Interview with Bjorn Nissen, MSF's head of mission in India about the intervention in flooded areas

In India, the relief effort continues in the northern state of Bihar. But three weeks after heavy floods devastated large swathes of the northern plains, many people remain stranded and have only received little aid. Access to large parts of the flooded areas is difficult because of the sheer amount of water discharged by the river Kosi and the lack of passable roads. MSF is providing medical assistance and distribution of Non-Food Items (NFI) to victims in the most affected areas. MSF's head of mission, Bjorn Nissen gives more details about the intervention:

Our mobile clinics are providing medical assistance to victims of the floods in the most affected districts of Araria, Supaul, Saharsa, Madhepura and Purnia. We've also conducted emergency relief distribution of non-food-items, such as plastic sheeting, jerrycans, water purification tablets, soaps and aim to cover around 7500 families, which is around 42 000 people.

At the same time, we continue to assess the situation in camps and settlements, conduct disease surveillance and see what mechanisms are in place to respond to any epidemic outbreak.

We focus on isolated displaced communities where access is difficult and neglected groups such as pregnant and lactating women, children under five. According to the latest National Family Health Survey, 6% of children under-five are suffering from severe or acute malnutrition in Bihar state and obviously, this emergency compounds the situation. Malnutrition is the main health issue we come across and the situation is likely to further deteriorate. MSF provides food therapy with plumpy-nut to those in need.  We've also met with local health authorities and actors to push and help them to cover the specific needs of this population.

What's the situation like in the areas where you are working?

We are covering "pockets" where the population has had no or little access to healthcare. Many people have lost everything in the floods. I saw a person who had been walking for 12 km, at knee-deep level in the water to reach the camps. Some were really on the brink of exhaustion.

People have taken refuge wherever they could find a dry area. They sometimes have settled along the roads or on a piece of highland and some were left without much structure or help. Others have managed to reach a school or building turned into a relief camp and supported by the government. Right now we're covering an area called Chuni in Supaul, which was cut off until now because of the floodwaters. The villages were situated nearby an embankment and when it broke the whole area was devastated. The population has built shelters with bamboos and whatever they could find and apart from some airdropped food supplies from the government, they hardly received anything. We've provided them with plastic sheeting, Non Food items and medical assistance.

What is the most pressing needs for the population?

At this stage it remains food, shelters and medical assistance especially for children under five and pregnant and lactating women. Apart from malnutrition we see a lot diarrhea, upper track infections and skin problems.

What is the risk of an epidemic outbreak?

Until now the government has been focusing mainly on its Search and Rescue operation (SAR). People were stranded and needed to be brought by boats onto dry land. But as the rescue reaches it final stage we hope they'll switch their effort to medical assistance in the camps and settlements in order to prevent epidemics.

The magnitude of the floods means that health structures in place in the camps need to be reinforced as well as water and sanitation activities to provide latrines, access to clean water to the displaced. It's not clear when the water will totally recede and when the population will be able to go back to their houses. There's been no disease outbreak so far but as the camps are getting more crowded, the risk is growing.

What is the most challenging part of the relief effort?

Access to the population is difficult; in semi-flooded areas the roads are impassable because of the floods. If there is 30 or 40 cm of water, it's enough to disrupt the distribution by trucks.  For example, for our distribution of relief items in Supaul, we had to use a tractor as part of the road was still under water. But as people are fixing the roads and the water begins to recede, things will get slowly easier.

The second challenge is linked to the fact that the population is quite mobile. There is a lot of movement. Some people have gone to the camps and come back; others are leaving to go to big cities like Delhi. We see people coming and going and it's difficult to estimate how many people are in the camps, where they are going and where they'll be staying.
What's your plan for the coming days and weeks?

We want to continue with our mobile clinics in the areas where people have no access to health care or have received little aid and move as fast as possible further West. The closer we get to the area near the river's bank and the more affected and neglected people will be, because access is more difficult. We are planning to use boats as soon as possible and we hope to soon be able to reach them.