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In Myanmar, healthcare and disease prevention are neglected casualties of war

“Myanmar alone could be responsible for reversing progress on malaria in Africa and globally.”

Two young man are walking on the sides of the doors of a health centre in Myanmar. There is a sign above in blue that reads: Kayan National Health Committee Sit Htet Aung / SOPA Images/Sipa USA via Reuters Connect
Resistance forces clearing the area near the Sa Lone Taung village clinic in Pin Laung township where the junta staged airstrikes.

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In September, Lamin came down with yet another bout of malaria. Over the course of 40 months, the community health worker in Myanmar’s southeastern Mon State has had the mosquito-borne disease nearly two dozen times. 

“Each time, it feels worse than the last,” the 28-year-old told The New Humanitarian and the Delta News Agency, a local news outlet, over a chat app. 

In a poor country like Myanmar, given the limited resources and a heightened exposure to contagious illnesses, it is common for healthcare professionals like Lamin to catch diseases from people they care for. 

But Lamin, who has nearly three years of experience in her role, said her repeated malaria infections, which began in June 2021 – a few months after the military launched a coup and seized power – were due to the lack of mosquito nets and other preventive tools.

As conflicts between the military and opposition forces have escalated across Myanmar and more people have been forced to flee their homes – often with only the clothes on their back – health workers say things like mosquito nets have become overlooked casualties of war. The UN says this ongoing shortage of malaria supplies has led to a resurgence of the disease “in several regions and states of Myanmar”.

Medical experts agree. 

“Since 2022, malaria outbreaks have been rampant. There’s also a noticeable increase in drug resistance, while the death toll continues to rise year by year,” a doctor, who requested to remain anonymous due to his safety, told DNA/The New Humanitarian. 

But it is not just malaria that is stalking Myanmar.

An analysis by DNA of the country’s latest healthcare data from UN reports showed that cases of malaria and TB soared seven-fold between 2020 and 2022, while HIV, another key infectious disease, increased by 10%. 

 

 

In interviews with healthcare agencies operating along the Thai-Myanmar border and half a dozen healthcare experts working inside the country, all blamed the military for this dire situation.

While these numbers are a cause for major concern, it is also likely that they are underestimates because there is significant under-reporting following the February 2021 coup, the experts said.

 

 

Armed conflict, political instability, logistical challenges, and targeted attacks on healthcare workers and facilities have shuttered hospitals, clinics, and monitoring programmes, and the provision of life-saving medication has also come to a complete stop in many parts of Myanmar, they said. If left untackled, Myanmar’s health crisis could have broader impacts on not just neighbouring countries but also further afield, the experts warned.

“The impact of reduction efforts in controlling the diseases will be felt in Myanmar, regionally and globally,” the *World Health Organization (WHO) team on Myanmar said in an email. 

“The biggest concerns, if these challenges remain unaddressed, include the potential for increased morbidity and mortality from HIV diseases, and the risk of spread of the disease, including the dangerous drug-resistant strains to neighbouring countries," she added in an email.

A UN report on Myanmar’s humanitarian needs for 2025 contained a dire warning: “The health system is in collapse.” 

Dr. Onyon, a 15-year veteran of public health who requested the use of her nickname for safety reasons, agreed. "By 2030, if things continue this way, our country will be a living hell," she said. 

Heading in the wrong direction

Before the coup, Myanmar was on track to be declared malaria-free by 2030, a status that was a real prospect to be achieved. Instead, the country regressed. Currently, 70% of Myanmar’s population – about 38 million people – may be at risk of malaria infection, according to the *WHO team.

The situation is particularly worrying for hundreds of thousands of internally displaced people in conflict-affected areas who are now living in forested areas. They face heightened mortality rates should they catch malaria, said health workers living and working across 20 different locations. 

Nearly 3.5 million people, about a third of whom are children, were estimated to be internally displaced as of December, according to the latest UN data. In addition, a total of 12.9 million people – around 23% of the population – need health assistance, the organisation has said.  

Dr. Suzi, who has nearly two decades of experience in public health and who also requested the use of her nickname, said there are hundreds of thousands of insecticide-treated mosquito nets stockpiled in military warehouses, but they remain undistributed due to restrictive regulations.

“If drug-resistant malaria emerges in Myanmar due to the lack of effective control, and people take medications improperly, there will be no new drugs to combat it.”

These life-saving items are languishing in storage rooms because the military wants to prevent them “falling into the wrong hands”, she said, referring to the opposition groups. “It’s not like these nets are guns or weapons! But the priority was to ensure they don’t reach the wrong people, so within these nearly four years, the distribution of mosquito nets stand at zero,” she added, her voice trembling with frustration.

Dr. Suzi paused for a moment to collect herself. “If drug-resistant malaria emerges in Myanmar due to the lack of effective control, and people take medications improperly, there will be no new drugs to combat it,” she said. 

“Just look at how COVID spread (from Asia to Africa). Should this strain spread to Africa, the global fight against malaria could be set back 10 to 15 years. Myanmar alone could be responsible for reversing progress on malaria in Africa and globally. That’s how dire I see the situation.”

The spread of drug-resistant malaria from Southeast Asia to Africa has happened before, when resistance to chloroquine, an earlier malarial drug, first appeared at the border between Cambodia and Thailand in the late 1960s and subsequently migrated to sub-Saharan Africa, according to scientists.

While health experts say malaria can be prevented by avoiding mosquito bites and is relatively easy to detect, TB can be transmitted through the air and requires proper medical equipment for diagnosis.

In 2020, Myanmar was again one of the few countries on track to eliminate TB. However, according to the latest WHO report, Myanmar now ranks 4th among countries with the worst TB outbreaks.

Dr. Aye Nyein Thu joined the Civil Disobedience Movement (CDM) to oppose the military coup. She now treats people in the mountainous region of Chin State in western Myanmar. Since 2021, she said she has noticed an increasing number of suspected TB patients each year in the areas under her care. However, a lack of diagnostic equipment makes it difficult to confirm the cases, and many locals are more afraid of airstrikes and artillery shells than of TB, she said.

Although collecting TB data in Myanmar is challenging, neighbouring Thailand has reported rising infection rates.

MAP Foundation, which focuses on the health, human rights, and labour rights of Myanmar migrants along the Thai-Myanmar border, has recorded an increase in suspected TB cases among the population it supports in Chiang Mai to nearly 12% in 2023 from 10% in 2022. In just the first five months of 2024, 80% of those who came for testing were confirmed to have TB. It is difficult to estimate how widespread TB is among the migrant population since this data only includes individuals who came for testing.

“After the coup, there was a massive influx of people [into Chiang Mai]. Many fled the conflicts inside Myanmar, and when they arrived here, overcrowded living conditions and the constant arrival of new people contributed to the rising TB cases,” said Hark Murng, health coordinator at MAP. 

The *WHO team said close to 50,000 deaths for the year 2022-2023 were a result of TB. 

A crisis without borders

According to Hark Murng, the rising cases he observed also include patients with HIV/AIDS.

The UN also estimated that over 10,000 new HIV infections occurred in Myanmar in 2023, with over 6,000 deaths related to the virus.

Before the military coup, over 180,000 people in Myanmar were on ART (antiretroviral therapy), and ART treatment centres had been established in over 240 townships across the country. 

ART is essential to combat HIV and used to be provided free of charge in Myanmar, with the support of international health initiatives. However, it is not readily available for purchase on the open market.

Things began to unravel when the COVID-19 pandemic hit, a year before the coup. In remote regions in Sagaing in the country’s centre and Chin in the west, travel restrictions and the remote locations of treatment centres forced more than 140 patients to cross the border into Manipur, India, to access ART.

In the nearly four years following the coup, the situation has deteriorated significantly across the whole of Myanmar since conflicts now affect almost all regions of the country, making it increasingly difficult to deliver ART medications.

“The current lack of containment has significant implications for neighbouring countries like Thailand and China, and it threatens the progress toward global eradication goals.”

Sometimes this was the result of wanton destruction. A resident from Thandwe in southern Rakhine in the country’s west recounted how the retreating Myanmar military destroyed medicines and supplies at hospitals and clinics. “The medicines were practically useless because they’d broken the bottles or threw them in the dirt,” the person said. 

“Eradicating diseases like HIV/AIDS cannot be achieved by one country alone – it requires cooperation across nations,” said Dr. Onyon. “The current lack of containment has significant implications for neighbouring countries like Thailand and China, and it threatens the progress toward global eradication goals.”

The situation in Myanmar remains volatile, and both the provision of healthcare and monitoring of disease outbreaks remain a major challenge. But the impacts are likely to go beyond Myanmar’s borders. For example, it is estimated that approximately six million Myanmar nationals are residing in Thailand, but over half are undocumented. This makes it challenging to gather accurate healthcare data. 

The National Unity Government's Ministry of Health, currently in exile, did not respond to detailed questions about the situation, referring only to the data published by the UN.

Telehealth, a group set up by striking doctors from Myanmar and providing online healthcare services, said it is unable to provide precise data due to the nature of remote consultations but noted that the number of general patients seeking care has been steadily increasing.

Local health teams affiliated with resistance groups also reported challenges in treating even straightforward illnesses like malaria. They mentioned that new strains of drug-resistant malaria are emerging, making effective treatment increasingly difficult.

The military regime did not respond to an emailed request for comment. 

Experts say urgent, concerted efforts from the regional and international community are needed to reverse the brewing crisis. 

“Neighbouring countries need to recognise that this is not just Myanmar’s problem,” said Dr. Onyon, warning of regional spread.

The *WHO team warned warned that it would take a long time for the region to recover otherwise: “Once communicable disease is out of hand, even a generation of effort will not be able to bring it back to below dangerous levels.”

Local data consultancy Myanmar Data Citizens contributed to the data visualisations in this article.

(*CORRECTION: The name of the initial source was removed on 20 January 2025 as the quote was wrongly attributed to an individual rather than the whole WHO team.)

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