October 28th, 1998 This was the fateful date on which Hurricane Mitch swept through Central America provoking a natural disaster without precedent in the American isthmus. An emergency situation on the Atlantic coast was declared on October 28th. That weekend, Hurricane Mitch crossed Honduras, Nicaragua, El Salvador and Guatemala.

Hell's doors opened freeing winds up to 250 Km/h and torrential rains. In the basin of the Choluteca river (Honduras), for example, about 900 million of cubic metres of water fell between 30th and 31st October. The poorest people, those who live in settlements that have grown up little by little on precipices, on river banks, were the most affected by the devastating effects of the hurricane.

"Some neighbourhoods in the city of Choluteca were flooded by water up to 1,5m high," remembers Roberto Ramos, a Honduran nurse auxiliary who worked with MSF in Choluteca, in the South of Honduras. "People screamed asking for help and some of us, helped by tyre inner tubes, threw ourselves into rescuing those trapped in their homes."

Balance of an intervention

At that moment, MSF ran a number of different, medium and long-term projects in Guatemala, Honduras and Nicaragua. Given the magnitude of the disaster, MSF teams called a halt to these longer-term projects in order to make use of the teams present in the area to respond to the emergency. In co-ordination with local authorities, the priority was to assist the displaced population, and to offer healthcare attention, drinkable water, shelter and food.

"At the very beginning, we used the drugs, medical and logistical material we had in each country for the projects we were running," explained Maria Basaran, at the time MSF's co-ordinator of the emergency intervention in Honduras.

In Guatemala City, for example, MSF started recovery work in settlements which had been particularly vulnerable to the elements. "Aiming at minimising the damage that would be provoked by natural disasters, we have helped to build sewage systems, and planted trees to avoid earth falls," explains Olaf Valverde, Field Co-ordinator of MSF in Guatemala.

"However, there are still some settlements of people displaced by the Hurricane which are in a very precarious situation, without access to basic services such as medical attention, water and sanitation.

But different problems, such as the land ownership, make it very difficult to solve the problems." In Honduras, a major concern for MSF was the destruction of factories and warehouses holding toxic chemicals in the area of Choluteca, on the Pacific coast. "MSF developed epidemiological studies and evaluations of environmental pollution," says Alex Coll, General Co-ordinator of MSF in Honduras. "Luckily, no intoxication cases and no major environmental pollution were registered."

In El Salvador, MSF works in the Departments of Ahuachapan, Sonsonate, La Paz and San Vicente. "Some areas of these departments are periodically flood-prone. So, the idea was to build water and sanitation systems that can be used even in flooding periods," says Jean Schmitz, General Co-ordinator of MSF in El Salvador.

"We have protected water wells and constructed high latrines that during this year's floods stayed above the water level." In Nicaragua, the settlements created after Hurricane Mitch to shelter displaced people lacked basic services such as water distribution systems, sanitation facilities and healthcare services. This situation increased the risk of epidemic outbreaks.

"MSF trained Integral Health Promoters in the settlements and organised their activities together with the Ministry of Health," explains Chus Alonso, General Co-ordinator of MSF in Nicaragua. "Teams rehabilitated some healthcare units damaged by Hurricane Mitch and passed consultations in some settlements with difficult access to healthcare centres."

However, two years after the disaster caused by Hurricane Mitch, there are still some settlements in which people live in very vulnerable conditions. MSF is concerned about the health risks thousands of people are still living under in settlements with precarious basic services. One of them is "El Limonal", in the Nicaraguan city of Chinandega. A health assessment carried out by MSF indicated the site to be inappropriate for human habitation, as it is literally in the middle of a rubbish dump.