In Myanmar, surprising recovery

A woman roles cigars in a factory, near Yangon, in Myanmar on Monday. (The Associated Press)

Resourceful villagers and private aid averted starvation and rise of disease

International Herald Tribune                                                                  

YANGON, Myanmar: More than six weeks have passed since Cyclone Nargis swept through the Irrawaddy Delta in southern Myanmar, leaving a trail of flattened villages and broken lives and arousing international sympathy that turned to anguish as the military government obstructed foreign aid.

Now doctors and aid workers who have gained access to remote areas of the delta are returning with a less pessimistic picture of the human cost of the delay in reaching survivors.

They say there have been no signs of starvation or widespread outbreaks of disease, and the number of lives lost because of the military government’s slow response to the disaster appears to have been very few.

Relief workers here continue to criticize the government’s secretive posture and obsession with security, its restrictions on foreign aid experts and the weeks of dawdling that left bloated bodies befouling waterways and survivors marooned with little food and supplies. But the specific character of Cyclone Nargis, the hardiness of villagers and efforts by private citizens to offer assistance mitigated against further death and sickness, aid workers say.

The storm that struck the night of May 2 and 3 killed great numbers of people, probably upward of 130,000, most of whom drowned in a tidal surge. But those who survived were not likely to need urgent medical attention, doctors say.

“We saw very, very few serious injuries,” said Frank Smithuis, head of mission in Myanmar for Médecins Sans Frontières, a medical charity with a large presence in the country. “You were dead or you were in O.K. shape.”

When the cyclone blew through the low-lying delta it swept away bamboo huts and in the hardest-hit villages left almost no trace of habitation.

Survivors who stayed afloat during the storm sometimes found themselves many kilometers from their homes when the waters receded. But unlike other natural disasters such as the recent earthquake in China, survivors were less likely to be injured by falling bricks, furniture, masonry or other heavy objects.

This, say doctors, aid workers and diplomats, appears to be the primary explanation why villagers were able to stay alive for weeks without any assistance. As they awaited aid, survivors, most of whom were fishermen and farmers, lived off of coconuts, rotten rice and fish.

“The Burmese people are used to getting nothing. They just did the best they could,” said Shari Villarosa, the highest-ranking U.S. diplomat in Myanmar, formerly known as Burma. “I’m not getting the sense that there have been a lot of deaths as a result of the delay.”

Aid workers stress that of the estimated 2.4 million survivors affected by the storm thousands remain vulnerable to sickness and many are still without adequate food, shelter and supplies.

But their ailments remain – for now – minor. Medical logs from Médecins Sans Frontières show that of the 30,000 patients they treated in the six weeks after the cyclone most had flesh wounds, diarrhea or respiratory infections. The latter two afflictions are common in rural areas across Southeast Asia even in normal times.

The number of people in need of serious medical attention was judged low enough that officials at Merlin, a British medical charity that has operated in Myanmar for three years, canceled plans to bring in a team of surgeons in the days after the storm, said Paula Sansom, the manager of Merlin’s emergency response team. Those patients who did require serious medical attention were treated at a local hospital by government surgeons.

For several weeks after the disaster the government prevented all but a handful of foreigners from entering the delta. Some journalists, including two reporters for this newspaper, were able to enter the country and slip past police checkpoints to reach remote corners of the delta and conduct interviews in dozens of villages.

Now a more comprehensive picture of the damage is being assembled by a team of 250 officials led by the Association of Southeast Asian Nations. They plan to release their findings next week.

The number of people killed in the storm may never be known. The government has not updated its death toll since May 16, when it said 77,738 people were killed and 55,917 were missing.

In a country that has not had a full census in decades, it is not even certain how many people lived in the area before the storm. Itinerant laborers who worked in the salt marshes and shrimp farms were probably not counted among the dead, aid workers say.

What is known is that in many villages women and children died in disproportionate numbers, said Osamu Kunii, chief of the health and nutrition section of the United Nations Children’s Fund in Myanmar.

“Only people who could endure the tidal surge and high winds could survive,” Kunii said. In one village with a pre-cyclone population of 700, all children under 7 died, he said.

With only minimal food supplies in villages, aid workers say residents of the delta will require assistance until at least the end of the year. The United Nations, after weeks of haggling with the Myanmar government for permission, is now using 10 helicopters to deliver supplies to hard-to-reach places and alerting relief experts at the earliest signs of disease outbreaks.

Doctors have treated thousands of cases of diarrhea, which can be especially dangerous for infants and young children, but it has not reached critical levels.

“The delta is already a diarrhea endemic area,” said May Myad Win, a general practitioner who works for Médecins Sans Frontières and spent 25 days in the delta treating an average of 25 patients a day.

“I can’t say it was an outbreak. It was not as severe as we feared,” she said.

Despite accelerated relief efforts, the military government continues to make it difficult for aid agencies to operate.

Last week the government issued a directive that accused foreign aid agencies and the United Nations of having “deviated from the normal procedures.” The government imposed an extra layer of approvals for travel into the delta, effectively requiring that all foreigners be accompanied by government officials.

“What we wanted to do was to get some degree of simple coherency in the overall relief effort,” said Chris Kaye, the head of operations in Myanmar for the World Food Program, a UN agency active in the effort.

“Instead they’re changing the goal posts,” he said. “We have a whole set of new procedures.”

UN officials are literally redrawing maps of the delta using satellite images from Google Earth because the most detailed maps they have are from 1949. They suspect the government has maps that are more up to date but is unwilling to provide them for security reasons.

The Myanmar government says it issued 815 visas for foreign aid workers and medical staff in the month after the cyclone. But some aid workers, such as the U.S. Agency for International Development’s disaster assistance response team, were never allowed in.

The United States has accused the military government of “criminal neglect” in its handling of the cyclone. Privately, many aid workers here agree with that assessment. The military, widely disliked among Myanmar’s citizens, did not have the means to lead a sustained relief campaign, aid workers say.

But relief workers say the debate over access for foreigners and the refusal of the government to allow in military helicopters and ships from the United States, France and Britain overshadowed a substantial relief operation carried out mainly by Myanmar citizens.

Médecins Sans Frontières, which has operated in Myanmar since 1993 and has more than 1,000 staff members in the country, sent hundreds of truckloads of aid to the delta in the days and weeks after the storm, including 50,000 portable water containers, two million kilograms of rice and beans, and 150,000 plastic sheets for shelter.

Smithuis, the Médecins Sans Frontières director, said he had the same “access problem” for his foreign staff as other agencies, so he sent Myanmar citizens, including 252 aid workers and 48 doctors.

“I thought it would be best not to send any white staff,” Smithuis said.

Relief efforts also benefited from the foresight of agencies that had stockpiled supplies before the cyclone. Although Myanmar officials haggled with the United Nations and foreign donors for weeks after the disaster, many key supplies were already in the country.

Unicef was able to ship water purification tablets, essential drugs and other supplies to the delta immediately after the storm from warehouses in Yangon that it had stocked in 2006 and replenished in February. The World Food Program drew from its local stockpiles and organized 60 flights into the country, delivering more than 15,000 tons of food to the delta.

Merlin, the British charity, had a warehouse stocked with water purifiers, essential drugs and metal sheeting in Labutta, a town in the heart of the delta. The roof blew off during the storm but “a lot of it was salvageable and a lot was very appropriate,” said Ben Mascall, a manager in charge of logistics.

Merlin had also trained and supplied 547 health workers across the western part of the delta in the two years before the storm. Those who survived the cyclone helped treat the sick and wounded. But in an indication of the scale of the disaster, only about half of the health workers have been accounted for.


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