Myanmar’s largest city has been rocked by cholera in recent months – but the regime has largely covered up the outbreak by avoiding naming the disease and including confirmed cases in its tallies of acute watery diarrhoea.
By ANT PWEH AUNG | FRONTIER
U Tun Win Than, 48, began experiencing intense, recurring diarrhoea just a few hours after finishing lunch on July 6. Overwhelmed by worry, his wife Daw Moe Moe Htay tried to alleviate his suffering with oral rehydration salts, but watched helplessly as his condition worsened.
He began vomiting regularly and developed painful leg cramps; by 1am he was too weak to move.
Moe Moe Htay contacted a volunteer emergency assistance team based in Yangon’s Dawbon Township, where her family lives, which helped bring him to Yangon General Hospital.
“I was terrified of losing him if he didn’t receive medical attention in time,” Moe Moe Htay told Frontier, asking that she and her husband be identified by pseudonyms for security reasons, due to the regime’s efforts to cover up the ongoing cholera outbreak.
At Yangon General Hospital, Tun Win Than was sent to a special ward for severe diarrhoea patients, where he joined nearly 40 others exhibiting similar symptoms. He required at least four intravenous fluid drips a day over the next two days to compensate for fluid loss, but his condition improved and the frequency of his diarrhoea gradually decreased.
But their relief was short-lived: on July 9, a rectal swab returned a positive result for cholera, necessitating Tun Win Than’s immediate transfer to Waibargi Specialist Hospital for Infectious Diseases in Yangon’s North Okkalapa Township.
Tun Win Than was part of what appears to be a widespread and ongoing cholera outbreak – but you wouldn’t know it by reading state media, which has seemingly sought to downplay and cover up the problem by using “acute watery diarrhoea” as a catch-all term to describe anyone suffering from diarrhoea whether or not they have been diagnosed with cholera.
Healthcare workers, volunteers and ordinary residents reported far more cases of cholera than the regime’s official figures, blaming the outbreak on unsanitary tap water and a public healthcare collapse since the military seized power in the 2021 coup.
Cholera by any other name
Cholera is a waterborne infectious disease caused by a particular bacteria transmitted through contaminated water or food. Despite the availability of a cholera vaccine and antibiotic treatments, the disease persists in Myanmar.
Cholera symptoms – which include watery, milky-white diarrhoea, vomiting, leg cramps and irritability – typically manifest within two to three days of exposure, and can kill within hours if left untreated. While acute watery diarrhoea, or AWD, can be a symptom of cholera, it doesn’t necessarily indicate the presence of the disease – and the regime has seemingly taken advantage of that ambiguity.
From July 6 to 22, the health ministry published daily figures of diarrhoea cases in Yangon. The July 9 report, for example, said 60 diarrhoea patients were admitted to Yangon hospitals on July 8, six of whom were diagnosed with severe diarrhoea. The report added that the “outbreak in Dawbon Township is under control and the infection rate is declining in Thaketa Township”.
According to these daily announcements, 1,199 diarrhoea patients were admitted to government hospitals in Yangon Region during this time period, but none of the reports mentioned cholera. To give the regime some credit, spokesperson Major-General Zaw Min Tun confirmed six cholera cases on July 6 – the only time the junta publicly acknowledged the presence of the disease.
But a volunteer from the Kanaung Funeral and Emergency Assistance Team in Insein Township said there have been so many cases of cholera that the Waibargi Specialist Hospital had to stop accepting patients in the third week of July because it was overwhelmed.
“It’s common knowledge that most government hospitals are treating cholera-confirmed patients in their isolation wards,” said the volunteer.
The medical superintendent of the Waibargi Specialist Hospital did not respond to requests for comment.

Dr Lwan Wai, founder of the Yangon Medical Network, said the regime is obscuring the true situation. Lwan Wai is one of tens of thousands of public healthcare workers that went on strike to protest the 2021 coup. The YMN is made up of striking healthcare workers like him, and those still working in the public sector who leak information.
Lwan Wai said the network confirmed more than 100 cholera cases and 10 deaths across 14 townships between late June and the end of July.
This would come as little surprise to those who followed the military’s response to the COVID-19 pandemic, particularly the devastating Delta wave in 2021. A Frontier investigation found the regime likely undercounted the death toll by hundreds of thousands.
Aid workers in Yangon’s Thingangyun Township also confirmed a cholera outbreak there. A volunteer at a local civil society group said there were 70 cases as of July 21, while a staffer from a national-level humanitarian organisation said there were 150 confirmed patients as of August 15. Both mentioned two deaths in Kyi Pwar Yay ward.
“In mid-July, the number of infected people increased greatly – an average of more than 10 people a day,” said the volunteer with the local group.
An official from the Shwe Myinttar Emergency Assistance Association, meanwhile, said a 10-year-old boy died of cholera in Shwepyithar Township in the second week of July.
The outbreak continues
The health ministry updates suddenly stopped on July 22, which may have led some to conclude the diarrhoea outbreak, ostensibly limited to a few townships, had come to an end.
But this appeared to be just a new phase in the cover-up. On August 14, the World Health Organization released a report on the “Myanmar Acute Watery Diarrhea/Cholera Outbreak”. Despite the headline, the report was frustratingly vague on the question of cholera.
The WHO said that as of August 8, a total of 2,261 people had been hospitalised with AWD in Yangon, with the most affected townships being Dawbon, Thaketa, East and West Hlaing Tharyar, Botahtaung and Thingangyun. It said 15 people had died, but the cause of the death was “unknown” and that cholera infection was confirmed in “some” of the diarrhoea cases. The WHO did not respond to requests for comment.
International organisations have come under great pressure to follow regime directives in order to maintain access.
In a clear sign that the outbreak was far from over, the WHO held a “high-level meeting” with junta health officials on July 31 to discuss a plan to “contain” the outbreak and “avoid spill-over in neighboring states/regions”.
Healthcare workers and volunteers also confirmed the outbreak was ongoing.
“The junta has not been able to control the diarrheal outbreak,” said Lwan Wai at the end of July. “The number of cases is still increasing.”
The staffer at a national humanitarian organisation said cases started dropping in mid-August in Thingangyun, but “are still being reported throughout the township”.
A volunteer from another emergency assistance group in Insein Township told Frontier that as of mid-August, cholera was still occurring in the township at a rate of about one new case every two days.
YCDC water quality questioned
Tun Win Than recovered and was discharged from the Waibargi Specialist Hospital on July 12. His wife, Moe Moe Htay, suspects that the cause of her husband’s illness was contaminated drinking water from the roadside shop where he had eaten lunch.
She blamed the Yangon City Development Committee for distributing water that was sometimes “dirty” and black in colour.
“The smell of the water is bad. We also see scum in the water, and sometimes it’s muddy,” she said, adding that YCDC officials should regularly inspect the water distributed through its pipelines and faucets.
Other Dawbon residents agreed, with one saying the drinking water is “not clean” and has “a bad smell”, while another criticised “inadequate, unsanitary” sewage management practices, including the disposal of waste in close proximity to drinking water sources.
Daw Thwe Naing Oo, deputy head of the YCDC’s water and sanitation engineering department, denied responsibility.
“I assure you, that is not true at all. We filter the water through various processes until it is purified. Only then do we chlorinate it,” she told junta media. “We have been using this system for a long time, not just during this diarrhoea outbreak. We chlorinate the water at a rate of four milligrammes per litre following WHO guidelines.”
But the August 2021 issue of Water Quality Research Journal concluded that Yangon’s public tap water system, which dates back to the 1840s, failed to meet “the minimum effective concentration of chlorine”, leading to “microbial contamination of tap water”.
Tests cited in the report showed that 95 percent of tap water delivered to homes was contaminated with Escherichia coli, which generally doesn’t pose a danger to people, but does often indicate the presence of other disease-causing bacteria, including those that cause AWD and cholera.
“According to researchers from the city’s health research department, acute diarrhoea in children under the age of five years due to drinking-water contamination is prevalent in Yangon,” the report said. “Substantial effort is needed to improve the YCDC tap-water supply system, including frequent quality monitoring in the service area.”
Moe Moe Htay said that despite the risks, many residents of Dawbon Township have no choice but to use tap water.
“People can’t afford to buy purified drinking water from shops. And then if an outbreak of diarrhoea or cholera occurs in a densely populated place like Dawbon, it’s hard to control its spread,” she said.
While some pointed the finger at YCDC, Yangon Medical Network founder Lwan Wai said the blame for the outbreak ultimately lies with the health ministry. He said the ministry failed to disseminate information and educate the public about cholera, took no preventive measures to avoid the outbreak and, once it occurred, was not prepared to deal with the crisis.
“One reason is lack of manpower,” he said, adding that more than 44,000 healthcare workers are still on strike. “Since the coup, government hospitals have been staffed by people with questionable healthcare qualifications.”