Viewpoint: By Jean-Sébastien Matte and Joe Belliveau, MSF operations managers One year ago, the global spotlight fell on Myanmar as Cyclone Nargis struck, leaving 140,000 people dead or missing and many more destitute. Even though critics rightly condemned the late and inadequate emergency response, many today silently overlook the harsh reality of the wider health crisis throughout the country. Every year, tens of thousands of people in Myanmar are dying from treatable diseases because of an extreme lack of basic medical care due to government inaction and international reluctance to engage in humanitarian assistance.

Slideshow photos courtesy : MSF, Marco van Hal, and Chris de Bode.

Slideshow: Nargis - A Window to a Wider Health Crisis Médecins Sans Frontières (MSF) reacted immediately to Nargis, bringing medical care, food and other essential items to survivors within 48 hours. But like other aid agencies, our efforts were hampered in those critical first days as foreign emergency specialists were denied access to the affected Delta area. The international community was rightly outraged, and some predicted many more deaths in the absence of immediate large-scale assistance. The subsequent death count in the Delta did not rise to the scale predicted, and eventually an unprecedented number of organizations became operational in the Delta, committed to meeting the immediate and longer-term needs of these still vulnerable people. In stark contrast, chronic health crises go largely unchecked in much of the rest of the country.  Major diseases like AIDS, malaria and TB kill tens of thousands each year, yet Myanmar receives hardly any official aid — just $3.50 Cnd per person per year — resulting in few aid agencies on the ground. There is no excuse for this dearth in assistance. It may not be easy, but it is possible to provide meaningful impartial assistance to people in Myanmar while also maintaining resource accountability. Unfortunately, most donor governments seem to prefer a general policy of disengagement from the country, even when it comes to life-saving assistance. Unless this changes, the death toll will continue to mount.                Of course the lack of international aid does not absolve the government of Myanmar for not meeting its responsibility to address the health care crisis. As far as MSF could see, the government’s response to Nargis was certainly slow and inadequate, but in the rest of the country its response has been worse. It spends just 0.3 per cent of its GDP on health, the lowest percentage in the world, and at the same time creates a difficult environment for international nongovernmental organizations. The combined result leaves the country with the lowest life expectancy and the highest rates of under-five mortality in the region, according to WHO, and a place where major diseases like malaria, AIDS and TB rage.  Malaria, a disease that is relatively easy to treat, is one of the number one killers in Myanmar due to a lack of good and affordable diagnosis and drugs. Likewise, HIV/AIDS kills thousands of people every year due to a severe lack of available antiretroviral treatment (ART); about 76,000 people urgently need ART yet only 14,000 of them receive it, most of it provided by MSF. We have lobbied for a rapid scale-up of treatment but the government program remains small and nongovernmental organizations have shied away from the commitment that comes with providing ART. Myanmar also has among the highest rates of TB worldwide, with the government reporting nearly 134,000 known TB cases in 2007. The national TB program is underfunded, while the unregulated private sector is both costly and leads to grossly substandard care. The result is high treatment failure rates leading to increased drug resistance.  By June 1, the government is expected to submit a proposal to The Global Fund to Fight AIDS, TB and Malaria. If successful, there will be new possibilities for responding to these diseases. However, the needs are so vast that even with this support an estimated 80 per cent of the outstanding needs will remain unmet. In human terms, this means tens of thousands of preventable deaths. Therefore it is crucial that other donors, including the Three Diseases Fund and the Global Disease Fund, recognize the huge gap in assistance and extend or add their support.   Although late, international agencies eventually poured into the Delta following Cyclone Nargis, which led to a far higher concentration of aid than anywhere else in the country. This evident commitment is crucial for the survivors of Nargis, many of whom will remain vulnerable for years to come. But there are tens of thousands more people throughout the country who will not survive HIV/AIDS, malaria or TB this year without access to the proper treatment. The responsibility to ensure people receive treatment lies first and foremost with the government of Myanmar which is falling far short. But one failure should not be compounded by another. The people of Myanmar cannot afford to wait while the international community withholds essential assistance in deference to a policy of non-engagement.   

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