Myanmar’s health system was collapsing. Then the earthquake hit.

“The houses, which were all built on the water, were gone — all flattened,” 15-year-old Myat Nyein from Inle Lake in Shan State, recalled in testimony to Save the Children. His mother died in the disaster, her body found covered in bruises with stitches on her head. He survived by jumping into the lake with his brother.

“I will never forget the moment I pulled my younger brother into the water, the sight of our fallen village, or my mother’s broken body,” Nyein said. “These memories will stay with me forever.”

Myat Nyein’s story is just one of thousands that have unfolded across Myanmar since the 7.7-magnitude earthquake struck a week ago. The earthquake shook six regions across the country, home to approximately 28 million people, including 6.7 million children.

The disaster has killed at least 3,838 people and injured over 4,000, with another 500 still missing, according to the latest UN estimates. The United States Geological Survey warns the death toll could potentially exceed 10,000 as search and rescue operations continue in remote regions.

Aid officials describe the situation as a humanitarian catastrophe of historic proportions.

“The needs are beyond words,” said Nadia Khoury, head of the International Federation of Red Cross and Red Crescent Societies (IFRC) in Myanmar. “Our response must match the sheer scale of the disaster – now and for the longer term.”

The disaster has devastated a health system already crippled by years of civil war. The earthquake destroyed three hospitals and partially damaged 22 others, according to the World Health Organization, severely limiting healthcare capacity when it is most needed. Around 40% of hospitals in Myanmar are located in territories contested in the civil war, making them inaccessible to many seeking urgent medical care.

“The earthquake has taken a heavy toll. Thousands of lives are lost. Families displaced. Health facilities have been damaged or overwhelmed in the hardest hit areas,” said Hyon Chol Pak, administrative officer at WHO’s Myanmar office.

Even before the earthquake – the largest to hit Myanmar in over a century – the country faced a dire humanitarian crisis. In its December 2024 assessment, the UN had already declared that “the health system is in collapse,” with 12.9 million people requiring humanitarian health interventions. Due to severe underfunding, only 2.4 million were targeted for assistance, UN figures show. 

This deterioration follows years of political and economic instability after the February 2021 military coup in the country, which had already shuttered hospitals, disrupted medical supply chains, and internally displaced millions of people. 

“Myanmar is shattered,” the UN Refugee Agency said Thursday. “Millions urgently need shelter, safety, and aid.”

Disease threats mount amid a health system in ruins

Health officials warn that disease outbreaks now pose an imminent threat to earthquake survivors, many of whom are sleeping outdoors in temperatures exceeding 40 degrees Celsius. An estimated 100 people, mostly children and the elderly, died in a similar heatwave last year as power outages left civilians with no recourse to escape the scorching heat. 

Medical staff, many themselves affected by the earthquake, are struggling to provide care in impossible conditions. In many areas, patients are being treated outdoors in unseasonal heat as buildings remain unsafe, with healthcare workers attempting to manage thousands of traumatic injuries without adequate supplies or facilities. 

Water and sanitation infrastructure has been destroyed in numerous communities, leaving many without safe access to drinking water. The contaminated water is causing rising illness rates among populations in Myanmar’s regions impacted by the earthquake, according to Malteser International. The WHO has already detected cases of acute watery diarrhea in displacement sites, with 47 cases reported across Mandalay and Sagaing regions.

“Especially for young children and older people, watery diarrhea combined with dehydration can quickly lead to death,” said Arno Coerver, Malteser International’s Global WASH advisor. “Additionally, contaminated water used to clean wounds significantly increases the risk of infections for injured individuals.”

Myanmar was battling multiple disease outbreaks before the historic seismic shocks hit the nation this week. Elena Vuolo, the deputy head of WHO’s Myanmar office, told Reuters that “cholera remains a particular concern for all of us,” pointing to an outbreak last year in Mandalay, one of the regions hardest hit by the earthquake.

Malaria and tuberculosis cases spiked sevenfold since the coup in 2021, while HIV infections have grown by 10%, according to WHO data.

“Due to the ongoing shortage of malaria supplies, malaria cases are resurging in several regions and states of Myanmar,” the WHO reported. “Dengue remains a major public health concern, affecting an increasing number of people, mostly children under 15 years of age.”

Vaccination coverage for childhood illnesses was already “persistently low” before the disaster. “An estimated 1.5 million children under-five have missed basic vaccinations since 2018, posing a serious threat to the risk of measles and diphtheria outbreaks and possible re-emergence of polio,” according to WHO assessments.

Now the earthquake has created conditions that could accelerate disease spread. 

“Earthquake-related displacement, limited access to safe water and food, overcrowded displaced populations, poor sanitation, inadequate disease prevention measures and potential movement of rodents into urban areas increase the likelihood of water-borne, vector-borne, and airborne disease transmission and risk of plague re-emergence,” WHO warned.

“Widespread displacement caused by armed conflict, climatic disasters, and ethnic tensions has put IDPs and migrant populations at increased risk of public health threats due to overcrowding, poor overall living standards, and limited health care infrastructure,” the UN health agency added. 

Aid organizations identify clean drinking water, sanitation, medical care, shelter, and access to basic necessities as the most critical immediate needs.

The Red Cross reports operating mobile health clinics, water purification units, and ambulances in Mandalay and Sagaing. WHO has transported essential medical supplies, including trauma kits and essential medicines, to hospitals and first responders in affected regions.

Beyond physical injuries and infectious diseases, the earthquake has inflicted severe psychological trauma on survivors.

“The scars of the earthquake are not all physical,” the Red Cross reported, noting the critical need for mental health and trauma support following the disaster. “The coming days, weeks and months will be critical for the people of Myanmar.”

“Mental health challenges are also a major concern,” WHO confirmed, explaining that the earthquake “exacerbates the mental health challenges because of its sudden and traumatic nature, leading to widespread disruption and amplifying feelings of fragility in an already vulnerable setting.”

Cascading crises

“In the INFORM Risk for 2025, Myanmar ranks 11th out of 191 countries, with a ‘very high’ risk classification driven by extremely high scores for hazards and conflict intensity,” the UN assessed months before the earthquake struck. “If the current trajectory is not reversed, the humanitarian situation in Myanmar is expected to remain extremely dire and further deteriorate in 2025.”

The epicenter was near Sagaing Township, a region that was already hosting one-third of the country’s internally displaced persons due to the ongoing civil war. Nationwide, an estimated 3.5 million people had been displaced since the military overthrew the democratically elected government of Aung San Suu Kyi in 2021, all before the earthquake struck.

Myanmar’s civil war, now in its fourth year, has become the world’s most violent conflict, killing at least 50,000 people, including at least 8,000 civilians, according to the Armed Conflict Location and Event Data Project.

The situation is set to worsen in the coming days, with weather forecasts predicting heavy rains from Sunday through April 11 in the earthquake-affected regions. 

“The monsoon season is right around the corner, it’s arriving in a couple weeks,” said Tommaso Della Longa, spokesperson at IFRC. “Of course, we cannot say the severity of the monsoon season, the severity of the rains, but by experience, we know that this kind of makeshift tent and temporary shelter are not enough to keep people safe. 

“There is a kind of domino effect where there is no proper shelter, where there is no proper water sanitation, where there is no proper health support, then you can have health issues,” Della Longa said. 

Regions hit by the earthquake were still recovering from the devastating floods caused by Typhoon Yagi, which swept across Myanmar and Thailand last year, raising concerns that another severe weather season could be even more catastrophic given the compounded crises of war and seismic damage.

“Imagine a disaster is a hammer,” said Unni Krishnan, global humanitarian director at Plan International. “One disaster has already struck which is the earthquake, then you bring another one called rains, then you bring the cyclone, and the floods and the storm surge. So, you’re talking about a bunch of hammers hitting the same spot again and again.”

Military operations hampering aid

The catastrophic health situation has been compounded by ongoing military operations and restricted humanitarian access. UN High Commissioner for Human Rights Volker Türk reported that the Myanmar military has continued operations and attacks in the aftermath of the earthquake, including airstrikes – some launched shortly after tremors subsided.

“The Office has received reports that the military has carried out at least 53 attacks, including strikes by aircraft and drones, artillery and paramotors in areas affected by the earthquake. At least 14 attacks by the military have been reported since they announced a temporary ceasefire taking effect on 2 April,” Türk stated.

While both the military junta and the opposition National Unity Government have announced ceasefires to facilitate aid operations, the continuing violence has severely restricted humanitarian access.

The humanitarian response faces additional challenges from an information blackout imposed by the military, making it extremely difficult to contact affected communities and assess the situation. Internet and telecommunication shutdowns have severely hampered coordination efforts.

“Sources from the ground describe a catastrophic humanitarian situation in earthquake-hit areas, especially those outside the military’s control, an absence of relief efforts, and a lack of clean water, food, and medicines,” Türk reported. “Fear and shock have augmented the suffering of a civilian population already subjected to four years of military violence since the coup.”

“I urge a halt to all military operations, and for the focus to be on assisting those impacted by the quake, as well as ensuring unhindered access to humanitarian organizations that are ready to support,” Türk said.

For Myanmar’s population, already suffering through years of conflict and inadequate healthcare, the earthquake has turned an ongoing crisis into a catastrophe of historic proportions—one that could have health implications extending far beyond the country’s borders.

“The people of Myanmar have suffered enough,” Türk concluded. “The response to this horrendous disaster must open pathways towards a comprehensive solution that upholds democracy and human rights.”

Image Credits: UNICEF.