Image: A deaf counselor in Mandalay, Myanmar, provides mental health counseling to deaf survivors of the March 2025 earthquake. (Aye Pyae Sone/CPI)
Disasters create barriers for deaf people that emergency responses rarely anticipate. In Mandalay, deaf community workers are showing what anticipating them looks like.
On 28 March 2025, a 7.7 magnitude earthquake struck central Myanmar. More than 3,600 people died, and OCHA estimated that over 17 million people were living in affected areas across 57 townships. Mandalay and surrounding areas of central Myanmar took the worst of it. What the response did next is a case study in why disability-inclusive humanitarian response has to be planned rather than improvised.
Daw Thida*, a deaf sign language interpreter in Mandalay, was lying in her room when the bed began to shake so violently she was thrown off it. “I couldn’t hear any sounds. I only felt the movement,” she says. She lost her hearing as a nine-year-old after a course of strong medication damaged her nerves.
“Since I couldn’t hear anything, I also didn’t feel afraid. I just stood in the doorway and observed,” she says. She watched water slosh out of the family aquarium and household items come down. When the first tremor stopped she went to check the tank, found it cracked, and was trying to rescue the fish when the second one hit. That was when she remembered to get out of the house.
“People nearby likely tried to warn me, but I couldn’t hear them,” she says.
Daw Eindra*, who is also deaf, was at a machine embroidery workshop winding thread. She felt the ground shake and saw stock falling, and could not get to her feet. “I didn’t fully understand how dangerous the situation was. I couldn’t even stand up and had to squat down,” she says. “Hearing people ran away, but I remained in place because I couldn’t hear the noise.” Her daughter was at her aunt’s house, and she went straight there as soon as she could move.
Deaf interviewees return to this point themselves, and U Win*, who is deaf and taught sign language at a school near Mandalay, puts it plainly. “For us deaf individuals, since we cannot hear, we might find the shaking unusual without immediately realizing what is happening. We often only make it outside if family members physically pull us to safety.”
That is the shape of the problem throughout. A great deal of emergency information travels by sound, through warnings, shouted instructions, public announcements and registration calls, and it’s rarely designed to reach people who cannot hear.
What happened next compounded this problem. Registration for relief was announced by voice, in public, in the chaotic days after the quake.
U Win toured the city and found deaf residents who had received nothing. “Data collectors were unaware of their presence, and the deaf individuals couldn’t hear calls for registration or realize that a survey was taking place,” he says.
Deafness carries no visible marker. “Since deaf people appear physically indistinguishable from the general population, others often don’t realize they have a disability,” he says. Daw Thida puts the same point more directly: “While physical disabilities are often visible, deafness is an invisible disability.”
So U Win and Daw Thida, who are married, did the work themselves. They gathered names, completed forms and collected photographs of damage for more than 80 deaf people, then submitted the list to disability support groups. That the community had to organise its own count is the clearest measure of the gap.
The earthquake also separated deaf residents from the information channel they depend on most.
“After the earthquake, both phone and internet connections were cut off, making it difficult for deaf individuals to communicate with one another,” U Win says. News about the response was circulating online, and they could not reach it. Even buying a phone top-up card became difficult in the weeks that followed.
What television carried was not much help either. Daw Thida found the sign language interpretation on broadcasts hard to follow, a problem Ko Kyaw* describes from the other end: broadcasts tend to use the signing style common in Yangon, which deaf viewers in Mandalay can find confusing.
Written information is not the fallback it appears to be. “Many deaf individuals face challenges with reading and often struggle to fully comprehend written text due to limitations in deaf education,” U Win says. “There are many who cannot read well.” Schooling shapes what reaches a person in an emergency decades later.
So the community fell back on itself, passing information between households by whatever means still worked. In some areas, people were only included in distributions because a ward administrator thought to add them to the list. Daw Thida’s own account of that period is short. “Unfortunately, we didn’t receive any aid whatsoever,” she says.
The economic damage compounded it. Workplaces closed, and deaf people who had been employed lost their jobs along with their income.
A situation analysis conducted shortly after the earthquake found comparable barriers across the disabled population as a whole. Transport to distribution points was inaccessible. Long queues were physically punishing for people with mobility impairments. Information about the response, including where and when distributions would happen, was largely unavailable in accessible formats. The analysis also described a charity-based approach to distribution that undermined the dignity and equitable access of people with disabilities.
It identified institutional causes as well. Organisations of people with disabilities were not included in the rapid needs assessments that humanitarian actors carried out, were under-represented in emergency coordination bodies, and were seldom consulted. Disability awareness among aid workers was found to be inadequate.
None of this is unique to Myanmar. A 2015 global consultation surveyed 484 people with disabilities in humanitarian settings. Three-quarters said they did not have adequate access to basic services such as water, shelter, food or health care. Only half reported receiving specialist services such as rehabilitation, assistive devices or interpreters. UN research estimates disaster mortality among people with disabilities at two to four times the rate of the general population.
Nearly six million people in Myanmar, about 13% of the population, live with one or more disabilities. They were already being left out.
A 2016 study found that two-thirds of children with disabilities were not in school, against one-fifth of children generally. Those gaps do not close with age; they determine, years later, whether a written warning or a printed distribution notice reaches someone at all. Data from 2015 showed adults with disabilities were more than twice as likely to be unemployed. Women and girls with disabilities fare worse than men on both counts.
Myanmar’s wider crisis has deepened all of it. As public health services decline, specialist and disability-inclusive care becomes harder to find. As the economy struggles, people already facing discrimination in hiring are pushed further out.
An earthquake does not create these gaps. It widens them, quickly, at the moment they matter most.
Psychological support was not part of the initial response for anyone. U Zaw* manages a mental health and psychosocial services (MHPSS) project for an organisation working with Community Partners International (CPI). His team distributed relief supplies in the earthquake’s aftermath, and saw what the material aid could not reach.
“Many communities were unfamiliar with the concept of mental health support, but through the process of delivering essential relief and rescue, we realized that mental health assistance is critically needed,” he says.
Within that general absence, deaf survivors faced one more barrier, and it was language. Counselling depends on talking, and Myanmar has too few sign language interpreters with the vocabulary for it. Schools for the deaf exist in only four cities, and signs vary between them.
The project runs across townships in Mandalay and other areas of central Myanmar, with a team of 40 community workers. Two are deaf and four have physical disabilities. Two sign language interpreters support the work, one of whom is deaf.
Daw Thida, U Win and Daw Eindra now work on it. Daw Thida is the project coordinator as well as a community worker and interpreter. U Win and Daw Eindra lead sessions.
The project serves disabled and non-disabled survivors alike, but having deaf community workers leading the deaf sessions is crucial, because deaf people rarely open up to hearing strangers. “Generally, deaf individuals tend to confide only in those they are close to,” U Win says.
Daw Thida warns against reading deaf composure as wellbeing. “Deaf individuals experience a wide range of emotions, outwardly, they may appear cheerful, but they often harbor deep inner feelings,” she says.
Before sessions, community workers and interpreters rehearse. They prepare the messages, practise the signs and agree which terms the group will understand, because mental health vocabulary in Myanmar Sign Language is still being built.
Groups run to seven or ten people and last around 90 minutes. Community workers explain what mental health is, discuss coping strategies and make the point that nobody in the room is alone in what they are feeling. Then come breathing and grounding exercises, including one that works through the five senses.
Afterwards, every participant completes the PHQ-2, a two-question screening tool for depression. A score of three or above leads to individual sessions, two per month. Those sessions end with the remaining seven questions of the PHQ-9, and a score of ten or higher triggers a referral to a professional service that works free of charge in hard-to-reach areas.
The community workers are clear about the limits of what they offer. “As volunteers, we can only provide basic information about mental health awareness,” U Win says. “We inform them that they can seek professional support through referrals if they wish.”
Referral is where the system thins out. Only four people had taken it up by the time of interview. Some decline because they do not want to visit a hospital or clinic, some because phone counselling does not appeal, and some because travel is not safe or affordable.
Daw Khine* taught at a school for the deaf for nearly two decades and now interprets for the project. She describes a steep learning curve. “Mental health work requires time, not just to learn the terminology, but to truly understand the core concepts,” she says. Her teaching habits work against her here, because years of using short, simple phrases for deaf children make it harder to find the right words for this material.
U Win had stopped working after the pandemic and describes struggling with depression in that period. “During the time I wasn’t working, I felt discouraged, believing there was nothing I could do to help,” he says. Working as a mental health counselor for the deaf community has given him a way back. Since the earthquake, though, he still does not sleep well, and has found his own arrangement: a dog that sleeps beside him. “So that if it reacts to a strange sound, I will know what is happening,” he says.
Daw Eindra lost her husband, who was also deaf, about two years ago, and raises their school-age daughter alone. She took the role to learn about mental health and pass it on to deaf friends, and for income.
Much of her work happens before anyone sits down. Getting deaf participants into a room takes effort that hearing sessions do not require, so she compiles lists of deaf residents, checks availability, and invites people by video call. When she cannot reach someone directly she passes a message through others, or goes to the house.
She is candid that the training did not land at first. “Initially, I struggled to understand what was being taught. It was only after participating in the actual mental health sessions that I grasped the concepts discussed earlier,” she says.
She also notices the difference between the two kinds of session she runs. Deaf participants ask her to repeat anything unclear. Hearing participants, reached through an interpreter, rarely do, and she says she feels nervous every time she leads one of those.
Daw Eindra describes what people arrive carrying, and very little of it is the earthquake alone. “Deaf individuals face various mental health challenges, including emotional distress, marital discord, financial and employment difficulties, and alcohol addiction,” she says. Rising prices and wages that do not cover the cost of living sit underneath much of it. Deaf parents struggle to afford school fees and clothes for their children.
For Ko Kyaw*, deaf since birth, the sessions introduced a concept he had never encountered. “Before this, I had never heard about mental health, so I came to learn and gain some knowledge about it,” he says. “Initially, I was dealing with a lot of distress, but after joining the mental health sessions, I learned how to alleviate that distress through breathing exercises.”
He is measured about what the format allows. “During the discussion, I was able to share my true feelings. However, I didn’t discuss much else because I was among others,” he says. He scored low enough on the screening to skip individual sessions, and says the breathing and physical exercises suited him best.
He has one clear request of the people running them. On the explanation of mental health topics, he says, “I would like them to be more precise and specific.”
Some subjects are not on the agenda yet. Daw Eindra wants sessions on gender-based violence and domestic violence, which she says occurs in the deaf community and usually goes unreported out of shame.
Beyond the deaf community, U Zaw is candid about who the project does not reach. It has no capacity for people with intellectual disabilities, though it invites family members, who carry heavy caregiving stress. Participation by people with visual impairments has been negligible. People with physical disabilities face the plainest barrier of all, which is getting to the venue.
Transport is a recurring theme. Deaf participants may be mobile but cannot always afford fuel. Where transport allowances exist, actual costs sometimes exceed them. U Zaw describes people with limited mobility being carried to distribution sites by others during the relief phase, because they feared missing out if they did not appear in person.
Children are the largest gap. The project works with people aged 16 and over, because its approach was not designed for younger participants.
Stigma persists too. “Some individuals feel embarrassed about seeking mental health counseling due to the limited familiarity with the concept of mental health in the community and the associated stigma,” he says.
Train more sign language interpreters, first and above everything. Without them, deaf people cannot reach any service that runs on conversation, mental health included. U Zaw makes the same point about the emergency phase: interpreters are needed when disaster information is disseminated, when relief is distributed and when public announcements are made. Daw Thida has spent a career on this, helping develop standardised Myanmar Sign Language and advocating for its recognition in disability law before that work stalled.
Make emergency information visual. Text alone does not work, because deaf education in Myanmar leaves many adults with limited reading. “Regarding information on natural disasters, using visual aids such as images would be more effective than relying solely on text, as many deaf individuals face challenges with reading,” Ko Kyaw says.
Pay for transport. Choose accessible venues. Put organisations of people with disabilities in the room when needs assessments and coordination happen, rather than after. The post-earthquake situation analysis reached the same conclusions from a different direction, calling for information materials in accessible formats, emergency hotlines and feedback mechanisms deaf people can actually use, disaster preparedness training designed with disabled people’s organisations, and evacuation centres built to be usable.
Above all, go looking. The failure running through these accounts is not that anyone turned deaf residents away. It is that a registration announced aloud never reached them, and nobody went to find out who had been missed. Reaching people is only the start. Knowing what a deaf household actually needs, and responding to that rather than to an assumption about it, is the rest of the job.
Deafness is also only one part of this. Each type of disability brings different barriers, and a response that solves for one has not solved for the rest. Inclusion means planning for the whole spectrum from the outset, not adding groups to the list as they are noticed.
Community Partners International (CPI) strengthens, equips and connects local organizations in Myanmar, Bangladesh and Thailand providing health, humanitarian relief and well-being services to conflict- and poverty-affected communities.
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