Responding to infectious diseases in Burma and her border regions

In January of 2007 an international scientific conference "Responding to Infectious Diseases in the Border Regions of South and Southeast Asia" was conducted by our collaborative group, and hosted by the Faculty of Tropical Medicine of Mahidol University in Bangkok, Thailand. The conference was something of a landmark, in that it attempted to bring together groups and individuals working on infectious diseases in Burma/Myanmar proper, those working on her border regions, and concerned representatives and scientists from the Burma neighbor states of Thailand, China, India and Bangladesh. Some 190 representatives from 9 countries attended, with representatives from Government, Academia, NGOs, relief groups including MSF France and MSF Switzerland, WHO SEARO Office and representative from WHO and UNAIDS in Burma/Myanmar, the U.S. CDC and USAID, and European donors including DFID. The diseases of concern included HIV/AIDS, TB, malaria, neglected tropical diseases prevalent in Burma including filariasis, anthrax, Japanese encephalitis, and the emergent epidemic of Avian Influenza. What made this effort unique, and perhaps uniquely challenging, is that Burma/Myanmar was at the time, and remains at this writing, a deeply divided country, where scientific and humanitarian efforts have all too often been forced to choose between work "inside" the country and so with the approval or engagement of the ruling military junta, or "outside" the control of the junta, in partnership with non-Burman ethnic minority and democratic forces. As a measure of how divided the country can be, those on differing ends of the political spectrum do not agree on the name for country or her major cities and states. Those presenting data on Myanmar often have little accurate or current information on the border regions and may face government censorship over what data they do have – while groups working on the borders often know a great deal more about their areas of operation – but may be unwilling to openly divulge where and in what domains they are active for security reasons. While all agree that Burma's peoples are in urgent need of health interventions and greatly expanded efforts to control and mitigate infectious diseases, the debate about how best to deliver those interventions has also been polarized, and there have been few, if any, opportunities for those engaged in the many and varied efforts underway to meet, share their efforts and undertakings, and discuss the potential for comprehensive responses. Given the politicization of humanitarian and health efforts in this troubled country, it seemed prudent to engage the many entities involved in a scientific meeting, where the diseases of importance could be addressed by the best available science and public health program approaches, and where health care providers working in challenging political environments might meet in a shared spirit of professionalism, mutual respect, and tolerance. The conference was "off the record" to maximize the security of those most vulnerable, such as representatives of ethnic nationality health organizations whose political leaders have not signed cease-fire agreements with the ruling junta, and representatives from groups working under junta auspices in Burma proper, and so subject to surveillance, as is generally the case for Burmese professionals when they attend international meetings. Two exceptions were made to this rule: we agreed to a post-conference session with the press to share de-attributed outcomes with the lay media, and we offered to the speakers and participants that we would assist those interested in turning their talks into manuscripts for this special series in Conflict and Health. The papers presented here are among the core outcomes of the conference, and we are delighted to be able to present them to a wider audience.