Interview with Celso Dulce, CARE’s Philippines representative and disaster risk reduction advisor

CARE and partner organizations distribute relief items to people affected by cyclone Bopha (Pable). © 2012 CARE

Cyclone Bopha has affected more than 6 million people. What are their greatest needs at the moment?

The affected people I spoke with said that their foremost needs are food and support for their livelihood recovery. Most of the affected people are engaged in smallholder farming of banana, coconut, oil palm and falcata trees, or as workers in big plantations. In between rows of coconut, smallholder farmers grow vegetables, mainly for household consumption. Cyclone Bopha (also called Pablo in the Philippines) destroyed all these.

At present, people depend to a large extent for their nourishment on food relief. The most common food being consumed by affected populations are steamed rice, instant noodles and canned sardines. People are requesting the inclusion of vegetables in future food distribution.

The main crops being grown by the affected population would take time to recover – banana would take a year to become productive again; coconut or oil palm three years or more. The people recognize the need to immediately restart their livelihood recovery process, but need assistance, in the form of seeds, farm inputs and replacement of farm equipment and machinery lost to Pablo. Considering the local seasonal calendar for agriculture, livelihood recovery support should be provided not later than January 2013. Failing to do so would lengthen the duration of food shortage among affected populations by at least three months.

Are women and girls particularly affected? If so, what are their greatest needs?

The women, consistent with their nurturing role in the family, worry about where to get food for the next meal. They also worry about their children getting sick because of poor shelter conditions, exposing children to the heat and cold and to carriers of diseases such as mosquitos, and because of lack of clean water for drinking and other uses. They worry that their community health center is not functioning anymore, and that they have no access to medicine and health services.

Children, boys and girls alike, are unable to attend school because the school buildings are damaged. Young boys and girls won’t be able to continue attending school due to lost household incomes.

How are CARE and its partner organizations responding?

CARE and our partners are collaborating with five other international organizations (INGO) to fill the gaps in the needs of the most vulnerable households in most affected areas. The INGO consortium is providing comprehensive assistance consisting of food, shelter and essential relief items, water, sanitation and hygiene as well as health support. CARE and partners have targeted upland areas, often populated by indigenous peoples, that are difficult to access and therefore receiving less assistance, if at all.

Targeted beneficiaries, and women in particular, are involved in planning and distribution of assistance. Disaster risk reduction is also incorporated in the response, by providing information on hazards and how individuals, families and communities can prepare for future hazards and reduce risks. Information is provided to households rebuilding their houses on how to incorporate basic risk reduction measures such as selecting proper location and improving construction practices.

Is there a high risk of an outbreak of diseases?

There is already a reported diarrhea outbreak in Cateel municipality in Davao Oriental. Tests conducted revealed that there is high level of contamination of water sources in the area. Mothers report of their children getting sick with fever and common colds, attributed to their exposure to the heat and the rain. In the most affected areas, almost all houses have sustained damage and therefore provide inadequate shelter to family members.

Cyclones are recurring every year in the Philippines. How can people better protect themselves from such a natural force?

The areas affected by Bopha were seldom visited by typhoons in the past. A combination of lack of awareness and preparedness amongst communities and local authorities, unsustainable agriculture practices, and environmental degradation has resulted in this disaster. On the other hand, in locations where CARE has been implementing community-based disaster preparedness that incorporates climate change adaptation and ecosystem management and restoration, communities and local authorities have demonstrated that losses and suffering from disaster can indeed be significantly reduced.

Saint Bernard municipality in Southern Leyte, communities in Agusan del Sur and in Bukidnon and Iligan City have demonstrated that people can better protect themselves by being aware of local risks, and having basic knowledge on what to do prior to, during and after a hazard event. Communities working together with local authorities can develop community contingency plans including early warning systems and evacuation plans, which can be activated in the event of a hazard.

Hurricane Sandy was the largest Atlantic storm ever recorded. Americans understandably view is it as an American emergency as the storm left 131 Americans dead and did tens of billions of dollars in damages to some of the most populated parts of the country.

Flooding in Léogâne © 2012 CARE

Before hitting the U.S., however, Sandy inflicted severe damage in the Caribbean. Worst-hit was Haiti, where the storm affected 1.8 million people, or nearly 1/5 of the country's total population. CARE's staff in Haiti reports the storm flooded 18,000 homes and forced more than 21,000 people into evacuation shelters.

Although the storm is long-gone, the worst of Sandy's impact in Haiti may be yet to come. Torrential rainfall during the storm and in the weeks since have devastated Haiti's agriculture sector. According to the UN's Office for the Coordination of Humanitarian Affairs, 42 percent of Haiti's corn crop, 30 percent of its rice crop and 20 percent of its bean crop have been destroyed. 1.2 million Haitians are vulnerable to immediate food insecurity and an even larger potential crisis looms because the crops destroyed in the ground last month made up a substantial proportion of Haiti's 2013 projected harvest.

Sandy was a powerful reminder of Haiti's vulnerability to environmental change. According to the Climate Change Vulnerability Index, Haiti ranks highest among 200 countries for risk of vulnerability to climate change in terms of potential floods and mudslides. As Haiti will continue to face natural disasters that destroy people's lives and livelihoods, CARE recognizes the urgent need to advocate for long-term development in Haiti while striving to integrate Disaster Risk Reduction activities into all of its programming.

In addition to our long-term work in Haiti, CARE is responding to the storm with water, sanitation and shelter initiatives that have reached 2,300 families, or approximately 12,000 people. In Grande Anse, CARE has distributed 252 hygiene and shelter kits. CARE has also received initial approval from USAID for an eight-month extension of its food voucher program in Grand Anse which provides nutritional foods to 12,000 families in 9 communities.

In Léogâne CARE has distributed 400 boxes of water purification tablets, 1,600 oral rehydration solution packets used to treat dehydration from severe diarrhea and 451 leaflets and posters on the prevention of diarrhea and related illnesses. The team distributing them also provided training on strengthening existing shelters, safety and cholera prevention. As part of on-going water and sanitation program in Carrefour, CARE is building latrines and outdoor shower facilities, some of which were damaged by Sandy.

by Elizabeth M. Campa, Water Sanitation and Hygiene Coordinator, CARE Haiti

Flood waters surround a water pump in Léogâne, Haiti. © 2012 CARE

"Haiti is the country with the highest risk of vulnerability to climate change in terms of potential floods and mudslides," according to the Climate Change Vulnerability Index. The index ranks nearly 200 nations and their vulnerability to climate change. The arrival of hurricane Sandy proved this tragic statistic true – once again.

Contrary to the effects causes by tropical storm Isaac, which hit Haiti in August and brought strong winds, this time communities were mostly affected by the massive quantities of rain. Assessments conducted on October 26 and 27 in the areas where CARE works (Léogane, Carrefour and Grande-Anse) showed the extent of the damages. In Léogane, located along the coastline, several villages were washed by massive flooding, leaving more than 300 families homeless and forced to seek refuge in schools and churches or with more fortunate neighbors.

The situation in Carrefour was even more devastating. Here, a region of over 450,000 inhabitants, most people are living in transitional shelters constructed after the devastating earthquake in 2010 (more than 1,100 of these shelters were built by CARE). Hurricane Sandy damaged more than 300 shelters and destroyed 200 latrines currently under construction.

Carrefour is also a region with very scarce access to potable water. People trying to reach water spring catchments can only do so by crossing a river that now is swollen. And to make a bad situation worse, many of the water kiosks (places where people are able to clean water for a small fee) have been closed, due to power shortages and the absence of operators, leaving the population no other choice than to use river water for drinking that has been contaminated by fecal matter due to lack of latrines in the area.

Grande-Anse, and its 12 communes, was most affected by Hurricane Sandy. Massive rainfalls washed away bridges and homes. An estimated 3,000 homes were destroyed or badly damaged, and more than 1,600 people displaced. Many areas are still completely cut off. The destruction has had a high impact on food security: 40-50 percent of crops are lost. The production was already expected to be low due to droughts and tropical storm Isaac, therefore placing this farming community at higher risk in terms of increasing levels of malnutrition.

Cholera is another pressing issue. Grande Anse has the highest cholera prevalence in the country. CARE’s immediate response consists of supporting cholera treatment centers through programs already in place in the area, repairing existing cholera treatment facilities, through our partner Médecins du Monde-France, as well as improving water sources. We’ll also focus on the distribution of aquatabs to purify water, tarpaulins and tents, hygiene and kitchen kits, and water containers as well as the promotion of hygiene in the area. In conjunction with the local water authority, DINEPA, CARE erected a water bladder containing 1,500 gallons of chlorinated water, and will continue to do so as needed, particularly in areas where cholera is likely to spread.
The lack of clean water and proper sanitation in Haiti is often simply overwhelming.

In my 12 years of experience working overseas in development and emergency programs, I find it unbelievable that Haiti experiences such low levels of access to water and sanitation, considering its close proximity to the U.S.A. Hurricane Sandy will not be the last storm that passes through Haiti. We will continue to see natural disasters destroying people’s lives and livelihoods and they will need our assistance. It is imperative that we invest in improving water and sanitation and disaster risk reduction, so people can protect themselves and be prepared for future disasters.

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In the village of Karidi in the Birni-Lafia region of Benin lives a farmer and fisherman who is 25 years old. He is married and a father of three.

Flooded area in the north of Benin. Photo: © 2012Parfait Dovonou/CARE

Hassan Ibrahim is living in a zone that is often flooded in the rainy season but parched in the dry season. In this environment, huts are constructed from cut branches or clay. The roofs are made of thatch and are almost always built without a metal sheet because of the zone's temperature extremes.

The inhabitants of this region generally make their living through fishing, agriculture and sometimes small businesses run by the women. They also raise certain domestic animals such as poultry, goats or sheep, which they sell to cover basic needs during the lean season. The region is predominantly rural and there is very little adequate social infrastructure. Karidi, for example, has no health center, no electricity, no latrine and no source of potable water. The nearest medical care facility is miles away. The river serves as a latrine and shower, as most of the households do not have a private bathroom – and this same river is also the only source of drinking water.

Since the floods that started two month ago, the lives of many people have become extremely difficult due to the dramatic impacts of the disaster: the unusual rise in water levels caused the destruction of shelters, food reserves, crops, livestock and other property.

Hassan Ibrahim, after having assessed the danger of his home collapsing, decided to build embankments himself in order to hold back the water. On Tuesday, Sept. 4, he set off at a run to collect the ears of corn, sorghum, and millet which he would need to bury along with the sand and mud to form the barrier. He began to dig and as he reached his hand into a hole to judge its depth, he suddenly felt a sharp pain in his hand: it was a sharp object that had been previously buried and which cut off his little finger on his right hand.

He had no way to get to the hospital: all of his possessions had been swept away by the water. He settled for applying a traditional treatment using leaves. The finger did not heal, and caused him extreme pain which prevented him from finding a way to feed his children. The water overtook the land, the children were saved by other people, and he himself has had trouble finding a safe house and supporting himself. Since then he is surviving on charity. His wish is to be able to recover his health and to access microfinance services or obtain an agricultural loan to restart his farm when the water subsides.

CARE is responding in the affected areas of Malanville, Karimama, N'Dali and Tchaourou to support people with basic relief items and clean water. During the floods in 2010, CARE Benin provided emergency relief and worked with partners and local actors to support with water, hygiene and sanitation, food distribution and shelter for 150,000 persons.

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© 2012 CARE

With the help of her neighbors, Gado Fathi had been able to build herself a shelter. However, the small hut was destroyed by the terrible floods in 2010. It had been very difficult for her to rebuild it.

This year misfortune struck again: one night, the floods came again, while she and the two children were deeply asleep. She was suddenly awakened, but most of the clothes had already been washed away. Her cookware was submerged and the structure of the shelter was already beginning to give way. She did not know what to do or where to go. Most of her belongings were already damaged beyond repair. "The rain fell almost every day, and heavily. The farm animals floated on the water and died", she says. "The granaries were swallowed up by the water in the village. There were no boats for transport. Even though we wanted to take refuge on dry land, we had no way of moving." Since she has lived in the village, the floods have never been that strong.

Gado Fathi began to fight the floods by herself, trying each time to bail out the water using old basins in order to have a little bit of living space in the shelter where she and her grandchildren might survive. Indeed, the house was surrounded by water and she had no help. During this almost endless fight against the water masses, she was struck for one week by an illness that completely immobilised her. Her legs were swollen and she could no longer move.

The children barely ate once a day: the lack of food became clear. Luckily, a passing neighbor offered to move them to a safer area. She asked for help for her two grandchildren, one of which had been showing signs of a strong fever in the previous 48 hours. The health center referred the case to a more qualified clinic in the city of Malanville. But on the way to the city the boy died of the disease. In the meantime, the second boy developed visible signs of malnutrition. People joined together to help the child’s recovery in the traditional way by giving him an infused bath, because they had no more money to treat the child at the health center.

These events happened in early September 2012, when the narrator of this story passed through the village. The old woman has found a host family but she is still not able to walk.
CARE is responding in the affected areas of Malanville, Karimama, N’Dali and Tchaourou to support people with basic relief items and clean water. During the floods in 2010, CARE Benin provided emergency relief and worked with partners and local actors to support with water, hygiene and sanitation, food distribution and shelter for 150,000 persons.

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A boy pushes a bike through a flooded street in Léogâne, Haiti. © 2012 CARE

The western regions of Grande Anse and Leogane, where CARE is currently active, were badly hit. According to initial CARE field assessments, more than 6,500 homes have been flooded, damaged or destroyed, with approximately 7,500 people having been displaced. However, a complete overview is sketchy at best as access to many areas, particularly in the Grande Anse, is difficult. The main route is inundated in places with a key bridge destroyed and other routes are impassable by vehicles. Boats and airplanes are currently the only means to transport relief items quickly. The Haitian National Emergency Center reports a total of 7,627 families (approximately 38,000 individuals) have been affected, with 44 deaths and 19 grave injuries.

CARE had been preparing for a possible emergency response in Grand Anse and Leogane these areas before the hurricane hit the country. The emergency team now is planning to support affected people with clean water as in many areas. Because water points have been damaged, the population dependent on river water for consumption, which is not only dangerous due to its dangerously high levels, but the risk of cholera.

CARE will assist in distributing aqua tabs to purify water, soap and jerry cans. In order to provide clean water, CARE’s water and sanitation team may also install water bladders as needed. CARE will also assess current project sites and cholera treatment centers to determine the level of repair required to reestablish access to potable water and sanitation facilities.

In Leogane, especially in the areas of Saria and Bino, where 300 families lost their homes and all possessions, CARE is supporting other local organizations which have already response plans in place CARE has more than 40 trained staff, including social mobilizers, water and sanitation experts, as well as engineers that are available to assist organizations carrying out emergency assistance.

John Uniack Davis, Country Director, CARE Madagascar
March 29, 2012

Marie-Jeanne lives with two of her three children in this house that is slowly crumbling around them, closer each day to collapsing completely. Marie-Jeanne ekes out a fragile existence selling charcoal to neighbors who are only slightly better-off than she is. Location: Andovoranto, Brickaville. Photo: Katia Rakotobe

"Six weeks have passed since Cyclone Giovanna hit the east coast of Madagascar, and the humanitarian situation is becoming more and more clear. Needs assessments carried out by the United Nations, NGOs and the Malagasy Government came in and they offer precision regarding the affected population and its needs. But even without quantitative data, the passage of time has allowed us to see who is able to get back on their feet on their own and who needs outside help to return their lives to normal.

This week, I returned to the Giovanna-affected zones for the first time since February 22-23. My objectives were to thank and encourage our team, which has been working non-stop since the days immediately following the cyclone, and to get a sense of the evolution of the humanitarian situation. I traveled to Vatomandry and Brickaville Districts, those that were the most affected by the wrath of the cyclone. Accompanying me were emergency operations manager Mamy Andriamasinoro, communications officer Katia Rakotobe, and emergency officer Emmanuel Lan Chun Yang of CARE France. We made an effort to visit some of the villages that I visited five weeks ago, in order to have a clear basis of comparison and evaluate the evolution of conditions on the ground and our activities. My visit brought many issues surrounding the response into sharp relief.

In Andranofolo, a hard-hit village just south of Vatomandry, we revisited a young woman named Voahanginirina. When we had seen her previously, she was living in the precarious fallen wreckage of her house with her three daughters aged eight, four, and three. When we visited this time, the ruins of her home looked even worse. Consequently, Voahanginirina, who is barely over 20 years old, made the wise decision to move her family into a little structure that once served as their kitchen. It doesn't give the family much space, but it is safer than where they were before. The family of four makes do with Voahanginirina's meager earnings from making and selling baskets.

In the same village, we came upon Rose-Marie, a 73-year-old widow using the roof, which is all that remains of her home after Giovanna, as a simple lean-to-like shelter with the two grandchildren she cares for. Demonstrating that she is doing her best to make a good life for her grandchildren under difficult circumstances, she proudly showed us the neat mosquito net hanging inside her tiny makeshift dwelling. Rose-Marie makes the best living she can collecting and drying reeds from the nearby marsh, which she sells to people like Voahanginirina for basket weaving.

The next day we returned to Andovoranto, in Brickaville District, where Giovanna made landfall on February 14. Things are slowly returning to normal for many in that small seaside town. But those without extra resources or family to help them remain in quite dire straits. For example, we went back to see a widow named Marie-Jeanne, who once had a sturdy little wooden house, but a direct hit from cyclone-force winds left it a twisted, misshapen remnant of what it once was. Marie-Jeanne lives with two of her three children in this house that is slowly crumbling around them, closer each day to collapsing completely. Marie-Jeanne ekes out a fragile existence selling charcoal to neighbors who are only slightly better-off than she is.

As CARE moves forward with our response to Cyclone Giovanna, we cannot help everyone, nor should we. Many families suffered a lot in the wake of the cyclone, but have nonetheless been able to rebuild their homes and reestablish their livelihoods, thanks to their own resources or the support of family and friends. But some people, such as Voahanginirina, Rose-Marie, and Marie-Jeanne, need a little bit of outside help to regain safe and decent housing and get their lives and their livelihoods back on firm ground. These are the types of people that CARE will continue to work with in coming weeks and months as we continue helping people rebuild their lives.

Our cyclone response activities evolve over time but the principal themes remain the same, focusing on food security, restoring safe shelter, and reestablishing transport infrastructure for economic activities as well as access to vital services such as health care. We are grateful to USAID and private sector donors for giving us the wherewithal to hit the ground running and begin bringing our activities to scale. We are currently finalizing plans with other generous partners, including the Government of France, who will help us to meet the most pressing needs of those worst affected by Cyclone Giovanna."

By John Uniack Davies, Country Director, CARE Madagascar
March 6, 2012

"Just over a month has passed since Cyclone Giovanna struck the east coast of Madagascar and left thousands of lives in disarray. The day after landfall, CARE led a helicopter overflight assessment of affected zones and we have been working non-stop since then to help people put their lives back together. First, we coordinated the distribution of pre-positioned USAID plastic sheeting to 4000 households, about 20,000 people, whose homes had been badly damaged and destroyed. We are now seeking funding for longer-term work helping the poorest and most at-risk to build inexpensive cyclone-resistant homes. In the meantime, we are helping people meet their food security needs while simultaneously rebuilding key roads and such in and around where they live.

Once plastic sheeting distribution was under way, we quickly began the painstaking work of distributing food to those most in need – the elderly, handicapped, or widows and other vulnerable female-headed households are being given urgently-needed food for their families with no reciprocal obligation of any kind. But the majority of the food we distribute is given out in the context of "Food-for-Work" activities – those who are seriously affected by the cyclone but are able-bodied receive rations in exchange for making a contribution to rebuilding their communities. In the case of the Cyclone Giovanna response, we are focusing Food-for-Work on rebuilding footpaths and dirt roads that are necessary to restart economic life. For example, after Giovanna made landfall in the small oceanfront town of Andovoranto, it became even more isolated than ever, with roads cut off and economic activity interrupted. The people of the communities south of Andovoranto are working with CARE to rebuild the oceanfront road that heads 45 kilometers south to the district capital and major market town of Vatomandry. In rebuilding this road, fishermen will ensure that they have a market outlet for their catch, thus restoring their principal livelihood. While they are rebuilding the road, they will receive food rations for their whole families, thus providing essential short-term access to food. In the current phase of our response to Cyclone Giovanna, we are supporting about 32,500 people with food assistance, most of this through Food-for-Work activities. We are grateful to USAID and the United Nations World Food Program (WFP) for supporting this important support to those most in need.

In spite of all this, much remains to be done. Many families lost their entire maize and cassava harvests, and many also lost other crops, including rice, Madagascar’s main staple. Consequently, many families do not have nearly enough food to make ends meet while they replant and get back on their feet. Many families will thus need food security assistance at the same time that they are going about rebuilding homes and other infrastructure and doing the hard work of another agricultural season. We at CARE Madagascar continue to work with the Madagascar Government Disaster Risk Management Agency (BNGRC) as well as the United Nations system and other partners in order to make sure the most affected get the help they need."

By John Uniack Davies, Country Director, CARE Madagascar
March 6, 2012

"This continues to be a difficult cyclone season for Madagascar. Two weeks after Cyclone Giovanna, Tropical Storm Irina crossed the northern part of the "Grande Ile" and then parked itself off the west coast, in the Mozambique Channel, dumping lots of rain and affecting weather throughout the island. The severe weather caused extensive flooding and mudslides in the southeast part of the island, which had also been badly effected by flooding after Tropical Storm Hubert and Cyclone Bingiza in 2010 and 2011, respectively.  In one mudslide in the roadside town of Ifanadiana alone, 47 people died, and the current death toll for Giovanna, Irina, and associated weather is now at least 100. But the number of lives affected by the storms far surpasses this number.

The town of Vangaindrano in the southeast has become, for all practical purposes, an island, and populations there are cut off from assistance and at great risk of crop loss as a result of flooding. Devastation to crops would make the local populations very vulnerable in the medium term, bereft of livelihoods. Our team in Vangaindrano is assessing the impact and we expect to mount an appropriate response. We are also discussing a possible overflight with other key actors in order to ensure that necessary, coordinated assistance reaches populations in need in the southeast.

CARE Madagascar continues to be a key actor in the response to Cyclone Giovanna, which struck on February 14.  We have overseen the distribution of 397 rolls of USAID plastic sheeting distribution, which have permitted 20,000 people to escape from the elements and begin to rebuild their lives. We are grateful to our colleagues at Catholic Relief Services (CRS), who played an important role in helping us to get plastic sheeting out to the needy populations of Brickaville quickly.  We are currently stepping up efforts to provide food to those in need. We are in the process of coordinating food for work teams to rebuild roads and restore access to villages cut off by Cyclone Giovanna, primarily by fallen trees and mudslides. Through our current food for work activities, 6500 households, at least 32,500 people, will benefit from 342 metric tons of rice and other food, and we are in the process of obtaining additional commodities from USAID and the World Food Program to permit additional rebuilding of infrastructure and providing short-term food aid to families in need.

Visitors to Brickaville and Vatomandry are moved by the difficult conditions in which families are living. CARE Emergency Operations Manager Mamy Andriamasinoro says that he is most struck by seeing children sleeping in precarious, damaged homes without roofs. ‘I realize how fortunate my own kids are, and as a parent I am really affected to see the conditions in which kids have no choice but to make do,' he says.

We at CARE Madagascar are doing our best to relieve the suffering of families affected by Cyclone Giovanna and other storms this year. We want to do our best to ensure that they have adequate shelter and enough food to eat in the short term. And in the medium term, we are looking to help the poorest farmers and fishermen restore their livelihoods and regain their self-sufficiency. For this, we will need additional support from the international community."

By John Uniack Davis, Country Director, CARE Madagascar
February 23, 2011

'Today we left Vatomandry at 6 a.m. to head back up the road 90 kilometers to Brickaville, the district hardest hit by Cyclone Giovanna. As we approached Brickaville, we saw major destruction in every settlement, houses flattened and large trees uprooted. 

The large town of Brickaville was bustling, with havoc wrought by the cyclone everywhere but people going about their business. We turned down a busy side street to come upon a group of young Malagasy in Red Cross garb and then pulled up at the busy makeshift field office that CARE shares with the Malagasy Red Cross and other humanitarian organizations. After paying a courtesy call on the Catholic Relief Services (CRS) team leader and meeting up with two colleagues from OCHA (Office for the Coordination of Humanitarian Affairs) who were going to the field with us, we hit the road again.

Shortly after leaving Brickaville in a well-worn Toyota Land Cruiser for the driving portion of our excursion to Andovoranto, the town where Giovanna made landfall, we spotted a lone man rebuilding his house. We were a ways out in the country on a verdant hillside with no other homes in sight.  We found out that the young man's name was Jackie and that his wife and young daughter and he had been in their home when it was torn asunder by the cyclone.  At that point, they were forced to huddle together in the open for hours until the storm passed.  His wife and daughter are now living with relatives in the town of Brickaville for the three weeks it will take him to rebuild their home. When we asked Jackie how his new house would compare to the old one, he shook his head sadly and said it would be worse.

Once CARE's response moves from immediate post-disaster relief to longer-term recovery activities, "building back better" will be a primary objective -- we want the most vulnerable victims of Cyclone Giovanna to emerge less at-risk and less vulnerable than they were before this cyclone. And to do this we need to help them to ensure that they are housed in less-precarious structures.

After 45 minutes of driving and 45 minutes in a CARE motor boat, we arrived in Andovoranto. The town sits on a narrow spit of land between the Pangalane Canal and the Indian Ocean. We were struck by the contrast between the beauty of the natural setting and the stark destruction that we saw everywhere we looked. A two-story private nursery school and primary school had one wing leveled, the second floor pancaking on top of the first, leaving a chaotic image of torn-up walls, a broken roof, and splintered furniture, garnished with a heartbreaking jumble of children's notebooks, workbooks,  homework, and school supplies.

Around the corner from the school we met a woman named Denise Charline. She and her children slept in their granary during the storm to escape their flimsy house. They are now back in their house, living in it despite a badly-damaged roof, thanks to USAID’s plastic sheeting distributed by CARE.

The images of the past two days spent in towns and villages affected by Cyclone Giovanna will stay with me for a long time. I am daunted by scenes of raw destruction but lifted up by the courage of those most affected by it. My team and I are fully committed to an emergency response that honors the dignity of the Malagasy people and helps them to "build back better" their homes, their livelihoods, and their lives."

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By John Uniack Davis, Country Director CARE Madagascar
February 22, 2012

"I am in the field with communications officer Katia Rakotobe visiting CARE's activities to bring relief to those most affected by Cyclone Giovanna. Today, we left Antananarivo ("Tana"), the capital of Madagascar, at 7 a.m. and headed east toward the coast to the two districts most hard hit by Giovanna, Brickaville and Vatomandry. About two and one-half hours' drive east of Tana, over halfway to the coast, we started seeing fairly significant storm damage -- roofs off houses, trees down, and mudslides partially blocking the road, eight days after the cyclone hit. East of Andasibe National Park, we saw whole stands of young trees bent in half or blown down, a vivid testimonial to the power of nature, the raw force of the cyclone.

We ate lunch at a roadside stand at Antsampanana, the crossroads between Brickaville to the east and Vatomandry to the south. As we ate, we saw nimble young men on nearby roofs repairing the cyclone damage. Farther south, we saw numerous houses completely leveled by the cyclone, and yet the simple rough-hewn frames of new houses are already in evidence. We were struck by the resilience of the people, knocked down by the storm but springing back up to rebuild their lives.

CARE's post-cyclone relief activities are aimed at those who are more vulnerable and less resilient. These are often, for example, women heads of households with young children or elderly people with no means of support.

We are in the process of distributing plastic sheeting to those exposed to the elements. With plastic sheeting supplied by USAID and the UK Department for International Development (DFID) and the help of partners like Catholic Relief Services (CRS), we will keep 20,000 to 30,000 people safe and dry.  In the medium term, we expect to help those most in need to rebuild their homes in a sturdy fashion. While many families have their own resources or a social safety net that will permit them to rebuild without outside help, we want to assist those who don't quite have the means to help themselves quickly enough.

CARE will also be providing food aid to destitute households in the short term and start food-for-work programs in the short and medium term. Food-for-work means that people will help removing rubble and reopening blocked roads and will receive sufficient food for themselves and their families in return.

As I write these lines on my Blackberry while bouncing along on a remote sand track near the Indian Ocean, it is clear that a lot of work lies ahead of us in order to provide relief and help those in need rebuild their lives and regain their self-sufficiency. My colleagues at CARE Madagascar and I welcome the challenge inherent in this important work.

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Impact of previous cyclones in Madagascar, such as wind damage. Picture taken by  by Katia Rakotobe– Location : Mananara (North East)

"On Wednesday morning, CARE sent a helicopter to the areas affected by cyclone Giovanna to assess the damage. The storm made landfall on Tuesday, February 14, on the east coast of the country and it brought heavy winds and rains. Our staff have been preparing for this as we could monitor the storm coming close. Luckily, when Giovanna made landfall, it lost some speed and was therefore not quite as strong as the Category 4 storm that had been predicted. But still, it left a path of destruction through several districts.  Two districts in particular, with a total population of over  400,000 were particularly hard hit. What was really unusual was that after hitting the coast and traveling inland, the cyclone passed directly over the capital city, so I and the rest of our staff had to stay home until late Tuesday morning. There were extremely strong winds. Giant billboards were blown down and debris was flying around. I am glad that all of my colleagues are safe and accounted for. Here in "Tana", as we call the capital, there has been quite some destruction and people were not really prepared for the storm.

Tomorrow we will have a better picture of the devastation when we evaluate the data from our aerial assessment. CARE staff from our sub-office in Vatomandry report that at least 60 percent of dwellings in the town have been partially damaged or completely destroyed. Houses in these poor areas are often built of bamboo and palm leaves, so it is easy for a strong wind to rip them apart. Many families have experienced these storms before, so they usually repair their houses quickly. But especially elder people or households headed by women need our help now to provide them with construction materials. There are sixteen reported deaths so far, but I expect the numbers to rise. Many areas are still cut off and have not been reached yet.

CARE had plastic sheeting prepositioned in our warehouse that we can distribute to 6,000 households or 30,000 people as a first emergency response. Once we have clearly assessed the needs and locations, we will begin with the distribution. People will probably also need food assistance, as their stocks might be lost in the damage. And as roads are destroyed, we need to rebuild them quickly to get access to affected villages. CARE is one of the most established emergency actors in Madagascar, we have provided emergency relief to cyclones in the past years, such as Bingiza and Hubert. I hope that this time again we will get the necessary support and funding to act quickly and reach those who need our help now."

John Uniack Davis, Country Director CARE Madagascar
February 16, 2012

Impact of previous cyclones in Madagascar, such as storm surge. Picture taken by Dasy Ibrahim CARE staff -- Location : Antalaha (North East)

"Our CARE team is in the second and final day of a helicopter assessment mission to target assistance to populations in need after Cyclone Giovanna hit the country on Tuesday morning. The team is reporting that, as expected, there is substantial damage in the Districts of Brickaville and Vatomandry, which are located on the east coast of Madagascar. In the commune of Andevoranto, the point of Giovanna’s landfall, 80 percent of dwellings were damaged or destroyed. For the town of Brickaville that figure is about 70 percent, whereas 40-50 percent of houses in Vatomandry were damaged. There is a stretch of coastline of 100 kilometers or more that suffered quite serious destruction. People lack shelter as well as access to food in the short term – we need to help them soon.

The assessment team is doing everything that it can to provide assistance as quickly as possible. For example, some remote communities have experienced serious wind damage and are largely bereft of shelter. So our team is bringing in the first batch of plastic sheeting by helicopter to help them build temporary shelter and get out of the elements. But a more sustained effort of relief and recovery will be necessary in order to help populations buffeted by Cyclone Giovanna get back on their feet. Our deputy emergency coordinator will stay in Brickaville today to open a makeshift emergency operations office and begin mobilizing experienced emergency staff to move forward with providing shelter and food and reopening disrupted transport routes.  Thanks to funds provided by the CARE Emergency Group in Geneva, we have been able to hit the ground running in order to provide vital help to those most in need. However, more resources will be needed in the coming weeks to scale up relief and recovery operations."

By Richard Wecker – CARE International in Vietnam
Isolated village of Văn Giáo commune, Tịnh Biên district
December 20

Nguyen Van Ngat lives with his wife, Le Thi San, and their four daughters on the edge of Tra Su national landscape reservation, near Văn Giáo commune of Tịnh Biên district.

The tree-lined road to their home remains some four metres below the surface of what is now a lake. Water levels have remained high for six weeks after the peak of the floods in An Giang province, Vietnam.

Ngat and his neighbours had the experience and foresight to elevate their wooden floors in preparation for this flood season. Their homes are sitting just above the water, propped up by makeshift stilts. "We were aware the floods would be high this season so we helped each other to prepare," he says. Without knowing the signs to look for and without taking heed of warnings, the family of six would otherwise be stranded, homeless.

At first glance, this isolated cluster of floating houses look purpose built, however all of inhabitants tread lightly as the renovations were rushed and the support beams were weakened by termites prior to the floods. "We need to reinforce our house as it may collapse at anytime but we have no money to do this," Ngat says. Many of the houses in his area were evacuated before the peak of the floods. Some residents have returned but many cannot live in their house due to risk it may collapse.

Ngat usually works as a hire-labourer, mainly farming rice, however his usual employers have no work for him. Seasonal flooding is normal in this part of the world but this year the water has reached record highs, destroying a large amount of the season's crop and creating a risk of poor people going hungry since they are the most affected. There are many people in Ngat's position, who is now faced with the challenge of feeding himself and his family for the next 3-6 months until floodwaters recede and the next season comes around.

Ngat usually fishes to supplement the family's income but the wind and tides are in motion, unsettling what might otherwise be a surrounding bounty for his family.

Furthermore, his fishing tackle is old and worn and his boat has holes in it. What Mr Ngat might catch on a good day might fetch 20-30.000 VND (US$1-1.50) at the market, which could buy just enough rice for the whole family of six. He expects the calm to return in December but he insists: "the weather has been unpredictable in recent years and no one can say what the future will bring".

Ngat's wife San suffers from chronic heart disease and so the eldest daughter stays at home to take care of her and the younger siblings. Occasionally she will also go out fishing with her father, leaving the house early in the morning to return around lunch time.

Of the four girls only one goes to school. She had been faring the floodwaters by boat with no safety gear and would take raw rice from the family's reserve rations for her teacher to prepare her lunch. As Ngat and San cannot pick up their daughter from school they rely on other members of the community to watch after her.

The lights of this household are extinguished early and the evening meals of rationed rice are cleared quickly to avoid attracting the swarms of mosquitoes from the nature reservation - dengue is rife this time of year. It's a precarious situation for Ngat and his family but they are looking out for each other.

CARE International in Vietnam has provided immediate food support to strengthen to capacity of people affected by the floods.

Ngat and his family are one of over 1,000 households in An Giang province that have received immediate food support. "It's enough for us to live for a month, we are very grateful for the support," Ngat says. Follow-up distributions are intended to provide additional support during this period while livelihoods have been disrupted. Any subsistence stocks of rice that remain in his area are inaccessible. Having this staple will prevent him and his family from falling in to a credit-debt spiral that threatens to prolong this period of hardship.

CARE has also distributed non-food items funded by the United States Agency for International Development (USAID) to strengthen the coping capacity of communities at high risk from the floods, including elderly people with little family support, people with disabilities, female-headed households with dependent children and infants, as well as poor families, landless families and those reliant on casual labour.

Ngat and San's daughter can now take filtered water to school in a bottle after they received a silver-impregnated water filter and training on how to manage their water using this device. They also received mosquito nets that will help to protect them from the mosquito swarms at night; hygiene kits to reduce the risk of contracting water-borne diseases or infections; a 10 litre bucket for hauling water; blankets for the coming cool months and lifejackets.

CARE is working with communities to plan how they can provide further support to families such during this peak-flood period and over the course of the next 3 to 6 months. The plans are to focus on livelihoods support while the water levels recede and families such as Ngat and San's wait for the next rice harvest season.

Richard Wecker – CARE International in Vietnam
Thạnh Mỹ Tây commune - Châu Phú district
December 20, 2011

Le Thi Dieu is 72 years-of-age but she possesses the sharp wit of a curious teenager. She offers her warm smile and laughs aloud, speaking candidly of her life in An Giang province - one of the most flood-prone areas of the Mekong Delta in Vietnam.

For many years Ba Dieu had resided under a makeshift shelter on the banks of the river only 10 minutes by boat from the centre of Thạnh Mỹ Tây Commune. She recounts stories of trudging through floodwaters, her house being uprooted and searching for food.

In her recent years, Ba Dieu has supported herself by collecting morning glory (an Asian vegetable) and selling it at the market to buy rice to eat. A day's collection might amount to VND 10.000 (US$0.50).

The Mekong Delta is her home and she has lived in this region her whole life.

An Giang is the northern most province of the Mekong Delta in Vietnam, which borders with Cambodia - the start of the floodplain. The floods are the source of livelihoods in this region as rich sediment and ample water moving downstream creates a nourishing environment for rice production. However, every so often – like this season – the floods are beyond normal levels, destroying the current crop and disrupting farming for some time after. This year the water has peaked at levels that were last recorded during the devastating floods in 2000, putting people like Ms Dieu in a serious situation. "I hadn't eaten rice for 2-3 days," Ba Dieu says.

Ba Dieu received a fortnight's worth of rations in an immediate distribution of food from CARE International in Vietnam. "I was so happy when I received the invitation to collect my rice. It means I now have enough to eat and I don't need to borrow from other people in the area. It's enough to support myself and my family for my family during the most difficult time of this flood," she says.

Ba Dieu says that she decided to give one of the three 10 kilogram rice bags she received to her adult son. "His eyesight is poor and it's difficult for him at this time too. It's hard to catch fish as the winds are still strong," she says, "he helps me tend to the garden and lift heavy things."

CARE's food distribution aimed to provide assistance for the most vulnerable people - the poor, women-headed households, people with disabilities and the elderly in flood-affected areas of An Giang. The food rations were intended to strengthen the coping capacity of the community while floodwaters remained high.

The area where Ba Dieu lives is surrounded by a ring dyke that has protected her from the full force of the floods, however she recounts when the floodwaters of previous years would rise between the cracks of her house. Ba Dieu smiles as she says: "if the dyke holds, I can survive like this".

It's a difficult time for many people living with the floods, especially this year, but Ba Dieu refrains from complaining about her own circumstances. Her strong character and charm has kept her in good stead with the community as a support network.

CARE International in Vietnam will provide additional food distributions to strengthen the coping capacity of at-risk communities in An Giang province. Livelihood interventions are also being planned in consultation with local communities to assist with the recovery period for 3 to 6 months from now.

Interview with Promboon Panitchpakdi, Executive Director Raks Thai Foundation (CARE Thailand)

Thailand has been experiencing severe floods for several weeks now. How is the situation at the moment?
Thailand has encountered the worst floods in 50 years. Almost 60 of the country's 76 provinces have been affected, impacting some eight million people. But even though the rains have stopped now, vast masses of water are flowing from the north to the south, inundating large areas and destroying homes, roads, farmlands and industrial compounds. Many businesses had to close down and I fear that after this natural disaster, Thailand will face an economic crisis.

Thailand. Female migrant worker stocking food supplies. The water level is approximately 1 meter in many living areas, hampering transportation and access to affected populations.

The main amount of water is still in the central provinces and in some areas it has risen up to three meters. People need boats or trucks to move around and provide assistance to those in need. More than 300 people died, mainly due to drowning and electric shocks. The provinces will stay inundated for at least one more month, some even longer.

How have the floods affected Bangkok?
Bangkok is located right at the southern spot where the water is flowing. So the water coming from the north flows into the Chaopraya river, which runs through the capital city. This means that eventually Bangkok will be flooded to the same extent as the other provinces, with water masses standing between one and three meters high. The government tries to divert the water to the western side, which is a suburb area, and therefore a lot of people are being evacuated. But even with all these efforts, the water gradually creeps closer; the old Don Muang airport is already half a meter under water. People are building sand bag dykes and trying to irrigate the many canals into the sea fast enough. But most calculations say that more and more areas of Bangkok will become flooded - including our office. We will need to relocate our key staff to a city outside of Bangkok.

What are the main needs of the population?
The floods have destroyed houses, crops, livelihoods. In those areas that have been flooded for almost one month now, water and sanitation conditions are very poor and people start to become sick with diarrhea and other diseases that come with dirty water. Many evacuation centers are crowded and ill-equipped without enough supplies to assist people who have lost everything.

But those affected most are marginalized groups, such as migrant workers. There are around three million migrant workers in Thailand that live here either with or without documents, most of them coming from Myanmar, Cambodia and Laos. They separate themselves from the Thai population through their language, uncertain status and fear of extortion. There is a real risk that they will be excluded from relief efforts. Migrant workers who are staying in apartment buildings are isolated, many are lacking food, water and other basic supplies and some of them have no access to public health services. They cannot travel to their homelands because their travel documents are often kept by their employer. Many have lost their jobs and their means to support their families.

Thailand. Some people managed to have a boat, an essential necessity for travelling.

How is Raks Thai assisting the migrant workers?
We conducted an initial assessment to find out their most urgent needs. Since many workers have been employed on a daily basis, they have no money to buy food. Also, in some areas outside of Bangkok most of the shops have run out of food and basic supplies. Raks Thai will therefore support almost 20,000 migrant workers, women and children in four provinces with food, clean water and essential relief items. We will organize and facilitate the transport of vulnerable people to emergency shelters and temporary accommodation. We plan to install water supply systems and implement sanitation and waste management systems.

Raks Thai Foundation was established in 1997 and became a member of CARE International in 2003. The organization employs 286 staff, 47 of which are nationalities of the migrant workers in Thailand. Raks Thai has responded to the 2004 tsunami and provided support to 113 communities in Thailand. Since then Raks Thai Foundation has implemented emergency response programs to several floods that hit the country.

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As part of a CARE's emergency response team in Cambodia I've been responding to South-East Asia's worst flooding in a decade.

The Mekong and Tonle Sap rivers have been at emergency flood levels for over a month now and unfortunately 247 people have died and 18 out of 24 provinces in Cambodia have suffered damage with Kandal, Kampong Thom, Prey Veng and Kampong Cham being the worst affected.

Whilst exact numbers are still hard to clarify it's estimated that more than 1.5 million people have been directly affected and more than 46,000 households evacuated.

The impact on livelihoods, especially for poorer rural families is looking dire with early reports suggesting that 405,686 hectares of lush rice fields have been damaged with more than 230,000 hectares reported as potentially destroyed which represents 9.4 per cent of total the crop.

I read a report in a local newspaper yesterday (Thursday 27 October) which said that some evacuated families have started returning home to their flood wrecked villages as the waters slowly recede in along the Mekong River and other parts of the country.

No such luck for Lower Mekong provinces such as Prey Veng, which is one of the worst affected areas. This is where my CARE team is working with people in urgent need of emergency supplies,
Prey Veng has been hit hard with more than 78,000 families across its 12 districts affected. Almost 7,000 families have been evacuated from their homes and 49 people have been reported dead.

In Prey Veng, the flood has affected almost 79,000 hectares of rice paddies and 45,000 hectares are estimated to have been destroyed. Many farmers take out agricultural loans for seeds and fertilizer at the beginning of the growing season, and pay the loan back following harvest. This season, many of these farmers will be significantly in debt. Requests are being received for CARE to provide seeds from fast maturing rice varieties as a matter of urgency, as well as other assistance, so that affected households can replant as quickly as possible.

At this time I believe the three greatest needs for people affected by the floods here in Cambodia are immediate food, water and hygiene and of course restoring livelihoods.

On Thursday 27 October, the CARE team distributed assistance to the most badly affected families in Prey Sneat commune, Prey Veng Province. This was part of a wider program in the same province to support more than a thousand families, who have had their homes destroyed or damaged, lost assets and had their livelihoods placed at risk due to the Mekong floods.

Distributing packages to the 337 families in Prey Sneat meant that families received essential food items, blankets, mosquito nets, hygiene kits and water filters, with nearly 17 tonnes of rice supplied by the World Food Program. Transport and logistics were assisted through a generous donation from Glaxo Smith Kline.

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Sitting three deep in a glorified canoe, I’m carefully motored across the Plane of Reeds on the Mekong Delta in south west Vietnam.

I'm told that six metres below the water’s surface sit rice fields, land which only a month ago held hope of a buster harvest, with it the offerings of a livelihood and a helping hand out of extreme poverty.

I'm wholly aware of the abnormality of the sights which surround me; the tops of thatched houses, immersed headstones of sacred graveyards and the surreal experience of being at head height with the electrical wires.

I was not prepared for the sheer number of stranded households, completely cut off by oceans of flood waters. As we drift along, a three generation family meets our gaze with a smile. Resilient and adaptive, they are finding comfort in maintaining what remains of their normal routine, washing clothes in the flood waters and children fishing from the communal living space.

Those families, whose houses are completely immersed, have been moved to higher ground by the Government but those families with only partially flooded houses are forced to stay where they are.

We drive straight into the living area of a wooden house and find two women in their mid-thirties and five children itching with boredom. The District People’s Committee has closed all the schools to prevent more drowning from children travelling in the unsafe and unpredictable flood waters.

We squeeze into the one room house and I notice the organised chaos. One corner is filled with piglets, another with baby chicks guarded by their wary mother, another corner is reserved for the storage of cooking utensils and a near empty bag of rice with the remaining area reserved for sleeping.

Just centimetres beneath the haphazard floor boards, water is lapping and a shoe floats by. I wonder if it belongs to the woman and whether I should pluck it from the flood waters?

A three year old boy lies in a deep sleep in a slung hammock, his cheeks are flushed and the mother tells me he is ill with diarrhea. With no latrine and no dry land in reach, the family is defecating in the flood waters.

The sick boy's family is surviving on rationing a 10kg bag of rice given to them by the local Buddhist pagoda. I ignorantly asked where they were getting their drinking water from and the mother points to the water beneath us.

A few house visits later, I am told to roll up my cargo pants and hop into the flood water. We are trying to access a cluster of houses in a village in Hau Thanh Dong commune.

After wading through the water, we reach a house which is partially submerged. I am directed to perch on the floor boards and am conscious of not wetting the house further with my drenched lower half.

The house occupants are an elderly disabled couple. Their legs either missing or deformed from bomb blasts during the Vietnam War. Their sinewy faces are marked with age, each wrinkle or crease telling stories of hot days in the sun, trying to make a living in this vulnerable environment. Unable to climb in and out of boats and with no source of income, the elderly couple eats only rice and survives on an occasional allocation of small fish gifted by neighbors in the village.

Too poor to move, these households living in the Mekong Delta are vulnerable to annual flooding.
What is certain is that in 2011 the floods are anything but normal.

Without immediate relief, families like these are at certain risk of food insecurity, hunger and ill health from the poor sanitation and hygiene conditions.

The quantity of water in the world never changes, it is constant. With so much water in South East Asia at the moment, I am baffled by where in the world must be equally as dry as we are wet?

Perhaps this counters the extreme we are currently seeing on our television screens from the Horn of Africa? Climate change arguments are meaningless to those families stranded now by famine or flood but both share the dilemma of where their next bowl of food will come from.

CARE International in Vietnam is responding and I am proud to be a part of this organisation.

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With each new flood, girls in Pakistan are at risk of quietly being sold for brides.

By Hadia Nusrat, Senior Gender Advisor, CARE Pakistan

Pakistan, southern Sindh. Water is receding slowly, and families face another month or two of displacement before they can return to rebuild their homes. Photo: CARE/Waleed Rauf

Driving through parts of Sindh is impossible, as so much of the area is underwater from new floods this year, with roads either inaccessible or crowded with families who have lost their homes. Sadly, in the far flung communities and villages of Dadu, people have lived in abject poverty for generations. Young women are particularly vulnerable. The scenery is reminiscent of last year, in the wake of the  floods where we found a young girl called Kanwal, who lives in a remote village in Dodo Birhamani. 

Displaced by the floods, Kanwal and her family of eleven members migrated to this village as they had relatives here, seeking shelter until they were able to build their own. But with no income and many mouths to feed, Kanwal's parents decided to raise funds by arranging a marriage for Kanwal, who was just nine years old at the time. Traditionally marriages take place early in the Birhamani tribe. Girls are usually married by age 15 -- any later and they would be stigmatized as being too old to be married. In Kanwal's case her parents would receive a sum of 70,000 Rupees (USD 800) as bride price that would allow them to buy a lot of land and some goats to resettle in this village.

A Stony Rescue
Kanwal was hauled away from a game of marbles she was playing with her friends by her mother, and informed that she needed to get ready for her wedding. She protested about the disruption of her game, only beginning to realize that this decision would change her life forever -- in ways she still cannot fully understand. When she resisted, her mother threatened to jump in the well and commit suicide. Her sister, who was also a young girl married at age eleven and is now the mother of two young boys, begged her not to refuse. The family's honor would be at stake. Her father would be humiliated in front of the other tribesmen. She cajoled her with promises that she would visit her often, and that she would get new clothes to wear as a bride.

Confused, scared and unwilling, Kanwal reluctantly agreed. The wedding date was set for the very next day. As the ceremony was proceeding, a police van and police officers (including a female officer) intercepted the wedding procession, took Kanwal into protective custody, and moved her to the nearby Dadu city.

It turned out to be Kanwal's special day after all. Someone from the village had called the police to report that the crime of marrying a nine year old was taking place. Normally such events go un-reported in Pakistan, but in Dadu an CARE project* funded by the European Union for protecting human rights had recently run street theatres, and shared contacts with village youth in case they wished to report crimes in the area. This small initiative had sparked an essential change in raising awareness, empowering local people with information and networks for reporting a crime in progress and intercepting it.

The rescue did not run smoothly. The police squad was stoned and their car was smashed. Kanwal's mother, who accompanied her young daughter to the police station, protested profusely. But when she learned that she, her husband and the groom's family could all be libel to fines, penalties and possible jail, she quieted, appreciating for perhaps the first time that marrying a girl so young was indeed a crime -- and seeing now how that they had been pushed in to it. At the time of the marriage agreement and exchange of bride price, Kanwal's mother explained, it was agreed that Kanwal would be wed only after puberty. But once the money was paid, the groom's family insisted she be wed quickly.

The Stigma of Shame
Now the family faces a greater challenge. Even though their young daughter has been spared the fate of being a young laborer in the guise of being a bride, she faces the stigma of shame that her marriage was stopped. Now her family is under pressure from the tribal elders' council decision that her family should return the cash or relinquish the land they bought in favor of the groom's family. The groom's family has used political connections to evade prosecution for any crime. On the contrary, they have had Kanwal's father jailed for false allegations of theft, creating greater heartache and problems for her family --who now blame her for the cycle of problems affecting them.

Kanwal is an energetic girl, who cooks the food for her family of eleven. Two of her siblings are mentally disabled, while the others are all young men and boys who leave the home to seek daily wage work. Often they return empty handed, as there is little work in the parched lands around the village. There is just one school in the village run by a local non-governmental organization and their charges make the education unaffordable for Kanwal's family. Kanwal knows there is an alternative – a young woman who is ready to teach her and other girls to read and write for much less -- and with her audience of visitors, she even dares to argue with her mother that she should be allowed to learn. Her mother is not interested in education. She needs her daughter's help in the house. Kanwal, however, remembers fondly and proudly the year she went to school in the village they used to live in before the floods. She can write the entire English and Sindhi alphabet, and can write her name in both languages. She holds up pages of her writing with the same enthusiasm she shows for her hand-stitched textile designs.

Though she has been saved from becoming a child bride, her human rights may still not be respected. Her rights to education, justice, access to information, decent living and livelihood may all still be denied, without schools, teachers, income generation opportunities, honest judiciary or law enforcement bodies that can carry the work forward. This is an unfinished story. Kanwal faces a perilous journey, as do many young girls in this region. With each new flood, they are at risk of quietly being sold for brides, as the only source of financial security for their families.

CARE has been working in Sindh since 2007, initially responding to floods, then with a Sexual and Reproductive Health and Rights program, and staying on to support these communities devastated by the 2010 and 2011 floods. CARE's priority is to work with marginalized women, providing primary health services and raising awareness on health and hygiene practices to help women help themselves.

*The EU funded CARE project works through a national partner organization called “Strengthening Participatory Organization” (SPO) which in turn forms Human Rights Forums comprised of civil society, police and judiciary. The forums organize advocacy events at village levels.

Doctors provide medical support, but more assistance is urgently needed

By Mujahid Hussain, Team Leader Lower Sindh, CARE International Pakistan

The monsoon floods of August 2011 have displaced millions of people from their modest huts in the areas of lower Sindh province. After almost three months stranded under open sky, many are still waiting for proper temporary shelter, water, sanitation and healthcare support. The most vulnerable are women and children, who are fighting unprotected from the health risks of exposure to hot sun during the day and mosquitoes at night.

Dr. Tabinda, age 23, female medical officer,  is providing health care services to the floods affected with the mobile health clinic, operated by CARE partner organization. Photo: CARE Mujahid Hussain.

CARE and its partners' health teams are providing primary healthcare and hygiene awareness education to some of the most severely affected people in the remote areas of district Mirpur Khas. This week the team visited a health camp organized by our partner at village Mahar Mohammad Buttar, UC Burghari. We travelled about two hours from Mirpur Khas city by road to reach the village. The road condition was very poor and in some areas it is surrounded by water. The level of water is now receding and some people have started to return to what is left of their nearby homes.

On the way to the camp village we stopped to ask questions in a local community. "We are happy to be going back to the debris of our home instead of sitting in camps on the roads and waiting for relief.  We try to survive with our own saved resources," said 55 year old Mero of village Goth Mitha Baluch.

We reached a village where a health camp had been set up by CARE local partner Takhleeq Foundation. The camp was well organized, with separate facilities for men and women, and with the active involvement of local elders.  Over 350 local people were gathered, including men, women and children, waiting for medical officers' consultation and medications. Four medical officers (two male and two female) were fully engaged in consultations.  In the waiting room staff were leading hygiene awareness sessions, focusing on how to ensure clean water and do hand washing. 

One of the female medical officers is 23-year-old Dr. Tabinda, who has been providing healthcare services in flood-affected areas for the last 15 days. Asked about her motivation, she said: "I am very happy to provide health services to these people. They are deprived, they are poor, and the way they are being neglected is inhuman. This village has a population of 20,000, and they have no health unit available for healthcare." She said she and her colleagues were travelling three to four hours on daily basis to access these remote areas. Yesterday the team had to go on foot for half an hour to conduct camp at another village. "Our motivation is high to serve these needy people, and I am sure to get their prayers." She pointed out one lactating woman sitting with her for treatment and said, "This woman is seven months pregnant.  She is weak, malnourished and shelters-less. She has had severe pain for last seven days, but her family could not afford to bring her to a checkup at Mirpur Khas city."   

Shewa, a 70-year old man, was suffering from fever and being treated by a male medical officer. "We are 16 in my family," he explained: "Five daughters, three sons, six grandsons, my wife and myself, all living in a hut with a cover made of plastic and our clothes. We lost all our standing crops -- cotton, vegetables, rice in the field and now we are looking for food and water to survive.  All our family members are ill, and have come to this camp for treatment. This medical support is blessing on us. My young grandson Rehman is studying in class 3 and he is suffering from malaria fever and not attending school.  If I could get some cash support in future, I will buy some livestock, foods, and construct a new hut for living."

I have experience working in some major disasters in Pakistan such as the disastrous earthquake in Pakistan in 2005 and the floods last year and I know that every disaster victim has different suffering and feelings of hope. But responding to the floods this year in lower Sindh, I witness that people are hopeless and frustrated after waiting for three months to get support. Many of these people will die from malnutrition and water borne diseases if a response cannot be expedited. CARE and other organizations urgently need more funding to support people in need.

Theo Alexopoulos, Deputy Safety and Security Manager, CARE Pakistan
September 20, 2011

"If you want something important done, don't do it on Christmas Day – everyone will be away," I remember my buddy joking, while we were bouncing around inside a Series 3 Land Rover on a security training exercise in New Zealand some time ago. Flash forward to Pakistan in August 2011: I am driving with our CARE team leader, Karuna, in a Toyota 4x4 on a field assessment in central Sindh. It is Eid, a major holiday, the end of the Ramadan. All our staff, including the drivers, have gone to their home villages to be with their families, and the country is on standstill observing national celebrations after a month of fasting for Ramadan. The heavy monsoon rainfall and rising waters have us a little on edge. We have no idea that our response will be one of the first by an NGO - right at the heart of another emergency.

As the rain continued non-stop for almost 2 full days, Karuna would suggest areas he was interested in visiting, and we would dart around the region, hoping for access and a return route on roads that were at risk of closing. We monitored the river and swelling canals, inspecting for damage and trouble spots. I was liaising frantically back with our country office via Blackberry, snapping shots between wiper blade strokes and potholes, and taking notes in my little note-book. From time to time we would stop to stretch our legs and reflect on the disaster unfolding before our eyes.

The roads around Dadu were eerily quiet, with no sign of the infamous chaotic traffic, only the drumming of persistent rain pelting the roads. By parking next to the door of our staff house in town, we could climb into the car to avoid wading through over a foot of water mixed with garbage and stinking sewage. In rural areas, we saw mud houses melting away like chocolate ice-cream.

When the rain stopped, we knew that a new deluge of work was coming our way. CARE staff and our local partners were headed back to the field office. They would need an immediate and accurate account of the situation. Media paints one story, helicopter rides another – but "eyes on the ground" can't be beat. We were there on the ground. Within days, after only a small break in the weather, Southern Sindh was hit much harder. Roadsides and school grounds became crowded with families who had lost their homes. Our nearby warehouse was packed with emergency stocks ready for distribution: tarpaulins for temporary shelter, mats, shawls, cooking utensils, hygiene sets with antibacterial soap, tanks for safe water storage. Our holiday would have to wait.

Sindh province, southern Pakistan. Just one year after an unprecedented flood affected 20 million people, new flooding is threatening lives and livelihoods in Pakistan. Sindh, a province in the south of the country, is the worst affected. Nearly one million houses have been damaged, thousands of livestock have been lost and more than five million people are struggling to rescue their livelihoods.

CARE distributes hot meals twice a day in three evacuation centers in Yamada, northern Japan. Photo CARE Japan

By Futaba Kaiharazuka, (Assistant Program Director, Emergency Response, CARE Japan)

In one of the evacuation centers where CARE Japan is providing hot meals, there is a man with perfectly groomed hair who wears a certain jacket. The man is in his late 60s or early 70s and always joins in the aid work at the center, volunteering to help with the heavy lifting. He is one of those people who is always courteous and never stops smiling.

One member of the CARE team had the chance to chat with him a few days ago during the food distribution. His house, like many of the disaster victims, and all his household possessions were washed away. When the tsunami struck he was wearing the same jacket he now wears all the time. He explained that he wears the jacket not because he cannot change his clothes; the evacuation center has received many relief items including clothing and underwear, rather, he wears it because out of all his personal possessions, his jacket is the only item that survived the tsunami. “Everything I had was washed away, but I am a fighter”, he said with his usual smile whilst chatting to the kitchen staff. There is a mountain of relief goods such as clothes and new items that have been delivered, but despite this, he feels wearing his own jacket gives him the strength and courage to go on.

In the midst of such great post-disaster disorder, CARE sees countless examples of people helping each other through the chaos, despite the severity of their own circumstances. The old man’s story shows the strength and courage of these people who are determined to pick themselves up again.

Otsuki town hall(total 18staffs including the mayer have been died by the Tsunami. Photo: CARE/Yoshio Kondo

By Yuko Ota, (Assistant Program Officer, Emergency Response, CARE Japan)

The CARE Japan team visited a family of 11 members including a grandfather, his daughter and her husband (in their 50s), a grandchild, two great-granddaughters (eight and two years old) as well as five relatives who had lost their house. The lived in Kirikiri district in the city of Otsuchi in Iwate Prefecture, one of the regions that was most destroyed by a massive tsunami on March 11. The sun was setting as the CARE team arrived so there was a chill in the air – but this area hasn't yet had the water or gas supply restored so the family could not use the heater in the living room. The temperature indoors was almost the same as outside.

We talked to the mother and she told us that electricity has still not been restored. ''A few days ago our neighbors let us share some of their power supply. For the first time in one month we saw the extent of the damage on TV'', she said. ''Until then we had no information at all, and since seeing the vast scale of destruction in Tohoku on TV, I cry everyday.'' She described witnessing the sheer might of the tsunami approaching: ''I thought tsunamis were noisy splashing waves. But the tsunami last month crept in silently and in an instant swept away houses and everything else in its path.''

When the earthquake struck, her grandmother was on her way to collect the great-grandchild from Kirikiri elementary school. ''She was swept away by the tsunami, was missing, and then nine days later her body was found'', described the mother through her tears. They finally found a crematorium and were told that usually bodies would be cremated within three days of being found, but there were so many bodies in that area that a regional mass funeral is scheduled to be held at a temple on 29th April.

The mother continued explaining how the first three nights after the tsunami the family of six slept in their car in case they had to suddenly escape. ''We are still so worried that there might be another earthquake in the night, so we slept fully clothed in case we have to flee.''

The only granddaughter is heavily pregnant. ''As she is in her final month of pregnancy, she should be growing bigger, but she hasn't really grown. I wish she could have bath in clean water, but there is still no water supply'', the mother described, looking very worried. The Japanese military set up simple bathing facilities in the Kirikiri elementary school nearby, but it is very exhausting for the granddaughter to go there.

The mother runs a barber shop next door, but as there is no water, gas or reliable electricity supply, she doesn't know when she will be able to reopen. ''We have no daily income. I am very unsure of our future. But we are the lucky ones. Many neighbors have lost family members, their houses and their possessions. The town mayor also died so we will have to join hands and work together and restore the town.''

It has now been one month since the disaster struck. The disaster victims, despite experiencing great hardship, are determined to encourage and help each other to grow stronger and step by step restore their lives. In order to support the strength of the local people, CARE assessed the situation in the disaster zone so we can provide the people with the aid they really need. We provide food to evacuees in three centers – in a situation like this, with cold temperatures and many older people in poor health condition, it is important to get nutritious food in order to stay healthy.

By Robert Laprade
CARE Emergency Team in Japan
April 6, 2011

Robert Laprade, CARE Emergency Team Leader in northern Japan. Photo: CARE

These are my last days in Japan. I am back in Tokyo now and will leave the country on Friday. It has been almost four weeks since the tsunami hit the coast of northern Japan; in many areas it was more than 30 meters high. There are still so many humanitarian needs. Even though infrastructure is getting repaired by the government, with roads being cleared, ports functioning again, and the lights coming back on, it is apparent even to those unfamiliar with emergency work that it will take five to ten years to rebuild the area--at least. Survivors living in evacuation centers or with host families face huge challenges. They will not be going back home anytime soon as many of their houses are now nothing more than a foundation. Others’ homes are partially damaged with windows and doors torn off, filled with a meter of a mixture of mud and miscellaneous, smashed rubbish. The initial shock of the disaster has receded – now it is dawning on many people just how bad their situation really is. They realize that they will not be able to live in their homes soon, if ever, again. It’s a huge challenge for the government. In the first weeks, the focus has rightly been on searching for survivors and remains of victims, putting a roof over the affected people as quickly as possible, and getting basic infrastructure back up and running. Now the government needs to determine how to house people for a longer period before permanent housing can be built. In the fishing towns of Yamada and Otsuchi and many others, most buildings are destroyed—only the wood, metal siding, beams, and contents remain, strewn across the hideous landscape kilometers from where they once stood as offices, houses, and schools. Much of the coastline where the tsunami hit is mountainous. The only flat area is the land lining the coves and inlets wiped almost clean in the disaster. There is not much space to build temporary houses for all evacuees.

When I visited the evacuation centers I saw that many survivors had nothing to do. Many just sat there traumatized. Others conversed with friends and relatives. Being in close quarters—sleeping, eating, and talking to the same group of people in very cramped space—can be a stressful experience after some time. Many people are still clearly grieving as it is only now becoming clear that they will probably never see their missing loved ones again. In some of the centers, we have been looking at helping with recreational and cultural activities that can help reduce some of the stress and monotony, especially for elderly people who may have extra challenges of mobility. These need to be things that are culturally and socially familiar to them, and that they identify as giving comfort or providing a bit of fun.

The evacuation centers in Yamada where CARE provides hot meals two times a day are located in a school compound. But the school year starts in the next few weeks. That’s another challenge. We have already been told that we need to remove our kitchen and storehouse as they were located in the classrooms. Evacuation center residents are sleeping in the gym and will not be forced to leave. My Japanese CARE colleagues now have to identify new places to store food and supplies and a place to cook. But that’s the nature of humanitarian operations. It is our duty to act in the best interest of those affected. In this case, we want the kids to go back to school, the people who don’t have a home to have a place to live, and to ensure that we can still serve nutritious food for the residents. We need to be flexible in a dynamic environment, finding ways to bring help to survivors and meet the many different needs they have.

The past weeks in Japan have shown me how fragile life is. Whether we live in developed or developing countries, whether in cities or villages, we can never be too secure. I also think we should respond to the humanitarian needs of survivors, no matter in which region of the world they live, even if they happen to come from a “rich” country. The tsunami in Japan also really underlines the importance of disaster risk reduction and early warning systems. Had those systems not been in place, clearly casualties would have been much higher. It was also great to see how people helped each other out in their time of greatest need. The Japanese people have all pulled together, everyone doing their own part to in some way show their support for the victims and survivors. There were numerous donations and offers to host homeless survivors. Inhabitants of Tokyo try to save energy whenever they can. The hotel where I am staying in Tokyo turns out the lights in the lobby when breakfast is over. All the glitter and glamour that you visualize when you think of Japan is toned down. Excessive celebrations during this important time of traditional cherry blossom festivals are even frowned upon. The CARE team in Tokyo is still working long hours, until 10 p.m. every day. Everyone seems content making sacrifices, knowing that in some small way they are paying their respects to the inhabitants of the ravaged Northeast coast and making a difference in the lives of survivors.

By Robert Laprade
April 1, 2011

Otsuchi--duplex houses occupied by two families or individuals. This is an area where people did not have much to begin with, where younger ones have moved to the cities to find better paid work and where only the old ones are left. Photo: CARE/Robert Laprade

Today we distributed hot meals to evacuees in Yamada. Since the tsunami hit northern Japan, many survivors have not received balanced, hot meals on a regular basis. They are mostly surviving on just rice and some occasional fruit. In a situation like this, with cold temperatures and many older people in poor health condition, it is important to get nutritious food in order to stay healthy. Trained cooks and cafeteria staff helped us to prepare the food to ensure cleanliness. We are providing two meals a day in three locations of one big school compound here in Yamada. The evacuees were really happy and thankful. In this rather positive mood we set off to do some further assessment in Otsuchi, a fishing town south of Yamada. When we arrived there, my good mood was suddenly replaced by pure shock. Described by some newspapers as one of the worst hit towns, Otsuchi was in dreadful condition. Here again we could see the destructive force of a tsunami: debris everywhere for kilometers as far as the eye could see—houses, cars, parts of large concrete bridges, large electrical turbines, even a few fire engines strewn across the muddy landscape as if a giant child had emptied his set of Legos and children's toys into a muddy, dirty sandbox. In the areas where the waves had reached their maximum incursion inland, some houses were but left with one to two meters of grey, ugly mud that now covers everything. Within that mud, everything imaginable is mixed. Driving through the area of Otsuchi where some of these houses survived, we saw elderly people digging in the mud, trying to find even just a few belongings that can remind them of the world they once knew.

We talked to one woman, who was picking around the smelly mud. She was around 70 years old. The tsunami took her husband away. When we approached her, she had just dug a few dishes out and squatted around a plastic bowl where she cleaned them in water. It was cold outside but she wanted to rescue her few little things; it was all that she had left. She told us that even though a few volunteers came to help, she was really doing the cleaning all by herself. Her house was still standing, but everything inside was destroyed. It was really heart-wrenching. The tears from my CARE Japanese colleagues ran down their cheeks for five minutes; I think it was a blessing that I required a translation and could not understand everything she said. We were so far away from the glittery, high-tech world of Tokyo that we see from the movies and TV about Japan. People here did not possess much to begin with, most lived in small duplex houses, provided by the government and which looked like trailers. This was a fishing area. Those young, agile, and educated enough have long gone to the cities to find better paid work. Only the old ones were left.

We met another woman together with her husband. Both were also digging through the mud, looking for a few valuables. She told me she was the youngest around here – and she was already 60 years of age. She pointed to some of the houses, saying that almost all of the inhabitants are 80 years and older. Most of them are just physically not able to clean the mud from their houses. They need help. They were questioning why the municipality did not help them. When we drove about a kilometer over a hilly outcropping and gazed out over a small bay we realized why nobody would help for a very, very long time. The entire commercial and downtown residential area of Otsuchi was gone. Washed away. The mayor died—so did anybody else who remained behind or couldn't run fast enough when the warning sirens went off. From the hill, it looked like a bomb hit this town. Probably only one in twenty buildings were even recognizable as buildings—just foundations or a post or two of metal, maybe a half wall here and there. When entering this burned out ghost town of mangled metal, concrete, and mud, I noticed an overhead highway sign that remained standing. It indicated that Sendai is 230 kilometers away--230 kilometers to the center of tsunami impact. How in the world could it look worse than here?

After this awful excursion into hell, we went back to Yamada. I am glad that we could provide the people here nutritious food. And we'll do more of it elsewhere. Afterall, it's people like the women we met who are the residents of the evacuation centers. There is so much work to do.

By Futaba Kaiharazuka, (Assistant Program Director, Emergency Response, CARE Japan)

800 people have sought shelter in a high school in Yamada. In the back is the "office" of the shelter where staff sort items and distribute medical supplies. Photo: CARE/Robert Laprade

The CARE Japan team returned for the second time to the disaster zone in the northeast of Japan and have now been here for a week.Whilst setting up CARE Japan's aid program, we have had days where we have made great progress, but also some days of setbacks and few advances- this is the reality of an emergency relief site.

Yamada town in Iwate Prefecture, the chosen town for CARE Japan's new relief programme, is one of the towns to have been very badly damaged by the earthquake and tsunami. I had never visited Iwate Prefecture until now, and didn't know much of the area, but the first time I visited Yamada and saw the sheer devastation, I was lost for words and my heart stopped. Many of the houses had been washed away and destroyed by the tsunami. A town of rubble, as far as the eye can see, with strangely shaped fragments in every nook and cranny, cars in outrageous places and a burnt odour looming over the houses that weren't washed away but burned down. Although I can't believe I am looking at a Japanese landscape, I was reminded that this is the present undeniable reality.

I looked out beyond the tsunami-scarred coastline, and saw the contrast of the tranquil and beautiful ocean. When we first came to conduct a survey, the beauty of the ocean caught my eye. I am sure the people of Yamada must have been proud of the ocean. It is easy to imagine the sea rich in marine life, such as oysters and seaweed. Everyone we have met who lived by the sea has had their house or people they loved, and their hometown's beautiful view engulfed by the tsunami in an instant. I keep asking myself 'what on earth can I do to help?'

However, everyone here is determined to overcome the devastation; the town hall officials working 46hours straight; the mothers who despite having damaged houses themselves, go to the evacuation centres everyday to help out in the soup kitchen; the high school students moving boxes as their small contribution, the people who wrote 'Smile!' in big colourful letters to encourage the children; everyone is playing their part towards the restoration. We were very encouraged by these people as we made our preparations to begin CARE Japan's relief cooperation.

The people of this town are determined to survive. Even though they face such great insecurity as to how they will live from now on, and questioning what will happen next, they all support and care for each other living as evacuees. The CARE Japan staff, our international colleagues who came to assist us and I aim to support the admirable people of Yamada to help restore their once beautiful town and their individual livelihoods.

After we had an early morning planning session over Japanese breakfast, we drove to the coast of Iwate prefecture. We came to a small city called Miyako, and while we were driving around the corner of what seemed like a normal street, all of sudden we arrived in hell. Before us lay total destruction. Cars were upside down, metal parts were scattered everywhere. The bizarre thing was that we looked on one side of the road and there was a supermarket, perfectly standing without a scratch. On the other side of the road, it was total destruction. But it got worse. We drove into Yamada town and there almost the entire downtown area was wiped out. Yamada is a fishing town, and some people farmed oysters and seaweed.Amongst the rubble and mud, fishing gear, nets and floats were strung everywhere. What was once the professional equipment of fishermen now lay like garland on a Christmas tree, but the ‘trees’ were mangled pieces of houses. Heaps of furniture and personal belongings and just about anything one could imagine stuck out of the mass of muck. The area of destruction was three to four square kilometres; we could not see the end of it. I was amazed how quickly the Japanese government has cleared the main roads. We drove through Yamada on perfectly clean, paved roads, but rubble and debris were piled up to ten metres on both sides.

While working our way through the maze of roads, I noticed through gaps in the debris that all houses built higher than 20 metres above sea level stood untouched by the wave. The city hall stood on a small hill and it survived without a scratch. However, right in front a field of cars, house parts, and machinery were burnt almost beyond recognition – black, burnt heaps of debris. I remember the pictures on television when the tsunami came in with rafts of burning rubbish; this now was how it looked after the water receded. Much of it reminded me of the post-apocalyptic world described in the novel The Road.

We entered the city hall looking for officials to whom we could explain our work and get permission to start looking for a base for operations. On the ground floor of the city hall, we sighted a billboard where people left notes for their lost loved ones in case they miraculously showed up looking for them. In another room, the search teams had placed wet and ragged photo albums they had found in the rubble. For some people, these memories are all they have left. We found the mayor on the second floor; he was a very friendly man who told us with a big hospitable smile that he lost his home. However, this was not the first time he experienced a large tsunami. In the 1960s, an earthquake in Chile triggered a series of waves which also smashed the coast of Yamada. He told us that Yamada has 21,000 inhabitants and that around 7,000 people are displaced living in about 30 shelters in schools, temples, and community centres. Around 1,500 families still live in their houses but cannot get out due to lack of gasoline or roads blocked by trash left by the tsunami. Currently there is no functioning grocery store anywhere to be found in Yamada itself so walking for food is not an option.

After meeting the mayor we went to an elementary school. Around 100 people were sheltered there. They told us that in the evenings inhabitants of the surrounding villages come by and the evacuees share their meals with them because they have no means to go and buy food. In one of the rooms used clothing lay on the floor and was being sorted. These were certainly donations, waiting to be distributed. However, we also heard that the food arriving at the shelter is not enough and often a meal of just rice. We talked to a group of women, all of them sitting on their mattresses. One woman told me that she and her family survived the tsunami but her home is completely gone. All her neighbours are dead. She was around 60 years old and the youngest of the group. She said they are all fishermen here but now have lost their boats, their nets and their income. She also did not know whether her insurance will cover her losses, since all her papers were washed away. “Our lives have fallen apart”.

When we drove to another evacuation centre, it started snowing again. Giant white snow flakes fell down. It is still freezing here. In this high school, 800 people have sought shelter. In the gym, mattress lay next to mattress. This place was really crowded. Although orderly, it did not look very comfortable. There was a stage which was now the office of the centre. We passed by the kitchen where three shifts of evacuees cooked whatever was delivered by the local government from donations from around Japan. Army trucks arrived and helped in delivering relief items; we were told the troops also regularly cooked rice for the evacuees.

Tomorrow we plan to go further north but tonight I will focus on putting together a strategic plan for a CARE emergency response while my colleagues Alain and Futaba will begin to write an operational plan to scale up our assistance. We need to locate key relief items and how to get them to the people who need them the most. We are looking at beginning a program to ensure that the nutritional value of meals prepared for evacuees is improved through the introduction of vegetables and fish or meat. Authorities have been overwhelmed in the search for survivors, getting roads cleared, and looking for missing people and just haven’t had the time. Japanese people are used to having good hot food for every meal just as we are at home, so it’s quite a hardship when they’ve lost loved ones, are suffering through incredible trauma, and can’t even get a decent meal. Many evacuees are elderly or children and good nutrition is especially important to keeping up their health in crowded, cold conditions.

Story and photo by Marie-Eve Bertrand, CARE Haiti
November 11, 2010

Yveline walks up to me with a nice smile, but I can tell she is reserved. As we walk into her parent's house, I notice that all of her family's belongings are stored on the table, on the higher cupboards or shelters.

"When Tomas approached, CARE staff brought a speakerphone to the community and told us to get prepared. We stored our things and, therefore, did not lose too much," Yveline says. "The rain and water filled the streets and our house." She shows me the mark on the wall, indicating the water level: three feet high.

Yveline is one of the 333 children that CARE sends to school here in Gonaïves. She has been in the project for six years and is really thankful for the help her family gets from CARE. She is smart and caring.

"My dream is to be a doctor because I want to help my community and other people who are disadvantaged. I know it is a lot of work, but thanks to CARE's generous donors, I have been able to concentrate on my studies," Yveline tells me. "My family supports me, and I know that one day I will do good work."

I asked her about cholera and the situation in Gonaïves. She tells me about what they have learned so far through CARE's prevention training."Cholera is an illness that is treatable and preventable. People need to wash their hands, disinfect their house if someone is sick and give them rehydration salts. And we need to make sure that we should not abandon those who are sick. They need help!"

She adds, "Cholera should not kill so many people. The problem is that we have little sanitation infrastructure, and now with Tomas' flooding it is even worse. We have very poor land management. We cut too many trees with no plans, and did not pay attention to our natural resources. Now, it is our infrastructure that is missing. We do not have enough gutters, and we do not care enough for our environment." "

When looking at her, you see that she does care for her neighbors. She is volunteering with CARE – attending meetings and training. She wants to make a difference in her world.

We walked outside of her parent's house, and jumped on stones to avoid stepping in the mud that covers their yard. The streets are filled with waste and mud. But, Yveline is off, helping spread information on how to prevent cholera.

Once she's gone, I can't help wonder how many out young Yvelines did not have the chance to go to school, live their dreams and build a better life for themselves and their communities.

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Story and photo by Marie-Eve Bertrand, CARE Haiti
November 11, 2010

The sun is shining, dogs are barking and the wind is blowing. This could be a normal day in Gonaïves. But it's not. Streets are empty, kids are not in school and mothers are concerned.

As I was with a community volunteers team, we were training women on how to purify the water they sell with bleach that CARE is providing them. A woman showed up. Wearing a mask, she was scared to approach me, scared to touch anyone.

Our team then visited an area called Descoteaux. This part of Gonaïves was flooded by Hurricane Tomas a few days ago. Now mud and garbage are covering streets. We stopped at Rosette Noël's house situated in a zone where CARE's volunteers and staff have distributed aid. A little girl is looking at us. Suddenly, another one joins her, then a grandma, a dad, two teenagers and a mom. Rosette is the mother of many kids she tells me. Her family includes her sister, her brother, and many siblings. I tried to get an exact figure. I don't think she knew.

Rosette tells me that when Tomas struck, they did not have enough time to gather their belongings. I could tell this was true by looking at the clothes and miscelleous household items drying on the brick wall between the houses.

"There was mud everywhere," she says. "We sought refuge with our neighbors. In this neighbourhood, we take care of one another. But what concerns me now is that my niece was sick yesterday. And now it is my sister. They are resting in bed, and we give them rehydration salts and clean them. We do what we hear on the radio messages." CARE's public information campaign via radio instructing Haitians on how best avoid and prevent cholera has reached at least 200,000 people to date. I am glad Rosette has hear them.

When I asked her why she was not taking them to the hospital, she turns her head. She is concerned about the fact that the hospitals are already over capacity and that the staff does have the ability to take care of her loved ones.

"We know that some people were left on the streets because they were sick. I don't want that to happen to my family. We can take care of them. I am afraid that they will get more sick in the hospital," Rosette explains. "Family is everything."

Her youngest looks at me. She is gorgeous and smiling. Her eyes are full of life and joy. I just wish I could do something to help them. But they know what to do.

"CARE helped us a lot. They came here to tell us how to protect ourselves before Tomas, and then after [explaines how to help]avoid being sick. We received soap bars and aquatabs," Rosette says.

As I leave the house, they wave goodbye to me. The grandma tells me to take good care and to stay healthy. These people are generous, and I am so proud I got to meet them.

• Read more blogs from Haiti
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by Dr. Franck Geneus, CARE health manager in Haiti
November 10, 2010

The situation here in Artibonite is all but reassuring. You can feel the angriness rising slowly but surely. In Raboto, it was reported that the dead were being abandoned in the streets. Hospitals are already at capacity with patients infected with diarrhea. Others who are infected are being discharged or discouraged not to go to the hospital in the first place. The police have assigned a car that transports infected people both dead and alive. This car is not being disinfected.

Protests in the streets were reported by the press. The fear of illness is everywhere. The sick are not adequately being taken care of and are seen as pests. Babies have been abandoned. Those that have children in schools are thinking of keeping them at home.

The number of new cholera cases have increased to 15 per day up from 3-5 cases before the hurricane struck. In the Hospital of Marmelade, over 200 cases have been reported since the beginning of the epidemic on October 20. Dead bodies are not being properly disposed of. Support staff are reluctant to come into contact with them because they don't have appropriate protective outfits.

CARE is supporting communities where we have our presence by providing early detection and management of cases; medically assisting rehydration; and conducting proper evacuation of cases. CARE's main focus is in helping facilities use proper hygiene and sanitation. CARE was approached by the Ministry of Education, for example, to clean a school which was flooded near a cemetery where bodies were wrongly disposed of. The cases are increasing and it wouldn't be a surprise if we see a boom in the epidemic in the coming days.

• Read more blogs from Haiti
• Find out more about our emergency response work in Haiti
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by Marie-Eve Bertrand, CARE Haiti Emergency Team

09:00, Nov. 6, 2010

Saturday was a busy day for CARE's team. I spent the day with CARE teams on their field visit to Léogâne. When we arrived in the downtown area, I was shocked by the level and the strength of water in the streets. The Rouyonne River had overflowed. Once again. And it has washed away a substantial part of downtown.

People are walking in the knee-deep water filled with garbage, human waste, bugs, and what else...

Women and men were cleaning their houses or shelters, removing the mud and trying to make it look clean. Truth is, I am concerned that a broomstick is not enough to sanitize a place that was filled with filthy water.

Yet, amazingly, not everyone we met was in despair. Indy, a young women living with her mom, was cleaning their little brick house. Her mom was telling me it was enough, it had to stop. She was cleaning her clothes as Indy was removing the muddy water from the one room they use as a kitchen, living room, dining room and bed room. Indy was smiling to me, and I asked her if she was upset. She said, "No ... What would it change?"

(Indy cleaning her house in Léogâne after Hurricane Tomas flooded the town. Photo: Marie-Eve Bertrand/CARE)

I stopped to visit the family living in CARE's first temporary shelter. I remember meeting her this summer, as she was just about to move in. It would have been great to meet her in a better situation. She lost everything but her family in January. This time, their belongings were pilled up, the mattress was wet, the walls were dirty, and her ti-moun (child) was hungry.

She looked at the sky and said: "This is an act of God, what else can I say? But it's enough. I want fresh food for my kids, I don't want them to be sick. There are very few latrines here. People do their things in bags and throw them in the canal. It was always like that. Now the canal is overflowing."

(Read more about CARE's work helping survivors have a sturdy roof over their heads and a strong foundation to rebuild their lives. Photo: Marie-Eve Bertrand/CARE)

Yes, it is. And I saw those bags floating around. Filled with human waste. While kids were playing around ...

Cholera, of course, is on the mind of everyone, including the CARE staff. Sunday, our CARE team distributed help to 9500 beneficiaries in Léôgane. We gave them aquatabs, Hygiene kits or BP5 (high energy biscuits) based on their needs. The response is done in partnerships with the other NGO's on the ground.

In Bino Lester, a grandma walked up to me. Her crops had flooded. She was frustrated. Enough, she said. This has to stop. Even the strong people of Haiti have their limits.

Tomorrow, I head to Gonaïves, where a CARE team will continue distributions and raise awareness of health risks such as cholera. The flooding was quite serious there. I might see another smile like Indy's. But given the triple-dose of disaster in Haiti these days, it would not surprise me if I did not.

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by Marie-Eve Bertrand, CARE Haiti Emergency Team

06:00, Nov. 5, 2010

I woke up to dark grey clouds. There is no sun in Port-au-Prince today. It was pretty quiet first thing this morning as the storm was 'stopped' by the mountains, but then suddenly, it was as if someone opened the tap. It is loud now... very loud! The rain sounds as if you're standing next to a waterfall. For a moment I thought we would be okay. Now I am really concerned about our staff and friends living in camps or shelters. You don't want to be outside at this time...

Yesterday the staff and people in our neighbourhood were getting ready for the storm - packing up food, water supplies. I was at the market yesterday and you could tell that people were nervous. Everyone was filling up their baskets, talking loud, moving fast ...

Usually the market it's pretty relaxed, but yesterday everything changed. People were in the streets, the traffic was heavier much sooner as everyone tried to get home to their families, and the businesses closed much earlier.

People were asking: "Why this? Why us? Why again?"

The rain is getting harder. The wind hasn't picked up yet, but if this gets worse, I can only imagine how bad it will be for the people in the camps.

• Read more blogs from Haiti
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by Deborah Underdown, CARE media specialist in Pakistan
September 3, 2010

As I left Islamabad for Swat I can't deny that I wasn't a little apprehensive. Most people have only heard about this region because of conflict and Swat's association with militant groups.

Swat has been hit hard by the floods with some people – a month after the rains – having still received nothing. Many roads and bridges have been destroyed making areas, and the people that live there, unreachable.

CARE, through our partner organization IDEA, is targeting the families who have yet to receive help. Families were identified last week and given a token and informed of the time and place they could collect essential goods such as soap, towels, pots and pans and a tent.

Today, I saw these people receive their goods. Arz, 60, said, "I walked for three hours to get here. I am happy to receive these goods. This is the first time we have had anything since the floods."

I am struck by the organization of the distribution – no one is fighting or pushing. People are calmly waiting in line to receive these precious goods and then sit, with what looks like relief, before picking up the goods and starting the long journey home.

CARE is also providing people with 2000 rupees to help them transport their goods home; the methods of transport include donkeys and mules. Arz told me that he is going to use the money for something else, "I am going to use the money that was given for the transport on new clothes for my children." He'll walk the return journey that will take 4-5 hours as he will be carrying a heavy load.

As we literally reach the end of the road, a huge chunk of it was washed away. But I am struck but the sheer determination of the people here. A zip wire has been strung across the vast Indus River and people and their goods are able to get from one side to the other. I look at people going across and at how high up they are, sitting in a small metal cage, and think how brave they are – it then hits me that they have no other choice.

Arz, 60, said, "I walked for three hours to get here. I am happy to receive these goods. This is the first time we have had anything since the floods."

A zip wire strung across the vast Indus River carries people from one side to the other.

Photos: 2010 Deborah Underdown/CARE

Read more about the floods and CARE's relief efforts in Pakistan >

by Jonathan Mitchell, CARE International's emergency response director
August 28, 2010

This blog entry is part of an e-mail that Jonathan sent to co-workers at CARE:

Dear Colleagues,

I have just returned from Pakistan, where I saw the flood situation and CARE's response first-hand, and worked with the country office and CARE USA's Asia regional director, Nick Osborne, to support scaling-up CARE's response.

As you will know, the devastation caused by the floods in Pakistan is unprecedented with an estimated 17 million people affected - stretching from the Himalayas in the North to the Arabian Sea in the South of the country. An estimated 1.2 million people have lost their homes and 3.4 million are displaced.

Together with CARE's country director Waleed Rauf, regional director Nick Osborne, other colleagues from CARE Pakistan and one of our local partners, we visited affected areas in Swat and Nowshera districts in Northwest Pakistan – one of the first areas hit by the floods four weeks ago.

In the Swat valley, the swollen river had cut huge swathes out of the river banks, destroying many homes, businesses, roads, bridges and other infrastructure, as well as agricultural land. Displaced people are mainly staying in school buildings or with host families. One of the main problems for aid delivery in areas like this is lack of access due to roads being cut. To get up the Swat valley, we had to leave vehicles behind at several points where there were no roads and hike by foot across steep hillsides to the next intact section of road.

In Swat, CARE has supported our local partner to quickly set up mobile health units providing badly-needed primary health services to the communities. Each unit moves around to different sites and includes both a female and a male doctor. The urgent priority now is to find alternative ways to overcome the access difficulties so that CARE and our partners can deliver other relief supplies such as tents, household kits, and materials for water and sanitation.

The situation in Nowshera district, which we also visited, is quite different. It is located south of Swat where the land opens into the plains. Here, the river flooded entire villages, washing away houses and livestock, and inundating agricultural land. Many displaced people are living in makeshift camps on higher ground close to their flooded or destroyed houses. CARE and our partners have set-up mobile health units here as well. In addition, CARE Pakistan quickly provided, through our partners, all of the tents and household kits that CARE Pakistan had stockpiled to people in Nowshera and another neighboring district. But this only met the immediate shelter needs of a small proportion of those needing help in these districts; CARE is working hard to procure the much larger quantities of supplies still needed. Three hundred additional tents were received from vendors last week, but with so much demand, all humanitarian agencies are experiencing serious delays getting enough supplies from vendors in Pakistan. Where appropriate, we are, therefore, looking at sourcing relief supplies from outside the country.

There are many other critical needs in the displaced people's camps as well. A camp that we visited had no water supply, toilets or other sanitation facilities. The situation for women, who have no access to private sanitation facilities, is particularly bad. CARE and our partners are focusing with urgency on the need to address the awful sanitation and water situation. Construction of toilets is starting, a shipment of water purification supplies has arrived, and two water purification plants are being set-up in Nowshera and the neighboring district.

The sanitation issues also illustrate why focusing on gender must be an important aspect of our response, and one that we need to address with sensitivity in the conservative social environment of many of the communities we are working in. The country office is hiring a full-time gender advisor to support our work in this area.

In addition to these districts in the northwest of Pakistan, CARE is also responding in South Punjab and Sindh Provinces further south.

During the visit, we worked with the country office to revise its emergency response strategy. The revised strategy plans for a scaled-up emergency response to reach 300,000 people in the three operational areas over an 18 month period. The response will be in two phases: the first relief phase will last up to nine months and will include interventions in health, shelter, non-food items and water/sanitation; the second recovery phase will overlap with the relief phase and will continue until around December 2011 and will include interventions in livelihood recovery, transitional shelter, etc.

I would like to sincerely appreciate the hard work of colleagues in CARE and our partners in Pakistan, under the strong leadership of country director, Waleed Rauf, who are doing so much to respond to this humanitarian crisis. The great support of many CARE International members is also most valued, and we look forward to continuing to work together with all involved to ensure that CARE's response to this crisis provides significant assistance to the people of Pakistan affected by these devastating floods.

Best regards,
Jon

Read more about the floods and CARE's relief efforts in Pakistan >

2010 Waleed Rauf/CARE

by Deborah Underdown, CARE media specialist in Pakistan
August 24, 2010

The word flood has taken on a new meaning for me. Last month, a flood was a burst water pipe in my flat in London, a few ruined carpets and the inconvenience of sleeping in my lounge. Today, a flood means your entire home being submerged with water. A flood is all your possessions being washed away. A flood is something that forces you to live in a tent wondering where fresh water and food will come from.

Nowshera is about an hour and a half drive from Pakistan's capital, Islamabad. When I arrived I was shocked to see the floods waters hadn't receded. On my left were the submerged houses and on the right, overlooking what used to be their homes, were families living in tents.

I met Khayal Marjan. She smiled at me from inside her tent, provide by CARE, and spoke to me about the floods.

"Our sewing machine was damaged in the flood – it was our only source of income," she said. "I also had 40 chickens and some goats and cows; they all drowned. We only had time to save ourselves."

Approximately 400 families are living in tents provided by CARE – a shelter from the monsoon rains that continue to fall. The needs of the families in these camps are numerous, ranging from shelter to medical care and food to clean water. CARE continues to help. There is a mobile health clinic treating skin diseases and the growing number of diarrhea cases.

The scale of this disaster is overwhelming and unimaginable. Nowshera is just one area of Pakistan affected by these floods. There are many other cities, towns and villages in the same situation - all needing more support.

Flood waters are still present on Nowshera, where some people told us that their homes are still submerged in 4 feet of water.

Children in Nowshera wade through flood water to salvage what they can from their homes.

A camp set up by CARE and local partner IDEA in the village of Nowshera.

Photos: 2010 Deborah Underdown/CARE

Read more about the floods and CARE's relief efforts in Pakistan >