Survival amid Myanmar's devastated Irrawaddy Delta - a volunteer's account

Driving out of Yangon, there is evidence of Cyclone Nargis, but it isn't immediately apparent. The buildings are shabby and they look uncared for, like Soviet-era monstrosities that have fallen into disrepair through lack of interest. I assume they're from the sixties, so I'm shocked to learn that they were built in 1993.

The broken windows don't look out of place in these buildings and although some families are obviously house proud, the overall impression is of neglect. We make a left turn and are immediately flagged down by armed police. This is the main road to the Delta region and the police are on strict instructions not to let any foreigners travel without appropriate paperwork. My papers are closely examined, but everything is in order and we're waved through. The police radio ahead to let other officers know a foreigner is on the way in an MSF car - we're stopped at each checkpoint and at every one they request another photocopy of the authorisation and my visa.

We trundle along in the car and soon reach the end of the paved road. The surrounding countryside is idyllic with verdant rice paddies being ploughed with water buffaloes as far as the eye can see. The houses are mostly built on low stilts and I imagine that life here has barely changed in the last few hundred years. This is what I keep hearing about Myanmar, it just doesn't change.

People who visited 15 years ago say that in most respects, it's exactly the same - entering Myanmar is like stepping back in time. Mobile phones are the preserve of the rich; a SIM card costs $2,000, meaning that the mass mobile revolution that has touched every corner of the planet has yet to make it here. Internet use is restricted and a personal computer is an unrealistic ambition for most. Ancient cars rattle along the road, people hitch rides on the top of a lorry or hang off the back of a pickup truck. Bicycle taxis hawk for trade - motorbikes are simply too expensive and, at $5 a litre for petrol, running one costs too much.

It's tempting to romanticise the lack of modernity, but I'm acutely aware that this is simply because the vast majority of people are simply too poor for modern luxuries.

As we drive mile after mile, the damage caused by the cyclone becomes increasingly apparent. Everywhere I look there are upended trees, blue plastic sheeting in place of roofs, broken telegraph poles and bent stupas - monuments marking a sacred Buddhist location or saint. The roadside is a hive of activity - the sound of hammering permeates the air and people are working to fix telegraph poles everywhere. We pass a government truck carrying agricultural equipment for people who have lost what they had before the cyclone. I later learn that the people who receive the equipment are expected to repay the cost within three years.

There is little traffic on the roads and by far the most common sight are the international NGO trucks ferrying back and forth. Eventually we catch sight of the red and white sign of a fellow MSF vehicle and everyone waves excitedly and shouts greetings at one another. The team has come together so well - particularly the national staff, who are confronted with the terrible sight of so many of their own people suffering in appalling conditions. But morale is high and people work hard towards their common goal.

After a few hours, we reach Pyapon. It's a large town and a hive of activity - bicycle taxis, motorcycles, cows and people all jostle along the road. We arrive at the MSF office, where I meet my colleagues; so far the medical teams have mostly treated people for injuries and flesh wounds caused by the cyclone, diarrhoea and coughs and colds. But from experience, everyone knows that a disease outbreak could happen, many diseases including malaria and dengue are endemic in Myanmar and the current living conditions are ideal for diseases to spread.

As soon as we leave Pyapon, it's clear that we've arrived in the Delta proper. The road is little more than a dirt track with potholes everywhere. On either side people live next to the water, with the water and on the water. It's obvious the road is not the main way to travel - the vast majority of people paddle along the narrow waterways to get around. Eventually we cross a bridge and I see a couple of sunken boats in the rivers. We've arrived in Bogale, one of the worst hit towns, and gateway to one of the hardest hit areas of the Delta. On the outskirts of town there's a slum area and every single house has tarpaulins on the roof. As we drive further into town, the larger, better-constructed buildings are all either being repaired, or sporting brand new corrugated iron on the roof. It is obvious that this town suffered major damage.

We arrive at the house where MSF is based and Rosa, the emergency co-ordinator, briefs me. Rosa is a veteran with 12 years field experience and has worked on the emergency team for two years. In that time she has seen wars, floods and earthquakes and is hardened to most of what human and natural forces can do. I ask her how the cyclone compares.

"It's like nothing I've seen before. It's been six weeks since the cyclone happened and we're still reaching people who have had barely any aid," she said. "There are so many dead bodies that have just been left to rot and in some villages there is nothing left - we went to one place where the only sign that there had ever been a village was the Buddha statue. I don't know how they're ever going to recover. We've found places where there are quite a lot of men who were strong enough to survive by swimming, and there are a few teenage girls who are more fit, but there are no other women at all. I saw one six-month-old baby - his father had climbed a tree with him and used his sarong to tie them there all night. The rest of his children and his wife drowned."

I go to dinner with Akemi, a Japanese nurse, who tells me about what she has seen. In one of the villages she went to, the only child left was a ten year old boy. He is the sole member of the younger generation in a village with no children. In such villages, Akemi treated no pregnant women for injuries as there were none - many men have lost their entire families.

I suggest that we have some fish for dinner. Akemi shakes her head and tells me that she's been avoiding the fish. "Lots of the bodies have been dead for six weeks. I've seen so many human bones stripped clean. One person was gutting a fish he had caught and found a human finger in the stomach. I wouldn't eat the fish."

The next morning I head down to the bustling riverside. MSF boxes are loaded onto a Zodiac dinghy and the team gets ready to leave. We whizz past canoes and fishing boats hired by NGOs and I'm struck by how extraordinary the relief effort must be for the local people, some of whom never had access to telephones or electricity before the cyclone. Now helicopters, outboard engines and pale skinned Europeans have all descended upon the sleepy gateway to the Delta where people have been living off the land in the same way as their ancestors since time immemorial.

Eventually we get close to shore and I see the skull of a buffalo and suddenly my nostrils are filled with a putrid stench. It is the unmistakable smell of rotting flesh. I see something yellow on the shoreline, and then realise that it's a head attached to a torso. Most of the bodies in the water are just bones now but the bodies above the tide line are decaying slowly and serve as gruesome reminders that it has only been a few weeks since the cyclone hit. The smell and the sight is something I experience again and again that day.

We move away from the shore, and head towards Pae da Gaew, where we have established a second base further south. The sheer logistics of travelling through the Delta have meant that it has been necessary to establish bases further south so that the teams can reach the most remote areas. Conditions here are basic - everyone is living on a fishing boat and forced to cook, sleep and wash on board. The river acts as the source of water for most activities (although thankfully not drinking water) as well as the waste disposal unit. I remember a nurse telling me that she had seen people showering in water a few yards from where a human corpse floated in the river - there are so many bodies that people have become immune to the sight of them.

It starts to rain and the cook offers to make us some lunch. As we sit around eating the warm stew, we talk to the crew about life on the boat. Quickly the conversation turns to the cyclone. These men are all from villages in the worst hit area. Every single one of them has lost family members and friends. The cook tells us that he has lost his entire family - he quickly became separated from his wife and 12-year-old son. He managed to keep hold of his two year old son and stay afloat by hanging on to a piece of wood but after several hours of clinging to one another a strong gust of wind swept the child away, and he was left alone.

We leave the boat and continue down a side channel into one of the worst hit zones of the area we cover. The entire area was flooded in the storm and up to three metres overhead I see grasses caught up in tree branches. We land at a small jetty and walk up to the remains of a house. Of this simple family home, made from bamboo and wood, there are only a few posts left in the ground. This home, where people lived, loved, cooked, ate, bickered and played, is now reduced to a few bits of wood in the ground. This is how I imagine a holocaust - it is the sheer nothingness of what remains. A history wiped clean, the only evidence of their existence are a few articles of clothing and some broken pottery.

We walk towards the MSF team who are busy pond washing. The delta has two seasons - wet and dry. In order to get clean water, people have dug large ponds, which fill up with rainwater during the rainy season. The water remains clean, and the system ensures that people have enough to drink all year round. But the problem is that this area was entirely flooded by seawater. When the water levels receded, the ponds were left full of salt and the water was too salty to drink.

It's the rainy season now and people are able to collect rainwater but the difficulty is that the ponds need to be washed quickly, so that they have time to fill up once more before the dry season. The only solution is to pump out all the dirty water - a laborious task, but essential if people will be able to survive next season in the delta. The problem of salt water also impacts what people eat. Much of the farmed land in the delta consists of rice paddies. Although the rice grown in this region has some resistance to salt, the current levels are far too high for the crop to be able to grow for next season. In a subsistence farming community, it is essential to anticipate the impact of the flooding on the eco-system.

These people have survived through the worst storm in living memory, but longer-term solutions are needed to ensure that people can recover and return to their former way of life. Their way of life is not just essential to survive but also to maintain a sense of normalcy. Another MSF project has started a school in one of the displaced people camps. Basic education is a way of getting the children back into a routine, and to ensure that they don't fall behind. The team anticipated 150 children on the first day but the fact that 500 turned up is an indication of how desperately people want to return to their regular daily lives. There are plans for a counselling service and to give each of the children high-energy biscuits for breakfast, hopefully averting the risk of malnutrition, which is a very real danger.

We spot an MSF flag on one of the boats doing a distribution. We pull up alongside and clamber onto the jetty, where we're asked to take off our shoes before stepping onto land. The distribution is being done through the local monastery, which is a common place for the teams to distribute. Prior to the cyclone, the monasteries formed the basis of the social fabric of society. Much schooling is done through the monasteries and monks tend to occupy a high position within the community. In this case, families are gathered in one of the monastery outbuildings and the head monk is overseeing the medical consultations.

Children under five are being weighed, measured, and having the circumference of their upper arms measured to check for malnutrition. Those at risk will be sent away with a ready to use therapeutic food called Plumpynut - a sweet peanut paste containing every conceivable vitamin and mineral that the children might be lacking in their daily diet. Lack of these essential foodstuffs will lead to health problems in the long run, and with so much of this year's crop ruined, malnutrition is a real concern. All the other children, pregnant women and breast-feeding mums are given high-energy biscuits. It's amazing to see the distribution in action and how this huge combined effort is actually making a difference to people. Those who are here are survivors but without basic shelter, food and clean water, life will be so much harder.

We leave, and lots of people flock down to the pier to say goodbye. One man comes up to me and says something in Burmese. One of the national staff translates: "Thank you so much for coming from your country to help us. We appreciate it so much. The cyclone took everything away, and we have to rebuild our lives. Thank you for your help."

I know that my part has been one cog in a huge machine, and that there are so many medical staff, logisticians and water/sanitation engineers who are doing so much more than I am, but it's incredibly gratifying to hear.