Sustaining recovery six months on: the role of health professionals
Doctors, nurses and other health professionals were on the front line from the moment the tsunami struck. Most hospitals and health centres were destroyed or extensively damaged. Working in rudimentary conditions,, health workers did what they could to care for survivors, many of whomhad inhaled seawater or suffered massive injuries. They also provided essential health care to those with chronic illness and disability who were suddenly made vulnerable because they lacked essential medicine and care.
Health staff were expected to manage a very large number of dead bodies - far more than they had ever seen in their entire professional careers. They had to provide care and counselling to to the thousands of survivors who had lost family members, including children orphaned by the tsunami. They did all this while coping with their own personal losses and bereavement.3 It soon became clear that hundreds of thousands of people had lost their homes. Roads, railways, bridges and embankments were washed away, leaving entire communities stranded. Thousands of international aid workers soon arrived to help with the aftermath of the tsunami. Over 200 different organizations joined the relief effort: this presented extraordinary coordination challenges. The response of the all those involved in the aftermath of the tsunami was magnificent. Many aid workers stayed for weeks on end to help communities whose lives had - quite literally - been torn apart.
Following a disaster, The level of illness and death among the surviving population is a a reliable indicator of how much basic relief is reaching people in need. People who do not have access to clean water, proper sanitation, sufficient food and shelter or adequate health careare at an increased risk of death. In the days following the tsunami, public health professionals stressed the importance of making sure survivors had adequate clean water, relief supplies and sanitation facilities. Aid organizations set up disease surveillance systems that allow them to detect and prevent disease outbreaks at an early stage. Whenever and wherever a suspected increase in disease was noted, public health professionals from government, NGOs, UN and other agencies were rapidly deployed to the affected locations stem the outbreak. Outbreaks of measles, dysentery and hepatitis were thus detected and prevented from spreading further at a very early stage.
Specialized international assistance was provided to survivors. Mental health experts helped those who had been psychologically traumatized. Forensic experts helped with the identification of the thousands of dead bodies. Health professionals helped to plan the reconstruction of entire health systems. National governments, NGOs and the international community have reviewed the way in which initial tsunami relief was provided. The lessons learned from this experience will be applied to other major disasters. WHO organized a "Conference on the Health Aspects of the Tsunami Disaster" in Phuket, Thailand in May 2005. Conference particants included key personnel from local and national communities and international agencies. The conference findings, presented to the World Health Assembly later that month, influenced the adoption of a resolution, unanimously passed by WHO's Member States, asking the Organization to increase its capacity to help them prepare for, and respond to, health aspects of disasters and crises.
Six months on, most people affected by the tsunami have yet to re-establish secure livelihoods, and continue to need relief assistance. Their governments, with support from the World Bank, international donors and the private sector, are rebuilding and strengthening health care systems and structures. New health facilities will be made earthquake- and tsunami-proof, and will be located in resettlement areas.
Rebuilding is inevitably a lengthy and frustrating process. Planning a complete reconstruction of damaged health services, in ways that ensure relevance of design and that address needs, cannot - indeed must not - be done overnight.
Governments of tsunami affected countries are working withthe UN, NGOs the World Bank and the private sector on a detailed, district-by-district assessment of progress in different communities. This will help them coordinate overall reconstruction efforts. It will also help them identify needs and gaps and indicate what more needs to be done to help speed recovery so that more people are able to rebuild their livelihoods and maintain good health. The UN's Special Envoy for Tsunami Recovery has been given the responsibility of improving the coordination of support to countries during the recovery process. The office of the Special Envoy places a strong emphasis on health, arguing that good health is the sign of successful recovery and that joint action for health is a sure sign that we are coordinating our collective efforts.
Concerted action is needed to ensure that the recovery effort is managed effectively. This calls for (a) effective coordination between different actors; (b) joint action in affected areas; (c) regular assessments of the overall impact of the recovery effort through regular information on the health status and well-being of tsunami-affected populations;, and (d) rigorous tracking of the extent to which funds provided for recovery programmes reach those in need, especially in the health and education sectors.
We are now at a critical stage in our tsunami relief efforts. Communities that suffer from major disasters usually depend on external assistance for at least six months, as authorities undertake the lengthy process of planning major reconstruction. If this dependence goes beyond six months, however, affected communities are liable to experience deep and lasting despair. This compounds their psychological trauma and can result in extremes of alienation and anger. The next three months are critical: the recovery must gain momentum in a way that reflects the extensive involvement of communities and attention to the needs of all, while, at the same time, maintaining relief efforts. We must do all we can to ensure that the planning and implementation of recovery programmes continue with as few impediments as possible.
The tsunami was an unprecedented catastrophe that affected millions of people. The unprecedented response engaged hundreds of millions more. The way we work together now to support affected communities will affect generations to come - both those immediately affected by the tragedy, and those who have sought to provide help. The way we work now will influence the world's response to future disasters. Our response to this catastrophe, and the lessons we learn from it, will help us improve future response operations. We must be in a position to demonstrate to those who have given so generously that their contributions can make a real and lasting change in people's health and well-being. Our successes will reinvigorate public confidence in international relief work. Our failures may well result in reduced support for future disasters. Six months on, we live with these responsibilities and this knowledge. The need to account for what we have - and have not - achieved increases day by day.