July 20, 2008

MSF was among the first organizations to provide large-scale assistance to victims of Cyclone Nargis, which hit Myanmar and devastated the Irrawaddy Delta on May 3.

Myanmar 2008 © Eyal Warshawski

Survivors of Cyclone Nargis wait in line to receive rice in Phyapon.


Doctors Without Borders/Médecins Sans Frontières (MSF) was among the first organizations to provide large-scale assistance to victims of Cyclone Nargis, which hit Myanmar and devastated the Irrawaddy delta on May 3. But one month after the region was destroyed, MSF teams were still encountering villages where survivors had not received any significant aid.

“We managed to send our first team to Pathein, in the delta, on May 5, and started first aid to victims further south the next day,” says Dr. Frank Smithuis, MSF’s head of mission in Myanmar. With immediate mobilization of its Burmese staff, MSF was able to provide aid on a large scale from the start. About 250 local doctors, nurses, and logisticians were soon working in the delta. Teams traveled by boat from one village to another, bringing food, shelter, water, and sanitation material, and giving hundreds of medical consultations.

“From the moment we left the boat, the villagers would come and follow us around,” says a 27-year-old Burmese physician who worked during the first two weeks in Ngapudaw, in the western part of the delta. “They’d help us to find a house to do consultations and set up the distribution. We saw a lot of patients with stress symptoms—aching limbs and hypertension—especially in villages where the destruction is on a massive scale and many people had been killed by the flooding.”

The first relief supplies were purchased locally, and the need for a major influx of food and equipment was immediate. On May 12, the first MSF cargo plane was permitted to land in Yangon, soon to be followed by four others, carrying a total of 500 tons of therapeutic food, plastic sheeting to build shelters, mosquito nets, pumps, and water treatments units. The aid was loaded onto trucks, transported to the delta, and most was transferred onto boats for distribution in the affected villages.

Eventually, MSF teams were able to reach the southern central part of the delta. These remote areas and islands are accessible only by small boats or on foot. Villages there have been basically erased from the map, and survivors are living in unimaginably harsh conditions. Emmanuel Goué, MSF field coordinator, returned in early June from Setsan, a five-hour boat trip south of Bogale, and described total devastation. “A giant wave during the cyclone simply flattened the area; 90 percent of the houses have been destroyed. We have there an estimated 21,000 people, including numerous children and elderly, who live in the middle of nowhere, in an ocean of mud. Everything has been broken and they have not seen any aid coming for one month.”

Myanmar 2008 © MSF\

MSF staff treats a cyclone survivor in Bogaley.

In relief operations such as this one, for a disaster comparable in scale to the 2004 tsunami, MSF would usually send to the field a large number of experienced international staff—doctors, emergency coordinators, and water and sanitation experts. However, initial restrictions imposed by Myanmar authorities officially prevented foreign experts from working in the delta in the first three weeks after the cyclone.

A few days before UN Secretary General Ban Ki Moon came to Yangon and announced on May 23 that the Myanmar government had agreed to grant international aid workers unhindered access to the delta, MSF had actually obtained formal authorization for eight international staff to carry out activities there. “That was a first, but obviously not enough,” says Dr. Smithuis. “Given the scale of the disaster, we need more experts in the field. Our Burmese staff are very capable, but they have no experience working in emergencies. They have done a tremendous job, but they need expertise to support them.” International staff presence is also an added guarantee that aid remains independent and is distributed objectively. One month after the disaster, more travel authorizations for MSF staff had just been received.

In May, MSF medical staff carried out more than 17,000 consultations, with an average of 500 per day during the last week. At first, more than half the patients were treated for injuries caused by the cyclone, but very soon other pathologies linked to the dire conditions in which people lived dominated the consultations. MSF teams have seen a high number of respiratory infections and diarrhea cases, which could be linked to a lack of access to clean water, absence of shelter, and exposure to heavy rains in recent weeks.

“In many areas, especially where death rates have been high, we are seeing more and more people suffering from mental health problems,” says Alena Koscalova, MSF medical coordinator in Yangon. “Some can not talk anymore; others are highly depressed after they lost their loved ones. In the coming weeks, we will try to address this problem by giving trauma counseling and psycho-social support with mental health specialists.”

MSF’s 36 mobile teams in the delta have not reported any disease outbreaks or alarming rates of malnutrition. Four weeks after the relief operations started, food, shelter, and access to clean water remain the biggest needs. Food supplies have been largely insufficient as specialized agencies have not been able to set up proper distribution channels, and in many areas, people have barely received enough to survive, if anything at all.

Displaced families have been moved out of temporary settlements in schools and monasteries. They are now in overcrowded camps set up by the government on the periphery of the main urban centers or back in their villages where there is a lack of adequate assistance. Despite initial constraints in access to the affected areas, MSF has, as of June 4, provided support to 300,000 victims of the cyclone. But much remains to be done, and the emergency is far from over.

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