November 15, 2013: Doctors Without Borders/Médecins Sans Frontières (MSF) teams have begun treating patients on the ground in some locations in the central Philippines that were battered by Typhoon Haiyan and are continuing to work elsewhere to overcome the huge logistical impediments that the disaster left in its wake.

The areas affected by the storm are spread out across a very wide region, and many main roads and airports are either destroyed, closed, or littered with debris. Some airstrips are too small to land large planes, and electricity and fuel supplies are very limited, all of which has made it very difficult to deliver cargo in the amounts necessary to set up programmes and provide medical care.

MSF has therefore been exploring all possible contingencies and modes of transport to get staff and supplies where they need to be to aid those in affected areas, particularly more remote islands and towns further from the centre of the overall relief effort.

Thinking Outside the Box

“When we run into an obstacle and plan A doesn’t work, we have to move to plan B, or plan C, or in some instances even plan D or E,” says Dr Natasha Reyes, MSF emergency coordinator in Cebu. “We have to think outside the box and be creative, because there are people who need assistance. MSF has been responding to emergencies for a long time, so we’ve done it before, and we now have to do it again as quickly as we can.”

For instance, MSF has been able to land cargo planes at the airport in the area’s largest city, Cebu, and to use smaller craft—planes, helicopters, and boats—to send small teams to assess the medical and humanitarian situation in towns and islands in the vicinity. And on Friday, an MSF emergency team in the eastern reaches of Samar Island, where the typhoon first made landfall, set up medical services and began seeing patients in the town of Guiuan, where nearly all of the buildings were destroyed by the storm and the local hospital is not functioning. The team is creating what will become an integrated system of mobile clinics and outpatient services in and around the town of Guiuan. The clinic in Guiuan will be able to keep more seriously ill patients overnight.

“Much of the work has involved treating existing wounds [that] have become infected,” says Johan Von Schreeb, an MSF doctor who arrived with the team yesterday. “We have done 25 minor surgeries in the past day and the queues are growing with patients suffering pneumonia and diarrhea.”

MSF will be providing water and sanitation services in the area as soon as possible and will also assist with shelter. The team will also assess smaller nearby islands by helicopter. If conditions allow, MSF will begin using boats to bring mobile clinics to other coastal regions of eastern Samar and surrounding islands.

Reaching the Surrounding Areas

In other locations: After several days of searching for a way to get teams and supplies to Tacloban, in Leyte Province, a six-person MSF team finally reached the city on November 14 and is working to set up a field hospital there (it would be an inflatable hospital that MSF has deployed in other disaster zones, such as Haiti after the 2010 earthquake, but this first requires finding a place with enough open ground free of debris and storm detritus to set it up—no small task given the scope of destruction in the area). The team also visited Palo, southeast of Tacloban, where the hospital was severely damaged by the typhoon.

In the town of Ormoc, in western Leyte, most buildings were destroyed and the hospital, which previously had a 200-bed capacity, can now run only a 25-bed emergency department. MSF will also assess the needs in the areas between Ormoc and Tacloban, and southern Leyte.

Travelling by helicopter, another MSF team observed that roughly half of Roxas City, in Capiz Province on Panay Island, was significantly damaged. They will carry out additional assessments in the smaller villages surrounding Roxas, while another team consisting of two nurses, a logistician, and a water and sanitation specialist will fly from Manila to Iloilo, from which they will try to reach San Dionisio, Estancia, and Balasan municipalities in northeastern Panay Island.

The nature of MSF’s response will vary from location to location, depending on the setting. But supporting local hospitals, many of which were damaged, is a clear priority, as is running mobile clinics to reach more isolated populations. This may include setting up mobile hubs or “bases” aboard boats that can move from one place to another as needs dictate. In all locations, whatever the obstacles, teams will continue to look for ways to reach those in need.