People cross the flood waters in Araria district, Bihar state. India, 2008.
Photo by Bjorn Nissen/MSF
In India, the relief effort continues in the state of Bihar. But three weeks after heavy floods devastated large swathes of the northern plains, many people remain stranded and have received little aid. Bjorn Nissen, head of mission in India, tells us about MSF’s relief efforts.
What are MSF doing to help in Bihar?
Our mobile clinics are providing medical assistance to victims of the floods in the worst 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 and soap. We aim to cover around 7,500 families, which is around 42,000 people.
A family in Araria district displaced by the Bihar floods. India, 2008.
Photo by Bjorn Nissen/MSF
We focus on isolated displaced communities where access is difficult, and neglected groups, especially children under five and pregnant and lactating women. Malnutrition is the main health issue we come across and the situation is likely to deteriorate further. MSF provides food therapy with Plumpy’Nut (ready-to-use-food) to those in need. Apart from malnutrition, we see a lot of diarrhoea, respiratory infections and skin problems. We have met with local health authorities and other organisations to push and help them to cover the specific needs of the population.
What’s the situation like on the ground?
People have taken refuge wherever they could find a dry area. They have sometimes 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. Many people have lost everything in the floods. I saw one person who had been walking for 12 km knee-deep in water to reach the camps. Some people were really on the brink of exhaustion.
We are covering ‘pockets’ where the population has had no or little healthcare. Right now we are covering an area called Chuni in Supaul, which was cut off until recently by the floodwaters. The villages were situated near an embankment and when it broke the whole area was devastated. People have built shelters with bamboo and whatever else they could find, and apart from some airdropped food supplies from the government, they had hardly received anything. We’ve provided them with plastic sheeting, non-food items and medical assistance.
What is the most challenging part of the relief effort?
Reaching people 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 relief distribution by trucks. In Supaul, we had to use a tractor to distribute relief supplies, as part of the road was still under water. But as people are fixing the roads and the water begins to recede, things will slowly get easier.
The second challenge is linked to the fact that the population is quite mobile. There is a lot of movement. 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.
A mother feeds her malnourished child ready-to-use-food. India, 2008.
Bjorn Nissen/MSF
What is the risk of an epidemic outbreak?
There’s been no disease outbreak so far, but as the camps are getting more crowded, the risk is growing. And it’s not clear when the water will totally recede and when people will be able to go back to their houses.
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. Until now the government has been focusing mainly on its search and rescue operation. People were stranded and need to be brought by boats to 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 centres in place in the camps need to be reinforced. Water and sanitation activities are crucial to provide latrines and access to clean water to the displaced.
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 healthcare or have received little aid and move as fast as possible further West. The closer we get to the area near the banks of the river Kosi, the more affected and neglected people will be. We are planning to use boats as soon as possible and hope to be able to reach them soon.