Nicaragua - On the second anniversary of the unprecedented disaster provoked by Hurricane Mitch in Central America, some people whose homes were destroyed are still living in precarious and unhealthy settlements. The international medical aid organisation Médecins Sans Frontières (MSF) wants to draw particular attention to the "El Limonal" settlement, in the Nicaraguan city of Chinandega, where people are still living in the middle of a rubbish dump in what was intended to have been a temporary refuge.

"MSF carried out a health assessment four months after Hurricane Mitch swept through Nicaragua and results indicated El Limonal site to be inappropriate for human habitation," explained Chus Alonso, General Co-ordinator of MSF in Nicaragua. "Environmental conditions remain the same. So MSF, together with Chinandega's Ministry of Health and other organisations present in the area, want to see the population resettled in another site where environmental conditions are better. There has been no action from the responsible authorities in the Municipality"

There are further examples of neglect and medical danger among the settlements created in Guatemala and the temporary shelters still standing in Honduras. In Guatemala, land ownership problems make it difficult to resolve the situation of around 13,000 people throughout the country living in settlements with inadequate basic services. In Honduras, delays in housing construction force people to remain in temporary shelters two years later.

When Hurricane Mitch swept through Central America at the end of October 1998, MSF launched an emergency programme to prevent epidemic outbreaks and improve healthcare assistance to the victims of this unprecedented disaster. An initial high epidemic risk for diseases such as diarrhoea, cholera, malaria, and leptospirosis was created by accumulated mud in flooded areas next to uncollected garbage and by lack of access to clean water.

Some 170 MSF national and international volunteers have run emergency projects to improve access to healthcare and water and sanitation facilities. Medical consultations, drug donations, epidemiological surveillance, construction of latrines and water wells, installation of water tanks and rehabilitation of water distribution systems are some of the activities developed by MSF teams. Two years after Hurricane Mitch, approximately one and a half million people and 192 healthcare structures in Guatemala, Honduras, Nicaragua and El Salvador have benefited from MSF post-Mitch interventions. The projects' costs amount to US$5 million.