Myanmar’s runaway virus outbreak is presenting wealthy nations donating COVID-19 vaccines and supplies with a tough choice: work with the generals that overthrew the civilian government or let the situation spiral further out of control.

Since the military took over in a coup more than six months ago, virus infections and deaths have soared. The country has officially disclosed a few hundred fatalities each day for the past month, though doctors say the real numbers are exponentially higher. The true scope of the catastrophe is unknown, as many citizens avoid health care facilities that have recently been the target of military attacks.

Desperation is growing. International aid groups and even the parallel National Unity Government that is challenging the legitimacy of the junta are pleading with other countries to extend humanitarian aid to help Myanmar get control of the situation — even if it means working with the regime that has become an international pariah.