MSF's  emergency response to the Nepal earthquake is now taking shape with approximately 38 staff on the ground in Nepal. Their first impressions of the capital, Katmandu are that it has experienced relatively low level destruction, with the vast majority of buildings and houses still standing. However, many people are sleeping outside in tents and makeshift shelters as they are afraid to be inside due to aftershocks. This is a concern given that storms are expected over the coming days. 
 
The position outside Kathmandu, in areas that are only accessible by helicopter, are more worrying. MSF's  first aerial assessments suggest that the damage is quite significant in a number of villages in the mountainous region. Our helicopter went to areas to the east, north and west of Kathmandu. Of approximately 65 villages viewed, around 45 had visible damage or were destroyed. These areas are very isolated. One village - Warpak - 45 km from Ghorka, has suffered extensive damage and the team plans to start working there. There is a particular need for relief items such as shelter, hygiene materials and cooking equipment. 
 
Another of our teams, who entered Nepal from India by road, have been through that town larger, Ghorka, and find that it has not suffered extensive damage. But relief items (1000 shelter kits, 500 hygiene kits, 500 kitchen kits) are on the way by road from Bihar (India) to be distributed to affected people in the more isolated villages. Another town, Bhaktapur, east of Kathmandu, has experienced destruction. The hospital does not have a functional operating theatre and all cases are being referred to Kathmandu. People are staying in makeshift shelters in the open-air and the sanitation conditions are concerning. There are no latrines and water is scarce. 
 
Back in the capital, a surgical team and rapid intervention surgical kit arrived late on Monday night. They are doing further assessments of hospitals in Kathmandu, including looking at capacity for the treatment of 'crush syndrome'. Meanwhile a cargo plane with a field hospital is departing from MSF's supply headquarters in Bordeaux, France, to Kathmandu.
 
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