5 May 2025
The March 28, 2025, earthquake that struck central Myanmar was one of the most devastating in the country's modern history. A 7.7-magnitude tremor shook the Sagaing Fault, flattening buildings across Mandalay, Sagaing, Naypyidaw, and surrounding regions. The number of casualties reported varies across sources, ranging from 3,770 fatalities and 5,106 injuries to 5,352 fatalities and 11,366 injuries. But the disaster's impact extends far beyond visible destruction. It revealed how layers of vulnerability—across infrastructure, health, insurance, and social protection—interact to compound harm when risks are not managed holistically.
Before we delve further, it is essential to acknowledge that capacity constraints matter. Myanmar entered the disaster with an estimated GDP per capita of US$1.2k for 2024, about 18% lower than the peak in 2021 due to a contraction and kyat depreciation. Since the February 2021 military intervention, various sanctions and measures have resulted in a foreign-exchange squeeze and loss of external credit, leaving the government financing about 80% of its deficit domestically, shrinking the fiscal space available for investment in long-term risk-reduction.
Donor trends matter too – overall humanitarian funding for Myanmar dropped sharply in 2024, forcing WFP to cut food assistance for more than 1 million people—a warning that disaster-prevention budgets are unlikely to attract large new grants without fresh international engagement.
Infrastructure Collapse—and Its Downstream Effects
Structural collapse was immediate and widespread. In Mandalay, a 12-storey apartment block pancaked. In Sagaing, religious structures and entire villages were flattened. A major bridge connecting Mandalay and Sagaing collapsed into the Irrawaddy River, severing critical supply routes and delaying rescue.
Some losses could potentially have been reduced with resources and sustained enforcement. Experts have long highlighted seismic risks in central Myanmar, including Mandalay, and the difficulty of updating older structures in a rapidly expanding, largely informal housing market. This was especially the case before the 2012 issuance of the provisional national building code and the 2016 introduction of the full national building code. However, given the fiscal and resource squeeze since 2021, even well-intentioned agencies struggled to enforce the codes.
Assessments following the 2012 earthquake also pointed to low compliance and widespread structural vulnerabilities. Given resource constraints, the limited scale of retrofitting or zoning enforcement meant that many critical structures—homes, hospitals, schools—were rarely designed to survive a major quake.
Constrained investment capacity in risk reduction measures is one of several factors that is believed to have contributed to increased casualties alongside the quake's shallow depth and rapid urban growth. The enforcement gaps are not purely a question of political will – the post-2021 fiscal squeeze reduced inspection staff and capital budgets, making systematic retrofitting or on-site checks nearly impossible.
Rapid in-migration to Mandalay and Yangon has outpaced formal housing supply for a decade. UN-Habitat estimates tens of thousands of low-income families live in informal rentals or squatter settlements without access to mortgage finance or building-code inspections. Small developers and owner-builders dominate this segment, so risk reduction depends as much on micro-credit and affordable retrofit kits as on state regulation.
A Fragile Health System, Stretched to Breaking Point
Myanmar's health system was among the most acutely affected sectors.
The earthquake severely damaged healthcare infrastructure, with at least three hospitals totally destroyed and over 20 others sustaining partial structural damage. Mandalay General Hospital, a major 1,000-bed facility, was evacuated after being declared unsafe; medical teams set up makeshift operating rooms in outdoor tents, treating patients on hospital lawns with limited resources.
Chronic under-investment is partly fiscal – health's share of the national budget has remained below 3% since FY2020, reflecting competing priorities and constrained revenues. In a country where 70 % of all health spending comes straight from patients' pockets, the quake merely exposed this long-standing structural weakness.
The World Health Organisation (WHO) reported urgent shortages of trauma supplies, surgical kits, and essential medicines in the immediate aftermath. Health workers, many displaced or personally affected, struggled to cope with the overwhelming demand. Approximately half of all healthcare facilities in the affected areas were damaged or non-operational.
Displacement and crowded conditions heightened disease outbreak risks, with the WHO specifically warning about cholera and other waterborne diseases, a particular concern given recent outbreaks in Mandalay. Extreme heat (around 38°C) and anticipated rainfall also increased the threat of vector-borne diseases like dengue and malaria.
Health Access, Insurance, and Financial Risk
Myanmar's health system is predominantly financed through out-of-pocket costs. According to 2021 data, approximately 70% of total health expenditures come directly from households (out-of-pocket). The Social Security Board's Health and Social Care scheme is the only social health insurance in the country, covering less than 2% of the population. There is no universal health coverage scheme, and the fiscal constraints further disrupted funding and capacity in the public health sector.
In the wake of the earthquake, this meant that many families had to pay, if they could, for transportation, surgery, medication, and long-term care. For lower-income households, these costs were unmanageable. In disaster settings, where income sources are also disrupted, medical impoverishment is a major but often invisible consequence of risk events.
The Hidden Toll of Mortality
The disaster also resulted in a significant mortality shock. Many of the deceased were breadwinners—teachers, shopkeepers, transport workers—leaving behind spouses, children, and elderly parents without financial support. Yet life insurance penetration in Myanmar is negligible, well under 0.1% of GDP. There is no formal government program offering compensation to families of deceased disaster victims.
This absence of survivor benefits means that thousands of households are now exposed to long-term economic insecurity. Families may fall into debt, withdraw children from school, or reduce consumption, impacts that persist for years. Studies show that mortality shocks in low-income households often drive intergenerational poverty if no formal protection mechanisms exist.
The Protection Gap Is Systemic
Myanmar's disaster was not simply about missing insurance—it was a convergence of systemic risk factors:
- Unsafe housing and public infrastructure
- Under-resourced health systems with limited surge capacity
- Absence of health or life insurance
- Lack of social safety nets or fiscal buffers
These weaknesses reinforce one another. When hospitals collapse, mortality rises. When households lose both shelter and income and have no access to care or financial support, recovery becomes extremely difficult. And when governments have no disaster fund or contingent financing, in part because sanctions and reduced tax receipts have eroded fiscal buffers, the response is delayed and underfunded.
Myanmar's experience illustrates that the impacts of one disaster risk event can span all three levels of disaster management measures, from risk reduction, insurance and social protection, to fiscal risk financing, and span other risks, in this case, health and mortality.
None of the disaster management measures is sufficient alone, but together, they can dramatically reduce disaster impacts. It is no longer enough to consider disaster risk events in isolation when planning for disaster management – other risks such as health and mortality must be considered holistically, to ensure the impacts of one disaster event will not be felt for generations to come.
A Call for Integrated Risk Management
Building resilience in such contexts requires cross-sectoral coordination:
- Engineering agencies must work alongside public health planners to identify and retrofit hospitals and schools in seismic zones.
- Finance ministries must incorporate disaster risk into national budgeting, including pre-arranged credit and insurance mechanisms.
- Insurance regulators and social policy designers must collaborate to expand households' access to life, health, and disaster coverage.
The goal is not to eliminate risk but to ensure it does not cascade into avoidable suffering and poverty. The Myanmar earthquake demonstrates how untreated risk multiplies and how its costs are disproportionately borne by the most vulnerable.
Planning with Clarity
To support this, GAIP is developing a practical framework to help policymakers take an integrated, holistic approach to protection gaps across all risks and risk management measures.
In line with this, policymakers will also benefit from a platform that brings together data on expected economic losses from multiple risks—earthquakes, floods, epidemics, mortality, health, etc.—and compares them to existing risk management measures. Such tools could inform national strategies, prioritisation, and investment.
