How a leprosy organisation became a leading player on landmine response in the world’s most mine-affected country

In 2023, Myanmar overtook Syria as the country with the most causalities caused by landmines, with the country recording just over 1,000 casualties. UNICEF data reports that this increased in 2024, to 1,052 casualties.

In 2024, the majority of those casualties (917), were maimed by a landmine across a total of 651 incidents.

Following the military coup in February 2021, landmine usage in Myanmar has created a humanitarian crisis, with thousands of people requiring assistive devices and ongoing care. Into that void stepped Myanmar's leading leprosy organisation: The Leprosy Mission Myanmar. This is the story of why, how, and what this means for leprosy work in Myanmar.

Why did The Leprosy Mission begin working on landmines?

Human rights imperative

Because persons affected by leprosy often need prosthetics, The Leprosy Mission Myanmar has had expertise in providing such devices since long before the most recent conflict in Myanmar.

In the words of TLM's Country Leader, Dr Zaw Moe Aung, ‘We are bound by the CRPD; we cannot offer prosthetic devices to persons affected by leprosy but refuse other persons with disability. We are both obliged to offer this and it is the right thing to do. What we didn’t realise when we started this work was the scale of the need that was waiting for us with this conflict.'

Access to funds

In a country wracked by conflict, accessing funds is a challenge, as Dr Zaw explains, ‘When the military seized power, Myanmar stopped being a safe place to invest funds. It is now harder for us to access funds, but the needs of persons affected by leprosy have not changed. We have had to search for new funding opportunities and humanitarian funding is one type of funding that is being invested in Myanmar. With humanitarian funding, we have been able to provide for the needs of persons affected by leprosy, whilst also reaching those affected by landmines.’

How did The Leprosy Mission develop into one of the leading players on landmines?

For the team in Myanmar, the process of becoming a leader in this field has been a slow and painstaking one. ‘We have had to find the right materials, the right machinery, the right experts, the right training’, explains Dr Zaw. 'It has taken us a long time and we have to acknowledge the dedication and perseverance of the team who have worked on this.

'At the start of the conflict we had four physiotherapists working on this with TLM Myanmar, but thanks to funding from Humanitarian Mine Action (HMA), we were able to set up a mobile workshop with four more physiotherapists who have received expert training. Today we have 15 technicians and physiotherapists working with us across workshops in Taungoo, Sittwe, and Pakokku, as well as mobile workshops in Kayah State.

'With support from TLM Netherlands, TLM Hungary, and the International Committee of the Red Cross, we have sent our teams to Viet Nam and Cambodia to receive training from people who have learnt this craft as a result of past conflicts in those countries. It has been a long process, but we are now providing about 50% of prosthetic services in Myanmar.

TLM is now providing around 50% of the prostheses available in Myanmar

What needs are being met by this work?

Lifelong care

Dr Zaw speaks of two children who were hit by landmines. One landmine was hidden under the bed of a little girl and a boy of about five years old was hit when looking for firewood. Both of them lost their legs above the knee, both will need extensive physiotherapy and both will need their prosthetics refitted as they grow and throughout their lives as the devices wear and tear. This is true for both landmine victims and persons affected by leprosy.

Holistic care

When a person loses a limb, they require more than just medical attention. While they undergo fitting and physiotherapy, they require a place to stay. For this reason, TLM has built dormitories alongside workshops. Beyond this, patients require counselling, they may need retraining to start a new livelihood, they need support to reintegrate into their communities. Once again, this is true for both landmine victims and persons affected by leprosy.

Inclusion training

Funding for work on mines has included support for inclusion training in Myanmar. The UN's Myanmar Humanitarian Fund has made $5m available to support disability inclusion and action on mines. Using some of these funds, TLM Myanmar has been continuing to support businesses and other organisations in Myanmar with disability inclusion training and mentoring. Leprosy inclusion is a crucial part of this training and has been since before the coup.

What is the future of this work?

‘Once it has started, it is difficult to close this work down,’ says Dr Zaw, ‘If we did that, we would be leaving people without a net. Both landmine victims and persons affected by leprosy need ongoing support throughout their lives.

'For us, it would be more interesting to grow that work. The conflicts in Cambodia and Viet Nam have led to training centres where physiotherapists and technicians come to learn from countries across the region, including our own teams. This training costs between $50-60k and, as we now have the expertise in our team, perhaps this is an opportunity for us to develop ourselves into an institution that can train and certify professionals.

'This would mean more trained people in Myanmar who could provide for the disability needs of persons affected by leprosy and also the resources to continue our work to end leprosy transmission in Myanmar.

‘We know that these resources will be needed for many years to come. We want to make sure no person in Myanmar lacks the support they need.’

What does this mean for TLM Myanmar?

'Leprosy will always be our priority. When the coup happened, our first worry was how we will continue to care for persons affected by leprosy and work towards ending the transmission of the disease.

'As funding for leprosy work withdrew, work on landmines became a lifeline for our work on leprosy. We have been able to continue our support for leprosy disability services and disability inclusion at the same time as continuing to meet a fast-growing need in our country. Whatever the years ahead hold for Myanmar, we will continue to find new ways to continue our leprosy work.

‘I want to finish by commending our physiotherapists and technicians. They have been working in deeply challenging circumstances and have persevered throughout. Last April we despatched a team of six people to a location we cannot disclose so they could operate a workshop in an area of the country with great need. They did not take a break or return home until December. That is the kind of dedication that is required of us in Myanmar. These teams deserve great respect for what they risk and what they sacrifice to provide for people in need.’

Days before the publication of this article, Myanmar suffered a 7.7 magnitude earthquake. There have been no casualties within our teams and the communities we support. However, hundreds are estimated to have died, with many more injured.

At the time of publication, TLM's team in Myanmar are in the process of establishing what needs must be met amongst our teams and the communities we support.

At this early stage, it is reasonable to assume that the need for prosthetics will increase rather than decrease over the coming weeks. However, our workshop in Taungoo was damaged by the earthquake and we are awaiting the outcome of a building assessment.

Once we have established the needs that we must meet, TLM's teams will be running emergency appeals. If you would like to contribute to those appeals, please search for The Leprosy Mission through a search engine or on social media.