By Andrew Jack in Rangoon

As you drive out of Rangoon in almost any direction, the thousands of blue plastic sheets that cover the roofs of makeshift wooden houses appear like sticking plasters on the wounds caused by the devastating cyclone Nargis.

Ships have been grounded or sunk in rivers, trees have been felled and electricity posts snapped in two, with their cables dragged down into ditches. Everywhere, people are at work clearing roads, chopping wood and repairing buildings.

But behind the obvious damage to infrastructure lies a less visible misery for hundreds of thousands of people left without shelter, water and food. Many have also lost members of their family, as well as the cattle they need to plough their fields and animals that provide food.

“Our rice is wet and inedible,” says Ma Htay, who lives in Padagyui, a village less than an hour’s drive south-east of Rangoon.

She stands next to four concrete stumps that once held timber supports for her house – they are all that remain intact on an otherwise empty plot of land. The thatched walls have been shredded and blown away. The tin roof is almost complete – 10 metres away across a muddy pathway.

She fled to a neighbour’s brick house during the storm, where, she says, even the walls shook. Her neighbour points to her leg, cut by metal roofing that blew around.

But both women were lucky compared with those in their village who were in huts in their fields when the cyclone struck. No one drowned, but many have been left with nothing after their possessions washed away. With supplies very short, the local elder has distributed relief by a lottery that gives preference to those who suffered most.

Most of the country’s relief emphasis has been placed on the needs of those in the Irrawaddy delta, where the impact of the cyclone and the concentration of victims means “you get more bangs for your buck”, as one international aid worker put it.

Settlements to the east, south-east and north-east of Rangoon were also badly affected yet they have received even less aid because the focus has been to the south-west.

In Padagyui, hidden from the road behind thick bushes, several dozen blue tents have been erected for those with no shelter. In another settlement near New Dagon, north-east of Rangoon, families are still crammed into a school and adjacent monastery.

Locals say authorities have held back on distributing plastic roofing and other aid because there is so little they fear handing it out would spark fighting between the recipients and the unlucky ones.

Most foreigners could not reach the worst-affected Irrawaddy delta region – which has been the focus of relief efforts and concern for Burmese aid workers and those from neighbouring countries to which the mulitary rulers have been more welcome – until the latest United Nations-brokered deal unveiled this weekend.

That has left Rangoon’s hotels and swiftly rented offices full of frustrated expatriates unable to carry out assessments of the extent of the problem and how it is being handled. Many are veterans of African conflicts and Asian cyclones and tsunamis.

Testimony from local staff of aid agencies, as well as the many Burmese volunteers taking food and other supplies into the delta and carrying out videos and pictures, reveals inadequate support to many villages and townships in the delta.

One local who organised a relief trip to Labutta last week with friends says: “It looked like after a war. People were walking on the streets with hopeless faces. They were mainly from the south, farmers who were comfortably off. Now they have nothing, not even spare clothes.”

Gruesome videos on sale on the streets of Rangoon show blackened, bloated corpses floating in rivers or ensnared in reeds. More troubling for the future are the images of people lining up by the roadsides, desperately waiting for food and water.

While the larger townships have clinics back in operation and are receiving some relief supplies, anecdotal reports suggest more remote villages – often accessible only by boat – have scarcely been reached.

For now, reports of infections are scarce. In the days and weeks ahead?that is likely to prove a leading indicator of how close national and international relief efforts are to achieving their aims.