Humanitarian Health Action

Situation report 32

1 February 2005

No disease outbreaks have been reported. However complacency must not set in as disease surveillance systems still have gaps, not all health actors are reporting though the same systems, conditions in affected areas remain favourable for communicable diseases, and people's capacities are overstretched. The reconstruction must rebuild a system that can withstand future calamities, can better and more equitably serve the population, and be a sustainable system. WHO is assisting national and local authorities both make the best use of external recovery assistance and maintain ownership and direction - reconstruction must be country driven, not supply-driven.


  • Malnutrition is emerging as a concern. In Indonesia, nutritional surveillance needs to start immediately, integrated with disease surveillance and accompanied by local level work such as growth monitoring, micronutrient supplementation, promotion of appropriate infant and young child feeding, and improved maternal nutrition.
  • Approximately 78 000 children (58%) have been covered by the measles vaccination campaign in Indonesia.
  • WHO plans to establish a task force trained to manage hazardous waste in Maldives.
  • In Somalia, Clean water supply is an issue in the village of Haffun. UNICEF is currently supplying water to the town from wells situated about eight kilometers away.
  • WHO in Sri Lanka has concluded that adequate sanitation facilities will determine the evolution of the public health situation.

Situational updates

Areas / people affected Damage Displaced Peoples 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 647 556 595 relief camps with 376,171 people.  638,297 people evacuated 6 898 5 551 10 872
Indonesia* Aceh: Districts (14 out of 21); 1 million people 172 sub-districts, 1550 villages, and 21 659 houses destroyed 417 124 living in spontaneous settlements 103 camps officially listed - numbers and camps remain fluid 1 736 hospitalized 127 749 101 199 buried
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 facilities at differing levels 10 578 1 313 26 83
Myanmar 23 villages, 10-15 000 people affected long-term.  5-7000 directly affected 592 houses of 17 villages destroyed 2 592 homeless/ households (537) 43 3 61
Sri Lanka* 12 coastal districts and 103 789 affected families 103 753 affected houses 500 668 328 relief camps 15 196 5 644 30 959
Thailand* 6 provinces on west Thai coast with 308 villages and 12 068 households 6.85M Baht have been provided to assist victims 47,708 rescue workers mobilized 8 457 3 144 5 ,332
Somalia Puntland region worst-hit, 650 km of coastline 600 families have lost properties. 2,600 fishing boats destroyed Approx. 4,000 Many sheltering under plastic sheeting or in branch huts NA NA At least 150

Health Priorities

Communicable Diseases
  • Indonesia: No outbreaks or epidemics have been reported. 10 clinical cases of measles have been identified in Aceh Utara; the cases have been isolated and treated, and their contacts vaccinated. The Ministry of Health has reported that approximately 78 000 children (58%) have been covered by the measles vaccination campaign. One hundred and fifty dengue diagnostic test kits have been sent to Aceh. One sporadic case of typhoid fever has been confirmed in Banda Aceh and a joint Ministry of Health / WHO field investigation is taking place into a confirmed typhoid case in Patek camp on the west coast of Aceh.
  • Maldives: No outbreaks or epidemics have been reported.
  • Sri Lanka: No outbreaks or epidemics have been reported. The WHO office in Ampara has received reports of two cases of measles in Kalmunai South community (not camps), which are being investigated.
Environmental Health (access to safe water and hygiene, sanitation situation)
  • Indonesia: WHO, UNICEF and an Australian environmental health team have completed an assessment of the water, sanitation and health situation of displaced persons in Banda Aceh. They have reported various concerns including: irregular refilling of water tanks at camps; many tents are constantly damp; water containers in short supply; and minimum "Sphere" sanitation standards not being met. Overcrowding at latrines, toilets with blocked drains and waste water left on toilet floors were observed. A joint WHO/UNICEF assessment team has recommended that when new IDP settlements are established, the construction of latrines and the supply of potable water and clean water for washing should be priorities.
  • Maldives: There are concerns over the amount of asbestos which may be among the debris of damaged and destroyed buildings. Guidelines on health and safety issues related to cleaning areas contaminated by hazardous waste such as asbestos and oil drums have been issued. There are plans to establish a task force trained to manage hazardous waste. WHO has been urgently requested to provide an expert to work with hospitals on the problem of clinical waste management.
  • Somalia: Clean water supply is an issue in the village of Haffun. UNICEF is currently supplying water to the town from wells situated about eight kilometers away. At a meeting with the mayor of Haffun town, priorities outlined included procuring boats and nets for the fishing industry, well digging to replace those destroyed by the tsunami, house reconstruction, and food. Sanitation is also very poor at present. There is a lot of rubbish, including fish rotting on the beach. There were no pit latrines before the tsunami and the community has no experience digging them.
  • Sri Lanka: Though water supply is not believed to be a problem in displaced persons camps, the water supply in affected communities has not been adequately assessed. The removal of debris obstructing the septic tanks in Galle district remains a priority need. WHO in Sri Lanka has concluded that adequate sanitation facilities will determine the evolution of the public health situation.
Other health issues (Mother and child health, mental health, nutrition)
  • Indonesia: A rapid assessment of 600 children carried out by UNICEF found that approximately 13% were acutely malnourished which by itself, does not signal a critical emergency. However, the malnutrition was strongly associated with a high prevalence of diarrhea (42.6%), coughing (69.7%), fever (55.9%) and vomiting (34.6%). Acute malnutrition, when combines with these health conditions, increase the seriousness of the situation. The establishment of a nutrition surveillance system, including the host communities, will monitor the situation and additional surveys (joint UN and Government) are planned.
  • The Maldives: WFP recently launched a school feeding programme in cooperation with the Maldivian Ministry of Education and plans to distribute fortified biscuits to 24,000 school children over a period of seven weeks.
  • Sri Lanka: A WFP assessment has suggested that the majority of people who earn an income in the service sector, retail trade and tourism sectors (approximately 170 000) will be able to sustain themselves from the end of February 2005. Some of the forthcoming projects (micro-credit schemes, boat repairs and public works schemes) will enable some households to regain their earning capacity. Food distribution in rice-producing areas (e.g. Ampara and Batticaloa) might negatively impact local markets.
Health system and infrastructure (functioning health facilities, access)
  • Indonesia: The Ministry of Health reports that Aceh Jaya needs two ambulances. Medical services are also needed in Calang, Teunom, Lamno and Lhoknga.
  • Maldives: International volunteer doctors are arriving or on their way to support the country's health systems. This will ease the immediate burden, but more will be required in the future. An epidemiologist and an expert in underground water have been requested.
  • Somalia: WHO has given the Ministry of Health one emergency health kit, with medicines to treat patients in three districts. Major constraints in providing aid include transportation (Haffun is 640 kilometers from Garowe which is the nearest main town), and limited presence of both government and implementing agencies as the area is so isolated.
  • Sri Lanka: Camp populations in Jaffna continue to decrease. Current estimates are that there are 8 000 persons in 12 camps. To avoid gaps and prevent duplication, mobile medical teams will be allocated geographic areas of responsibility by the Health Coordinator. WHO and the Ministry of Health are working at improving data collection from the field.
    "…when a number-hungry press shifts its audience's attention from the survivors to the deaths and from the deaths to the toll, there are also negative consequences….So should we refrain from publishing death tolls in real time? Not at all - they are valuable indicators of the human extent of a catastrophe. Although emergency environments make the collection of information difficult, scientific techniques exist to overcome such constraints. The techniques should be agreed upon, applied in a transparent manner from the beginning, and incorporated into the data audit trail. In this way, those who generate the disaster-related statistics can be held accountable to the media and the public."
    "Asian Tsunami: Death-Toll Addiction and It's Downside"
    Bulletin of the World Health Organization, Feb 05
    Michel Thieren, Department of Measurement and Health Information Systems, WHO
Contributions/pledges to WHO for the Indian Ocean Tsunami response 31 January 2005


Donor Contributions received (USD) Firm Pledges (USD) Soft Pledges (USD) Location
WHO Director General Office 100,000 Region
Australia 774,593 Indonesia
Canada 1,229,508 Region
China 1,000,000
Denmark 2,313,058 Indonesia
EC/ECHO 678,426 Indonesia
Finland 2,035,278 Region
France 5,305,040 Region
Ireland 678,426 Region
Japan 6,000,000 Indonesia, Sri Lanka, Maldives
Luxembourg 1,017,639 Region
Republic of Korea 1,000,000 Region
Netherlands 2,394,844 Indonesia
Netherlands 1,000,000 Sri Lanka
Norway 6,000,000 Region
Poland 108,548 Region
Portugal 542,741 Region
Saudi Arabia 500,000 Region
Sweden 5,295,008 Region
Switzerland 884,955 Region
UK/DFID 100,000 Region
UK/DFID 3,831,418 Region
UK/DFID 1,149,425 Indonesia
UK/DFID 1,149,425 Indonesia
USA/USAID 291,500 Indonesia
TOTAL 15,377,646 24,915,176 5,087,010


Donor Contributions received (USD) Firm Pledges (USD) Soft Pledges (USD) Location
Vienna Philharmonic 156,038 Region
Online donations 90,588 Region
SMS donations, South Africa 206,157 Somalia
Other private donations 201,149 Region
TOTAL 653,932
Grand total contributions, firm & soft pledges: 46,033,764
WHO's financial requirements in the Flash Appeal: 67,060,220
Shortfall: 21,026,456