Protecting health following the Asian Tsunami
The earthquakes and tsunamis that struck twelve countries on 26 December 2004, from South-East Asia to the Horn of Africa, have caused one of the worst natural disasters in modern history, and have directly caused over 150,000 deaths, leaving at least half a million injured, and five million people homeless or without adequate access to safe drinking water, food or health services.
A focus on life
The response to any disaster has one primary focus - enabling those who are affected to live, to sustain their lives and enrich their livelihoods.
The Health sector is called on from the start of the response:
- Much suffering and death can be averted if health issues are addressed in the earliest stages of the response.
- Health indicators - including information on disease incidence - are a barometer of the response. They are an early and sensitive measure of the effectiveness of the humanitarian action.
- Functioning, dependable, accessible health services - that respond to the needs of all affected people - are a critical sign that recovery is under-way. Along with schools that work, and means to ensure security and the rule of law, health services are key elements of recovering societies.
Health indicators provide highly sensitive measures of the effectiveness of the response and rehabilitation. If the recovery of local health services is delayed or ineffective, infectious diseases such as cholera, diarrhoea, hepatitis and pneumonia, will add to the heavy toll of the disaster itself. The risks are especially severe for the very young and the elderly in temporary shelters. Displacement and overcrowded conditions may also lead to an increased risk of measles, influenza, meningitis, respiratory infections and tuberculosis. Pre-existing chronic diseases and events such as childbirth can become threats to life if left unattended. Vector-transmitted diseases such as malaria and dengue are likely to pose a significant threat for weeks and months following such a disaster, particularly if environmental needs are not addressed.
Local and national systems have shown remarkable coping capacities, ensuring rescue, assessments and vital relief in the first week. Before this catastrophe, the health systems of the affected countries had many strengths and contributed to progress in achieving the Millennium Development Goals (MDGs). Supported by strong institutions, civil society and NGOs, they have been active in action and coordination for health since the first hours of relief. It is right that they will take the lead in relief and rehabilitation.
Health action in crisis
In the period immediately following the tsunami, it was local and national health services that took the lead in responding to people's distress. They were supported by an extraordinary mobilization of neighbourhoods, civil society groups and nongovernmental organizations from the affected communities themselves. These same groups are taking the lead in repairing damaged water, sanitation and health systems - they are the heroes of the hour now - and they will be the drivers of rehabilitation. The most pressing needs for life are now safe food and drinking water, sanitation and hygiene, shelter for those who are displaced, and basic essentials like soap, the means to cook and protection from vectors of disease. Those who provide assistance must track the responses of health services to respond: they must repair damage in ways that reflect an understanding of needs, current capacities and the potential support available. Wherever possible, WHO has sought to guide this assistance, whether from governments, private actors, NGOs or UN partners.
WHO has concentrated on five areas:
- Surveillance of disease. Ensuring that national authorities are able to provide early warning of potential health threats, as they emerge, verify them and trigger a prompt and correct response. Teams of experts have been deployed in countries through the WHO Global Outbreak Alert and Response Network (GOARN), producing daily epidemiological updates.
- Access to essential health care through assessing and responding to need. Collating information from reviews of the damage to the health service infrastructure and assessment of the health needs of affected populations - analysing the results, together with Health Ministries, as quickly as possible, and making this available to all who seek to save lives and support recovery.
- Essential public health. WHO provides technical guidance to national authorities, NGOs and all other humanitarian actors, on health policy - including the disposal of dead bodies, responses to disease outbreaks, maintaining water quality, dealing with excreta, sewage and chemical threats, managing chronic diseases, vaccination programmes and maintaining mental health.
- Strengthening supply systems. Ensuring the supply of medicines, equipment, transport and other vital assets, so that all in need can access the services they require (immediate replacement of lost health assets, supply of emergency health kits, vital vaccines): many of these items are obtained locally, though when external donations are carefully matched to local need, they can make a vital difference. WHO has focused on enabling the in-country health groups to procure these items themselves.
- Coordination of international health response. The coordination effort must enable an effective health sector response, appropriate use of volunteer health workers and the fullest possible involvement of local communities (including women's organisations). WHO helps coordinate, manage assistance and secure the best possible outcomes through briefing of donors and technical support - including common Logistical Supply Systems that are used by the UN system and NGOs.
Much of this activity has been carried out in collaboration with Ministries of Health and other key partners in the humanitarian response.
Health action in rehabilitation
The continued good health of populations is key to the social and economic fabric of communities. Hence successful action to preserve health is a critical starting point to sustainable development. We must never forget that poor people, together with persons suffering from disabilities and chronic disabilities, remain vulnerable even as longer term efforts are started. Hence the WHO response in the rehabilitation phase will focus on the following areas:
- Planning of health systems and services. Based on assessments of health needs and capacity of the health care infrastructure, WHO will assist governments plan for rehabilitation of health services. In many areas, health care workers have died or been displaced, and human resources needs will also need to be urgently addressed. WHO provides technical support to Ministries of Health so that interested donors and financial institutions execute plans that reflect the long-term needs of all - in line with national goals (including the MDGs).
- Policy guidance. WHO's extensive health expertise, made available under the guidance of its Member States, within UN and other international coordination, is used by affected communities to guide the overall international health assistance. All international agencies are applying the lessons of earlier crises as they support recovery: one critical requirement, now, is that rehabilitation incorporates the building of local capacity to assess risks, prepare for, and respond to, any future catastrophes. This includes initiatives to reduce disaster damage in critical health facilities. Such matters are bound to be addressed at the forthcoming UN World Conference on Disaster Reduction in Kobe.
The crisis is a tragedy in itself. It is a major set back to the social, economic and health development gains of recent years within the region. WHO is focused both on the health needs of the survivors and the reconstruction and rehabilitation of health systems. Both must be addressed now, together with a long-term strategy to reduce the vulnerability to future disasters. It is imperative that the international support is adequate, effective and sustained. It must be country-led, country-centred and country-coordinated.