Managing indirect disaster-related deaths after the 2025 Myanmar earthquake: A public health proposal

The 2025 Myanmar earthquake caused extensive destruction. Beyond 3,800 direct disaster-related deaths (direct DRDs) and 5,100 injuries, indirect disaster-related deaths (indirect DRDs) remain a persistent concern. Indirect DRDs are deaths caused by secondary health effects after a disaster, rather than by the direct physical impact of the hazard itself. They may arise through disrupted healthcare delivery, deteriorating living and evacuation environments, interruptions to chronic-disease management, and psychosocial stress. Evidence from Japan, including the 2011 Great East Japan Earthquake and the 2024 Noto Peninsula Earthquake, shows that prolonged displacement and repeated disruptions in health and social systems can sustain mortality risk over time. Based on these insights, this Perspective synthesizes publicly available United Nations and humanitarian reports to identify risks of indirect DRDs in Myanmar. Months after the earthquake, many survivors remain in fragile shelters with degraded water, sanitation, and hygiene conditions. Health facilities were damaged or closed, healthcare access remains constrained, and vulnerable groups-including children, pregnant women, older adults, persons with disabilities, and patients with chronic diseases-face sustained risks. These conditions increase the likelihood of infectious disease outbreaks, chronic disease decompensation, heat illness, and psychosocial distress. Priorities include continuity of essential services, access to noncommunicable disease medicines, maternal-child health and psychosocial support, improved shelter and WASH conditions, standardized documentation of disaster relevance in medical records and death certification, and sustained, coordinated recovery. Framing indirect DRDs as preventable and measurable can strengthen protection of vulnerable groups, resilience, accountability, and dignity.