Getting supplies to survivors suffering from a brutal cyclone in Myanmar is now a "race against time" to prevent a disease disaster as some impoverished victims continue to wait for help a week after the storm, experts warned Saturday.
Reports of diarrhea, malaria and skin problems have already surfaced, and health officials fear waterborne illnesses will emerge due to a lack of clean water, along with highly contagious diseases such as measles that are easily spread.
Children, many of whom are now orphaned by the storm, face some of the greatest risks.
The threat is heightened because many people living in the worst-affected Irrawaddy delta were in poor health prior to the cyclone that killed at least 23,000 people and left nearly 40,000 missing, according to state media. Tens of thousands more were left homeless in the secretive military-run country, which is home to one of the world's worst health systems.
'Very, very vulnerable'"The fact that there are people we still haven't gotten to is very distressing to all of us. We don't know how many that is," Tim Costello, president of aid agency World Vision-Australia, said by telephone from the country's largest city, Yangon. "The people are all exposed to the elements, and they are very, very vulnerable. It's a race against time."
The World Health Organization has reported children suffering from upper respiratory diseases, and with next week's forecast calling for rain, there was yet another urgent reason to move quickly. Fears of mosquito-borne diseases such as malaria and dengue fever, which are endemic to the area, also have heightened before the monsoon season begins.
Cholera remains another concern, but there have been no diagnosed cases.
Some victims have been drinking whatever water is available with many freshwater sources contaminated by saltwater or decaying human bodies and animal carcasses. UNICEF has reported diarrhea in up to 20 percent of the children living in affected areas.
But Costello said frustration with the military junta's slow response and restrictions placed on humanitarian aid entering the country has reached a critical point.
"The government initially admitted that this was bigger than them. But now they have said, `While we need more aid, we are the military. We made this nation, and we're very proud of it and we can cope with it,'" Costello said. "It is absolutely clear that they can't."
World's worst health system
Tens of thousands of people die every year in Myanmar, also known as Burma, from diseases such as tuberculosis, AIDS and diarrhea. Malaria alone kills about 3,000 people annually in a country where medical care is too expensive for most people to afford. In 2000, WHO ranked Myanmar's health system as the world's worst after war-ravaged Sierra Leone.
About 90 percent of the population lives on just $1 a day. Millions also go hungry, with a third of Myanmar's children estimated to be malnourished.
"It is an unfortunate reality that this storm hit a country that already had this very marginal ... health system," said Dr. Chris Beyrer, an epidemiologist from Johns Hopkins University, who has worked extensively in Myanmar. "When you have malnourishment with infectious diseases, the fatality rates go up."
He co-authored a critical report published last year that found the government spends only about 3 percent of its annual budget on health, compared to 40 percent on the military. The country's overall ailing health system, combined with the ruling junta's paranoia of foreigners is a cocktail for an even bigger disaster in the storm's aftermath, Beyrer said.
"I think when it comes to this regime, nothing is that surprising," he said by telephone from Maryland. "The fundamental issue is access. This is what we were arguing about for HIV/TB and malaria control five years ago — that it is access and that the international community is ready to help."