 |
Six Months After The Asia Tsunami Disaster: MSF Operations & Financial OverviewJune 21, 2005
Six 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. Today, MSF has reoriented its work in Indonesia and has closed its tsunami-related programs in other countries except India. 93 international staff and over 650 national staff continue to work in tsunami-affected areas in Indonesia (89 international, 637 national staff) and India (4 international, 29 national staff). As an emergency medical organization, MSF believes is not the best suited to engage in long-term development programs or large-scale rehabilitation and reconstruction which are still required in many of the tsunami-affected areas. MSF continues to support people affected by the tsunami in Indonesia and India, mainly by providing psychosocial care. At the same time MSF is continuing to help communities in Aceh, who, as a result of the ongoing conflict, have little or no access to basic quality care. 1. SIX MONTHS OPERATIONS OVERVIEWStart-up chronology:
According to the Indonesian government, to date, over 126,002 bodies have been found and over 93,638 people remain missing in Aceh. There are an estimated 514, 150 displaced persons.
An MSF team of 8 people, including 3 nurses and 2 doctors arrived in Banda Aceh, the regional capital, on Dec 28. They brought with them 3.5 metric tons of medical and relief materials. They immediately set up a medical clinic in the city and began assessments and relief operations in Banda Aceh and, by helicopter, in locations along the western and northeastern coasts. Nearly 200 metric tons of additional medical, water/sanitation and relief materials as well as dozens of additional MSF personnel (doctors, nurses, psychologists, logisticians, water & sanitation experts) arrived in Aceh the week following the tsunami. During the first week following the tsunami, MSF:
Up and down the coast MSF ran mobile clinics, evacuated by helicopter those in urgent need of care, ran counselling sessions and donated food, tarpaulins and medical equipment. By the second week MSF was supporting two other district hospitals in Meulaboh and Sigli and launched further distributions of non-food items down the west coast including family tents, kitchen kits, tools etc. Teams were also sent to assess the situation in Simeulue island and the Banyak Archipelago. Days after another undersea earthquake hit the island of Nias on March 28, 2005, MSF teams distributed tents and relief items in the island's northeastern district of Tuhenberua. MSF continued to reinforce its activities, particularly psychological support. A tetanus vaccination campaign was launched in response to the high number of cases coming forward.
Mental health is considered one of the greatest ongoing needs in Aceh and almost all MSF programs have a mental health component. Water and sanitation in displaced camps are also a concern, particularly during heavy rains. MSF has handed over the majority of its water & sanitation projects but continues to monitor for disease outbreaks. MSF is now looking to provide basic health care in a number of areas where people have little or no access to it as a result of the ongoing conflict. MSF is presently running medical (•) and non-medical (ø) programs in 6 districts: Banda Aceh, Aceh Barat, Pidie, Aceh Utara, Aceh Barat Daya, Simeulue: BANDA ACEH:
ACEH BARAT(Lamno):
• 1 health clinic (rehabilitated) • Surgery • 2 pre-fabricated health units • Mobile clinic • Vaccination (measles and other) • TB ø Water & sanitation ø Distribution of non-food items ø Training Ministry of Health staff (Meulaboh):
• Mental health care • Vaccination ø Water & sanitation ø Distribution of non-food items ø Training Ministry of Health staff PIDIE DISTRICT(Sigli):
• 3 mobile clinics to remote areas • 3 health clinics • Support to network of clinics • Mental health care in the trauma center of Sigli ACEH UTARA(Lhokseumawe)
• Vaccination • Malaria assessment & preparation ø Water & sanitation ø Distribution of non-food items ø Training Ministry of Health staff ACEH BARAT DAYA
• Tetanus & measles vaccination ø Distribution of non-food items ø House construction SIMEULUE
• Measles vaccination • Epidemiological surveillance & early warning systems ø Water & sanitation ø Rehabilitation of temporary health centers
Medical careTotal medical consultations: approx 28,000 8 Primary health care clinics DistributionSince its arrival in Aceh at the end of December, MSF has distributed tens of thousands of non-food items to people who lost everything in the tsunami. This has included hygiene kits, kitchen sets, tents and blankets – anything people needed until shelter was provided. MSF continues to distribute relocation/construction kits and has also been involved in low scale boat building and house construction. Mental health careMSF found mental health to be one of the most important needs. Teams have offered care to people suffering from post-traumatic stress disorder (PTSD) as a result of the tsunami and possibly also of the ongoing conflict.
Vaccination campaignsVaccination campaigns focusing on measles and tetanus were organized in seven districts covering more than 120,000 people. Measles vaccination campaigns are still planned for Sigli camps. Vitamin A was distributed during the measles vaccination campaigns, and in some locations a deworming was organized for all children over age 2. Water & sanitationClean water was provided to displaced families through a combination of water trucking, bladders, well cleaning and construction. Hundreds of latrines were built, waste disposal was organised for clinics and hospitals. Many of these activities have been handed over. Early warning system & epidemiological surveillanceAs water and sanitation conditions in camps are still quite poor, MSF mobile teams are monitoring them for disease outbreaks (cholera, measles, malaria, dengue fever). Supplies are on stand-by in Banda Aceh and Jakarta and Ministry of Health staff is being trained to recognize and report cases. MSF is also providing hygiene education.
MSF provided emergency medical aid through mobile clinics and existing medical facilities and distributed relief goods and drinkable 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 drinkable 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 non-governmental organization Shade till the end of April.
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, with some people suffering from post-traumatic stress disorder. 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. A team of 4 international and 29 national staff continues to provide mental health care in Cuddalore, Nagappatinam and Tamil Nadu as well as operate a mobile medical clinic in Tamil Nadu.
In general, the Thai emergency response was found to be fast and well-organized. MSF decided 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. 2. SIX MONTHS FINANCIAL OVERVIEWIn an extraordinary outpouring of support, MSF sections worldwide received 105 million Euros in donations to provide emergency relief to people affected by the tsunami. By the end of April 2005, MSF had spent 17.9 million Euros on tsunami-related operations in South Asia. In total the organisation will most likely spend 24.5 million Euro for activities in the regions affected by the tsunami in 2004 and 2005. MSF Operational Budget MSF Expenses (end of April) 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 MSF's response to this particular emergency. Instead they were encouraged to support our work providing medical care in other emergencies and ongoing conflicts such as the Democratic Republic of Congo, Somalia or the Darfur region of Sudan. MSF offices around the world also began contacting individuals requesting their permission to use their funds to support MSF's work in emergencies elsewhere in the world. This process is still ongoing, but so far an overwhelming majority of donors have accepted that we use their donations elsewhere. 52% 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 derestrict a further 23.5% of the donations and 1% has been refunded on request. Fundraising situation (end of May) MSF is extremely grateful for the unprecedented surge of spontaneous donations we received following the tsunami disaster and will continue to use this money to provide medical and psychosocial care in the regions affected by the tsunami. At the same time, we are heartened by the trust our supporters have placed in us in allowing us to use their funds where they are needed most. We believe that being open and transparent with our donors about how we use their funds is essential, as it is their support that allows us to alleviate the suffering of the most vulnerable in the worst conflicts and disasters around the world. ANNEX: Indonesia Six Months Operations Overview in detailMEDICAL CAREBANDA ACEH:total consultations week 1-5 = 2184; no medical activities now.MEULABOH
LAMNO
SIGLI
BEURENOUN
SIMEULUE
DISTRIBUTIONBANDA ACEH
LAMNO
MEULABOH AND LHOKSEUMAWE
SIGLI
SELATAN, SIMEULUE, TELUK DALAM, SALANG, TEPUA BARATdistributed hygiene kits, mosquito nets, blankets, construction kits and tarpaulin to 8455 families; MENTAL HEALTH CAREBANDA ACEH
LAMNO
SIGLI
MEULABOH
LHOKSEUMAWE
SIMEULUE AND BARAT DAYA
VACCINATION CAMPAIGNSSIMEULUE:measles 15,040ACEH BARAT DAYA:measles 35,013 tetanus 3,187ACEH SELATAN:measles 51,520 tetanus 3,650BANDA ACEH:tetanus 322LAMNO:measles 4,046SIGLI:measles 6,541MEULABOH:tetanus 1,636WATER & SANITATIONSIMEULUE
ACEH BARAT DAYA
BANDA ACEH
LAMNO
SIGLI
MEULABOH
LHOKSEUMAWE
EARLY WARNING SYSTEM & EPIDEMIOLOGICAL SURVEILLANCEMEULABOH AND LHOKSEUMAWE
SIMEULUE
JAKARTA, LAMNO AND SIGLI
|
||
|
|
||
