The Aftermath in Myanmar

The devastation from the cyclone that ravaged Myanmar on May 3 is still unclear amid a rising death toll and limited aid relief for victims. CFR’s Senior Fellow for Global Health, Laurie Garrett, says if the regime continues to try to limit international access and insists only on receiving supplies without the expertise, “I think it is very reasonable that the death toll is going to exceed anything that we have ever seen in an Asian nation in the last thirty, forty years.” Garrett says the next few days is the last remaining window to save those “that are clinging on the edge of life,” and this “requires knowledge that is very deep and if not done properly can do more harm than good.”

What are the major health related risks that the people of Myanmar face now in the aftermath of the cyclone?

Certainly the top of the list is going to be horrible infections due to untreated traumatic injuries. Even relatively minor injuries, scrapes, and cuts, if left untreated and exposed to the elements and contaminated water, can indeed turn into bacterially infected wounds that could have life threatening repercussions. As far as we can tell, getting appropriate supplies for treatments and getting them especially to the remote parts of the country is proving extremely difficult for a host of reasons.

I think the second big concern is just general exposure. People shouldn’t be sleeping outdoors, particularly if they are already traumatized and may have underlying illnesses of any kind. As far as we can tell there has not been any massive effort to provide tents or temporary structures to protect individuals from the elements. So I expect that there will be a large death toll simply for the lack of any kind of substitute housing.

I think the third concern is for a particular range of infectious diseases. Myanmar has long been a site of very serious infectious diseases of several different types but government has not been terribly cooperative with international health authorities, so we don’t have numbers even before the cyclone that we can really hook our hands around and say we respect these figures. Nevertheless, it’s pretty clear that Myanmar had a very high HIV rate, perhaps the highest in the region or only second to perhaps Cambodia; that it had a very high hepatitis B and hepatitis C rates; cholera has been an ongoing ancient problem; tuberculosis has been present and in drug-resistant forms; and of course like most of the Southeast Asian region, it is prone to severe outbreaks of malaria. All of these could have been grossly exacerbated by the disaster.

What should be the main priorities for the relief agencies at this point?

Well, priority one is food and safe drinking water. If the reports I am getting are accurate there have already been deaths in Myanmar post-cyclone due to starvation and dehydration. It’s urgent that safe drinking water get to people. As far as food goes, you probably have noticed that most of the international humanitarian agencies have tried first to get high-protein bars into the area, these special peanut-butter-type bars and other formulations that have really revolutionized humanitarian aid and are especially good at keeping children alive. But down the road, perhaps not very far at this point down the road, all the essentials of the Burmese diet are going to be needed: rice, cooking oils, essential proteins, and so on. We have to assume that agriculture will take years to come back in this region from what we could see of the NASA satellite photos—the entire agricultural delta from the Irrawaddy River has been just devastated. It’s not going to turn into fertile, decent agricultural land again anytime soon.

How does this affect the global food crisis that we are already facing? In return, how do rising food prices affect the people of Myanmar?

We have already seen on the speculation market for rice futures that at least the global markets think that this disaster has a huge impact on rice, and rice prices have soared since the disaster was announced. Certainly it affects the regional market in Southeast Asia. Aid organizations will be trying to buy Thai rice, Vietnamese rice, Laotian rice for emergency relief in Myanmar, assuming the junta or the regime allows them to bring rice in. That will drive up Southeast Asian rice prices. Internationally, we are of course in a grave food crisis but perhaps in a sense the word crisis is wrong. It implies that it’s a transient emergency. In reality I very much believe and I think the evidence will back me, that what we’re in is a new permanent state of higher food prices, the end of cheap food for anyone in the world and escalating demand and escalating costs.

This, I think, is only going to make us more vulnerable as a global community to natural catastrophes that affect agricultural production or leave us with hundreds of thousands of hungry refugees. Whether it’s an earthquake in China, a cyclone in Burma, a drought in East Africa, or a tsunami, the same outcomes are going to be seen every time. It’s going to be harder and harder to affordably purchase the same tonnage every time—the same tonnage of rice, the same tonnage of wheat—and mobilize it and get it where it needs to get whether it’s locally purchased or donated as foodstuffs by donor countries.

What is the situation of clean drinking water, especially in the worst cyclone-hit areas?

We only have scanty information because no journalist has been granted visas into Myanmar so the only reporting we’re getting is from those humanitarian workers or journalists that were already there before the cyclone occurred. But from what we can tell is that people do not have fuel, any kind of fuel, so they cannot cook water to boil it to make it safe to drink. That means people are drinking river water, well water perhaps, and it is more than likely that the water is unsafe to drink.

With the ruling regime not letting in enough aid and the delay in help reaching the victims, how bad can the situation get?

I was in a meeting last week with several of the top officials of the United Nations system and privately almost all of them agree that this is going to end up creating a carnage worse than what we saw with tsunami. Of course in the case of the tsunami, five nations were hard hit, three or four other nations suffered minor impacts. This is an impact felt on a single nation and it is a nation that has not shown itself to be a resilient society, an open society, or for that matter a politically rational society, so the long-term impact of this is now at this point in the hands of that government. If they choose to let the international community in—which is poised all over the region ready to pounce—and do their utmost at every level to keep the populations alive, keep them well fed, provide them with necessary medical care, and build shelters, then we may see the ultimate death toll stay below 200,000 and the ultimate devastation lead to a recuperation of village life over the next year or two.

But if the regime continues to try to limit international access and insists only on receiving supplies without the expertise and personnel that have long-time skill sets to appropriately use those supplies and save as many people as possible, I think it is very reasonable that the death toll is going to exceed anything that we have ever seen in an Asian nation in the last thirty, forty years.

And what do you think is the next stage in the relief efforts, after the most urgent needs of the people are met?

Well, I mean the problem is at this point, none of the urgent needs are being met because nobody can get in there. Part of the problem, as I understand it, is that the Burmese government wants to have its people perceive relief efforts as coming from the Myanmar regime, not from outsiders, so they want the military’s face on it, stamps of approval on packages that are delivered of relief food and medical care. All of that impedes the flow. All of that is predicated on the notion that the Myanmar military has the skill set in their training to do it correctly, to get out and find people, and reach those in most desperate need. Frankly there are few organizations on the entire planet that know how to deal with something on this scale. This is not a skill set that your average soldier has, whether they are from America, Myanmar, France, anywhere. This is not a skill set that is intuitive and a lot of what gets done in the next few remaining days that are the last window to save those that are clinging on the edge of life requires knowledge that is very deep and if not done properly can do more harm than good.

One of the things that we have seen everywhere in the world in a crisis, whether it is a war refugee situation such as in Darfur, or it’s a famine sort of situation, what we see is that if left to their own devices in a somewhat chaotic situation, when aid arrives, if its in the form of food or medical supplies, valuable drugs in particular, the crowds jostle. It is the young, strong men, typically between fifteen and forty years of age who trample down everybody else, all the women, all the children, all the elderly, and get their hands on all the supplies first. Then a substantial percentage of them turn around and create a black market selling the relief supplies at an exorbitant cost, trying to get rich in the process. Often I have found in my past travels looking at these situations, the relief supplies, especially relief drugs, may show up on the black market more than a thousand miles away. The only way you save all lives, including small children and elderly women, is if people know how to do this process, have their heart set on having it work properly, and have the appropriate tools of security to ensure that the supplies are not stolen, that guns are not fired. They know how to make sure the distribution is done properly. I cannot imagine that the Myanmar military have in their ranks anybody who has ever seen anything on this scale before and has the slightest idea about how to go about doing equitable distribution of medical supplies, of food, of water that reach all elements of society, not just the strong, youthful males.

Is there a role that other militaries, especially the United States, could play in relief efforts, something like what we saw in the tsunami before this?

You know the United States was a major responder in the tsunami. At one point we had more armed forces on the ground in Aceh, Indonesia, than we did in Afghanistan. We have a long experience of mobilizing supplies and getting the army corps of engineers in place to rebuild the essential bridges and roads on an urgent basis to allow relief supplies to get trucked in to remote areas. Similarly, the Singapore military, the Japanese military, the Chinese military, and many others in the region, of course Australia and New Zealand, have those skill sets and could right now be helping, but the Burmese government will not let them in.