By Veronique Terrasse

A month after the river Kosi broke its banks and flooded large swathes of India's northern plains, access to flood victims remains challenging in some areas. In Bihar state, thousands of people may still be stranded, far from the reach of aid workers.

In Supaul, which is among the worst affected districts, Médecins Sans Frontières (MSF) teams have been providing humanitarian assistance to a large settlement in Chuni. The camp had been cut off for weeks by floodwaters and the displaced had received very little aid other than airdropped food packets from the government.

MSF's medical activities will continue there but distribution of non-food items is now coming to an end. The teams are now exploring ways to provide humanitarian assistance beyond Chuni, deep into the heart of the flooded zone in Chhatapur, where the floods have created small islands and access is difficult.

At the back of the army rescue boat, 22-year-old Nandu Devi holds tight her one-year-old baby and wipes away a tear, thinking of what she's left behind. Her house is totally flooded, the goats have been swept away by the rising water and all the crops and food are gone.

They lost everything apart from a buffalo, which is why she, like many other villagers in the flooded area in Chhatapur, preferred to stay in her village rather than join the nearby camp of Chuni.

Clinging to the hope that the water will recede, they face harsh conditions to keep an eye on the house and cattle. But after weeks of sleeping rough, hunger finally defeated her and forced the family to trudge wearily 5 kilometres through floodwaters to reach the Petrol Pump, a stretch of dry land from where the army rescue teams offer free boat rides to Chuni camp.

"We ate our stock of rice and grains, all the food that we had left. Now that there's nothing left we have no choice but go to the camps," explains Nandu, who comes from Bipha, one of the flooded villages West of Chuni.

"We stayed six days with several other families on the roof of the orphanage because the water had risen to neck level. When it went down we walked to the Pump Station and slept in the open for several days. At least half the village have stayed including my husband and people are now hungry, sick and exhausted."

Thousands of people may still be marooned in the floodwater, which has created scattered islands of dry land, where some cattle can be seen grazing.

"It's been a real problem for us," admits Lieutenant Harendra Singh Rawat, leading the rescue team in Chuni. "We go around to offer a lift to the camp but they refuse to come with us. They say they want to stay with the cattle. All they need is food but it's dangerous and the water could rise again."

MSF is assessing the situation but the logistics are challenging. In places the water has become too shallow to access villages by boat.

"Today we saw many people in the flooded villages. They don't want to leave but ask for food and water purification tablets and drugs. Their houses have been partially or fully flooded but they prefer to live with their cattle on what have become small islands," says MSF emergency coordinator Ilaria Porta.

"Some have constructed rafts with bamboo canes or empty steel barrels and they try moving from village to village in search of food. Once we fully assess the situation we hope to organise mobile clinics by boat to all these pockets."

But as their food reserves dwindle, it is likely that more people like Nandu will join the camp.

Housing at least 4,000 families, the camp forms a long line of shelters that stretches out of sight along a canal. MSF has been focusing primarily on children under five and pregnant and lactating women and is providing systematic treatment, follow-up and Ready-To-Use Therapeutic Food to all those who need it.

"India's latest National Family Health Survey shows that 6 percent of children under three are suffering from severe or acute malnutrition in Bihar state. The floods and lack of food have now made the situation even worse for these people and malnutrition is the main health issue we come across in our mobile clinics," says Porta.

Most of the displaced in Chuni were rescued from hundreds of surrounding villages in the Chattipur block, but the floods and the mud have made the roads impassable. Logistics were until now difficult and forced the MSF team to use a boat, motorbikes and a tractor to bring relief material to its destination.

"When we first reached Chuni, it had been totally neglected because no one from the outside had managed to bring aid. Apart from airdropped food packets and a small army health point, they had received no assistance," explains MSF logistician and water and sanitation expert Eva Fernandez. "People were desperate and angry and complained they were lacking drugs, clean water, food and clothes."

For five consecutive days, MSF's mobile clinics treated severe and acute malnutrition in pregnant and lactating women and children under five and controlled the beginning of a diarrhoea outbreak. The teams also distributed around 2,000 non-food items including plastic sheets and soap.

"It meant a lot for them. For weeks these people had been sleeping in the open or in shelters made of whatever they could find. They had lost everything - crops, food, cattle - and they felt abandoned and homeless."

But as the situation stabilises in the camp, the risks of epidemic remain serious. As the floods recede, stagnant water becomes a breeding ground for mosquitoes and water-borne disease.

"Most of the water sources are polluted by debris and excrement," explains Eva Fernandez. "The displaced use tube-wells and the water sources are shallow. It's like drinking from the floodwaters and it could be a bomb waiting to explode. To reduce the risks, we've distributed jerry cans and water purification tablets and we are conducting regular water surveillance. We must stay vigilant."

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