Burma is a place of widespread misery. The indicators are alarming: one in 10 children don't see their fifth birthday, the highest rate outside Africa except for Afghanistan; malaria, a preventable disease, is the country's biggest killer; HIV rates are the highest in Southeast Asia.

Poverty, political persecution and human rights abuses have forced hundreds of thousands to flee their homes. There are an estimated 2 million Burmese in Thailand alone. Thousands of others cross the western border into Bangladesh and India. Although some find their way into refugee camps, the majority live an underground existence due to policies in all these countries aimed at discouraging asylum seekers.

The challenge of responding to the overall humanitarian needs of the Burmese people is immense. Yet I came away from a recent mission to Burma more inspired than depressed, inspired particularly by the Burmese, who are working within the constraints of an oppressive political system - sometimes with international support - to address the chronic deprivation that plagues their country. I met a Buddhist monk and a Christian aid worker, who are collaborating on education programs in eastern Burma, and I heard about an international organization working with informal groups of AIDS sufferers on health promotion and treatment. I concluded that donor governments were missing opportunities to support independent humanitarian work inside the country.

The obstacles to humanitarian action are formidable. The generals who run Burma are deeply suspicious of the motivations of the United Nations agencies and international non-governmental organizations. They block independent access to areas of conflict along the eastern border. They impose travel restrictions on international staff and, in the aftermath of the September 2007 popular protests, they have delayed granting and renewing visas, especially for personnel from countries perceived as hostile to their interests. In December they expelled the U.N. resident coordinator for issuing a statement linking the protests to poverty.

Outside the country humanitarian action is also circumscribed. The Thai government refuses to allow Burmese with refugee status to leave their camps and work legally. The United States has led the effort to resettle thousands of Burmese in third countries, but the camp populations have remained static amid reports that Burmese in Thailand are buying their way into the camps to fill slots vacated by resettled individuals, compromising the camps as places for refugee protection. Cross-border operations from Thailand, which provide health care and education in zones off-limits to Rangoon-based agencies, are the only way to reach several hundred thousand conflict-affected people, but the operations involve collaboration with armed groups and international staff presence is limited.

Despite these obstacles, independent humanitarian work is possible. The geographic scope of international aid organizations inside Burma has increased significantly in recent years. These programs rely heavily on local staff, who face fewer restrictions on their ability to travel and monitor work, and on partnerships with village-level groups, such as temple and church associations, small-scale credit schemes, groups of health promoters, and other informal, often unregistered entities.

Donors have been slow to respond to these developments. The United States, for example, directs the bulk of its aid to the refugee and cross-border operations, and places severe limitations on the amount and type of funding provided inside the country to convey its abhorrence of Burma's military government. Overall funding is so limited compared to the need that it forces the border-based and Rangoon-based organizations into an unseemly competition for a limited pot of resources, which helps feed rivalries and resentments between the two groups.

The recent policy adjustments of Britain's Department for International Development are very welcome in this context. It has committed to doubling its overall contribution to Burma over the next three years, from £9 million to £18 million, but as important is its commitment to approaching Burma holistically, assessing the entire situation as an interlocking set of humanitarian problems. DFID will allocate funds using humanitarian criteria, supporting programs where the need is greatest and organizations are able to respond to the need independently.

U.N. agencies and international non-governmental organizations need to make a conscious effort to find common ground on an overarching analysis of Burma's humanitarian problems and ways to address them in the current political environment. Organizations committed to the humanitarian principles of humanity, independence, and impartiality, whether they are based in Rangoon or along the Thai-Burma border, should come together to make a sustained case for increased aid. There is a strong incentive for the agencies to do so, because their ability to make a united case will encourage donors to commit additional resources. This in turn will increase the likelihood that more of the urgent needs of the Burmese people will actually be met.

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