More than 60 Médecins Sans Frontières (MSF) surgeons, doctors, nurses, logisticians and other staff are currently part of the substantial international and local aid effort in Manila in the Philippines, Padang in Indonesia and Samoa in the South Pacific. In addition to these teams, 45 tonnes of medical and relief material are on their way to Indonesia. MSF teams are trying to identify unmet urgent needs and have started carrying out mobile medical activities and the distribution of relief items in targeted sites. The Philippines One MSF team is assessing the situation in Tuguegarao, a city in the north of the country, where a second typhoon caused extensive damage and killed 15 people this past Saturday. Other teams are focusing on Manila and surrounding areas one week after tropical storm Ketsana caused massive flooding which, according to official figures, killed 300 people and displaced 320,000 in and around Manila. The floodwaters have started to recede and many people are returning to their homes. However some places are still under water and it could take months for all the water to clear. MSF has started a mobile clinic and has begun distributing non-food item, including soap, bowls and plastic sheeting, in Laguna Bay, south east of Manila, an area still partially flooded. The scale and topography of the region make it difficult to reach communities that may be in need of urgent assistance. MSF teams are using helicopters or boats to carry out their work. No outbreaks of disease reported Two mobile clinics are providing around 70 medical consultations each in some of the 505 evacuation centres in Manila and surrounding areas. The main diseases people are being treated for are diarrhoea and skin infections. Our medical teams have set up surveillance monitoring in order to respond to possible outbreaks of water borne diseases or respiratory tract infections. “After every major natural disaster, alarm calls have been issued regarding major epidemic risks,” notes Jean Rigal, a doctor and MSF medical director. “The fact is that there was no outbreak of disease after the tsunami in 2005, the Katrina hurricane the same year or the Mitch hurricane in 1998. Actually, there are rarely epidemics immediately after a natural disaster. But they can still occur later if the disease was already present, if access to healthcare and to drinkable water has deteriorated and where people are forced together in the restricted space of temporary camps. That’s why a monitoring system is needed.” Even so, the health risks from dead bodies, which are often raised as a hazard, are relatively minor. Indonesia About 40 MSF staff – including surgeons, nurses, psychologists and logisticians – are assessing the needs in the city of Padang and in the surrounding area , mainly in the area of Pariaman, where close to 90 per cent of the houses have been destroyed. The latest official estimate is of 704 dead and possibly 1,000 to 3,000 missing almost a week after a powerful earthquake hit the Indonesian island of Sumatra. There are around 800 severely injured and another 2,600 people with minor injuries. But the overall medical provision, with several field hospitals, seems to be adequate for now. MSF teams are focusing on the potential needs in the surrounding rural areas. Work is now starting with mobile clinics and the distribution of relief items. Assessments in Samoa islands in the South Pacific A small team consisting of a coordinator, a water and sanitation specialist and a psychologist have visited the south coast of Upolu Island between Lalomanu and Fusi villages to carry out initial evaluations. A significant part of this coastal stretch (between Lalomanu and Lotofaga) took the full impact of the earthquake and resulting tsunami on Sept. 29. An MSF team is also visiting Manono Island, west of Upolu. Accessible only by boat, this area has so far not received any assistance from aid organizations. MSF will be assessing the psychological needs of people in the hardest hit areas.