Humanitarian Health Action

Situation report 21

Period covered: 18 January 2005

Continuing health assessments in the province of Aceh in Indonesia confirm that many people still lack access to the basics such as water, sanitation, hygiene and health care. It is also becoming increasingly clear that many people affected by the tsunami need psychosocial care. In other places, such as southern India, Sri Lanka and Thailand, the focus has moved more to planning for rehabilitation and reconstruction. Disease surveillance continues to be strengthened across the region in order to rapidly identify potential outbreaks. Experts are standing by in the case of an outbreak.


  • No disease outbreaks have been reported
  • In the Maldives, lack of water storage facilities is becoming an urgent problem.
  • In Sri Lanka, lack of sanitation in some displacement camps remains a concern.
  • In Somalia, health assessments for the affected population continue despite the difficult terrain, non-existent roads, size of the affected areas and communication constraints.
  • Across the region, the need for mental health care and psychosocial counseling is becoming increasingly acute.

Situational Updates

Areas affected Damage Displaced Relief Injured Missing Deaths
India 2200 km of coastal land; 300m to 3 km inland and 3 million people 897 villages, 157,393 dwelling units, 11,827 HA of cropped area, and 1.56B USD 647,546 595 relief camps with 376,171 people.  646,256 people evacuated 3,324 in Tamil Nadu only. N/A for other areas 5,669 10,744
Indonesia Aceh: Districts (14 out of 21); 1 mill. people 172 sub-districts, 1550 villages, and 21,659 houses destroyed 703,518 1,443 hospitalized 12,132 110,229
Malaysia NW states of Penang and Kedah 8,000 30,000 in 9 camps 73 in-patient/ 694 outpatient 6 68
Maldives 20 atolls, 100,000 people affected 3,997 buildings, including 30 health facilites at differing levels Approx. 6,500 2,214 26 83
Myanmar 10-15,000 affected long-term.  5-7000 directly affected 592 houses of 17 villages destroyed 3,205 homeless/ households (638) 43 3 61
Sri Lanka Affected families (103,789), houses (103753) 90,241 fully damaged houses/ 41,960 partially damaged houses 431,224 404 relief camps 15,256 6,020 30,920
Thailand 6 provinces on west Thai coast 6.85M Baht have been provided to assist victims 47,708 rescue workers mobilized 8,457 3,396 5,303
Somalia Puntland region worst hit- 650 km of coast line 600 families have lost properties. 2,600 fishing boats destroyed Around 4.000 Many sheltering under plastic sheetings or in huts made from branches At least 150

Health Priorities

Communicable Diseases

Across the region, WHO has put in place or strengthened surveillance systems and has prepared stockpiles of supplies and teams of experts to respond in the case of an outbreak.

  • India: There are no reports of disease outbreaks. Technical assistance for laboratory surveillance for shigellosis and cholera is ongoing.
  • Indonesia: There are no reports of disease outbreaks although sporadic cases of diarrhoea have been investigated. Laboratory investigation for sporadic cases of encephalitis is underway. Public health laboratories have been established in Banda Aceh and Meulaboh with assistance from the University of Malaysia. Surveillance for communicable disease is being strengthened with involvement of all NGOs providing health care services in the affected areas.
  • Maldives: No outbreaks of diseases have been reported.
  • Sri Lanka: No outbreaks of diseases have been reported. The central epidemiology unit has begun to collect and compile information on a weekly basis. The surveillance team undertook a comprehensive evaluation of the epidemic preparedness and response capacity in the Ampara district. A detailed plan of action of WHO support is being prepared in each sub office.
  • Thailand: No outbreaks of diseases have been reported.
Environmental Health (access to safe water and hygiene, sanitation situation)

Clean water and sanitation saves lives and protects health.

  • India: WHO continues to provide technical assistance for monitoring microbiological contamination of water. WHO was named lead coordinator for NGOs and UN agencies working in tsunami-affected areas assessing water quality issues.
  • Indonesia: The Epidemic Alert and Response Team in Banda Aceh reported poor sanitary conditions (lack of soap, many flies and uncovered food) and poor water practices (untreated well water being used instead of freely available purified drinking water). WHO is coordinating the distribution of hygiene materials such as soap to people living on the west cost of Aceh province.
  • Maldives: Water storage is becoming an extremely urgent issue. Desalinization plants and a US Navy ship with water supplies expected to arrive in the next two days mean water production is no longer such a crucial issue.
  • Somalia: UNICEF is planning activities to ensure clear water. The affected areas had already been suffering from shortages in clean water and absence of sanitation systems.
  • Sri Lanka: Field officers have reported poor sanitation conditions in some camps, including poor toilet facilities and inadequate waste disposal and water distribution. A WHO water and sanitation team visiting Galle district reported that water supply and chlorination were satisfactory but water distribution needs to be streamlined and open drains in urban areas filled with debris urgently need to be cleaned.
Other health issues (Mother and child health, mental health)

The tsunami and earthquake affected vulnerable populations such as women, children, elderly, poor more than most

  • Maldives: A United Nations Population Fund (UNFPA) team visited seven islands to the south and on 16 January 2005 and reported varying degrees of psycho-social issues including signs of severe anxiety, nightmares, withdrawal and loss of appetite along with people feeling isolated and neglected since the tsunami. Rumours of forced displacement and water contamination were having a destabilizing effect on the population. Combined with the lack of support facilities, UNPF is concerned that it may be difficult for the community to cope.
  • Somalia: Documented malnutrition has increased in the affected districts due to the tsunami and droughts
  • Thailand: WHO has been asked to provide technical expertise and guidance for mental health work in the affected areas, particularly among children. Teams of psychologists and counsellors have been sent from Bangkok to the south. Their mobile units will visit villages affected by the disaster. Counsellors and psychologists will be rotated every 6 days to avoid burn-out among staff.
Health system and infrastructure (functioning health facilities, access)

Relief work must support the reconstruction of a sustainable health system.

  • Indonesia: Work is under way to establish a new joint WHO and Ministry of Health (MoH) disease surveillance centre.
  • Maldives: The government has urgently requested assistance to procure 80 portable oxygen tanks, 120 nebulizer pumps and 500 respiratory rate timers. A United Nations Population Fund (UNFPA) field team observed extensive water damage to hospital equipment and the loss of medical records and vaccines on some southern islands.
  • Sri Lanka: A team from United Nations Office of Procurement Services (UNOPS) is working with the Ministry of Health to assess where help is most urgently needed for reconstructing health facilities.
WHO Country Information

India: The government has begun more long term rehabilitation measures for the affected people while still providing temporary shelters to those who have lost their homes. As fishermen have been worst-affected, a comprehensive package is under consideration for rehabilitation of this affected population by providing houses, fishing boats and fishing nets.

Indonesia: The inter-agency rapid health assessment team accompanied by officials from the UN, the Indonesian Ministry of Health, the Indonesian Military and the US Marine Corps conducted its fourth day of assessments along the west coast of Aceh, deploying four teams by helicopter to five areas. Access to some areas is beginning to improve. Disease surveillance continues to be strengthened and basic medical supplies have been distributed to displaced populations in this area. WHO distributed basic medical supplies (New Emergency Health Kits which each cover the primary health care needs of 10 000 people for three months along with other supplies) to seven international NGOs and five Indonesian NGOs active on the west coast of Aceh and in Banda Aceh. WHO will send an epidemiologist / NGO coordinator and a logistician to Meulaboh on January 20, 2005 to establish the early warning and surveillance system there.

Sri Lanka: WHO has supplied water and sanitation equipment to field offices including 500 water storage tanks, 15 water pumps, 50 chlorine meters, and 80,000 DPD tablets. A WHO food safety expert, after evaluating food hygiene standards, recommends that the port authorities monitor the condition of incoming food aid more closely, the airport storage facilities for perishable goods be upgraded; people handling food preparation in camps be given training, and public health laboratories be upgraded for effective surveillance of new food-borne risks and contaminants.

Thailand: WHO continues to provide technical support to the Ministry of Health for environmental health, sanitation and mental health.

MAP: Somalia - extent of affected areas due to tsunami

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 Australia (cash), Canada (in kind), Denmark (in kind), Finland (cash), France (cash), Germany (in kind), Italy (in kind), Japan (cash), the Netherlands (cash), Norway (in kind), Poland (cash), Portugal (cash), Kingdom of Saudi Arabia (in cash), Sweden (in cash), Switzerland (in kind and in cash), the United Kingdom (DFID in cash and in kind), and the United States (USAID in cash) for recent and early contributions. Expressions of support from individuals around the world are overwhelming