Francisco Diaz, director of Doctors Without Borders/Médecins Sans Frontières (MSF) logistics department in Paris, went to Guatemala to work with the MSF teams responding to Tropical Storm Stan. Below he speaks about the conditions he found and MSF's response.

Tropical storm Stan is a major national crisis in Guatemala. Even Hurricane Mitch, which hit the country in October 1998, was less devastating. Tens of thousands of people were affected by the storm and its consequences: floods, landslides and mudslides. As is often when responding to a natural disaster, the key for MSF is to target our response carefully, and therefore to conduct multi-pronged needs assessments.

Needs assessments are essential as in any type of intervention

The living conditions of the affected population are horrific and many are isolated and geographically widely dispersed. We launched exploratory missions in several areas: in the Chinquimulilla and Jutiapa regions in the south east as well as in San Marcos and Tacana in the south western part of the country.

According to official statistics, for example, there were 15,000 victims in the Chiquimulilla region, an area of about 10 miles, encompassing 42 villages, with nine health centers. I was part of one of the first teams to go to three sites in the Chiquimulilla region: La Bomba, and further down the valley two other affected villages: Las Pozas and La Rubia.. All three villages are isolated and flooded. A nearby river overflowed several hundred yards, destroying everything. The poorest villages are also the most vulnerable because they are less well equipped. There's nothing but mud. We had to travel across fields because the road was impassable, with 10 inches of water.

Guaranteeing quality of medical care and water supply

The first evaluations gave us a general sense of the affected populations' needs and the situation of the local health facilities. During those missions, we also provided first aid support, distributing medical supplies, blankets, drinking water, and water chlorination equipment.

Our objective was to start by assessing health centers and collecting, for each village, the following data, among other information: the status of drug supplies, access to water and the extent of damage, particularly with respect to housing. First of all, we want to be sure that health centers are providing high-quality medical care. When needed, we supplied medicines and equipment. Access to water is, once again, vital. Some of the health centers I visited, for instance in La Bomba, had no more water because the storm had destroyed the pump.

Once the first round of exploratory missions is completed, we decide where to intervene. In this case, we decided to work the Chinquimulilla district, an area where no other organization was present and where populations were in the process of returning home to harsh living conditions. Our intervention will bring relief to the 3,000 families in the area.

A second exploratory mission to refine needs assessment

The second assessment phase was as crucial as the first one since people had returned home and needs had changed. We focused our intervention on donation of drugs and medical equipment to the nine health centers of the Chinquimulilla district, water supply and distribution of relief items and construction material to rebuild houses.

Floods have contaminated the usual sources of water. We repaired La Bomba's health center's well and MSF teams are planning on setting up other water distribution systems in other health centers. Our teams are currently looking for the best way to clean these wells that have been filled with mud. The only short-term option for the affected population is to rely on water trucking.

We are planning to distribute different types of tools to families: hygiene kits (with soap, plastic buckets, etc.), cooking kits for families who lost everything, and also construction materials and tools.

Responding and planning for other health problems

Contrary to what one might think, the epidemic risk is not necessarily higher after a natural disaster. Hepatitis A cases had been recorded in the region before the hurricane, so we were prepared to respond by setting up an epidemiological monitoring system and creating the capacity to provide rapid treatment. The primary illnesses that our doctors observed during the evaluation missions in the Chiquimulilla region were some cases of diarrhea, respiratory infections, and skin infections.

Dengue fever and malaria are also normally present in this area. The priority is to limit transmission risks. Our team will distribute 9,000 insecticide-impregnated mosquito nets and spray stagnant water to eliminate mosquitoes, the main vector of these diseases. Mobiles clinics have been set up and five teams have been visiting neighboring villages to provide medical assistance.

Daily survival

Providing food supplies to isolated populations is also an area of concern. The water carried off everything, including food stocks. Of course, local actors, like the emergency committee, have distributed free rations but those provide just enough for two or three days and the distribution method does not guarantee equitable access. According to the information I gathered, distributions are conducted on a "first come, first served" basis. There is no registration system to prevent from double distributions.

Some of the inhabitants of this area have lost almost everything–their houses, food stocks, harvests and work. The next harvest in this region will be in May 2006. The farmers grow primarily corn and a few fruits like papaya, but many of the residents work as day laborers on large agricultural holdings called "fincas." Those properties were flooded, too. There's no work for these laborers and, so, no income.

In general, the people I met are not thinking about the future. They are doing what they can to survive. Conditions, especially sanitary conditions, were already difficult before the hurricane. It remains to be seen for how long they will be dependent on outside assistance. A first question already seems to be taking shape since the World Food Program has decided to stop food distribution. Who will assist these populations who have lost their food stocks and their harvests?