NEWS UPDATE

Operational situation

Five months have passed since an enormous tsunami hit parts of South Asia, leaving behind a horrifying trail of destruction and suffering. Within days of the December 26, 2004 disaster, Doctors Without Borders/Médecins Sans Frontières (MSF) teams began working alongside national efforts to provide assistance to individuals in need of medical care, food, clean water, shelter, and other basic necessities. The majority of MSF's work focused on hard-hit communities in Indonesia and Sri Lanka, though staff provided assistance to people in Thailand and India too. Initial exploratory teams assessed needs in Malaysia, Myanmar, Bangladesh, and Somalia as well, but did not find any serious unmet medical needs.

With the emergency phase now ended, MSF has reoriented its work in Indonesia and has closed its tsunami-related programs in other countries except India. More than 80 international staff and 400 national staff are currently working in the areas affected by the tsunami in Indonesia (76 international and 370 national staff) and India (4 international staff and 30 national staff). As an emergency medical organization, MSF believes it is not within its mission or line of expertise to engage in long-term development programs and large-scale rehabilitation and reconstruction which are still required in many places. Other organizations are undoubtedly better suited to undertake these tasks.

Indonesia

Five months since the tsunami, MSF's work in Indonesia has entered a post-emergency phase with noticeably scaled-back operations. MSF teams are continuing to address remaining needs and provide quality medical care through local hospitals, health centers, and mobile clinics as local communities cope with the tsunami's aftermath.

The teams are focusing their efforts on:

The mental anguish caused by the disaster is being addressed by MSF medical staff. In Aceh, MSF staff continue to offer psychosocial help at established health centers, hospitals, and through a network of mobile clinics. These mobile clinics are active in camps for displaced people and relocation centers where thousands continue to seek shelter until they can rebuild their homes. The teams offer individual and group counseling and try to detect other health problems in patients.

By May, MSF teams had provided thousands of tents and other relief supplies like jerry cans, tents, sleeping mats, reconstruction kits, hygiene kits, oil lamps, matches, oil, undergarments, and shoes to vulnerable families lacking basic supplies. MSF distributed these supplies directly to the affected people, and adapted the distributed items to local needs.

In some locations, MSF also set up activities to help people regain a measure of control over their lives. After consulting with some of the worst hit communities where MSF was providing medical support, teams also helped with the construction of houses and boats for local fishermen. In some locations the latter activity was a component of MSF's psychosocial care program. MSF provided tools and material and set up boat factories in Bak Paoh and Lambaroh. Approximately 240 boats were produced.

To date, hundreds of salt water contaminated wells have been cleaned, and many others have been constructed or rehabilitated. Many new latrines have also been installed. MSF trucked in water and water bladders to areas in desperate need of clean drinking water. MSF teams will continue to organize water-and-sanitation activities in displaced persons camps and vulnerable communities for the near future. Latrine construction will also be ongoing.

Current locations:
Banda Aceh: mental health mobile clinics.
Lamno (Aceh Jaya district): medical activities in referral health structures (operating room and inpatient departments), medical mobile clinics, mental health support including reconstruction help, and water and sanitation.
Meulaboh (Aceh Barat district): mobile clinics, staff training and supervision, provision of medical material and drugs, mental health care, water and sanitation, and distributions.
Sigli (main city of Pidie district): surgical and nursing support to Sigli Hospital, hospitalizations in Beurenoun health center plus management of the admissions ward, medical mobile clinics, mental health care (psychological counseling at various locations and setting up a mental health clinic), distributions, reconstruction, and opening of health structures.
Simeulue District: rebuilding health centers, providing medical material and drugs, mental health care, training staff on standard case definitions and epidemiological surveillance, completed measles vaccination campaign, water and sanitation, and distributions.
Northeastern coast (Aceh Utara, Lhokseumawe and Bireuen districts): Mental health care, water and sanitation.
Tapaktuan (Aceh Selatan district): Completed tetanus and measles vaccination campaigns, water and sanitation.
Blangpidi (Aceh Barat Daya district): mental health care, completed tetanus and measles vaccination campaigns, construction of permanent wooden houses, water and sanitation, and aid supply distributions.

Sri Lanka

MSF provided emergency medical aid through mobile clinics and existing medical facilities and distributed relief goods and drinking water during the first weeks after the tsunami.

In a second phase, MSF tried to support some of the most vulnerable people by clearing land parcels so that they could rebuild their homes, providing safe water and sanitation facilities, cleaning and reconstructing wells and latrines, distributing fishing nets and tool kits (in Batticaloa region), and building semi-permanent houses (for 180 families in the Tangalla region). In the same area of the southern coast, MSF started an outpatient clinic and set up shelters for local homeless families. In the nearby town of Matara, an MSF team assisted more than 3,000 displaced people and started mobile medical clinics. An outpatient clinic was also opened in nearby Hambantoa. Once emergency medical needs were met, MSF began organizing a network of local doctors to provide psychosocial support to the many people traumatized by the disaster and its consequences.

In Ampara and Killinochi, MSF provided psychosocial support through the local NGO, Shade, till the end of April.
No current locations

India

Because of quick government and community mobilization, emergency medical needs caused by the tsunami were mostly covered in this country. The principal problem for many communities was psychological trauma. In response, MSF began offering psychological support in Cuddalore and Nagappatinam districts by training NGO community volunteers as counselors and psychosocial assistants. In Tamil Nadu, in southern India, MSF trained medical students to spot people with health-care problems or psychological trauma who were living in displaced persons camps so that they could be helped more quickly and referred to needed services. MSF also runs a mobile clinic. In addition to giving medical consultations, the mobile team also identifies the most severely traumatized survivors of the tsunami.

Current locations:
Cuddalore and Nagappatinam districts: mental health care
Tamil Nadu: mental health care, mobile medical clinic

Thailand

In general, the Thai emergency response was found to be fast and well-organized. MSF saw no urgent need to intervene and instead moved to help improve the situation for Burmese migrant workers affected by the tsunami. More than 50,000 Burmese migrants are registered as workers in six provinces along the western coast of southern Thailand, but as many as 500,000 are actually thought to live in the area. An estimated 5,000 Burmese were missing after the tsunami struck the coast and many more found themselves in a precarious situation having lost their papers or job after the tourist industry collapsed. MSF is now working with a local NGO to set up public-health workshops to inform migrants from different parts of Phang Nga province about basic health care and sanitation and to help them gain access to needed health care.
Current locations:
Phang Nga province: support for Burmese migrants, improving access to medical care.

MSF and Donations for South Asia Tsunami Relief

MSF received an enormous outpouring of support from donors around the world for our emergency relief work in the regions affected by the tsunami. MSF sections worldwide received 105 million Euros in donations. By the end of March 2005, MSF had spent over 16 million Euros on our emergency operations in South Asia and will likely spend in excess of 22 million Euro for tsunami-related relief activities in 2005.

The generosity of hundreds of thousands of MSF donors worldwide made it possible for MSF teams to begin assessing the needs and providing medical relief in the most-affected areas of Indonesia, Sri Lanka, Thailand, and other countries within 48 hours of the disaster.

Less than a week after the tsunami, estimating that we had already received sufficient funds for our foreseen emergency activities, MSF began asking donors to stop giving donations for our response to this particular emergency. Instead they were encouraged to support our work providing medical care in other emergencies and ongoing conflicts such as Democratic Republic of Congo, Somalia, or the Darfur region of Sudan.

In early January, MSF offices around the world began contacting individuals who contributed to MSF's tsunami relief efforts to request their permission to use their funds to support MSF's work in emergencies elsewhere in the world. This process is ongoing, but so far an overwhelming majority of donors who had originally designated their donations for the South Asia emergency have agreed to de-restrict their donations to MSF. To date, 43 percent of the funds initially received for the emergency can now be used to support MSF's other emergency medical programs around the world. MSF seeks to de-restrict a further 35 percent of the donations received. At this time, less than 1% (920,000 Euros) of the total contributions received have been refunded. MSF is heartened by the trust our supporters have placed in us in allowing us to direct their funds to where they are needed most.

The ongoing generosity of our supporters enables MSF's emergency medical relief work, and therefore we believe that being open and transparent with our donors about how we are using their funds is extremely important. MSF is very grateful for the unprecedented surge of spontaneous donations we received following the tsunami disaster. As a need-driven emergency medical organization, MSF is committed to alleviating the suffering of the most vulnerable in the worst conflicts and disasters around the world.

© 2005 Doctors Without Borders/ Médecins Sans Frontières (MSF)