December 9, 2005
Days after an enormous tsunami battered parts of South East Asia on December 26, 2004, Doctors Without Borders/Médecins Sans Frontières (MSF) teams began working alongside national efforts to provide assistance to individuals in need of medical care, food, water, shelter and other basic necessities.
MSF offices sent over 200 volunteers who concentrated their efforts on hard-hit communities in Sri Lanka and Indonesia, with smaller scale activities in Thailand, Malaysia and India. Assessments completed by MSF teams across the tsunami region showed different needs in different countries, but it became quickly apparent that medical needs were limited.
The mobilization of national emergency services and civil society saved the most lives in the first crucial days. MSF saw its main role as identifying needs that were overlooked. In Thailand, MSF responded by helping Burmese migrant workers who found themselves in a particularly precarious position. In India, MSF offered psychological support. In Sri Lanka, where the damage was more extensive, MSF initially provided medical assistance and distributed relief goods. But by far the greatest focus of MSF activities has been in Aceh, Indonesia, where many key health personnel were killed in the tsunami, and the health infrastructure was destroyed.
Despite predictions and popular belief, huge epidemics did not occur. Now, a year later, MSF has reoriented its work in Indonesia, where 55 international and 350 national staff continue to work, and has finished its tsunami-related programs in other countries. Within Aceh, MSF is anticipating scaling down its activities over the next year.
Throughout its intervention, MSF has remained determined that its programs be driven by need alone, and not by a desire to spend surplus funds. Perhaps the most controversial decision MSF made during the tsunami response, made less than one week after the disaster, was to stop accepting funds that could be used to help victims.
Despite this announcement, in an extraordinary outpouring of solidarity, MSF sections received a total of 110 million euros while a forecast indicated that 25 million euros would be sufficient to run programs for the rest of 2005. MSF decided to contact its donors, asking permission to de-restrict their donations so they could be earmarked for other emergencies and forgotten crises. The response was overwhelmingly positive. Of all the people contacted, only 1% asked that their money be refunded rather than redirected.
By the end of 2005, MSF will have used 90.1 million euros, or 82% of the tsunami donations, to fund its operations in the Tsunami region (M€ 24.7) and to meet urgent needs in other emergencies and forgotten crises (M€ 65.4) such as the nutritional crisis in Niger, the conflict in Darfur and the earthquake in Pakistan.
Remaining funds allocated for operations in 2006/7 will be used primarily for emergencies and forgotten crises. MSF will nevertheless continue activities in Aceh, where teams still find unmet medical needs regarding vaccination programs, mother-child health and infectious diseases like tuberculosis. Few other organizations are running psychologist-led mental health programs, leaving those traumatised by the tsunami and civil conflict with few places to turn. MSF is also exploring the inland area of Aceh, which few NGOs have accessed but where decades of fighting has taken its toll.
ONE YEAR OPERATIONS OVERVIEW
In response to the tsunami, MSF's activities focused on Indonesia and Sri Lanka, though staff also provided assistance to people in Thailand and India. Initial exploratory teams also assessed needs in Malaysia, Myanmar and Bangladesh, but did not find any serious unmet medical needs. Today, MSF continues to carry out tsunami-related operations only in Aceh, Indonesia.
MSF was active in Indonesia prior to the tsunami, assisting patients suffering from infectious diseases and helping victims of violence and natural disasters. On December 28, 2004, the first team arrived in Aceh's regional capital of Banda Aceh, where they saw patients in a medical clinic and began assessments and relief operations. The following week, nearly 200 metric tons of additional medical, water/sanitation and relief materials, as well as dozens of MSF doctors, nurses, psychologists, logisticians, and water and sanitation experts, arrived. Greenpeace's flagship, the Rainbow Warrior, provided additional logistical support, and while roads were still impassable, MSF teams travelled by helicopter to areas along the western and north-eastern coasts.
By the end of January, the emergency phase had ended. Teams began focusing on rehabilitating health structures and addressing the basic health requirements of affected communities. Particular attention was given to people's mental health needs.
One year on, MSF's distribution of emergency aid items and programs to provide water and sanitation have for the most part been completed or handed over to partners. However, MSF continues to run mobile clinics to treat people in villages and in camps for displaced people. Teams are also setting up basic health services in remote areas including inland areas of the Aceh Barat district and in the town of Takengon, in Bener Meriah where access to medical care has been severely limited, due in part to the protracted conflict between rebels and the government in Aceh.
Psychological assistance remains one of the greatest ongoing needs in Aceh, and almost all MSF programs contain a mental health element. Indonesian and international psychologists continue to offer individual treatment to hundreds of patients each month.
Currently, MSF is running programs in 6 districts:
BANDA ACEH/ACEH BESAR
Mental health care
ACEH JAYA (Lamno)
Mental health care
1 health clinic (rehabilitated)
2 pre-fabricated health units
Vaccination (measles and other)
Water & sanitation
Distribution of non-food items
Training Ministry of Health (MoH) staff
BENER MERIAH (Takengon)
Support to basic health care structures
Rehabilitation of health structures (water/sanitation)
Training MoH staff
ACEH BARAT (Meulaboh)
Health clinics (including in conflict area)
Mental health care
Water & sanitation
Training MoH staff
PIDIE DISTRICT (Sigli and Beureunoun)
Support to 2 hospitals: surgery & post-op care
3 mobile teams
3 health clinics
Support to network of clinics
Mental health care activities
Water & sanitation
ACEH UTARA (Lhokseumawe)Mental health care
MSF's initial assessments revealed uneven destruction of the coastal villages and found health practitioners taking care of the wounded, most of whom were treated within the first three days. Local communities organized accommodation and communal kitchens for the displaced people. MSF teams responded to specific medical needs and addressed other needs on an ad-hoc basis. Four weeks after the tsunami, teams were active in Ampara, Batticaloa, Trincomalee, Hambantota, Vanni and Matara districts.
Though a significant amount of aid poured in, it was not necessarily adapted to people's needs, and coordination of activities was difficult. In the first weeks after the tsunami, some areas received disproportionate amounts of aid and relief items, while others received nothing. In one case, the MSF mobile medical team was the 18th medical team to arrive in a displaced camp in the same day. In some villages people received so much clothing, they did not know what to do with it. Conversely, in one village cut off by a broken bridge, the team found 975 families yet to receive any assistance. However, as time went by, some form of relief reached practically all affected communities, and by mid-January more than 160 non-governmental organizations (NGOs) were present on the ground.
During the emergency phase, MSF focused on providing medical consultations through mobile clinics and existing medical facilities, distributing relief goods and improving the living conditions for displaced people in welfare centers and transit camps. Teams provided drinkable water and sanitation facilities, distributed tents, built temporary shelters and distributed non-food items such as hygiene kits, blankets, sleeping mats, mosquito nets and jerry cans.
In a second phase, teams focused on supporting some of the most vulnerable people in rebuilding their homes and lives. The main communities targeted were fishing villages as well as families with very little resources living areas controlled by the Liberation Tigers of Tamil Eelam (LTTE)) . MSF helped clear plots of land, build (semi) permanent housing, and distribute tool kits and non-food items such as kitchen utensils. MSF also started providing psychosocial support in collaboration with the local NGO Shade and the NGO Payasos Sin Fronteras ('Clowns Without Borders').
Because of quick government and community mobilization in India, emergency medical needs caused by the tsunami were mostly covered. 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 counsellors and psychosocial assistants. In Tamil Nadu, in southern India, MSF trained medical students to identify people with health care problems or psychological trauma living in displaced camps so they could be helped more quickly and referred to needed services. The program is in the process of being handed over.
Operational budget: M€ 0.61
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)