Needs of survivors remain critical two months after Cyclone Nargis

Two months of MSF emergency response in Myanmar

Myanmar is marking the two-month anniversary of Cyclone Nargis, which struck the country on May 02, devastating entire communities and destroying thousands of lives. Though eight weeks have passed, the needs facing survivors remain critical.

While the headlines have disappeared, the suffering of those who survived has not. As the story falls off the media agenda, thousands of people in the worst-affected Irrawaddy Delta area continue to struggle with day-to-day survival and there is a significant shortage of adequate aid and assistance in many areas.

As the people of Myanmar attempt to rebuild their lives and communities, MSF is clear that an urgent need for basic aid will continue, including food, water, shelter and medical supplies. While the media's attention has turned elsewhere, the delivery of aid in Myanmar remains vitally important.

MSF now has full access to people in the Delta region and over the past weeks MSF teams on the ground have significantly increased their emergency activities and medical coverage to reach survivors who had still not received adequate levels of aid.

MSF teams are working to reach up to 350,000 people with emergency aid in the worst-affected Delta area. MSF is running both mobile and fixed clinics to reach the greatest numbers of affected people in the area.

Since the start of its emergency response two months ago, MSF has reached more than 460,000 people through its emergency aid programme, delivered 939 tons of medical and relief supplies and carried out more than 30,000 medical consultations.

MSF Supplies

Much-needed food aid
• 2,642,700kgs of Rice
• 617,938kgs of Beans
• 202,390ltrs of Oil
• 151,302 sachets of Plumpy Nut
• 98,284kgs of Salt
• 64,111 packets of High Energy Biscuits
• 22,752kgs of Fish

Essential Relief Items
• 186,611 Pieces of Plastic Sheeting
• 183,196 Mosquito Nets
• 131,125 Water Containers
• 63,560 Wool Blankets
• 19,717 Hygiene Kits
• 10,865  Bars of Soap
• 2  Water Treatment Units

Medical Issues in the Delta

MSF has carried out more than 30,000 medical consultations and is treating people for diarrhoea, respiratory tract infections, malaria, dengue fever and malnutrition. Despite an increase in numbers being treated for dengue fever, respiratory infections and malaria, currently there are no reports of disease outbreaks or epidemics and pathologies remain relatively stable. 

However, future outbreaks of disease among the survivors are a concern, particularly as the heavy rains continue. Many diseases, including malaria and dengue, are endemic in Myanmar. Currently, it is the season for these two diseases and as heavy rains continue and people lack adequate access to food, shelter or clean water, their vulnerability to disease increases.

Currently, cases of diarrhoea represent more than one tenth of MSF medical consultations (approx 11.77%), caused by a combination of poor sanitary conditions, contaminated water and exposure to the weather.

The number of respiratory tract infections represents around 12.5% of MSF medical consultations. As the heavy rains continue and people lack adequate shelter, the constant damp and cold is a serious concern and could lead to higher numbers presenting with respiratory conditions in the future. While construction of more permanent shelter is certainly taking place, many people remain in temporary structures constructed out of plastic sheeting distributed by aid agencies or other materials that people managed to find.

There have been a small number of cases of measles and the WHO/Ministry of Health carried out a vaccination campaign in Labutt Camp.

Both malaria and dengue fever are endemic in Myanmar. Though the figures for dengue fever currently remain relatively low, MSF is carefully monitoring the disease in areas where it is working. MSF is also taking part in the WHO-led initiative to prevent further transmission of dengue, a disease particularly risky for children and international aid workers who have little resistance to it. MSF is improving drainage systems and reducing stagnant water in high-risk areas.

Malnutrition is an ongoing concern. Due to the lack of regular access to food for survivors in remote regions of the Delta, MSF is closely monitoring malnutrition levels for groups that are most at-risk in these areas, particularly children under five. MSF is increasing the number of children that it screens. Teams in Bogaley, Setsu and Pyapon have found that there is a high proportion (15%) of children at risk of malnutrition. In a number of its clinics, MSF has already treated some cases of severe acute malnutrition in children. Numbers are low (between 0 and 0.5% of children). MSF is also providing food supplements to groups of people who have been identified as moderately malnourished to ensure their rapid recovery, and to other vulnerable groups, such as pregnant and breastfeeding women.

Mental Health: Legacy of Trauma for Survivors

This is a major concern. In certain areas, MSF teams report that up to 30% of their patients have mental health problems related to the stressful events they survived. MSF staff encounter a large number of patients with profound sadness/depression and complaints like lethargy; anxiety; sleeping difficulties; hyper-tension; palpitations and other non-specific body complaints that are most likely related to psychological problems.

To address theses mental health problems, MSF is integrating a mental health and psycho-social programme into its emergency response. MSF Mental Health Officers arrived in the Delta in early June to implement the psycho-social program. They established a system of support to the community by training community health workers and counselors to assist traumatized survivors. Over the coming weeks, MSF will further scale up its response to the mental health problem.

MSF also started a school in Labutta Camp for 500 children. This simple initiative has a significant impact, helping to bring routine and some sense of normalcy back into the children's lives. The school is valued and appreciated by the community in the camps.

The cyclone devastated entire communities. Those that survived are altered beyond recognition. In areas totally flooded by the cyclone only the strongest swimmers and best climbers survived. In some of these areas there are no women left, as more men and younger people survived. As the strongest survived many men have lost their entire families.

In one village, 60 men, 6 teenage girls and one baby of 6 months survived. The baby survived because the father climbed a tree and tied both of them to this tree with his sarong. The mother and the other children in the family all drowned. In another village, only one single child of ten survived. As the only child in the village he has no one his age to play with, study with or share his grief with.

There are still dead bodies floating in the water, which rains have carried to the surface. The bloated corpses are a constant, distressing reminder to survivors of the cyclone’s toll.

Survivors are trying to deal with the trauma of having lost family, relatives and friends before their eyes. Many can't sleep properly. At night some see the faces and feel the hands of the people they let go during the cyclone - of those they couldn't save. Not only are people grieving the traumatic loss of loved ones, they are also deeply worried about their futures. They have lost their livelihoods; many have no seeds to plant or permanent shelter.

Challenges in the Delta

WEATHER: Not only are the current rains a major threat to the health of the population, but they are also a block in terms of accessing the most isolated communities in the Delta. The rains are very heavy and last for 1-2 hours. This rain means increased exposure for survivors to disease because of the damp and cold. In addition, it makes it difficult for people to go about their daily activities – such as farming or fishing – in order to make a living.

During the current monsoon rainy season in Myanmar, there are always tropical storms. However, since the cyclone, people have become very cautious and anxious about bad weather. Boatmen, needed to help carry the MSF supplies and teams to remote areas, often refuse to go out on aid deliveries when weather is bad, fearful that there is another cyclone on the way. This hinders the speed with which MSF can get vital aid to survivors that need it.

LOGISTICS: The scale of this emergency operation is huge because the Delta is such a large area with so many villages scattered around.  A complicated and time-consuming system of large trucks, big boats and small boats are still required to get relief supplies and medical aid to communities in isolated areas. To access people you have to make your way through a labyrinth of waterways and even once you reach your destinations you find that many jetties have been destroyed. In certain areas, MSF staff push through thick tracts of mud to access communities. Other areas can only be accessed by walking 6 hours through the mountains. Logistically it’s very difficult to get adequate medical aid and relief supplies into such areas.