Five-year-old May May Hlaing came down with a fever on Tuesday. She started vomiting on Wednesday. Her parents rushed her to the Yangon Children's Hospital on Thursday morning. She never saw one of the 17 paediatricians at the hospital who were overwhelmed with the numbers of children turning up. She died of dengue fever in her mother's arms before night.

Dengue is caused by a mosquito called Aedes egypti. In some countries there are control programmes. In army-ruled Myanmar, where more than half the government's budget is spent on the military, and less than 0.4 percent is spent on health care ($0.50 per person), there is no such programme. Not surprisingly dengue outbreaks hit the impoverished country hard and fast.

Throughout Myanmar more than 1000 people a week, most of them children, were diagnosed with dengue in July, according to government statistics. However this figure is only for public hospitals. In Yangon alone there are over 1000 private clinics.

One paediatrician who runs a private clinic in Yangon reported seeing more than 100 children a day in the first 10 days of August. "I started work every day at 6am and didn't finish until 11pm. It hasn't been this bad since the outbreak in 1996," he says. In 1996, tens of thousands of people were affected.

The cost of treating dengue is $1.50. The average Myanmar family makes $1.64 a day. But even if a family is able to pay for tests, the medicines may not be available. One paediatrician who didn't want to be identified said medicines were not stockpiled in advance for an epidemic.

And where are the humanitarian agencies? World Health Organisation (WHO) held its first coordination meeting on August 3 in Yangon. At around the same time, the U.N. children's agency UNICEF started distributing leaflets with information on how to prevent dengue, identify the symptoms and what to do at the first sign a child has the disease.

However, the problem is less likely to be one of awareness so much as a lack of planning and prevention at a larger scale. Governmental and humanitarian agencies with the mandate, the responsibility, and the capacity to prevent epidemics such as the current one simply did not do their job.

You might be surprised that U.N. and international aid agencies are allowed to work in Myanmar, a country which has been ruled by the military since the 1960s. The authorities keep close tabs on the agencies but they can undertake needs assessments and distribute relief in close coordination with the government.

Dengue is cyclical and surges in the number of mosquitoes carrying the disease are predictable so it shouldn't be impossible to plan for an outbreak.

Cases in April and May were nearly double what they were the year before, official statistics show. In June, WHO's regional office reported there was a risk of a major outbreak.

But WHO's first coordination meeting to combat the epidemic was four months after the numbers of children showing up at public hospitals with the disease started to exceed average levels.

In August, UNICEF received a request from the government for $55,000 to buy pesticides, fumigation equipment, and continue education campaigns. However, UNICEF and WHO officials said that even if they had ordered the pesticides and equipment then, it would have been more than a month, possibly two, before it was available in the country. By then it would have been October and the rains would have stopped. Instead, the agencies have decided to focus their efforts on being better prepared for next year.

If nothing is done and the trend continues, 2007 will be the worst outbreak in a decade. For the hundreds of children, maybe thousands, who will have died it will have been too little, too late.

Reuters AlertNet is not responsible for the content of external websites.