When Hurricane Mitch swept through Central America nearly two years ago, one of the communities first blasted, then washed from their homes were relocated in what should have been temporary shelters next to both a rubbish dump and a sewage works.

The people come from the town of Chinadega, 139 km from the capital Managua. They were forced to move to the outskirts, to a patch of land called El Limonal. Two years later, despite official promises, and protests from organisations like MSF, 320 families, some 1,800 people, are still living on the edge of a major health threat. MSF carried out a health assessment in this settlement between 6th and 8th March 1999, four months after Hurricane Mitch.

The results indicated the El Limonal site to be inappropriate for human habitation. But the local municipality now intends to build permanent houses there so that the people stay. "We presented the conclusions of our health assessment to the Municipality, the Ministry of Health and the Ministry of Housing and Family," said Chus Alonso, General Co-ordinator for MSF in Nicaragua. "The local Ministry of Health is very concerned but there has been no response from the Municipality". MSF is doing a repeat health assessment in November 2000 to highlight the environmental risks in the area, and expects to use the results to put pressure on the local government to resettle the people in a healthier area.

Obscure bureaucracy and political corruption

The case of El Limonal is an illustration of the wider problems which have plagued the victims of Hurricane Mitch. The Nicaraguan government's response to the hurricane emergency was to try and control all foreign aid. This created a lot of obstacles and difficulties for the aid agencies (NGO's) trying to help. Excessive red tape made it hard to mobilise teams and materials arriving from overseas, and much of the humanitarian aid was held for long periods at Managua airport.

In April this year, the first media reports of alleged mismanagement of money donated for the victims of the Mitch disaster surfaced. At present (early October 2000), the Republic's General Contraloria, the office responsible for public spending, is investigating the accusations.

Present situation in El Limonal

The settlement is on a wasteland, 50m from the city's rubbish dump, 150m from the cemetery, 150m from the city's sewage depot and some 200m from the Acome river, where an oil factory pours its waste water. The wasteland is a wide area, made up of 13 blocks separated by five long streets. It is very dry, without vegetation, and full of fine sand that is whipped up by the slightest wind. The huts, where the families live, are made of black plastic and zinc, or recycled material (tins, carton) with no doors or windows. To the south of the settlement there is a riverbank, where more families are settled in even more precarious conditions, waiting to get a place on the wasteland - and improve their conditions.

Environmental conditions

The Acome river is polluted by sewage from other communities further upstream, and by toxic waste from the sewage treatment plant. Green water from a nearby oil factory pours into the river just 10m from where the residents of El Limonal take their baths and clean their clothes. Bacteriological analysis from May 1999 found salmonella in this water, a dangerous bacteria for people's health.

There are three water wells in this settlement where residents were supposed to get their drinking water. However, bacteriological analysis shows the water is polluted by shigella at levels two million times higher than international norms (El Limonal levels are 20,000,000 faecal coliformes/100ml with international norms advising less than 10 faecal coliformes/100ml).

Even strict chlorinating measures will not guarantee clean water, due to the pollution of the subterranean aquifer cloak by the sewage plant close to the settlement, and by the river which receives industrial waste. Air pollution is also a constant. The air is polluted by an extremely fine dust, which covers the entire wasteland and rises with the slightest gust of wind and then hangs in the air, inhaled by the residents and adding to problems of respiratory infections.

In addition, there is toxic gas and smoke coming from the municipality's rubbish dump. The ground surface is also polluted by garbage waste carried by the wind, and by the latrines, which were not dug deep enough. The rubbish dump is so close that flies and mosquito proliferate, increasing the possibility of transmission of disease.

What MSF has done

A medical team from MSF carried out consultations once a week for a nine-month period after the first health survey in March. The average number of consultations per month was 270. The main pathologies recorded were respiratory infections (43%), followed by diarrhoea, intestinal infections and skin diseases.

Afterwards, the Ministry of Health (Minsa) continued the medical work with staff from a healthcare centre close to the settlement. MSF also installed a 30,000 litre water tank, filled by Chinandega's municipality twice a day, providing the families with access to potable water. Later, a connection was made to the city's water system.

From bad to worse

The President of Nicaragua, Arnoldo Alemn, visited El Limonal on December 14, 1999 to hand out the papers of another site where decent homes were going to be built for these families. Chinandega's Mayor was also there.

Three months later, in March 2000, people were informed they would be resettled in a different place called El Tempizque - hardly 1,500m upstream from El Limonal - where there are two active septic piles.

Given these conditions, the El Limonal residents decided not to move and are currently in exactly the same place where they arrived over one and a half years ago. The municipality is now trying to turn this unhealthy site into a permanent residential area by building houses. "It is clear that people in El Limonal live under high epidemic risks," declared Alonso. "Political will is needed to change this situation."

Recommendations

1. MSF will carry out a second health assessment in El Limonal in November 2000. However, MSF is pessimistic about the outcome of the assessment, given that there has been no improvement in environmental conditions.

2. MSF, together with the Ministry of Health in Chinandega and other organisations present in the area, want to see the population resettled by the municipal authorities in another site where environmental conditions are better.