In Myanmar, Earthquakes Add a New, Deadly Threat to Struggling Health Systems

When Dr. Si Thura describes the horrific earthquakes that struck central Myanmar on March 28, he sees not just an isolated event, but a new, devastating chapter in a longer story of instability.

The quakes, the strongest of which registered at a magnitude of 7.7, have killed more than 3,500 people and injured thousands more. Dr. Si Thura, the chief executive officer of Asia-based nonprofit Community Partners International, described local health centers reduced to rubble, and no medicines or supplies available in some areas, even for patients with physical trauma.

"At all levels, the facilities are gone," he said.

So many people lost their homes that thousands have been sleeping on the street. "There are rains in the central Myanmar area…so people are now sleeping in the rain," compounding the risk of water-borne illnesses, tetanus, and digestive diseases caused by contamination, Dr. Si Thura said. "It's a bad situation for hygiene."

CPI's teams on the ground have spent the days since the earthquakes providing emergency care through a roving mobile clinic, distributing water and sanitary supplies, assessing health facilities for damage, and delivering medicines and medical supplies to health centers and hospitals that are still able to operate.

Decades spent building relationships within Myanmar's complex and fragmented social and political contexts, and deep partnerships with local service providers embedded in the country's hardest to reach communities, give CPI extensive reach.

"Because of the trust we've built over 27 years, and our partner network on the ground, we're able to reach most of the affected areas," explained Dr. Tom Lee, CPI's founder and a professor of emergency medicine at UCLA.

A background of conflict

More than 70 years of conflict in Myanmar have taken a tremendous toll on its citizens' health. HIV, tuberculosis, and malaria are all serious health concerns in the country - and CPI's programs focused on preventing infectious disease were shut down in February, due to USAID freezes.

Airstrikes and other conflict-related violence cause physical injuries and limit access to health care. Rohingya refugees, forced to flee their homes in 2017 in response to genocidal violence, continue to need care in camps that are vulnerable to flooding and disease.

Communities in Myanmar still strongly feel Covid-19 pandemic's economic and health impacts, Dr. Lee said.

Trust-based relationships, crucial access

All of these elements add to the devastation the earthquakes have caused, he said. While Myanmar's urban centers, like Mandalay, generally have more health resources, they're in no way equipped for the extraordinary medical and mental health needs.

These areas are so densely populated that Dr. Lee thinks the actual death toll and the number of injured are likely "much greater" than current estimates.

Media reports in the earthquake's aftermath have focused on NGOs' difficulty receiving official permission to enter Myanmar and deliver supplies in the country. "It's hard to get permission…because there's conflict and there's civil war," Dr. Lee explained. CPI's local presence in Myanmar and deep, trust-based relationships have allowed staff members crucial access to patients and healthcare providers.

"A way to make it happen"

Until the most emergent needs from the earthquake are met, Dr. Si Thura explained, CPI will focus on getting medicines and supplies to community healthcare partners, providing medical care in areas where local partners are incapacitated, and delivering water and supplies to affected communities to reduce the impacts of damaged sanitation.

Over the long term, however, bigger goals will have to be achieved. Damaged health systems will need to be restored. Infectious diseases like TB and malaria will likely spread in crowded and wet conditions, and a lack of cold-chain infrastructure will make vaccination more difficult. Dr. Si Thura is even concerned the lack of containment may have international consequences: "Diseases don't respect borders."

Providing mental health resources will also be an urgent priority, Dr. Si Thura explained: The people of Myanmar, already living against a background of violence, now must confront the aftermath of a devastating disaster.

"Psychosocial support is really needed, because people are really desperate," he explained. "We are going to find a way to make it happen."

Providing the right support, as urgently as possible, is Dr. Lee's highest priority. A Direct Relief emergency grant of $100,000 will fund CPI's first, most urgent response phase.

"Five minutes after the earthquake hit, I got a text" from a Direct Relief emergency responder, Dr. Lee recalled. "You guys always come through."

Dr. Lee cautioned that what's most needed after a disaster isn't always what people might expect: For example, he remembered, Rohingya people fleeing genocide received plenty of rice and pans to cook it in, but not nearly enough fuel to light cooking fires. CPI's model of working with community providers relies heavily on local expertise and insight, to help them source medicines and decide on next steps.

"The local people are the smartest ones, the ones who know exactly what they need," Dr. Lee said.