On May 2, 2008, Cyclone Nargis, a Category 4 storm of enormous force, brought high winds and 12-foot storm surges. Heavy rains destroyed much of the fragile infrastructure of the Irrawaddy Delta region of Burma. The ruling Burmese military regime has reported upward of 29,000 lives lost in the storm itself, over 42,000 people still missing, and as many as 1.5 million left displaced. Available accounts of survivors and the limited number of international observers in the region suggest that the initial loss of life was likely substantially greater. The United Nations estimates some 220,000 missing and 63,000 to 101,000 dead, though these figures are anticipated to rise. While some 200,000 people may have been reached with assistance thus far, the vast majority of survivors, more than a week after the cyclone, remain without sufficient food, water, shelter, medication for the sick or means of escape from flooded regions. The secretary general of the UN, Ban ki Moon, has expressed “deep concern” and “immense frustration” with the unacceptably slow response to the crisis by the government of Myanmar. The next wave of death is set to take hold as thirst, starvation, untreated injuries and infectious diseases pose an increasing threat to population health.
Regions and populations vulnerable to the cyclone were estimated using Geographic Information Systems (GIS) based models that were subsequently overlaid with spatially distributed population data. Geographic vulnerability models were based on storm path, estimated storm surge derived from the cyclone data, and elevation. Models included all townships within 250 kilometers of the hurricane path, and yielded an affected area of more than 10,000 square kilometers. Spatially distributed population data for at-risk areas from the Global Rural Urban Mapping Project (GRUMP) at CIESIN, Columbia University, were overlaid with GIS-based vulnerability models and aggregated to estimate the affected population. Vulnerability was approximated by a score that reflects proportion of land area and population at risk.
Overall, an estimated 3.2 million people were affected by Cyclone Nargis, the majority of which were in Ayeyarwady (1.8 million) and Yangon (1.1 million) administrative divisions; at least 100,000 people in both the Bago East and Mon divisions were also affected. Overall, 20 percent of the population in the four divisions was affected by the cyclone, with Ayeyarwady Division being hardest hit, with an estimated 36 percent of the population affected. The townships with the highest vulnerability scores are illustrated in the map below; however, it is important to note this is a relative measure based on proportion of land area affected. The greatest impact is anticipated in the areas where the storm first made landfall, notably the townships of Labutta and Bogale, where over 200,000 people are thought to have been affected.
Major health threats for cyclone survivors in the immediate phases of storm recovery include waterborne diseases such as typhoid, which has already been reported from some areas in the Delta, and potential outbreaks of dysentery, cholera and E. Coli. Measles outbreaks in children, which are common in settings of mass displacement, are also a possible threat. Measles is known to have a high case fatality rate among malnourished children—UNICEF estimates that one-third of Burma’s children under age 5 were malnourished before Cyclone Nargis—and measles vaccination rates for the affected areas are well below thresholds required to prevent an epidemic. Vector-borne diseases are also an important health concern. Mosquito-borne diseases, particularly malaria and dengue fever, were prevalent in Burma before the storm, and their risk is now compounded by huge numbers of people sleeping outside and surrounded by water; more than 80 percent of malaria cases in Burma are P. falciparum, the most deadly form of the disease. Food-borne diseases, from eating poor quality, old or spoiled food, are also a potential health risk which is compounded by the lack of cooking fuel and equipment among much of the affected population. Lastly, two diseases endemic in Burma and spread by rodents—plague and leptospirosis—also must be considered as potential health risks. Plague is a particular concern, since rodents who have survived the storm will also seek the same dry ground where people will gather, and rodents, fleas and displaced populations historically have lead to epidemics of plague.
Disease outbreaks have not occurred following the majority of tropical cyclones in the past several decades, primarily because of timely humanitarian response, which incorporates immediate prevention strategies including provision of adequate water and sanitation, and vaccination campaigns. The underlying population health status of the Burmese population and environmental factors place the population at increased risk of disease. In the aftermath of Cyclone Nargis, where humanitarian assistance is delayed and woefully inadequate in scale, the risk of disease outbreaks is especially high.
International guidelines on human rights and natural disasters cite the right of all affected populations to evacuation and other lifesaving measures, protection against negative impacts of natural hazards, and access to adequate food, water, shelter, sanitation and health services. The primary duty and responsibility to provide such protection and assistance lies with national authorities, but where the capacity and/or willingness of national authorities is insufficient to provide these basic protections, the international community has a humanitarian imperative to respond. In the case of Cyclone Nargis, the international community has responded with multiple offers of humanitarian assistance and human expertise. The military regime of General Than Shwe has, however, rebuffed many of these offers—more than a week after the storm, the junta continues to restrict visas, limit international observers and insist upon relying solely on its own response— an effort which, by all accounts, is markedly inadequate.
What do the existing human rights conventions say about the responsibility to protect those in need? The most relevant convention is arguably the 1976 International Covenant on Economic, Social and Cultural Rights. Burma is not a signatory to this covenant, so is not bound to it in international law. But many of its neighbors and allies, including China, India and Thailand, are signatory states. This convention includes Article 12, the most articulated statement we have on the right to health care access. The covenant posits that signatory states “… recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Steps to be taken to realize this right include: the improvement of all aspects of environmental and industrial hygiene; the prevention, treatment and control of epidemic, endemic, occupational and other diseases; and the creation of conditions which would assure access to medical services for all and medical attention in the event of sickness. Burma has ratified the Convention on the Rights of the Child (in 1991), which mandates that no child be denied health services. So it is under statutory obligation to at least not inhibit health access to the children who have survived the cyclone and are now in need of relief and treatment. Until Cyclone Nargis, the marked lack of health care access in Burma and the regime’s poor record of responses to HIV, TB and malaria epidemics received little international attention. This has changed abruptly as the international community has witnessed the intransigence of the regime, and its priorities of secrecy and control over human health and well-being.
Do Burmese citizens deserve protection from epidemic diseases, such as the diarrheal disease outbreaks underway already in the flooded Delta? Yes. Do they have the right to basic necessities such as food, water, shelter and medical attention which the international community and humanitarian assistance teams now waiting for visas in Burma’s neighbor states can help provide? Again, they clearly do. The limitations placed on these forms of humanitarian assistance on the part of the Burmese junta arguably amount to human rights violations. Rights violations against civilians have been a reality of life under the generals for many years in Burma, where a UN Special Rapportuer for Human Rights was appointed under Kofi Annan—but rarely has the world seen this regime’s actions and attitudes so openly exposed.
But once again, the people of Burma are rising to a huge task. Relief efforts are underway by many private groups and citizens organizations. Our local partner on the ground, Emergency Assistance Team—Burma, has eight relief teams with five persons each working in Rangoon and the Delta. These teams are trained in rapid assessment and response. They are adapting to needs on the ground: water purification, food distribution (food and other essentials need to be purchased—as survivors are being charged for relief), clothing, cremations, house repairs and emergency medicine. They are trying their best to fulfill responsibility to protect, even if their government is failing to do so. Donations to support JHU and their partners in cyclone relief can be made at the Center for Refugee and Disaster Response’s Make a Gift page.
Authors of this press release include Chris Beyrer of the Center for Public Health & Human Rights and Shannon Doocy and Courtland Robinson of the Center for Refugee and Disaster Response (CRDR). Maps and vulnerability indices were developed in collaboration with Yuri Gorokhovich of Lehman College, CUNY, with the support of a Human and Social Dynamics Grant from the National Science Foundation (No. 0624106). The authors would like to thank Debra Balk from Baruch College, CUNY, and Gilbert Burnham of CRDR for consultation; CIESIN for population data; and GIST, WebRelief, UNOSAT, CGIAR-CSI for supplying GIS data and satellite imagery.
Inquiries on estimated population at risk and vulnerability maps can be addressed to Yuri Gorkhovich (email@example.com) at Lehman College, CUNY, or Shannon Doocy (firstname.lastname@example.org).
Map 1 (high resoultion jpg)
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Public Affairs media contact: Tim Parsons at 410-955-6878 or email@example.com.