Speaking on May 28, Vince Hoedt, MSF's Emergency Coordinator in Yangon, Myanmar, explained some of the challenges of continuing to run the massive cyclone relief effort.
Before international staff were allowed into the Delta, MSF's Burmese staff set up and ran all the relief work in the Delta. Some have now returned to Yangon after three weeks working with cyclone victims. How are they physically and mentally?
"This disaster has obviously taken a very heavy toll on our Burmese staff. Those who have been there from the beginning are now slowly returning to their normal work and to their families. Some of them were actually affected at home as well, their houses damaged or family members among the victims.
"Those who have been working for two or three weeks in the Delta area were the ones who witnessed the worst. They saw the bodies in the river. They saw the half-flattened villages. They are the ones who speak the language, who heard all the terrible stories of people that lost family members or even saw family members drowning in front of their eyes.
"So, yes, concerns for the Burmese staff are very valid; They've worked hard and witnessed a lot. At the very beginning when it was total disaster, total destruction, death and mayhem, they must have gone through a terrible period and we owe it to them to look after their wellbeing."
What is MSF doing to look after their wellbeing?
"For the wellbeing of our staff, we have brought in a mental health expert from Amsterdam. He will also look at the mental health needs of the population - of course, the people affected by the cyclone have far more need than the local staff but the local staff do deserve attention as well.
"We have, in the last couple of days, started talking with staff about ways of coping with recent events and how to deal with certain emotions. Of course, people also have their own coping mechanisms. People have religious beliefs and their circle of friends and families. Generally, what we see among the staff here is that they are very proud of what they have achieved and what they were able to do for their fellow countrymen."
What difference will it make in the delta now the Burmese government is allowing access to international staff?
"The access we have now enables expatriates from our organisation and also from other organisations to see the area first hand and enables sharing of expertise from other countries. People who have worked in different emergencies can help to develop our programmes in Myanmardiscuss new techniques and guarantee that aid remains independent and is distributed objectively, which, at this stage, we believe it is.
"It is important to remember that the bulk of the aid reached the victims of the cyclone before any expatriates could officially join the aid effort, thanks to a tremendous pool of very capable and very experienced local staff who were here 48 hours after the cyclone struck. They were the people that got in there immediately and started distributing food, plastic sheeting for those that lost their houses and performed initial medical consultations."
Are there still areas in the Delta where aid has not reached?
"We are managing to cover large areas, but there may still be places we haven't reached, either because they are too remote, they have small populations or they have simply been overlooked. Where they might be at this moment is hard to know; we cannot pin them on a map and it is still too early to say that all areas have been covered.
"It will need ongoing assessment to make sure that any last areas that have not received aid are reached soon and that distributions, medical care and humanitarian attention are provided."
Are there enough supplies getting through to MSF teams?
"At the moment the teams working on the ground have sufficient supplies. We could, however, definitely use more supplies and more people, but our bottle neck at the moment is not availability of supplies per se
. The struggle is to make sure the supplies are reaching the teams fast enough because it is a very long supply line.
"Goods from Yangon have to be put on trucks for a day, then offloaded to a logistical centre, then put on river boats, then offloaded to smaller boats and finally delivered to the islands. So, for us the bottleneck is actually handling that whole pipeline, all the way to where the goods are really needed."
What are the biggest challenges facing MSF teams at the moment?
"The vastness of it is our biggest challenge. There are so many places to go, so many people who need to be served, there is an incredibly large amount of goods that have to be handled - shipped from Yangon, loaded,, offloaded, distributed and tallied up. It is a huge operation and the challenge is actually keeping this immense machinery going.
"Hundreds of aid workers, tens of thousands of people needing aid, hundreds of tons of goods, data that we want to collect and share properly so we know what has been sent where. The biggest challenge is keeping all this going smoothly."
How do you think MSF operations will change in the coming weeks?
"Looking back, the last few weeks have been focused on pure relief and getting to as much of the affected area as fast as we could. Our operations in the weeks to come will change to adapt to specific needs for specific locations and communities. For example we are developing a programme of psycho-social care specifically for one area because it has been worse hit than others.
"Another big challenge is also going to come now that other organisations are coming in. We have to make sure we work constructively with those that have more experience of large-scale, non-food item distributions. So, where initially it was one major dash into an open area and doing as much as you can, now it will be more about focusing and sticking to specific activities for the longer term.
"We also need to share and hand over activities to other organisations that are now deploying, like Save the Children and World Vision, which is great now they are in the area. How we are going to find our way in the weeks to come is going to be an interesting and necessary strategic discussion."
What do you think are the longer term needs for the Burmese people affected by the hurricane?
"We have covered a large area - that's very true - but even in the areas we have covered, we have not provided for all needs. People have not only lost houses; they've also lost their fishing boats, in some cases shrimp farms and salt plains that they were getting income from.
"It's not only about looking for new areas or new activities, it's looking at the humanitarian intervention as a whole, whatever activities are needed now and for the long term, some of which will most likely be beyond the initial relief efforts of organisations like MSF."
How does this relief effort compare with others you have been involved in with MSF?
"Comparing emergencies is not always easy. What they have in common is that they all have a tremendous impact on people's wellbeing. We have difficulty even grasping the immense trauma that these people will probably be carrying for the rest of their lives. Seeing family members die in front of your eyes, seeing total destruction in your village, that is what these emergencies have in common, that incredible 'nothing you can do about it' feeling.
"Each emergency is different in a practical sense. For example, this is a river area whereas Pashmina was a mountain area. Other emergency operations have been run by international staff whereas this one was 80-90 percent set up, designed, run, managed and executed by Burmese staff.
Practically they all differ but what it boils down to in the end is what they all have in common and that is the incredible measure of human suffering that comes with them."