Case Study

Background Context

Myanmar’s healthcare infrastructure has deteriorated over decades under military rule, with defense spending consistently prioritized over health budgets. The 2021 military coup triggered a civil war that transformed a weakened system into a full-scale humanitarian crisis. By 2025, the country’s health surveillance and treatment capabilities have essentially collapsed, creating what epidemiologists describe as an “epidemiologic blind spot” in Southeast Asia.

The Crisis Unfolds

The Mae Tao Clinic in Mae Sot, Thailand, established in 1989 after an earlier military crackdown, now operates so close to the Myanmar border that staff can hear artillery fire and see smoke from combat. Since the 2021 coup, patient numbers have doubled on particularly busy days. A nurse with over ten years of experience encountered her first case of diphtheria, a disease previously absent from the region, highlighting how vaccine-preventable illnesses are resurging.

Myanmar ranks among countries with the highest number of never-vaccinated children according to UNICEF. Over 3 million people have been internally displaced by fighting, losing access to basic disease prevention tools like mosquito nets, condoms, and masks. Many shelter in jungle areas infested with disease-carrying mosquitoes, with some patients contracting malaria up to 20 times.

Military Targeting of Healthcare

The World Health Organization documented 67 military attacks on health facilities in Myanmar during 2025 alone. In December, an airstrike on a 300-bed hospital in a rebel stronghold near the Bangladesh border killed at least 34 people. Doctors have gone on strike, budgets have been slashed, and medical professionals have fled. In some settlements, dentists are running hospitals in the absence of qualified physicians.

Cross-Border Contagion

Thailand’s Maesot General Hospital has experienced a 50% increase in caseload, leading to physician burnout and resignations. In 2024, cholera erupted in scam centers operating in Myanmar’s lawless conflict zones. Despite Thailand sending medicines to contain the outbreak, at least four people contracted cholera, including two Thai citizens. A tuberculosis patient working as a cook in a scam center raised concerns about potential transmission during international travel.

Thailand was on track to eliminate malaria by 2024, but the Myanmar crisis reversed this progress, with case numbers rising again. A polio case was confirmed in northeastern Myanmar in summer 2025, threatening the region’s eradication efforts.

Solutions

Immediate Interventions

Border Health Capacity Building: Thailand must expand medical facilities and staffing along the Myanmar border to handle increased patient loads. This includes recruiting additional healthcare workers and establishing temporary field hospitals to prevent system overwhelm. The Shoklo Malaria Research Unit’s “TB village” model, which isolates tuberculosis patients in remote areas, demonstrates one approach to protecting local communities while providing treatment.

Emergency Disease Surveillance: International health organizations should establish cross-border disease monitoring networks to detect outbreaks early. Mobile health teams equipped with rapid diagnostic tools could provide surveillance in areas where Myanmar’s system has failed, focusing particularly on vaccine-preventable diseases and drug-resistant pathogens.

Vaccination Campaigns: Mobile vaccination units targeting displaced populations and border communities could prevent outbreaks of diphtheria, polio, and other vaccine-preventable diseases. These campaigns should prioritize children who have never been vaccinated and adults who missed routine boosters.

Medium-Term Strategies

Regional Coordination Framework: ASEAN nations, WHO, and international NGOs should establish a formal coordination mechanism for Myanmar’s health crisis. This framework should facilitate information sharing, resource allocation, and joint outbreak response protocols. Thailand, Bangladesh, India, and China as Myanmar’s neighbors have direct stakes in containing infectious disease spread.

Humanitarian Health Corridors: Negotiate with all parties to the conflict to establish protected health corridors allowing medical supplies, personnel, and patients to move safely. The targeting of healthcare facilities violates international humanitarian law and must be addressed through diplomatic pressure and documentation for potential future accountability.

Sustained Funding Mechanisms: International donors must commit multi-year funding to support border health services and humanitarian medical operations. The US cuts to foreign aid in 2025 exacerbated the problem, demonstrating the vulnerability of relying on single-source funding. Diversified, sustained funding from multiple donors, regional governments, and international health funds is essential.

Long-Term Structural Solutions

Parallel Health System Development: Support the establishment of health services in rebel-controlled areas, recognizing that centralized government healthcare has collapsed. This pragmatic approach, while politically sensitive, acknowledges on-the-ground realities and serves the humanitarian imperative of disease prevention.

Conflict Resolution Support: The underlying driver of the health crisis is the civil war itself. International diplomatic efforts must intensify to broker ceasefires, humanitarian access agreements, and ultimately political solutions. Regional powers, particularly China and ASEAN members, should leverage their influence to pressure all parties toward negotiation.

Health System Resilience Planning: Once stability eventually returns, Myanmar will need comprehensive health system reconstruction with emphasis on resilience. This includes decentralized healthcare delivery, emergency preparedness, robust disease surveillance infrastructure, and constitutional protections for health budgets to prevent future militarization of resources.

Outlook

Short-Term (2025-2027)

The situation is likely to deteriorate before improving. With no immediate end to the civil war in sight, healthcare system collapse will continue. Border health facilities in Thailand, Bangladesh, and other neighboring countries will face increasing strain. Additional outbreaks of cholera, diphtheria, measles, and other diseases are probable.

Drug-resistant malaria strains may develop as disrupted treatment allows partial medication courses. The tuberculosis treatment interruptions described in the article create ideal conditions for drug resistance emergence. Thailand’s malaria elimination timeline has already been derailed, and polio could re-establish itself in the region after decades of progress.

Medium-Term (2027-2030)

Two scenarios appear most likely. In an optimistic scenario, sustained international humanitarian response, combined with regional pressure and conflict fatigue, could lead to negotiated settlements in parts of Myanmar. This would allow gradual health system rebuilding in stable areas, though full recovery would take years.

In a pessimistic scenario, protracted conflict continues with Myanmar becoming a permanent “epidemiologic blind spot.” Neighboring countries establish long-term border health infrastructure as a new normal, accepting ongoing disease management costs. Regional disease elimination programs for malaria, polio, and other illnesses are abandoned in favor of containment strategies.

Long-Term (2030+)

Myanmar’s health crisis could become a defining case study in how civil conflict creates regional and global health security threats. If drug-resistant disease strains emerge and spread internationally, as has happened with malaria moving from Southeast Asia to Africa previously, the global health community may face decades of consequences from Myanmar’s current crisis.

Reconstruction of Myanmar’s health system, whenever it occurs, will require a generation of effort. The loss of trained medical professionals through emigration, the destruction of physical infrastructure, and the erosion of public health data systems cannot be quickly reversed. Countries that experienced similar collapses, such as Afghanistan or Somalia, provide cautionary examples of how difficult rebuilding proves.

Impact Assessment

Public Health Impact

Myanmar: The domestic impact is catastrophic. Vaccine coverage has plummeted, maternal and child mortality are rising unchecked, and communicable disease control has essentially ceased. The emergence of diphtheria cases where none existed previously indicates how rapidly vaccine-preventable diseases return when immunization stops. With millions displaced and living in jungle areas with poor sanitation and high mosquito populations, the population faces compounding health threats.

Chronic diseases like HIV, tuberculosis, and diabetes go untreated as healthcare access disappears. The article’s mention of patients contracting malaria 20 times illustrates the breakdown of both prevention and treatment. Mental health impacts from trauma, displacement, and loss compound physical health crises but receive virtually no attention.

Regional: Thailand faces the most immediate spillover, with border hospitals experiencing 50% caseload increases and doctors resigning from burnout. The country’s malaria elimination program has been reversed, and cholera cases have appeared in Thai citizens. Bangladesh, India, and China face similar pressures along their respective borders with Myanmar.

The broader Southeast Asian region sees disease elimination programs threatened. Polio, which the region had nearly eradicated, has re-emerged. Resources that could address other health priorities are diverted to managing Myanmar’s crisis. The “TB village” isolation facility in Thailand represents infrastructure and resources needed only because of cross-border disease transmission.

Global: Myanmar’s transformation into an epidemiologic blind spot creates a gap in global disease surveillance networks. Virus mutations, drug-resistant pathogen strains, or novel disease emergence could go undetected until they spread beyond Myanmar’s borders. The historical precedent of drug-resistant malaria spreading from Southeast Asia to Africa demonstrates how localized drug resistance can become a global problem.

International health security frameworks depend on surveillance networks that include every country. Myanmar’s absence from these networks creates vulnerability. If a novel influenza strain, drug-resistant tuberculosis, or other serious pathogen emerges in Myanmar’s population of 55 million people, the world may not know until it appears elsewhere.

Economic Impact

Healthcare Costs: Thailand and other border countries bear substantial costs treating Myanmar nationals. While the Maesot Hospital deputy director frames this as necessary to prevent disease spread, it represents an ongoing fiscal burden. Border regions require enhanced disease surveillance, isolation facilities, and expanded hospital capacity—all expensive infrastructure.

Disease outbreaks have direct economic costs through treatment expenses, outbreak response, and mortality. Cholera outbreaks, tuberculosis treatment, malaria care, and management of vaccine-preventable diseases require resources that governments must divert from other priorities.

Trade and Movement: Disease outbreaks can trigger border restrictions, quarantine requirements, and trade disruptions. The tuberculosis patient working as a cook and potentially traveling internationally illustrates how infectious diseases threaten safe cross-border movement. While not yet resulting in major border closures, continued deterioration could force such measures with significant economic consequences.

Lost Productivity: Myanmar’s economic collapse intertwines with its health crisis. A population battling repeated malaria infections, tuberculosis, and other diseases cannot maintain productivity. The displacement of 3 million people removes them from productive economic activity. The long-term effect is a lost generation of economic development.

Humanitarian Impact

Displacement and Suffering: Over 3 million internally displaced people face daily struggles for survival, with health crises adding to their burden. Access to basic medical care, once taken for granted in urban areas, has disappeared. The article’s description of patients in bamboo settlements counting days in isolation illustrates the human cost.

Families watch children contract preventable diseases. Pregnant women lack prenatal care and safe delivery options. The elderly and chronically ill suffer without medications. HIV patients lose access to antiretroviral therapy, and cancer patients go untreated. These individual tragedies multiply across millions of people.

Healthcare Worker Exodus: Myanmar has lost substantial portions of its medical workforce through strikes, flight, and targeting. Doctors work abroad, in border clinics, or abandon medicine entirely. The article mentions a dentist running a hospital and Burmese doctors working in Thai facilities. This brain drain will hamper reconstruction efforts for decades.

The targeting of healthcare facilities has violated international humanitarian law and created a climate of fear. Doctors and nurses face impossible choices between staying to help patients and fleeing to safety. Those who remain work under extreme conditions with inadequate supplies and constant danger.

Political and Security Impact

Conflict Prolongation: Health system collapse removes a potential incentive for conflict resolution. With no functioning government services to restore, there’s less practical reason for populations to accept military rule. However, the humanitarian crisis also creates desperation that armed groups can exploit for recruitment.

Regional Stability: Myanmar’s crisis tests ASEAN unity and effectiveness. The organization’s principle of non-interference conflicts with the reality that Myanmar’s internal situation threatens member states’ security. How ASEAN responds to this challenge will shape its credibility and future effectiveness.

International Relations: China, India, and other powers with interests in Myanmar face pressure to use their influence constructively. The health crisis adds urgency to existing diplomatic efforts around the conflict. Countries providing humanitarian assistance, like Thailand, may seek greater international burden-sharing and support.

Long-Term Development Impact

Myanmar faces decades of lost development progress. The collapse of health infrastructure, education systems, and governance capacity will take a generation to rebuild even after conflict ends. Children growing up without vaccinations, education, or proper nutrition will carry these deficits into adulthood.

The country that briefly moved toward democracy and development in the 2010s has regressed dramatically. Health indicators that had improved during civilian governance have collapsed. The trust required between populations and health systems, necessary for vaccination campaigns and disease surveillance, has been shattered and will require years to restore.

Neighboring countries’ development plans are also affected as they divert resources to managing spillover effects. Thailand’s malaria elimination program represented significant investment and progress, now undone by events beyond its borders. This demonstrates how regional development is interdependent and how one country’s crisis can undermine neighbors’ achievements.