Three weeks after Cyclone Nargis hit Myanmar, many survivors still lack basic supplies needed to survive and the amount of aid entering the affected area remains inadequate.

While Médecins Sans Frontières (MSF) has been able to get urgently needed food and other items to approximately 120,000 people living in the devastated Irrawaddy Delta region, huge challenges remain. Government restrictions on foreign aid workers and the area's difficult terrain mean that many more still face a desperate situation.

"Thousands of people have not seen any aid workers and still have not received any assistance," emphasised Jean-Sebastien Matte, MSF Emergency Coordinator. "Yesterday, our teams who are travelling by boat to reach the most isolated areas, managed to reach more distant villages around the Bogaley area. In these villages we found people who had run out of food and who had not eaten in three days. They were crying and begging for food. We were able to distribute some emergency food rations. However, unfortunately, there are many more villages like this with people in desperate need."

Lacking food and shelter

The biggest needs continue to be food and adequate shelter. A network of 36 mobile MSF teams are distributing goods, according to the populations' needs, near the southern townships of Bogaley, Labutta, and Ngapudaw. So far MSF staff have distributed more than 310 metric tons of rice, about 84,000 cans of fish, 16,500 liters of cooking oil, and plastic sheeting to use as shelter for more than 60,000 families. Some areas have been identified to get a second round of distributions because of the continuing needs.

Medical needs changing

MSF is also providing much needed medical care in various locations. Using both set clinics and mobile teams, medical staff carry out an average of 500 consultations a day.

Initially, staff treated small wounds and fractures caused by sharp debris or falling trees. However, the teams are now seeing fewer such cases and proportionally more patients suffering from fever, diarrhoea, and respiratory tract infections.

These illnesses can be caused or exacerbated by the dismal living conditions facing many survivors, including exposure due to lack of proper shelter, poor quality drinking water, and not enough food. More serious medical cases are referred to area hospitals.

Water and sanitation problems

MSF water and sanitation experts have distributed water containers, cleaned contaminated ponds, brought in water tanks and taps, and built water treatment units in a number of locations to help ensure clean drinking water. However, obtaining safe water remains a problem in many areas.

In addition, many latrines were destroyed by the storm and need to be rebuilt. For these reasons, MSF remains concerned about possible outbreaks of infectious diseases, but to date, none have been detected.

Unbearable memories

There is a substantial need for psychosocial support. Many of those who lived through the cyclone and the subsequent surging water have witnessed horrible things. A large number are traumatised by their experiences. Some have trouble sleeping or suffer from stomach or chest pain. Others have high blood pressure. Many can't speak.

One national staff doctor remembers such a patient.

"I treated a man who was injured. He carried his child around his neck while he swam. But after a while, he had no more energy. He let his child go. His wife couldn't accept this and she tried to save the child. She swam behind the child and both drowned. He couldn't do anything. When I saw him, he was completely broken. I didn't know what to say."

The next steps

Now that the government has promised to relax restrictions barring most foreign aid workers, MSF is preparing to send more international staff to the affected area. They will provide needed expertise and experience in all areas of its operations (many of the national staff from Myanmar have never worked in a disaster area before).

Currently, MSF has approximately 250 doctors, nurses, logisticians, and coordinators on the ground in the Delta area, including more than a dozen international staff specialized in technical areas like water and sanitation as well as in coordination of emergency operations.

MSF has also started interviewing its field staff to find out if they are facing specific difficulties and obstacles in carrying out their work. Surveys are also being done to find out if the local population is happy with the assistance provided by MSF.

"We don't only try to make sure the goods have reached the right place. We also want to know if our help is thorough and of acceptable quality," said Vincent Hoedt, Emergency Coordinator.

MSF is starting to rotate its national staff out of the Delta, many of whom were pulled out of other projects in the country to help assist victims of the disaster. Many national staff do not have past experience or expertise working in emergency situations. In addition, some of them and their own families have also been affected by the cyclone. Nevertheless, most of our staff have worked incessantly over the past three weeks under difficult physical and emotional circumstances.

MSF remains the only aid organisation operating in several parts of the Delta.