Dáil Éireann díospóireacht -
Thursday, 13 Apr 2017

Vol. 947 No. 2

Topical Issue Debate

Hospital Staff Recruitment

Deputy Pat The Cope Gallagher

We in Donegal realise all too well the absolute necessity for the appointment of a second breast surgeon to assist and work with the surgeon currently in Letterkenny. The situation in Letterkenny is critical. I am seriously concerned about the level of service available for patients in County Donegal. Due to limited time, I will refer to a letter sent by the breast surgeon in Letterkenny to the Minister for Health on 16 January. The letter warns of the need to address as an absolute priority the current waiting list or patients will have delayed diagnosis of cancer as a result of the length of time, some in excess of a year. We must take that seriously. These are the words of the only breast surgeon in Letterkenny. The Minister received that letter in January 2017 but has done absolutely nothing about it.

What has the Government done since 25 January 2016 when the Minister of State from the county at that time, Deputy McHugh, delivered the decision of the former Minister for Health that there would be a second surgeon? That was a typical pre-election stunt and I make a charge against both Ministers who did that at the time. Advertisements for a locum continue. We want a permanent breast surgeon in Letterkenny. An advertisement for a locum will not attract any interest whatsoever. Anyone who is interested in the post will take it if it is permanent. I am making a charge here in the House that the half-hearted advertising of this position by the national cancer control programme, NCCP, and the HSE is contemptible. The continuous advertising of this post is a smoke screen. There is no interest. I was disappointed to receive a letter today from the Minister from which I will quote. The letter states that "Meanwhile, the requirements of the Letterkenny breast cancer service in the medium term are being assessed." A decision was taken in January 2016 that there would be a second surgeon and almost a year and half later, we are told it is being assessed. Why is it being assessed? The letter states "this is being done in light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes". We are very happy with those who provide services in Letterkenny but they need support and we must ensure that there is no continuation of what we have been living with for the past number of years. If patients are not being diagnosed at an early stage, the delays will result in them having to travel to other areas. It has been suggested they can move elsewhere. We are not going to accept that. County Donegal is on the periphery. There should be a special package for regions. I have great respect for the Minister of State, Deputy Catherine Byrne, but, obviously, the Minister, Deputy Harris, obviously has no respect. Whatever he is doing in this city today must be very important if it is more important than the appointment of a breast surgeon in Letterkenny. We are not going to accept this. The Government and its representatives are good at public relations and putting out statements saying they are planning to do this and that but no funding is provided for it. We could well be in a more serious situation. I know that the Minister of State has come in here to deliver the script on behalf of the Minister but we want to meet the Minister and I ask the Minister of State to do that on our behalf. It is not right and proper that Deputies from Donegal should be ignored by the Minister when it is such an important issue for Donegal. We will ensure that Donegal will have a second breast surgeon. For the Minister to do a U-turn at this stage is despicable and we will not accept it. I am grateful to have the opportunity to speak on this. This is important for Donegal.

Deputy Thomas Pringle

While I respect the fact that the Minister of State is here to take the Topical Issue, I am disappointed that the Minister could not see fit to come to the House to deal with this matter. The purpose of the Topical Issue debate is for Ministers to make themselves available to deal with the issues because they are important for the constituencies Members represent.

In January 2016, the Minister of State, Deputy McHugh, announced that the second breast surgeon for Letterkenny was approved and that recruitment would start straight away. We now know this was an empty pre-election promise because we have seen nothing happen since then. As has been said, almost a year and a half later we have seen no action. While this goes on, the number of referrals continues to grow. There is an average of 1,950 referrals to the breast clinic in Letterkenny every year that are dealt with by a single surgeon who does Trojan work and is so passionate about looking after the patients he sees and making sure the service in Letterkenny is maintained. I know it is hard for people in Dublin to understand but it is a four-and-a-half-hour trip from Inishowen to Galway to attend the clinics there. As these are patients who are ill or are worried that they might be ill and might receive a diagnosis of cancer, it is vitally important that this service in Letterkenny continues to grow. The way to do that is to appoint the second breast surgeon, which would allow the waiting lists to be shortened. I can only think that it is a deliberate policy on the part of the NCCP and the HSE to ensure this appointment does not happen and that the waiting lists continue to grow in order that the demand will be to move the entire service to Galway.

The Minister of State will state in her reply that not enough surgeries take place in Letterkenny to justify two surgeons because that is the response we constantly get, even though the Department has agreed to appoint a second surgeon. I point out to her that were the same figures to be used by the Department and enforced around the rest of the country, approximately one quarter of the breast surgeons nationwide would not be carrying out enough operations. A total of 96 new cancers were identified in Letterkenny in 2015 while the number in 2016 was 89. To my mind, that clearly justifies the need to appoint a second surgeon in Letterkenny. It is not enough to make excuses that there are difficulties around recruitment.

Minister of State at the Department of Health (Deputy Catherine Byrne)

I offer the apologies of the Minister who, unfortunately, cannot be present. I do not know specifically where he is but I have been asked to take this matter on his behalf. In 2007, in recognition of the particular and unique geographical circumstances applying to Donegal, the Department set out a clear policy direction approved by Government that the Letterkenny breast cancer service should operate as a satellite centre of University Hospital Galway. Specifically, on a sole exception basis, the Government agreed that Galway should be permitted to enter into outreach service delivery in Letterkenny as an additional activity. This exception was subject to a number of conditions, including case volumes meeting the minimum criteria and all other quality assurance standards being satisfied on the same basis as for care being delivered in Galway.

The Saolta University Healthcare Group remains committed to continuing the Letterkenny service as a fully integrated part of the symptomatic breast disease service in Galway, including through a joint multidisciplinary team approach. The Letterkenny service has been run by a single consultant who also undertakes general surgery at the hospital. Support is provided by Galway-based Saolta consultants who travel to carry out clinics in the Letterkenny service to meet needs arising. The Letterkenny service has been under some pressure to meet key performance indicators of late. While a particular focus has been maintained on urgent referrals, challenges are arising regarding addressing non-urgent breast cancer referrals in a timely way. A locum consultant surgeon will be in place for a period from mid-May and this appointment will help to alleviate the backlog. Meanwhile, the requirements of the Letterkenny breast cancer service in the medium term are being assessed. This is being done in the light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes.

In addition, efforts to recruit GP support and further advanced nurse practitioner support for the Letterkenny service are continuing. The possibility of medium-term requirements being addressed in co-operation with health services in Northern Ireland is also being explored, including the possibility of having a shared locum consultant. This would build on the co-operation already in place in the radiation therapy services at the North West Cancer Centre in Altnagelvin Area Hospital. This centre opened in November last year and is providing access to radiation therapy services for people from both jurisdictions.

A radiologist post for Letterkenny University Hospital has been advertised. A locum radiologist is also being sought to provide cover for the radiology service. Radiographer numbers in Letterkenny have increased and the hospital will continue to develop its radiography service to meet the needs of patients. The Minister recently met patient representatives from Donegal to discuss cancer services in the north west and further such meetings are planned. He remains committed to the continued provision of high-quality, timely services for patients attending breast cancer services in Letterkenny University Hospital.

Deputy Pat The Cope Gallagher

I thank the Minister of State for responding but not for her response. We are very proud of the service that has been provided at Letterkenny University Hospital and I pay tribute to all of those who are involved. However, they are under serious pressure. Until Deputy Pringle and I received this letter, we were of the view that it was only a matter of time before the appointment of a breast surgeon to Letterkenny University Hospital. Then we are told that there would be a locum from May until we do not know when. Now we are told the situation is being reassessed. This is a U-turn. I make the charge against the then Minister for Health, Deputy Varadkar, and his Minister of State, Deputy McHugh, who announced the post weeks before the election. There was no sincerity there. Both must stand up and tell the people of Donegal why they deceived them. These are the people we represent and we are not going to accept this. We want to ensure the Government fulfils its commitment on this post. We talk about numbers and outputs but it is no different to any other part of the State. We believe Donegal to be a special place - it is a special place and it deserves this recognition. All I ask is for the Government to deliver on its commitment.

Deputy Thomas Pringle

I thank the Minister of State for delivering the response and hopefully she will take the message back to the Minister that we are not satisfied with the answer that has been provided. The response states:

[T]he requirements of the Letterkenny breast cancer service in the medium term are being assessed. This is being done in the light of the clear evidence that patients who are operated on by surgeons who carry out higher volumes of surgery achieve better outcomes.

Perhaps the Minister of State will indicate where this clear evidence is to be found. As I said earlier, some 25% of surgeons across the service in the so-called centres of excellence actually carry out less than the 50 operations touted as being the desired number to justify having a breast surgeon. The figure of 50 operations is not backed up by any clinical evidence or any research internationally. Clearly, it is an arbitrary figure picked by the HSE to stifle the development of services at facilities such as Letterkenny University Hospital. This is wrong.

The Ministers need to deliver on their promises. I have attended some of the meetings that took place with previous Ministers regarding the cancer services at Letterkenny University Hospital. We hear plenty of kind words and sentiment at those meetings but we see no delivery. To my mind, there must be something going on behind the scenes. Is it that the system is being allowed to run down to such an extent that people will be happy to go to Galway and that the HSE will then have achieved what it wants in closing the service in Letterkenny University Hospital?

Deputy Catherine Byrne

I wish to make a number of comments. Deputy Gallagher has requested a meeting with the Minister and I will certainly pass on that request. It is my understanding from the reply that every effort is being made to fill the post but, unfortunately, it has not yet been filled. The Deputies have clearly indicated their concerns in respect of the service in Letterkenny University Hospital. As a woman, I want to add my voice to that. I really believe that it is important to give women peace of mind. It is an awful time in a woman's life when she is asked to attend a breast clinic and the only thing that can quench the fear is the fact that she can get a speedy diagnosis, one way or the other. I understand perfectly that when women are in the position of going to breast cancer clinics, they need to be given peace of mind. I will relay the Deputies' points on to the Minister.

I cannot comment on the Deputies' comments about an announcement regarding a consultant post prior to the general election. I have no comment on that but I do not believe that anyone would try to deceive anybody on such a serious issue as the appointment of a senior breast consultant coming up to an election.

I thank both Deputies on behalf of the Minister, who sends his apologies for not being in the Chamber. I will make sure that he has a copy of my notes when I return to my office so he can respond, and especially to the request by Deputy Gallagher for a meeting to take place with Deputies in Donegal.

Middle East Issues

Deputy Kevin O'Keeffe

I thank the Ceann Comhairle for facilitating this debate. I am not looking for a change in foreign policy but for more emphasis to be put on this issue, which my colleagues Deputies Mattie McGrath and Noel Grealish join with me in raising today.

Ireland was once known as the land of saints and scholars. This arose from our conversion to Christianity centuries ago. Europe has come a long way with its multicultural society but there are still major Christian values in place. The Middle East - including Syria - was the birthplace of Christianity and when its population came under attack centuries ago, we had the Crusades, which involved multinational armies drawn from countries across Europe such as Britain and Ireland. Those involved played no small part in ensuring that Christians could live where they were born, as was the case with their ancestors.

There have been many attempts at systematic extermination since then. It is ironic that, under previous dictatorship regimes in the Middle East, Christians were afforded some reasonable protection and lived in harmony with the Muslims and the other minority religious groups. Deputies Mattie McGrath, Durkan and I attended a conference at which we were well briefed on what is happening in the Middle East. We met some of the authorities from the Christian communities and the stories they told us of what is happening in there would make the hairs stand up on the back of the neck. What has happened is shameful.

It is six years since the crisis erupted in Syria, but it took the washing up of the body of a little boy on the shoreline of a European country to bring home what is going on in the Middle East. Ireland and the EU opened their borders for the influx of refugees. I commend the Ministers and their Departments on making available the ships of the Naval Service and I commend the crews of those vessels on the good work they have done to provide protection for people who are trying to escape from these hostile communities. We should, however, be doing more on the ground in the Middle East to ensure that the Christians to whom I refer are protected in order that they can survive in their own homelands, which constitute the birthplace of Christianity. I ask that the Minister for Foreign Affairs and Trade, Deputy Flanagan give serious thought to this matter.

Deputy Michael Collins

Open Doors, an advocacy group, has been monitoring Christian persecution for over 60 years.

It has stated a number of facts in its assessment of global trends in persecution in its world watch list for 2017. Open Doors has noted that 2017 is the fourth year in a row in which the level of overall persecution has risen. North Korea is still the number one offender. Islamic extremism continues to strangle the expression of the Christian faith. Millions of Christians around the world now live their lives in the shadow of varying levels of discrimination, violence and unrest.

I wish to outline some of the key facts in terms of international persecution of Christians. Islamic extremism fuels persecution in 14 out of the top 20 countries and in 35 of the top 50. It is North Korea, however, that is the number one offender, as has been the case since 2002. Worldwide persecution of Christians has risen for the fourth year in a row. Asia, in particular, is showing a rapid rise. Pakistan rises to fourth on the list, with levels of violence even greater than those in northern Nigeria. As Hindu nationalists batter the churches, India has climbed to its highest ever ranking of 15th. In Bangladesh, Vietnam and tiny Bhutan, things are getting more difficult for Christians. Buddhist nationalism returns Sri Lanka to the top 50 persecutors of Christians. Sudan rises to number five as President Omar al-Bashir seeks to fulfil his 2011 boast to the effect that "Now we can impose Sharia here." Turkey rises to 37 as President Erdoan uses the failed coup of 2016 to purge opponents and push the country towards increased Islamism. Christians continue to be caught in the crossfire of wars in the Middle East. War-torn Yemen returns to the top ten, while Christians in Syria and Iraq continue to be targeted by Islamic militants.

Deputy Mattie McGrath

Go raibh maith agat. Ar an chéad dul síos ba mhaith liom mo bhuíochas a ghabháil leis an Cheann Comhairle as an motion inniu.

I thank the Acting Chairman for the opportunity to speak and I thank the Minister, Deputy Flanagan, for being here. I know he is very busy. I thank him for his engagement with myself and Deputies Grealish, O'Keeffe and Michael Collins on this issue. We have had a number of meetings but we will need a follow-up meeting after Easter.

Christians and other religious minorities in Iraq and Syria will be exterminated or forced to migrate, solely on the basis of their religion, by Islamic State - also known as ISIS or Daesh - and other militant extremists. Christians and other religious minorities in Iraq and Syria have been an integral part of the region's cultural fabric for millennia. Since 2003, minority groups in Iraq and Syria have been the target of systematic violence, with millions fleeing their ancestral homes. Christians and members of other religious minorities - I stress other minorities, including minority Muslim groups - in Iraq and Syria have been murdered, subjugated and have suffered grievous bodily and psychological harm, including sexual enslavement and abuse inflicted in a deliberate and calculated manner in violation of the UN Convention on the Prevention and Punishment of the Crime of Genocide. These atrocities were undertaken with the specific intent of bringing about the eradication and displacement of their communities and the destruction of their cultural heritage in violation of that convention.

Genocide is a crime under international law that shall be punished, whether committed by "constitutionally responsible rulers, public officials or private individuals" as provided by the UN Convention on the Prevention and Punishment of the Crime of Genocide. Article I of the convention, signed at Paris on 9 December 1948 - all that long ago - states that "the Contracting Parties confirm that genocide, whether committed in time of peace or in time of war, is a crime under international law which they undertake to prevent and to punish." Article II states:

In the present Convention, genocide means any of the following acts committed with the intent to destroy, in whole or in part, a national, ethnical, racial or religious group, as such:

(a) killing members of the group;

(b) causing serious bodily or mental harm to members of the group;

(c) deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part;

(d) imposing measures intended to prevent births within the group; and

(e) forcibly transferring children of the group to another group.

Article III affirms that the following acts shall be punishable:

(a) genocide;

(b) conspiracy to commit genocide;

(c) direct and public incitement to commit genocide;

(d) attempt to commit genocide;

(e) complicity in genocide

On 13 March, 2015 the United Nations Committee on Human Rights reported that ethnic and religious groups targeted by Islamic State include Yazidis, Christians, Turkmen, Sabian Mandaeans, Kakais, Kurds and Shias and that it is reasonable to conclude that some of the incidents in Iraq in 2014-2015 may constitute genocide. I appeal to the Minister to do something. This is happening right under our noses. Like my colleagues, I salute the Government and the Minister for Defence for sending in the rescue ships of our proud Naval Service. The number of people they have plucked from the water and saved is astonishing. Sadly, many have also drowned.

I travelled to Lebanon with Deputy Grealish and Senator Rónán Mullen and I visited the camps. I will quote from one poor woman I met in a camp at 10 o'clock one Sunday night. She recalled the harrowing story of her family, which was turned upside down in the blink of an eye when their home town in Syria was overrun by Islamic State forces. The family I met living in this camp is a retired couple. He is 82 and his wife is 73. She was crying as she told me what happened to them and their 40 year old daughter who has two children. They were a regular Catholic family living an ordinary regular life in their home in Syria. When ISIS came to town, all the Christian houses were, unfortunately, marked with a cross, which is so sad. Then the knock came on the door in the morning and they were told by ISIS they had to convert to Islam within a week, leave within half an hour or be shot on the spot. When the ISIS soldiers returned, the daughter's husband refused to leave. Who would blame him? He was executed on the spot in front of the family - shot dead for refusing to agree to their terms to leave or convert to Islam. The family then agreed to leave. They had to leave their house with the clothes on their backs. ISIS took over their house, car and all their property. They had to walk in excess of 200 km to the Syria-Lebanon border, where they now live in a refugee camp a few miles from that border.

That family is typical of huge numbers of Christians driven from their homes in Syria and Iraq by ISIS. They were a self-sufficient family, working and carrying out their ordinary lives in their home country. The man who was executed had a well-paid job on an oil rig. The mother is a retired nurse and the father had worked with the local authority. They are not economic migrants. They are fleeing the most awful persecution and terror of their lives. They do not want to stay in an Army barracks in Mullingar or any other country to which they might be sent, particularly in light of language barriers and everything else. It was so sad. We met the children. The poor little children came out to meet us and had a little cáca milis, a welcoming party for us in the dark and they did a special dance for us. To see in that camp only grannies, very old people and children under ten or 11, no sign of the men and no sign of the mothers.

Christianity has been a stabilising factor in the Middle East since the first Easter but now it is being undermined and driven out. It is going to be a less safe place and the world itself will be a most dangerous place. His Holiness - we met him, as Deputy O'Keeffe said - pleaded with us to go back to our parliaments. Some parliaments, such as the United States Congress and the Parliament in the UK, have passed motions in this regard. I await the Minister's response.

Minister for Foreign Affairs and Trade (Deputy Charles Flanagan)

I thank the Deputies for raising this important issue. There is a grim timeliness about this Topical Issue debate. It is deeply dismaying that we should need to discuss continuing violence and persecution against Christians in the Middle East as we prepare to commemorate the Easter holidays. I must begin by expressing my horror at the attacks on two Coptic churches in Egypt on Sunday, and to extend my deepest condolences to the victims and their families. The political turmoil which has overwhelmed many countries in the Middle East in recent years has led to increased concerns about the safety of many religious minorities and other minority groups.

Christian communities have indeed suffered greatly in many of these countries. In Syria and Iraq, notably, they have been caught up in a general collapse of state control and authority, and increasingly sectarian violence which has made all minorities vulnerable.

This has culminated in both countries in the murderous bigotry of Daesh and other terrorist groups that have attacked and murdered many communities and groups of people for their religious beliefs and way of life. The attacks in Egypt and similar earlier incidents were, in all likelihood, a deliberate attempt to provoke similar sectarian divisions in that country. However, thus far the reaction of Egyptians has been exactly the opposite.

Even when the current violence is brought to an end, as it will be, many of these ancient communities will be permanently diminished. Over half of Iraqi Christians have fled the country. While some may return, many are now settled in the United States and Australia and they will not return. These tragic events are the result of crises of governance and legitimacy and, in some places, the collapse of state authority. The grim reality is that the only means of securing the protection of Christian communities and other minorities throughout the Middle East is through the promotion of sustainable political solutions to the conflicts that have for so long destabilised the region and have been the key factor in the promotion of radical and extremist ideologies.

Ireland has consistently called for inclusive, democratic solutions to the unrest in the Middle East and north Africa. Deputies will be aware that we have been to the fore under successive Governments in trying to focus international attention and effort on these problems. We have actively supported and encouraged successive political efforts to achieve ceasefires and to advance and progress peace agreements. We have worked to discourage outside interventions that have worsened these conflicts. We have worked to urge mechanisms of accountability for those guilty of war crimes.

Irish peacekeepers and professional staff have served with UN missions in Lebanon, Syria, the Palestinian territories and Iraq. We have supported efforts to establish humanitarian corridors. We have significantly increased humanitarian aid in addition to the marvellous efforts of Irish NGOs throughout the region. I pay tribute to Irish NGOs and peacekeepers for the manner in which they conduct their business and for their experience and expertise in some of the most challenging regions in the world.

More broadly and in view of the longer term, Ireland engages in international work to combat the persecution of Christians and other minorities in the Middle East. There is not time in this short debate to cover these in detail. However, I acknowledge the importance of these issues to the Deputies who have raised the matter. I was pleased to meet Deputy McGrath and others, as he evidenced.

Ireland has made freedom of religion and belief a priority of our engagement. At the United Nations General Assembly I have condemned all forms of persecution, intolerance and discrimination based on religion or belief. Ireland has consistently supported resolutions on freedom of religion or belief at the UN Human Rights Council in Geneva, including co-sponsorship of the resolution at the most recent session of the Human Rights Council some weeks back in March.

In addition, Ireland frequently raises the issue of the persecution of Christians through our bilateral contacts in the region. We stress the responsibility of governments to protect all citizens and minorities, irrespective of their religion or belief. I assure the Deputies that Ireland will continue to play an important role in this area and actively support freedom of religion or belief across our foreign policy.

Deputy Kevin O'Keeffe

I thank the Minister for his response. I agree with what he has said. I acknowledge the good work of the NGOs, our Defence Forces and the Naval Service. However, we believe more could be done. Europe has learned its lesson from the Yugoslav war. It was a neighbouring country of EU countries. We should remember what happened there with the minority religious groups. Plenty of international attention is being given to this issue but more needs to be done.

Europe reacted quickly to the creation of a Jewish state after the Second World War. We are not looking for a new state to be created for Christians or other minority groups in the Middle East. We are simply asking that they be left to go back to where they came from and continue their traditions, which have created many of the values that we have today. I thank the Minister for his response and I hope that we get more back in the future.

Deputy Mattie McGrath

I thank the Minister for his compassion and interest. It is sad that it is Holy Thursday evening during seachtain na Cásca when we are having this debate. That is our choosing. It is appropriate to have it this evening.

I apologise for Deputy Grealish who had to leave for an engagement in Galway. I thank him. I know Deputy O'Keeffe and others are travelling to Frascati again this year in August to meet world leaders. I was glad that the leaders of the Coptic Church were brought before the Joint Committee on Foreign Affairs and Trade to engage with us. There is a Coptic Christian community in Cahir in Tipperary. They are most welcome and valuable members of the community. I have sympathised with them totally and with their colleagues in Egypt after the horrific attacks that took place on Palm Sunday which caused deaths, slaughter and devastation. It beggars belief.

I salute the NGOs and peacekeepers. We have a proud record. Deputy Grealish referred recently on Leaders' Questions to some of the peacekeepers of the past. He made the case that they have not been recognised properly for the gallantry they displayed. We are proud in Ireland.

The United Nations has been lax in this case. It is ironic that under the dictatorships of certain countries – I will not name them but we know which ones – Christians were allowed to practise their faith with impunity, as were minority Muslim faiths. There was peace and harmony. They all worshipped whatever God they believed in or thought they were worshipping and there was no problem. However, things have changed since the bombing by the US, England and other countries. Since the removal of those dictators, there is no possibility for these people to worship or to hold their right to freedom of expression or anything else. The situation is far worse than it ever was.

Aid to the Church in Need produced a report in 2016 on religious freedom in the world. The report analysed the situation of 196 countries from June 2014 to June 2016. It concluded that Islamic extremism is the main threat for Christians and other religions. That is an honest report. It states that more than 334 million Christians are persecuted and discriminated against because of their religion. Cardinal Mauro Piacenza, president of Aid to the Church in Need, made several observations at the launch of the report. He said that persecution has always threatened Christians and always will. However, he said that does not mean they need to have a pessimistic attitude or do nothing about it. We have to act. Out of the 196 countries under the microscope, 38 host Christian communities have suffered serious violations. This is savage. In 23 countries there is strong religious persecution and in 15 countries there is discrimination. The most dangerous countries for Christians are in the Middle East and Africa. These include Saudi Arabia, Afghanistan, Syria, Iraq, Nigeria and Somalia among others. According to the cardinal, this is the worst problem in the world community but we remain oblivious to the toil of these communities.

The media have a role to play as well. We are not getting the attention. We get it when there is a horrific atrocity, and rightly so. However, we are not getting it otherwise. Since 2014, one in five counties has been the victim of an attack from Islamic State. Islamic extremism is felt more strongly every day and has caused a rise in the number of refugees. In 2015, a total of 5.8 million people had to flee their homes. They lost everything. According to the United Nations, the total number of refugees in the world is 65.3 million. It is unimaginable. This is the situation that the Bishop of Syria has to endure every day.

These are the types of issues that arise. Christians who live under authoritarian regimes like those in China or Turkestan undergo difficult circumstances. In two years in the Chinese province of Zhejiang, 2,000 crucifixes have been removed from churches. We are at that in our country. We remove them from hospitals and places and we do not think of the consequences. I do not see the need or the rush to do it. We do not think of the awful consequences and the signal this sends to those people who are being savagely persecuted.

Acting Chairman (Deputy Bernard J. Durkan)

Thank you, Deputy.

Deputy Mattie McGrath

I beg your indulgence for a minute. Deputy Collins did not take his time, so you might allow me a little grace.

I am delighted that we got the opportunity to raise this matter. I am very pleased that the Minister is present to hear us. I know he is engaging and that he intends to engage. We have many Muslims in my constituency and in the constituencies of my colleagues as well. They are here and happy to be here. We are happy to have them. They play a vital role. That is the way it should be. We are not against any one faith or another. As I said, the minority sects of Muslims and others get even more horrific persecution. Something has to happen. Account has to be taken of where we are.

The United States Congress and the United Kingdom Parliament have passed motions recently. We need to come to this Chamber without fear of any big powers. We need to stand up against the persecution of ordinary decent families. These people simply want to live out their lives under their own culture, in their own country and to be allowed to raise their families in safety.

The whole world is being completely destabilised by what is happening in the Middle East. It will have earth-shattering consequences going forward if we do not deal with it. I thank the Cathaoirleach for his forbearance, as well as the Minister and my colleagues who helped to raise this discussion today.

Deputy Charles Flanagan

I thank Deputies O'Keeffe, Michael Collins and Mattie McGrath for raising this important issue. Let me reiterate in the strongest possible terms that Ireland strongly condemns all forms of persecution on the basis of religion or belief, irrespective of where they occur or who the victims are or might be. We attach great importance to combatting all forms of discrimination based on religion or belief and all forms of incitement to religious hatred. We firmly believe in the matter of tolerance, non-discrimination, freedom of expression, freedom of thought, freedom of conscience, freedom of religion and freedom of belief. Ireland consistently raises the issue of intolerance and unequal treatment at the UN Human Rights Council during the council's universal periodic review of the United Nations' member states.

I acknowledge what Deputy McGrath said on the matter of the United Nations. I note that Ireland also consistently raises this issue at meetings of the Organisation for Security and Co-operation in Europe, OSCE, and on a continuous basis in meetings and engagements of the Council of Europe. The promotion of inclusive societies in which the human rights of all individuals are respected is a core objective of our engagement. It is a core cornerstone of foreign policy to promote issues such as the freedom expression, the freedom of religion and the freedom of belief.

During our recent Presidency of the Council of Ministers in 2013, Ireland played a key role in the development and adoption of EU guidelines on the freedom of religion and belief. These guidelines provide a framework for the promotion of freedom of religion or belief in the EU's external human rights policy. Later, in 2015, Ireland pressed for the inclusion of the promotion of freedom of religion or belief in the EU action plan for human rights and democracy, a four-year plan from 2015 to 2019. Let me assure the Deputy that I will continue to raise the voice of the Irish Government, Parliament and people on these important issues. I thank the Deputies for raising this issue, particularly today on Holy Thursday at the start of the most important Christian festival in our calendar.

Syrian Conflict

Deputy Mick Wallace

I thank the Minister for being here to take the issue and the Ceann Comhairle for allowing it. If Bashar al-Assad deliberately used chemical weapons on his own people, that is horrific. He should certainly be held to account. He has done bad things previously but the refusal to look for evidence and to have an independent inquiry is worrying. If the response to the assumption that there was a chemical weapon attack is a military strike, then we have a higher level of responsibility to ensure that it took place. The site should be visited, the evidence should be found and taken to the UN Security Council and, if necessary, to the Hague to initiate criminal proceedings.

In Iraq back in 2003, there was no proof of any of the claims of the weapons of mass destruction. In Libya, there was no proof of the claims that Muammar Gaddafi was going to slaughter many people but this assumption was used as a pretext to bomb the living daylights out of the country. The same people who cheerled those disastrous wars are cheerleading this aggression now.

Saudi Arabia approves of the airstrikes. This is because Saudi Arabia, Qatar, Turkey, the US and the UK have been helping to fund these so-called moderate groups who end up being cousins to ISIS, al-Qaeda and al-Nusra. These groups are trying to take over the government of Syria which, like it or not, is a pluralistic society. The US, the UK, Saudi Arabia, Qatar and Turkey are promoting and funding this extremist jihadi movement. They want a regime change.

This particular US attack was not the most deadly attack in Syria that the US staged last week. Many of the people calling for the US to intervene in Syria do not seem to realise that it is already at war there. In Syria and in Iraq, over recent weeks and months, US air attacks have hit mosques, schools and apartment complexes and have killed many hundreds of civilians to the extent that those who monitor this, such as the Airwars group, have estimated that the US has now surpassed Russia in its killing of civilians by bombing raids.

As investigative journalist Mr. Allan Nairn claims, the murder of civilians is simply calculated out of existence as people forget that numbers are not valueless. Mr. Nairn said the following:

Within the U.S. system, those killings of civilians are excused, because the U.S. was not targeting those civilians per se. They just happened to be next to the targets, so they died in the explosion. So the U.S. system says it’s OK .... They calculate how many civilians they predict will die by accident. So, in a certain sense, it’s an accident. But in another sense, if you were applying domestic criminal law standards, it wouldn’t be considered an accident. They could be charged with criminally negligent homicide. They could [even] be charged with various kinds of manslaughter.

The death toll from a 17 March US airstrike in the Iraqi city of Mosul has risen to more than 300 civilians, including many children. While speaking to Mr. Jeremy Scahill on "Intercepted" this week, the former Ohio Democratic Congressman, Mr. Dennis Kucinich, laid out precisely why we should not fall into line with the hawks and warmongers and sleepwalk to the tune of the arms industry. In October 2013, then-President Obama sent Mr. John Kerry to meet Russia's Foreign Minister to come to an agreement to end the fighting in Syria. There were reports that the Pentagon and the CIA were opposed to any agreement with Russia. They did not want to share any intelligence with them. An agreement had been made between the Russians and Mr. Kerry but less than a week later, there was a US bombing attack on a Syrian army base. Approximately 100 Syrian military soldiers were killed and that ended the agreement. Effectively, the Pentagon and the CIA overruled the President of the United States and the Secretary of State and decided they were not going to tolerate any kind of agreement with Russia. They bombed a barracks in a country the Russians had been invited into to protect. This was a calculated effort to drive a wedge between the US and Russia so that the permanent war machine can just keep going on and on. There is no money in peace.

I plead with the Irish Government to take a neutral position. I would not defend for a second what Assad does or what the Russians do, but I wish to God everybody would stop bombing any part of Syria.

Deputy Charles Flanagan

I welcome the opportunity to address this House on the situation in Syria once again. It is beyond doubt the greatest challenge facing the international community at present. The situation continues to be a matter of gravest concern and efforts to resolve it reflect not only the challenges internal to Syria, but wider regional and global dynamics. I was horrified by the news of last week’s chemical attack in which men, women and children were indiscriminately murdered. Just yesterday, a UN Security Council resolution on investigating this incident was vetoed by Russia. This is a further clear example of the challenges faced in trying to move towards a resolution of this terrible conflict.

The attack at Khan Shaykhun underlines the need for full accountability for war crimes and crimes against humanity in Syria. Those responsible for crimes on all sides must be held accountable. We have consistently called for accountability and the referral of the situation in Syria to the International Criminal Court. We will continue to work to ensure accountability is achieved.

I welcome the establishment of the international, impartial and independent mechanism on Syria. Established by the UN General Assembly last December, it will assist in the investigation and prosecution of persons responsible for the most serious crimes under international law that have been committed in Syria. It is a small step but it is a step in the right direction. I am considering how best Ireland can support this mechanism.

I had the opportunity to discuss the situation in Syria with EU Foreign Ministers at the Foreign Affairs Council in Luxembourg last week. My EU colleagues joined me in condemning the continued widespread abuses of human rights and violations of international humanitarian law by all parties, especially the Syrian regime. We also agreed the new EU strategy for Syria. This sets out the EU’s clear position that there can be no EU support for reconstruction in Syria until a comprehensive, genuine and inclusive political transition owned by the Syrian people is firmly under way. The Council also agreed to support the resilience of the Syrian population and Syrian society through the provision of education and job creation, as well as support for local civilian governance structures in opposition-held areas, including by working with the Syrian interim government, and working to avoid the collapse of the state administration in Syria.

Ireland will continue to make contributions to the humanitarian effort in Syria. Since 2012, Ireland has contributed €76.5 million to the crisis. Last week, the Minister of State, Deputy McHugh, attended the conference on supporting the future of Syria and the region in Brussels and we announced an additional pledge of €25 million for this year of 2017.

This is Irish Aid’s largest response to a single crisis in recent years, indicative of the level of priority we attach to this issue. In providing support to Syria, it is important not to forget the impact of the conflict on the wider region, in particular on neighbouring Jordan and Lebanon, and Irish Aid support is also disbursed in those countries.

I want to underline Ireland’s support for the UN-led Geneva peace process and commend the efforts of UN Special Envoy for Syria, Staffan de Mistura. The Geneva process is the only way of achieving an inclusive, sustainable and peaceful resolution to the crisis in Syria. I assure Members of this House that Ireland remains wholly committed to efforts to achieving this outcome. I have no doubt we will be back in this House discussing the crisis in Syria, both the war and its humanitarian impact, on other occasions in the future. This is the sad reality of the situation in Syria as we speak. However, we must also continue to have some hope that progress can be made, even if this progress is sometimes slow and intermittent. For my part, I assure the House that I will ensure that Ireland’s voice is heard where it is most effective - in Brussels, New York and Geneva - urging progress toward peace and political transition, followed by the rebuilding of lives and livelihoods and ultimately accountability for crimes that have been committed against the people of Syria.

Deputy Mick Wallace

I am in favour of holding accountable all people who commit crimes, and I am talking about people on both sides. The Minister says the EU is working towards a genuine and inclusive political transition but I get the impression that "political transition" also refers to regime change. They went into Iraq to implement regime change and look at the mayhem they have left behind them. As bad as Saddam was, things were not as bad as they are now. As bad as Gaddafi, was, things were not as bad under him as they are now. The whole region has been destroyed in so many ways by military intervention. It is nonsense and it does not work. There is not going to be a military solution in Syria. It is possible to get everybody talking but those in Saudi Arabia, the UAE and Qatar get arms from the British and the Americans, and they have been giving them to extreme groups that have totally escalated what has happened in Syria. It is illogical.

I understand there is a very pro-US position in the EU and that there is also one here, and the evidence of that is that we are still allowing Shannon to be used as a US military air base. For the life of me, I do not understand how we can still do it. Surely the Minister will have to admit that, as bad as things were with Obama, it has become more dangerous. Watching Trump talking about eating chocolate cake when the news came through that the air strikes took place is frightening. Only recently, Trump made it plain to the military and the CIA that they could make their own decisions on the ground as to where and when to bomb and use drones. Under Obama, as bad as it was, the decisions were run through the White House bureaucracy and it involved lawyers. With Trump, the attitude is, "Don't worry about the limits or the lawyers. If you feel the need to bomb somewhere, go for it". We are talking about people who have a vested interest in promoting the arms industry. We have to disassociate ourselves from this military activity. We have to take a neutral position. I do not expect the Irish Government to support Assad or the Russians but I wish to God we were not supporting the US military effort either.

Deputy Charles Flanagan

Deputy Wallace and I disagree on a wide range of issues in regard to foreign policy and, indeed, domestic policy but there are two issues here with which I fully agree with him. The first is that there is not, in my view, any military solution to the situation in Syria and there must be a political and diplomatic solution. Second, I share Deputy Wallace's horror at the continuing conflict in Syria and its impact on the population of Syria and the wider population of the region.

The last time I saw anything that looked like real progress involving broadly-based international support was in late 2015 and early 2016, at the time of the adoption of UN Security Council Resolution 2254. I believe that resolution is still important in that it set out a roadmap for peace, and while it has not yet been possible to follow it, that resolution of the United Nations still remains the guide for our collective efforts.

International political dynamics have changed considerably since the resolution was adopted over a year ago and we are seeing further shifts in recent weeks. The International Syria Support Group, which is co-chaired by the US and Russia, had earlier offered some cause for optimism. It remains to be seen if there is a real prospect of that track being renewed. However, the immediate goal of the international community must be the renewal of the Geneva process. On the ground we need to see a full cessation of hostilities and the lifting of the various sieges in the cities throughout Syria. In the meantime, Ireland will continue to play a very strong role in the sustainability of countrywide humanitarian access in order that humanitarian relief from the various countries, including Ireland, can be received and distributed to those people who are most in need.

I do not see a military solution. I see a political solution and a diplomatic solution, and I see that coming through the Geneva process.

The Dáil adjourned at 5.55 p.m. until 2. p.m. on Tuesday, 2 May 2017.