Executive Summary: When Cyclone Nargis struck the coast of Myanmar in May 2008, an estimated 140,000 lives were lost. Similar to other recent natural disasters, such as the Indian Ocean Tsunami in Aceh, Indonesia, the sheer scale of this disaster requires ongoing relief and recovery assistance for the affected population. Half a year after the disaster and the provision of aid and assistance, the Tripartite Core Group (TCG) commenced a series of periodic reviews to assess the needs of people and communities, and progress towards recovery. This is the first report of this effort. Over the next nine months, the Periodic Review process will seek to inform humanitarian assistance strategies and programme change to benefit the people affected by Cyclone Nargis. By providing relevant data on the situation and needs of the affected people, coordination may be strengthened across sectors and between international and domestic actors. The comprehensive geographic and multi-sectoral coverage of the Review pioneers a new approach to post-disaster needs assessment and monitoring. This report does not seek to evaluate in detail the success of the assistance provided or to make policy recommendations. Instead, it presents findings from analysis of data collected from 2,376 households in 108 communities spread across the area of Myanmar worst affected by Cyclone Nargis. The findings of the first round of the Periodic Review process are presented here by sector and take into account cross-cutting issues. They provide a snapshot of the situation for communities living in the Cyclone-affected areas. It is important to note that the areas covered by the survey were affected to different degrees and that the situation of the surveyed communities was not homogenous prior to the Cyclone. Subsequently, it is not possible to attribute all of the results presented in this report directly or exclusively to the Cyclone, or to subsequent relief efforts. Indicators for the health sector reveal good results for access to health care and outreach into communities. However, the findings raise concerns around the functioning of the health system as only one third of households reported that medicine was available at local clinics all or most of the time. In addition, the prevalence of fever and diarrhoea in communities suggests problems with infectious disease in the centre and west of the Delta and north of Yangon. Findings for nutrition and food security are interlinked with health outcomes, as nutrition reflects the health status and food availability for a population. The proportion of children suffering undernurtition is highest around Yangon (over 15 per cent) and may represent a chronic problem, rather than being directly related to the impact of Cyclone Nargis. By contrast, inappropriate treatment of diarrhoea is most common in the Delta. Food aid had reached every surveyed community along the path of the Cyclone. However, food insecurity persists in the southwest and around Yangon and food consumption is poor across the west. Again, this may reflect chronic problems as well as the impact of Cyclone Nargis. Across the survey area, the majority of households are either using an improved (safe) water source, or treating their water effectively, with the exception of a small area south of Yangon. The percentage of households using chlorine tablets is low, less than three per cent. With the end of the Monsoon season, households are using less rainwater (down from 30 per cent reported in the Village Tract Assessment (VTA) in June to around 20 per cent) and more surface water, from ponds for example. There is concern that increased dependence on surface water and the salination of ponds caused by the storm surge may result in water shortages as the dry season continues. By contrast, the use of unsanitary practices almost halved since the VTA. High proportions of households remain in inadequate shelters that are often overcrowded and offer little protection from the heat and rain. In only around 10 per cent of communities surveyed did every household report adequate living conditions, the same or better than before the Cyclone. Of particular concern is the very high proportion of households using plastic or canvas for their roofs or walls in the area of the southern delta where the storm surge struck. These are temporary repairs, not rebuilding, and occur in around 30 per cent of villages surveyed. Post-Nargis Periodic Review I 2 Education is widely available and the main barrier to school attendance are the costs associated, such as for the school uniform. For older children, needing to work, either to earn income or as a carer in the home, is also an important factor. There is good awareness of Parent Teacher Associations (PTAs), which were mobilised to assist with reconstruction of schools, and areas of low PTA participation are correlated with areas where school attendance rates are lower. Livelihoods have been disrupted across the affected area as fishing, livestock rearing and agriculture all suffered heavy losses. Along the path of the Cyclone, communities are a long way from fully recovering these losses, for example in poultry stocks, arable land, buffalo for ploughing, fishing nets and boats. Recovery will take several years both because of the types of loss suffered (salinated land and fallen trees) and the breadth of need (the very large numbers of livestock and fishing equipment that need to be replaced). Social structures around employment and access to credit have been disrupted with both lack of access and more unfavourable terms observed. People also lost assets and savings, which has reduced their capacity for self recovery and increased indebtedness. While the assistance that has been delivered is making an impact, the depth and geographic coverage is not yet sufficient to meet all needs. In particular, assistance is not reaching the western delta and some of the larger towns and periurban areas as effectively as the eastern delta. The persistence of need, even in areas that received substantial aid, means that the depth of that assistance is not yet sufficient and greater efforts are required if these needs are to be met. Many of the issues facing the Cyclone-affected communities are interlinked and cut across sectors. These include: the interaction of the health system, nutrition, food, shelter and sanitation for improved health outcomes; and the need for recovery in livelihoods to improve food security. Others, such as increasing concerns over water availability through the dry season, will have knock on effects in other sectors. The needs of people vary between and within communities according to the nature and extent of the damage caused by the Cyclone and the vulnerability of members of communities. Meeting the needs of those traditionally considered most vulnerable in a sustainable way requires rehabilitating the communities in which they live. In order to effectively address the complexity in interdependence of issues identified in this report, greater coordination and horizontal integration of programming may be required. As peoples? immediate needs are met, and the shift from relief to recovery begins, it is important that assistance to communities addresses the diversity of needs in the community and works with existing social and economic structures. The diversity of needs between and within communities means that ongoing relief as well as recovery assistance is required. Review and reform of programme modalities may be required to meet these evolving needs. Some people remain dependent on emergency assistance to meet their daily needs. While for others, what is required is an opportunity to re-establish and secure their livelihoods.