One of the most difficult things about working in the Delta is getting access to communities. We have to do most of it by boat, but the boats are in short supply because so many of them were destroyed in the storm and everyone wants to use the remaining boats.
Vincent works on the MSF emergency desk in Amsterdam, and is highly experienced at dealing with emergency situations. He travelled down to the Delta at the end of May and is in charge of co-ordinating MSF's emergency response to Cyclone Nargis in the Delta.
"The scale of the operation is huge because the Delta is such a large area with so many villages scattered around. The situation is different to when you have a few large groups of beneficiaries in one area. The fact that we have to do all our transportation by boat makes the operation really quite cumbersome. The last small part of the distribution takes a huge amount of effort.
"One of the most difficult things about working in the Delta is getting access to communities. We have to do most of it by boat, but the boats are in short supply because so many of them were destroyed in the storm and everyone wants to use the remaining boats. However, we managed to find boats to hire eventually.
"The boats aren't particularly good, but the guys who are in charge of them are very capable indeed. Most of the boats are 30 metre long river boats and have a kitchen at the back where the captain's family lives. The load is full of our cargo, bags of rice, beans etc. Quite often our staff have to sleep on the boats as well.
"The boats are reliant on the tides being right to be able to move and land in the right places. Recently there have been quite a few storm warnings so the ships have not been able to move. When we arrived at one village, the wind was blowing in the wrong direction so we simply weren't able to moor the boat. The villagers eventually managed to come out to our boat on a much smaller boat but it took a very long time to unload the supplies and get them onto the shore.
"The other problem we often have is that, once it gets dark, the captains do not want to sail if they don't know the area. The Delta is a labyrinth of large waterways, little inlets and much smaller riverways. We tend to use local guides who know the area in order to navigate in the delta.
"Quite often the jetties have been completely destroyed or the harbours are very overcrowded so actually mooring the boat becomes extremely difficult. The additional problem is that the creeks are very shallow, so the boats can often only move at high tide with the right current. So we have to be very patient as we sometimes have to wait for the right tide so that we can move.
"Offloading the boat all happens by hand. It often takes place at night, as it takes quite a long time to arrive at the places we are trying to access. So if you are trying to offload 200 sacks of rice then people have to go one after the other onto the boat. It takes hours and hours to unload the boats in this way. In the bigger villages we recruit people to help with the unloading but in the smaller villages the whole population pitches in.
"Another problem is that our teams can only take a certain amount of supplies with them in each boat. Before the teams leave they will have an estimation of the people living in the village they are trying to reach. But what often happens is that they come across other villages where people have not received any aid and the population is equally needy.
"Obviously, the teams want to help out both villages but this means that it is extremely difficult to ensure that we are distributing enough supplies. It is one thing to say that we will try to reach an estimated population of 200,000 people. We send out enough food from the warehouses to cover that population for a certain amount of time. The difficulty comes when you look at the figures after a month of distributions.
"When you look at the amount of aid people have received in each village you often discover that the population of 200,000 have only about 40 to 50 percent of the basic amount of supplies they need each month. Of course, not everyone has lost everything and there is a little food in each of the villages. There are other organisations distributing food and people are even getting small amounts of food from the army. But it's still going to be a few weeks before we can say that everyone has had their basic needs covered.
"With a disaster on this scale you are constantly faced with dilemmas. The dilemma we have is that you can give a million people a very small amount of food, or 50,000 people three square meals a day.
"One of the difficulties is that we are trying to distribute at the same time as assessing the needs of the population. If we spent a month doing a proper assessment of the area trying to direct where the need is greatest then in the meantime, we would not have given anyone any help. Otherwise we could have gone to three areas that were easily accessible and given those communities everything they need. We are trying to find a balance. That we have managed to cover about 50 percent of needs means we still have a lot of work to do but that we have tried to give people the minimum of what they need while covering as large an area as possible.
"The work is very hard for our national staff. They spend weeks on the boat where they are moving around constantly and having to camp in monasteries at night. The circumstances they are working in are physically very hard. Pouring rain and deep mud makes moving very difficult - you have to be barefoot as you will lose shoes in the mud, but then you risk getting infections. This is added to what they are seeing.
"I am impressed at how resourceful they are. The national staff are people who have experienced working in our normal programmes but they have never done any emergency work like this before. They are very motivated and know how much their work is appreciated by the people in the Delta. The staff feel very compassionate about their fellow countrymen.
"The biggest difficulties we are facing are the sheer volume and the distances we have to cover. It is extremely difficult to map out the area, which villages you need to reach and the ones you have to return to. Because we are also trying to do watsan activites we have to work out which villages we need to return to with equipment and engineers - it's more complicated than just delivering food.
"Delivering food and doing medical consultations is very hard - you might aim to reach four villages in a day, but you might come across very sick people who take longer to treat. You have to risk missing the tide and not being able to deliver the aid to everyone, or not leaving without treating the patients properly.
"We have had problems getting all the supplies we need at times. You have to choose between leaving without essentials such as plastic sheeting, or not leaving with everything and making people wait longer for food. People face these kinds of dilemmas everyday."