing the effect of the regime’s restrictions on international human rights efforts, we focused on ILO and ICRC because their missions in Burma are primarily related to human rights. We did not focus on ancillary efforts by agencies whose primary mission is to address development and humanitarian concerns. 5. The UNCT letter states that we did not include the examples of successes in Burma that we requested in February 2007. We reviewed the information the UN organizations sent to us and believe we fairly summarized UN achievements in Burma. In addition to the person named above, Cheryl Goodman (Assistant Director), Pierre Toureille, Lyric Clark, Barbara Shields, Debbie Chung, and Ian Hongola made key contributions to this report. Martin De Alteriis and Mary Moutsos provided technical assistance.

Summary: Burma is one of the world's most impoverished and isolated countries. The United Nations (UN) and other international organizations have become important sources of outside assistance to the country. In recent years, UN entities have increased their funding for activities aimed at addressing Burma's problems. However, Burma's military regime has imposed restrictions on international organizations' activities in Burma. GAO (1) identified principal efforts of the United Nations and other international organizations to address Burma's problems and (2) described the impact of the regime's recent actions on these efforts. We reviewed UN, U.S., and Burmese official documents and interviewed UN, U.S., Burmese, and nongovernmental organization officials in the United States and Burma. We also visited UN project sites in Burma. The United Nations and other international organizations have undertaken numerous efforts aimed at addressing Burma's most pressing problems, which include forced labor, harsh prison conditions, ethnic conflict, an HIV/AIDS epidemic, and poverty. The International Labor Organization (ILO) and the International Committee of the Red Cross (ICRC) have sought to monitor forced labor and prison conditions in Burma by allowing victims to voice their complaints without interference from the regime. The UN High Commissioner for Refugees (UNHCR) and ICRC seek to assist populations in conflict areas near Burma's border with Thailand. International organizations also attempt to provide food to vulnerable populations, promote local economic development, improve health conditions, and strengthen the Burmese educational system. For example, several UN entities provide assistance to combat HIV/AIDS, malaria, tuberculosis, and drug abuse, as well as to improve reproductive health. Burma's military regime has blocked or impeded activities undertaken by many international organizations in Burma over the past 3 years. In 2004, the regime distanced itself from these organizations and began adopting increasingly restrictive policies. In 2006, it published formal guidelines to restrict international activities in Burma. These guidelines, which have yet to be fully implemented, contain provisions that UN officials consider to be unacceptable. The regime's restrictions have had the greatest impact on international efforts to monitor prison conditions, investigate claims of forced labor, and assist victims of ethnic conflict. The regime has blocked ICRC efforts to monitor prison conditions and, until recently, ILO efforts to address forced labor. The regime has also restricted UNHCR and ICRC efforts to assist populations living in areas affected by ethnic conflict. To a lesser degree, the regime has impeded UN food, development, and health programs by restricting their ability to (1) move food and international staff freely within the country and (2) conduct research needed to determine the nature and scope of some of Burma's problems. Despite these restrictions, several international organization officials told us they are still able to achieve meaningful results in their efforts to mitigate some of Burma's humanitarian, health, and development problems. We asked the Department of State and officials of international organizations to comment on a draft of this report. State commented that the draft report was thorough, accurate, and balanced. The United Nations' country team for Burma did not dispute our specific findings regarding the regime's restrictions but expressed concern that that we had not noted that it had achieved "a significant opening of humanitarian space on the ground." We believe that this statement is not consistent with information provided to us earlier by UN officials, who stated that conditions in Burma had deteriorated since the 2004 purge within the regime. Other comments and our responses to them are contained in appendixes II, III, and IV.