Interview with Michel Becks, Médecins Sans Frontières (MSF) water and sanitation advisor. Michel works in an advisory role with MSF in Amsterdam and has had extensive experience working in emergency situations in the field. Recently, he has worked in Zimbabwe, dealing with a cholera outbreak and last year set up water and sanitation systems in an internally displaced people's camp in Chad.
Why are water and sanitation so important in Myanmar at the moment, in the wake of Cyclone Nargis?
"It is clear that access to clean drinking water is a very basic need. If people cannot get safe drinking water they won't survive more than three days. People can go for longer without food, but clean water is one of the primary needs.
"The other problem is sanitation. In Myanmar, there is water everywhere but no safe sanitation. If human waste gets into the water supply, disease can spread very quickly. Two of the most pressing needs in an emergency situation are providing people with safe drinking water and working out how to dispose of human waste."
What kind of health problems do you see if you don't have access to clean drinking water and there is no sanitation system?
"The obvious health problem is diarrhoeal disease. Cholera has an incubation period so isn't immediately obvious. Diarrhoea is very obvious from the start and it is a particular risk for children under five years of age. Peoples' houses have been destroyed so they are living in very crowded situations. If people are living in crowded conditions and do not have access to safe drinking water and toilet facilities, then disease can spread very fast."
What is the procedure for providing adequate access to safe water and sanitation facilities in an emergency such as the cyclone?
"The first step is to get a good overview of the area where people are living. The teams on the ground have a specific checklist in order to assess the needs of the population. We assemble our emergency stocks of basic water and sanitation materials.
"When there is extensive flooding with dead bodies and dead animals in the water we need to clean out and disinfect an identified water supply. We usually try to use wells, but sometimes it will be a flowing water supply such as a river.
"Then the challenge is to get the water from the well to a distribution point. In these kinds of situations we use water points that are very quick to erect, such as water bladders. We pump the water into the bladders that have already been disinfected. Once this has been done, the water is ready for distribution through taps.
"The water needs to be distributed quite fast. We aim to be able to provide at least five litres of clean water per person per day in the initial stage of an emergency.
"On a smaller scale, as soon as we get to an emergency we start distributing water purification tablets to people and doing bucket chlorination. Bucket chlorination simply involve standing next to the sources where people fetch their water and adding some chlorine to people's buckets of water so that it is safe for drinking.
"Often people have lost their homes and all their belongings, so it is important to make sure that they have the means to collect water and to wash themselves. We distribute buckets and soap to ensure that people are able to fetch water and to wash."
Are you facing any restrictions in terms of providing adequate water and sanitation to people in the Delta region of Myanmar since the cyclone?
"Our biggest problem at the moment is in terms of staffing. At the moment we have just one national staff member who is a dedicated water and sanitation specialist. Our team of water and sanitation people are able to do the smaller scale water treatments such as bucket chlorination and distributing buckets and soap, but they are not experienced in dealing with emergency situations on this scale. The cyclone is not an everyday situation.
"If we are to prevent the spread of disease it is very important to have the right number of people with the right skills on the ground. You need a whole different mind-set to deal with an emergency situation. We have a pool of people who are very skilled at setting up this kind of equipment in a very short space of time, and then making sure that it runs correctly.
"Keeping the equipment running is actually more of a challenge than setting it up in the first place."
From your experience of working in emergency situations, what do you think will happen if a proper water and sanitation system cannot be installed quickly in the Delta region?
"If a proper water and sanitation system is not set up, people will continue drinking water and they will not have access to proper sanitation. We may well see an explosion of diarrhoeal diseases. In emergency situations like this, the bulk of the medical consultations our staff deal with tend to be related to the lack of access to clean water and proper sanitation."