Amid such carnage, political concerns must come second

Even before the devastating cyclone hit Burma at the weekend, the country was in desperate need of help. The government now says 22,000 people have died and 41,000 are missing, figures far higher than it originally admitted. The biggest problem will be obtaining access to affected areas. Burma's government has long been suspicious of international aid agencies, and although it has accepted help from UN agencies already working there, their activities are tightly controlled.

Burma only receives around $3 per capita of international aid, far less than its neighbours: Vietnam receives $33 per capita, Cambodia $47 and Laos $63. This is a result of the international sanctions in place since the mid-90s. Some humanitarian agencies, such as Médecins Sans Frontières, have left the country, while the Red Cross has suspended its programmes due to government restrictions.

Burma used to be one of the largest rice exporters in the world, but decades of conflict and economic mismanagement by its reclusive military junta have pushed much of its population to the brink of starvation. According to the World Food Programme (WFP), one of the few international agencies allowed to operate in the country, 10% of the population does not receive enough food to meet its basic daily needs, and 30% lives under the absolute poverty line. This figure climbs to 70% in many rural areas.

It is extremely difficult for agencies to obtain permission to begin operations. Those allowed to do so must accept restrictions as to where they can work and have to submit their assessments, surveys and reports for clearance by the authorities. During the uprisings last autumn, the UN country team issued a statement highlighting the difficulties faced by the population daily. Although it drew exclusively on government statistics, this brought a furious rebuttal from the regime. It expelled the UN humanitarian coordinator and has since carried out a bureaucratic harassment of aid workers - delaying visa applications or refusing accreditation.

Countries such as Burma and North Korea, where the WFP also has a large programme, pose a real dilemma for humanitarian agencies about how far they should be prepared to accept such restrictions in the interests of the people they are trying to help. When Afghanistan was ruled by the Taliban, some humanitarian agencies, such as Oxfam, suspended their programmes rather than comply with the Taliban's anti-women edicts. Oxfam eventually concluded this had been a mistake that had caused greater suffering to ordinary Afghans, but there clearly is a tension of conflicting principles in such situations.

A couple of years ago I spent a week on the Burmese-Thai border talking to opposition activists about the human rights and humanitarian situation there. Most felt that the presence of the international community had helped provide cover for the development of Burmese civil society, although clearly there is a dilemma as to how much "constructive engagement" merely legitimises the regime. During a humanitarian crisis, however, such calculations need to be set to one side, since the imperative is to provide people with life-saving help.

Aid agencies estimate that about a million people may be without shelter after the cyclone tore away their homes, and whole villages have simply vanished in the floods. The problem with mounting humanitarian operations during complex emergencies such as this is that it is very difficult to separate the effects of conflict, natural disaster and the overall political situation. This has blurred the distinction between development and humanitarian aid, because countries like Burma are now in chronic crises in which the man-made disasters weaken their capacity to deal with natural ones.

Burma has experienced several decades of conflict, and there has been a number of ethnically based insurgencies, which the regime has dealt with through coercion and cooption. This has led to the creation of military fiefdoms which in effect ruled by former warlords. Even when humanitarian agencies have obtained central government permission to operate in a particular area, they often have to negotiate it again at a local level.

The opium trade has done much to fuel the conflicts, and both warlords and the army are accused of conscripting labour and levying taxes. This creates a further dilemma for humanitarian agencies, whose staff often witness such violations. Ignoring them might be seen as tantamount to condoning them, but speaking out could bring loss of access.

In practice, most agencies tend to opt for private advocacy with the authorities and a continual reassessment of the costs and benefits of their presence. Some have argued that aid should be made conditional on the government agreeing to meaningful political reform and dialogue with the pro-democracy movement. But if the government rejects this, then refusing aid will simply increase the suffering of the poorest and most vulnerable people.

As one UN official told me recently: "We simply cannot delay providing assistance until a viable political situation evolves. The human costs for the Burmese people will be too high."

Conor Foley, a humanitarian aid worker and a research fellow, Human Rights Law Centre at the University of Nottingham.