Myanmar is still reeling from the devastation of Cyclone Nargis in 2008. It was rated the eighth deadliest cyclone ever. Assessments suggest that more than 2.4 million people were severely affected and 23 per cent of all respondents to the post-Nargis joint assessment for relief, recovery and reconstruction (PONJA)(1) reported that family members had observed psychological problems related to the cyclone. The Myanmar Red Cross Society (MRCS), well known for being one of the first on the scene following cyclones, floods, fires and other natural disasters, showed once again how it was one of the leaders in the national response. Over the last 60 years, 11 severe tropical cyclones have made landfall in Myanmar. Floods remain a seasonal hazard, especially for the river basins of the Chindwin, Ayeyarwady, Thanlwin and Sittaung.
The International Federation of Red Cross and Red Crescent Societies launched an emergency appeal to assist the MRCS in its response to the Nargis-affected communities over a three-year period (2008-2010). This work is ongoing and has received much appreciated support from the Red Cross Red Crescent Movement. However, it is important not to lose sight of the other humanitarian concerns outside of the cyclone-affected area. There are significant issues of vulnerability to which the MRCS and its committed volunteers continue to respond across the country. The 2009-2010 plan has been developed with the intention of integrating the valuable lessons and resources made available to the MRCS in response to its worst natural disaster in living memory, into the plan for 2009-2010 for the rest of the country. The International Federation will work closely with the MRCS and partners to ensure a coordinated approach.
In the current response, Myanmar has a unique opportunity to address recurring risks in particularly hazard-prone areas across the country. The promotion of disaster risk reduction (DRR) born from the International Federation's experiences in disaster response, recovery and preparedness activities, acknowledges that preparing for and coping with disasters need to be augmented by reducing risks and building safer communities. With the support of national networks that were developed in contingency planning workshops over the last year and technical support from Movement and external partners operating bilaterally and multilaterally, this plan outlines how the MRCS will be strengthened to respond to issues outside the delta region. The MRCS will take the opportunity to explore with interested partners various practical possibilities that could help prevent disasters - this may include planting trees, improving levy banks or mitigating the impact of disasters such as improving evacuation routes and identifying safe areas.
This plan considers the unique opportunity of mobilizing the unprecedented resources now available in-country and builds upon that potential for other areas of the country in need of MRCS support. Working with states and divisions across all sectors, the MRCS will assist communities to recognize that they are able to do much for themselves to mitigate the impact of disasters and address the root causes of natural hazards - this will enable them to sustain their basic functions and structures despite the recurring risks they face.
The MRCS understands that building safety and resilience is a long-term process that requires commitment. There is much that can be done to adapt to future problems by building on what is already known. This plan supports the concept that being safe coupled with building resilience means that there is a greater chance of increasing health and development outcomes.
This plan will be implemented taking into consideration the essential support required for ongoing community-based health initiatives, and further builds upon existing resources, expertise and organizational strengths. It is designed to improve the capacity of the national society to work with communities to prepare for and respond to future disasters and health-related hazards. This plan will also allow the MRCS to build upon the support received so far, to further develop its capacity across all sectors. It focuses on community-based disaster preparedness; health promotion and community mobilization; understanding that communities are frequently the 'experts' in responding to issues of concern in preparing, responding and especially, preventing diseases, health issues and hazards.
One of the underlying principles of this plan is that the impact of disasters can be significantly reduced through advanced planning and investment.
The total budget for 2009 is CHF 1,446,213 (USD 1,321,949 or EUR 921,155) and for 2010 is CHF 1,357,775 (USD 1,241,110 or EUR 864,825).
Nargis has drawn attention to Myanmar's vulnerability to high-impact low-frequency natural hazards 'and also the need to undertake a range of actions for reducing, mitigating and managing disaster risks in the future'.(2) To this end, Myanmar has formally committed itself to key priorities for action identified in the Hyogo Framework for Action (2005-2015).
The Myanmar Department of Meteorology and Hydrology has unpublished data(3) that suggests a gradual warming of the Bay of Bengal over the last 40 years. However, it is worth noting that of the 11 severe tropical cyclones to hit Myanmar over the last 60 years, nine have made landfall outside the recently severely-affected delta region. This illustrates one of the significant reasons to include ''post-Nargis'' responses outside the area directly affected.
Cyclone Nargis provided an insight into the lack of preparedness within many communities. There was some important preparedness work undertaken by communities but this action was in anticipation of smaller-scale hazards. There is a need for a more comprehensive approach towards community-based disaster management (CBDM) that builds on local knowledge and maximizes the potential use of community resources to address a variety of disasters, emergencies and hazards.
In addition, the diversity in Myanmar is reflected in its estimated 170 different ethno-linguistic groups.(4) Recent publications confirm that despite improvements in some indicators, the health status of the people of Myanmar remains of concern with noteworthy differences in health and nutrition, depending on where people live(5).
Government expenditure on health is low and estimated at 0.2 per cent of the GDP (2005). Malaria remains a major health risk with 70 per cent of the population living in endemic areas, and the country continues to struggle with tuberculosis (TB). Myanmar is now ranked 19 among 23 countries designated as having a ''high tuberculosis burden country''. Conservative estimates of the number of people living with HIV start from 240,000 with others estimating the scale of the problem to be far greater. There is limited information on the causes of child morbidity but acute respiratory infections, diarrhoea, meningitis and malaria are believed to be among the primary causes. Malnutrition is also a serious concern. Priority health issues certainly include HIV, malaria and TB, but the incidence of less prominent diseases such as children succumbing to beriberi due to vitamin deficiency, is also worthy of further analysis. Household surveys indicate that possibly 30 per cent of the population has insufficient means to cover basic food and essential needs.
Health services are provided through the public and private sector with significant numbers of the population relying on traditional medicine. Public health services are centralized at the township level(6). Generally, this
comprises a 16- to 50-bed hospital at township level, with one or two station hospitals and four or more rural health centres providing health care services for a population of 20,000-25,000 people. A mid-wife or a community health worker is often the primary resource at sub-rural health clinics. The ministry of health is reported to have 839 hospitals, 86 primary and secondary health centres, 1,473 rural health centres and 6,599 sub-rural health clinics. UNICEF estimates that 60 per cent of all visits to health services are to the private sector, with public sector doctors also providing services through private clinics.
Formal social welfare systems in Myanmar are very limited. In this context, community-based responses are an important part of community resilience and coping strategies. In rural areas, 17 per cent of households have female heads.(7) ''Traditions and customs expect a woman to control the purse, to prepare food, make clothing and look after the children.''(8) After many natural disasters, women's vulnerability is exacerbated as they continue to maintain the burden of caring for the family as well as the extra burden caused by the loss of traditional income.