Humanitarian Health Action

Situation report 13

Period covered: 10 January 2005

The fate of nearly one million people along the western coast of Indonesia's Aceh is slowly being assessed with anecdotal reports of death rates in excees of 50%. The highest priority is getting aid to those it has not reached. Simultaneously, plans for rehabilitation are picking up, particularly in Sri Lanka. Health actors, supported by WHO, are progressing with health assessments and know what is needed technically. The current challenge is developing the operational capacities on the ground.


  • Relief efforts are still critical: Some populations in remote areas in Banda Aceh Province in Indonesia remain difficult to reach.
  • Treating injuries from the tsunami and earthquake is still a concern.
  • In India, the Maldives and Sri Lanka, reconstruction efforts starting simultaneously with the relief efforts.
  • WHO's operational priority is now to extend the operational platform from capital cities out to field offices, in collaboration with other UN agencies wherever possible.
  • No disease outbreaks have been reported. Isolated cases of measles in Aceh prompted an immunization campaign.
  • Access to safe water and sanitation remain of critical concern.
  • WHO continues to provide technical support to countries to rebuild public health infrastructure, while guiding and coordinating public health efforts among national authorities, other UN organizations, NGOs, the civil and military sector.

Map of Banda Aceh province - 10 January 2005

Communicable Diseases

Countries are on the alert for possible disease outbreaks and are monitoring the situation through disease surveillance and verification.

  • India: No outbreaks of communicable diseases or epidemics have been reported. The Ministry of Health (MOH) and state administrations with support from WHO have been monitoring the situation. 22,320 patients have been treated since the biggest of the crisis. in all the five states and Union Territories (UTs). Three sporadic cases of typhoid and chickenpox have been reported in the affected districts of Kerala. Immunization of children aged 6 to 59 months has been completed in all districts affected in Tamil Nadu. The combined figures for Tamilnadu, Pondicherry and Kairakal are: 67,071 children vaccinated for measles, 66,262 for OPV and 66,774 administered vitamin A.
  • Indonesia: No outbreaks reported. There have been two cases of measles in Aceh which were followed up by vaccinations. Other unconfirmed cases of measles are being investigated in Meulaboh. Vaccinations may be hampered by lack of access to BioFarma, a nationally sourced vaccine and the only one Indonesia’s government permits. Current production of the vaccine is suspended. WHO is examining other means of procurement as a matter of urgency. Unconfirmed cases of cholera and other water-borne diseases are currently being investigated.
  • Maldives: A detailed disease surveillance system is being developed. WHO field staff are analyzing data from each island concerning acute gastroenteritis, viral fever, ARI, typhoid and hepatitis to determine whether there are any increases in the numbers of cases. Maldives surveillance system reports daily on twelve communicable diseases and as needed on twenty three other communicable diseases.
  • Sri Lanka: No outbreaks have been reported. The number of displaced persons continues to decline (545,492 compared to more than 850,000 on 29 December).
  • Thailand: No outbreaks have been reported. The most common disease occurrence are diarrheas, respiratory syndromes and wound infections.
Environmental Health (access to safe water and hygiene, sanitation situation)
  • India: MOH is providing 17 fogging machines with operators to tackle mosquito breeding. 873 metric tons of water have been airlifted to the A&N Islands to date.
  • Indonesia: Banda Aceh lacks basic sanitation which runs the risk of promoting mosquito breeding. Expanses of water and large quantities of debris (fishing boats, tires, plastic bins and boxes,) are scattered around Banda Aceh. There are currently no resources available to tackle breeding sites or to set up effective vector controls. Provision of drinking water is also a major challenge. With no water distribution system left intact and no large reservoirs, water needs to be distributed from centralized points (preferably located adjacent to displaced persons centers). This will require large-scale production, large capacity containers at watering points (bladders) and smaller (5 gallon) containers for people to carry water. The situation in Banda Aceh remains acute and efforts are underway to reduce the risk of outbreaks of disease. The Government of Indonesia and UN relief agencies continue to work together with a sense of urgency. Significant progress has been made in supplying drinking water in some affected areas. Some 19 agencies are working on the water supply issue. Sanitation and waste disposal are more of a problem; logistics and supply line bottlenecks continue to exist although they have been lessened by increasing coordination.
  • Maldives: Overall, the situation is relatively stable. 5 desalinization plants are in place. Additionally, two boats provided by the Maldives private sector is carrying desalinization plants, circulating in the northern and southern atolls.
  • Sri Lanka: While access to clean water is generally improving, an increased coordination is necessary to ensure a more structured supply, including regularized disinfection of water through chlorination, draining of all contaminated shallow open wells, and water testing. Health education programmes in some displacement camps are being initiated to promote more effective hygiene and sanitation. Materials urgently needed are pumps to empty out well water, chloroscopes, water testing field kits, chemicals for water testing and hygiene awareness posters.
Health system and infrastructure (functioning health facilities, access etc)
  • India: According to assessments by government agencies, damage to health infrastructure facilities was limited. Electrical supplies are being restored on the A&N Islands with the instillation of 21 DG sets and 300 smaller DG sets. As of 7 January, electricity on the A&N islands is being provided to over 40 relief camps, to medical centers, to communication centers, to water supply systems and to a harbor. Kalapakkam atomic power station came back on line on January 9. This has improved the power supply in North Andaman.
  • Indonesia: There is only one functional hospital in Banda Aceh, on the city’s outskirts. It re-opened the day after the earthquake and is staffed by approximately 6 doctors and a team which includes a staff surgeon, anesthesiologist, a pediatrician, OB/GYN, family practice and surgery, as well as nurses flown in from other parts of the country. Approximately 200-300 patients have been treated daily, according to staff physicians, but numbers are falling dramatically. The hospital has an emergency room, one surgical suite, and an inpatient ward with potentially 20 beds, though without mattresses. There were no local health clinics left standing after the tsunami.
  • Sri Lanka: Ongoing medical services through existing mobile medical teams need to be continued to further counteract potential disease outbreaks in displacement camps. Disease surveillance is being strengthened, and planning is underway to being the rehabilitation process, in the first instance to rebuild damaged district hospitals, health facilities and replacements of ambulances. Vector control activities, including fogging and spraying, are being implemented in displacement camps.
WHO Country information
  • India: The Ministry of Home affairs, which is coordinating relief measures, has instructed that transportation of relief, rehabilitation and reconstruction materials to tsunami affected areas be made available free of charge. This applies to NGOs and other organizations as well as state bodies.
  • Indonesia: WHO coordinating with 29 partners through an active Health Coordination Group. Medical supply chain must be urgently re-established, including drug ordering and stock monitoring mechanism implementations.
  • Myanmar: WHO is providing five New Emergency Health Kits, capable of providing basic medical needs to more than 165,000 for a period of three months, along with 22,000 malaria treatment kits. Ongoing assessments by the authorities in Myanmar indicate that the country was largely spared from the destructive force of the tsunami. While initial emergency needs are being met, assessments indicate immediate needs are required in the areas of shelter, access to safe drinking water, food and non-food items (blankets, clothes, cooking sets, mosquito nets, etc). The country is beginning to focus on mid- and longer-term needs, to rebuild any potential damaged infrastructure.
  • Maldives: UN Secretary General Kofi Annan visited the Maldives on 10 January, to personally review the extent of the affected areas. Electricity and communications has been restored to all inhabited islands, but transport continues to be a problem. Transport may become more of a problem as heavy moving equipment increasingly begins to arrive. Affected populations are beginning to be provided with psychosocial support.
  • Thailand: WHO continues to strengthen inter-country emergency in health coordination, in coordination with other UN organizations and NGOs.
WHO Action

WHO's scope of work encompasses five strategic priorities in responding to this event: surveillance, health systems assessment (damage plus rehabilitation), key public health guidance, supply systems and coordination. In order to achieve these goals, action taken by WHO is as follows:

Getting an operational platform in place in the theater: The support system, consisting of office space, IT infrastructure, and human resources management, needs to be good enough to host and make the most of the work of the different international and national experts. WHO's operational priority is now to extend the platform from the capital cities to affected areas, working, wherever possible, with the joint UN facilities. VSAT satellite engineers arrived in Indonesia yesterday and are improving communications infrastructure. Plans are underway to send more logisticians and IT professionals to Indonesia. Maldives has two logisticians en route.

Getting expert people to the theater of operations: The Global Outbreak Alert and Response Network (GOARN) has been activated and epidemiologists and water and sanitation experts from GOARN and WHO are either on standby or en route to countries.

Getting supplies to the theater of operations: Backlogs at the Bande Aceh and Medah airport are improving as aid is being routed through Singapore and Malaysia. Roads in Aceh are still difficult or inaccessible. The first WHO shipment for the emergency response includes 191 New Emergency Health Kits (NEHK), each one covering 10,000 people for primary health care for 3 months, 100 surgical kits, each one covering 100 surgical interventions, and 40 diarrhea kits, each one covering 100 severe cases. 80% of this first batch of supplies have been delivered and are now in country. 81 vehicles have also been mobilized.

Getting funding: WHO has made an appeal for 67 million USD and has so far received pledges for 27 million USD. WHO feels that the aid needs to be properly sequenced and planned. Thus, at the current time, WHO is not in a position to absorb further personnel, medicines and related items for the immediate emergency response to the crisis in South-east Asia. WHO would be grateful if in-kind offers could be reiterated in the coming weeks/months, when reconstruction activities are underway and when stock and personnel may have to be renewed or a diverse kind of support is required.

Through the Emergency Health Action Programme for South-East Asia, the financial requirements for WHO’s health response over the forthcoming six-months period is assessed at US$67 million. WHO thanks the Vienna Philharmonic Orchestra (cash) and the governments of Canada (in-kind), China (in-kind), Denmark (in-kind), Finland (in cash), France (cash), Germany (in kind), Italy (in-kind), Japan (cash), Norway (in-kind), Kingdom of Saudia Arabia (cash), Sweden (cash), Switzerland (cash and in-kind), the United Kingdom (DFID for cash and in-kind), and the United States (USAID for cash) for recent and early contributions. Expressions of support from individuals around the world are overwhelming.