Changsha - As winter sets in, tens of thousands of victims of this summer's floods in central China are still living in temporary, make-shift shelters without enough food, clothing or medical care.
Local government agencies have used their reserve supplies of medicines and money, and officials fear that outbreaks of various diseases are inevitable now that free medical care - required by law during an emergency - is no longer available. Officials in Hunan and Hubei provinces said they cannot proceed with planned vaccinations against typhoid and haemorrhagic fever, endemic in some of the flooded areas.
Emergency clinics that had been maintained by the Public Health Bureaus are now closing, and as many as 200,000 people will remain in their shelters - built mostly with plastic sheets over salvaged materials from their former homes - until at least the end of winter. In recent weeks, the incidence of respiratory diseases has begun to rise again.
As the temperature drops, pneumonia and other illnesses will almost certainly follow if the homeless do not receive further assistance.
At present, many families have only one blanket between them, and most still on the dykes are surviving on a minimal diet, generally a small amount of rice. In severely flooded areas, residents have been unable to grow vegetables or grains, normally their sole source of income.
MSF teams, who since July have distributed medicines, water purification supplies, blankets and other materials, are now pushing forward with another phase of emergency medical assistance.
During the next month, MSF will provide basic medical supplies to clinics damaged or destroyed by the floods as well as cotton padded quilts to those still living in tents and other temporary shelters.