More than three weeks after Myanmar suffered its worst earthquake disaster in over a century, the ongoing civil war is continuing to frustrate response efforts, leaving essential needs like food, shelter, and medical assistance unmet for many survivors.
The toll from the 7.7-magnitude earthquake and strong aftershocks that struck on 28 March has risen to 3,700 dead, 4,800 injured, and 129 missing, according to the AHA Centre, which is coordinating the humanitarian response on behalf of ASEAN, the Southeast Asian regional bloc.
“The real toll is likely much higher, with challenges in data collection, verification and processing and underreporting making it difficult to grasp the full scale of the disaster,” the UN’s emergency aid coordination body, OCHA, noted in its latest situation report.
Gaining reliable information from the disaster zone, which crosses the front lines of Myanmar’s intensifying civil war, is difficult, so The New Humanitarian teamed up with exiled Myanmar news outlet Myaelatt Athan to establish the situation on the ground in the Sagaing region, which, along with Mandalay, was the worst-affected part of the country.
Most of the survivors and healthcare workers – interviewed by email, WhatsApp, and over the phone – would not be quoted by name given the security risks, but they described a response that was badly in need of support and hampered by the restrictions of the conflict and the junta.
Sagaing, a major township of 300,000 people 15 kilometres from the epicentre of the most powerful earthquake, did not encounter any international aid organisations or medical teams for the first 10 days, local rescue groups said. A handful of local and international NGOs, including the World Health Organization (WHO) and a 69-strong medical team from Malaysia, are now providing healthcare and other support with the permission of the military junta, but needs continue to far outweigh the level of assistance, they added.
Bodies were left unretrieved for days leading to a strong stench of decomposition across certain neighbourhoods, according to one rescue worker. “In the town centre, areas along accessible roads have been cleared. But in narrow lanes and places with unsafe buildings, some bodies haven’t been recovered and the stench remains,” he added.
The military junta issued a rare appeal for international help but has been accused of withholding aid to areas not under its control and prioritising its own survival rather than the earthquake response.
The damaged roads, the strict military checkpoints in and around Sagaing, and the military’s desire to control rescue and aid work made it difficult for outside aid workers to reach affected areas, according to an eyewitness denied entry into the town in early April.
The shallow 7.7-magnitude quake on 28 March levelled many parts of Sagaing City, which is currently under the junta’s control. Widespread destruction has also been reported in the surrounding rural areas, many of which are controlled by the People’s Defence Force (PDF), the armed wing of the exiled National Unity Government (NUG).
Perched on the western bank of the Ayeyarwady, the country’s largest river, Sagaing is part of Myanmar’s central Buddhist heartland – its ancient pagodas and monastic schools are popular destinations for devout Buddhists pilgrims, with an economy based on domestic and international tourists, arts and crafts, and farming.
Mid-April is when Myanmar ushers in a new year, but for aid workers and the millions of Sagaing residents affected by the earthquake, the biggest fear is that a lack of humanitarian aid, especially healthcare – coupled with a lack of water and sanitation – may unleash further casualties.
“Due to the earthquake, medicine and treatment are already insufficient. If fast-spreading diarrhoeal diseases break out as well, it could lead to more deaths, and widespread disruption in other sectors.”
“There’s a real fear of diarrhoea and other waterborne diseases,” said Zaw Zaw*, a local volunteer helping those displaced in Sagaing.
As thousands of people have moved into temporary shelters since the earthquakes – especially along the riverbanks – the number of people defecating in the open is increasing due to the lack of toilet facilities.
“Due to the earthquake, medicine and treatment are already insufficient. If fast-spreading diarrhoeal diseases break out as well, it could lead to more deaths, and widespread disruption in other sectors,” Zaw Zaw said.
Even before the earthquakes, the healthcare situation in Myanmar was dire, with disease outbreaks spiralling and clinics and hospitals in some areas becoming targets for junta bombs.
“The worst-affected communities are still without safe shelter, clean water and sanitation, stable electricity, healthcare and essential services,” said the OCHA report. “The compounding effects of the disaster on already vulnerable communities – many of whom have been grappling with pervasive conflict, poor infrastructure, and limited services – are severe.”
Ceasefires having little to no effect
Sagaing was woefully unprepared for a natural disaster of this magnitude.
For four years, Myanmar has been caught in a brutal civil war between the junta, which came to power after a February 2021 coup, and dozens of armed groups trying to wrest control from the military leaders. Many of them had been fighting their own battles for greater autonomy or independence for decades.
Sagaing, less than an hour’s drive from Mandalay, the nation’s second-largest city, has long been a hotspot of fighting between the junta and armed groups, in particular the PDF, which formed after the coup. Formerly a peaceful agricultural area, the region has gone from being a prime recruiting ground for the army, to an equally formidable resistance stronghold.
While a major infantry division is based in Sagaing City, surrounding areas are under the control of the PDF, and the state has become the site of intense fighting between the junta and opposition forces, putting civilians in the crossfire. It has also come under regular junta bombardment.
According to ACAPS, a non-profit specialising in independent humanitarian analysis, the Sagaing region has experienced “the highest recorded number of aerial, shelling, and other explosive attacks nationwide”, and in 2022 it was reportedly enduring more than 40% of all junta airstrikes.
A ceasefire to facilitate humanitarian aid was first announced by the PDF and other armed groups within 24 hours of the disaster. The military declared its own ceasefire four days later, and has since announced an extension until 30 April.
In reality, however, these ceasefires have not been holding, with both sides accusing the other of breaching them. The UN and the NUG have both slammed the military for its continued airstrikes, including in quake-affected areas.
The Sagaing region – the second largest in Myanmar, and home to an estimated 5.3 million people – also shares a border with India’s Nagaland and Manipur states.
Even before the earthquakes, 2.7 million people were in need of assistance in the region, according to the non-profit Data Friendly Space (DFS), which added that it also “bears the highest landmine/UXO (unexploded ordnance) casualty rate nationwide”.
From bad to much worse
Myanmar was already in a profound polycrisis even before the latest tragedy struck, with rising levels of poverty, hunger, and infectious diseases, and widespread armed clashes between the military and its opponents.
In Sagaing, the earthquakes have worsened the already dire situation in the sharply divided region. The military’s regular communication and mobile service blackouts have been compounded by damage to communication towers and key parts of the power infrastructure. The earthquakes also badly damaged the highway leading to Sagaing, and destroyed a key bridge linking Mandalay and Sagaing.
Local aid workers are concerned that a combination of scorching heat – daytime temperatures in Sagaing can reach up to 44°C (111°F) – and the showers that usually accompany Myanmar’s new year could worsen the health and hygiene problems.
“Living conditions have deteriorated sharply, with thousands of people continuing to sleep in the open, exposed to adverse weather conditions and the risk of venomous insect and snake bites,” said the OCHA report.
A nurse running a temporary clinic in Sagaing told The New Humanitarian and Myaelatt Athan she has treated several people with diarrhoea and gastro issues from consuming contaminated food. She is also seeing children develop kidney problems and skin rashes, a consequence of the harsh weather, their temporary conditions, and the lack of clean water.
After a couple of weeks of treating quake-related injuries, they are now turning their attention back to some of the more chronic illnesses like diabetes and heart diseases. But there is another big problem: They are running low on supplies.
“The patients are holding onto a thread of hope. Donations have decreased, and if nothing more comes in, even if we want to help, we simply won’t be able to.”
“We’re about to run out of medicine, especially since each patient often requires a month’s worth of medication, especially those with chronic conditions,” said the nurse, who spoke on condition of anonymity.
Although preparations are underway to reopen a temporary free clinic in Sagaing City, there are growing concerns that thousands of local residents and chronic patients may not receive adequate treatment due to the shortage of donated medical supplies.
“For patients with high blood pressure or diabetes, running out of medication makes their condition unmanageable,” the nurse said. “If diabetes medication can't control the condition, it can lead to kidney failure. They’ll suffer complications. If they run out of medicine and there’s no treatment available, they’ll be left at home, waiting for death.”
In the immediate aftermath of the earthquakes, between 2 April and 11 April, nearly 80 million kyat ($38,131) worth of medicine and supplies were donated. But as only around 20 million kyat worth of supplies have been received recently, the clinic is currently closed until more come in.
“It’s truly heartbreaking,” said the nurse. “The patients are holding onto a thread of hope. Donations have decreased, and if nothing more comes in, even if we want to help, we simply won’t be able to.”
The WHO sounded a similar alarm in its latest report: “Essential medicines are in severe shortage, affecting the continued treatment of communicable diseases (e.g. HIV and tuberculosis) and noncommunicable diseases (e.g. hypertension and diabetes). Disruption in treatment may lead to drug resistance, and increased morbidity and mortality.”
“There’s no clinic to go to”
Across Myanmar, the earthquakes destroyed or damaged hundreds of hospitals and clinics, “disrupting access to health services, while many health facilities are operating under strained conditions”, according to the WHO.
At the Sagaing General Hospital, some medical treatments are ongoing, but the walls are cracked, parts of the roofs over the patient wards have collapsed, and, given the aftershocks, most people don’t dare risk going inside anyway.
Current medical support and drug supplies are estimated to meet only 50% of needs, according to a local doctor who is providing free healthcare to survivors.
While international medical teams from countries such as China, Singapore, India, Japan, and Russia have provided treatment in Mandalay, few are in Sagaing, where almost all emergency health facilities are being operated primarily by volunteers, the doctor said.
“The rescue teams, the doctors, and the nurses are all volunteers. As for medicine and supplies, we haven’t seen any international organisations or government-related sectors,” he said, adding that the volunteers have been working 16 hours a day: “When it’s getting very late and I really need a break, I will say I’m going to take one but people start pleading. So I end up treating everyone.”
Earthquake survivors face a long road to recovery. Some are in temporary displacement camps set up by volunteer groups where food and drinking water comes from donations.
Others are in makeshift shelters, like the more than 50 young Buddhist nuns who used to live in a monastic school in the northern part of the city but whose home is now a cramped, makeshift tent in an open field.
The quake destroyed four residential buildings, the dhamma hall, the communal bathing area, and most of the toilets in their school compound.
No one died, but the nuns, ranging in age from seven to 15, lost the few belongings they had and now have nowhere to live, especially as many are orphans. There are few safe spaces for shade and shelter as whatever buildings didn’t collapse were badly damaged.
For four days following the earthquakes, they had no access to water. They also need food, particularly rice and oil, but it is “impossible to go on alms rounds because everyone has been affected by the quake”, the head nun said. “During the day, we stay within the school compound, but at night we have to sleep under a temporary tent in the field next to the school,” she explained. “The tent is just some bamboo poles with a cover thrown over.”
They have also been suffering from nosebleeds, mouth ulcers, and fevers, the head nun said, adding: “There’s no clinic to go to.”
For some, like San Min*, a Sagaing resident in his 40s, getting medical care means travelling further afield. San Min lost three family members, including his mother and daughter, after their three-storey building collapsed during the earthquakes. Two of his sisters were also injured.
Within hours, neighbours helped him recover the bodies of his deceased family members from the rubble. But they couldn’t help with the healthcare, and the Sagaing General Hospital and the temporary clinics were at full capacity. He ended up taking one of his injured sisters to Shwebo, about 50 miles (77 kilometers) away over damaged roads, for treatment.
The surviving family members have been camped out in a vacant lot across from their collapsed home, suffering through the extreme heat and swarms of mosquitoes. “I’m just heartbroken,” San Min said. “My family is now incomplete. I just feel like I’m cursed with bad luck.”
*Name changed for security reasons. The author’s name, Hein Sen, is also a pen name. It is common practice for Burmese journalists to use pen names due to the security risks they face.
Edited by Ali M. Latifi and Andrew Gully.
