INDONESIA: tsunami three month review

Background Three months after the disaster and having entered a post emergency phase, MSF has scaled down its emergency operations. However, teams continue to address the basic health needs of affected communities with a partricular focus on mental health, as well as to rehabilitate health structures and carry out epidemiological surveillance. MSF Activity Overview in Aceh
  • Total current MSF staff: 89 international staff and over 200 national staff
  • Total relief materials arrived: over 1200 metric tons, excluding a significant amount of supplies which were bought locally
  • MSF teams currently active in: Banda Aceh, Pidie, Aceh Jaya (Lamno sub-district), Aceh Barah, Aceh Barat Daya, Lhokseumawe (with sub-base at Biruen) Medan, Meulaboh, Sigli, Simeulue Island, Aceh Selatan. Emergency response An MSF team of eight people, including three nurses and two doctors, arrived in Banda Aceh on 28th December, two days after the tsunami struck, on a chartered aircraft also carrying 3.5 metric tons of medical and relief materials. They immediately set up a medical clinic in the city and began assessments and relief operations in Banda Aceh and, by helicopter, in locations along the western and northeastern coasts of Aceh province. Nearly 200 metric tons of additional medical, water/sanitation and relief materials, as well as dozens of additional MSF personnel, arrived in Aceh in the week following the tsunami. During the first ten days of operations, MSF provided medical and sanitation support in one of the main hospitals in Banda Aceh and ran three mobile medical clinics to camps for displaced people in the city. In numerous locations along the hard-hit western and eastern coasts, including Batee, Bireuen, Breueh, Chalang, Lamno, Lampe-Ngo, Lam Teungoh, Legan, Lhok Timon, Meulaboh, Puleu-I and Sigli, MSF teams provided emergency medical care; donated rice, tarpaulins, and other medical and relief materials; carried out mental trauma counseling; and evacuated wounded people in urgent need of care. Between January 1-9, mobile medical clinics in the Cot Keung, Darussalam, Small Msjid, Desa Lam, Kota Baru and Leumpeng areas of Banda Aceh, as well as in the surrounding Aceh Besar district, provided over 1200 consultations, mainly for people suffering from wounds, respiratory tract infections, diarrhea, and skin diseases. MSF water and sanitation teams set up water bladders and water systems in IDP (internally displaced people) locations in the city as well as in one of the main hospitals. Over 500 body bags were distributed to workers collecting human remains in the city. In the second week of operations, MSF began supporting the main hospitals in Meulaboh and Sigli, and began running mobile medical clinics in Lamno, Meulaboh, and Sigli, in addition to those continuing in Banda Aceh. Water and sanitation activities were carried out in all locations. Additional assessments and donations of medicines and relief materials were carried out between Bireuen and Lokseumawe on the eastern coast, where an estimated 38,000 IDPs had gathered, as well as in Aceh Selatan and Aceh Barat Daya districts, Krueng, Pulau Nasi, and 25 locations along the western coast. Three months after - activities per location Banda Aceh Mental Health Mobile Clinics are active in 5 displaced camps and/or relocation centers where they offer individual and group counselling for tsunami victims. Their aim is also to detect other health problems. A 'drop-in' center for psychosocial support was set up and has been operating since March 11th. Water & sanitation activities have been taken over by the government and other actors. Hygiene conditions in displaced camps are improving, MSF now only monitors. Lamno (Aceh Jaya district) Around 10,000 displaced people (about 7,000 staying in 15 camps and 3,000 living in the community). Medical activities in referral health structures As the referral hospital of Aceh Jaya district was totally destroyed, the 'Puskesmas' or health center became the 'referral hospital'. MSF has an official agreement for working in the operation theater and in-patients department after the Pakistani army finished its intervention on 3 March. MSF provided material, drugs and staff within one week and started surgerical activities on 9 March. Medical Mobile Clinics MSF teams are still running mobile clinics in 'SMP camp', in 3 relocation centers and in villages which are being reconstructed. They carry out an average of 135 medical consultations a week. The schedule of mobile clinics changes as people are continuously moving. Epidemiological surveillance is carried out through the medical consultations. Reconstruction help Boat construction project After consulting with the community, MSF started a boat construction project for fishermen. MSF provided the tools and materials and set up a first boat factory in Bak Paoh, then a second one in Lambaroh. By the end of april 38 boats are expected to be built, which will be equipped with outboard engines and fishing nets. One boat will be managed by 3 families. Reinstallation kits Most people don't want to go to relocation centers, they want to rebuild their villages. MSF provides them with tool kits for house construction. Water & Sanitation MSF provides water and sanitation support in displaced camps around Lamno, ensuring storage capacity and water distribution in 13 different locations. Water and sanitation facilities were also installed also at the Lamno health center. In total, around 60,000 liters of water storage capacity was installed. Aceh Barat district Target population in Aceh Barat district: approx. 77.000 displaced and local vulnerable population Medical
  • Meulaboh hospital: Activities were stopped in February, as numerous NGOs were working already in the hospital. The 14 Indonesian nurses hired by MSF to help the hospital staff (as a number of them had died in the tsunami) went home progressively during February. Main activities before leaving were at the post op level. In all : 61 patients hospitalized including 30 post operation patients and 5 tetanus cases.
  • Rehabilitation of several health centers or 'puskesmas' and set up of temporary pre-fabricated ones, including water and sanitation facilities and health waste disposal systems.
  • Providing primary health care in these various health centers (Drien Rampak, Meureubo, Peurenum, Cot Pluh...).
  • Untill local health facilities are restarted, MSF mobile clinics continue to be held at several health centers.
  • Staff training and supervision with respect to standard case definition and epidemiological surveillance.
  • Provision of medical materials and drugs. Mental health
  • Individual and group consultations, including for MSF national staff.
  • five MSF psychologists are setting up provision of community or health center-based mental health care. Water & Sanitation
  • By 20 of March 2005 a total of 180 wells have been cleaned, 63 wells have been constructed or rehabilitated, and 113 latrines have been set up; water trucking and provisions of water bladders.
  • Community based teams have been cleaning up debris, helping with roofing and burial. Distribution Two rounds of distributions were set up : a first round answering to basic needs, a second round giving tools for cleaning up and reconstruction of family houses. All distributions were done directly to the affected persons, with as much flexibility as possible, adapting the distributed items to the needs as much as possible. 6,099 families were concerned in Meulaboh area. 3419 family tents were handed out. Plus kits including soaps, jerry cans, rope, saw, hammer, shovels, nails, plates, cups, gayong, buckets. 5120 cooking sets. 4892 hygiene kits
  • Ongoing for non-food items and water and sanitation materials such as jerry cans for family use, tents, family kitchen, hygiene-, and construction-kits, sleeping mats, oil lamps, matches, oil, undergarments, flip-flops, ...
  • Sigli (Pidie district) MSF provides assistance to 15,045 displaced in Pidie district. Medical
  • Mobile clinics The medical team continues to run mobile clinics twice a week in 10 displaced camps carrying out an average of 350 consultations a week.
  • Sigli hospital This is the only hospital in Pidie District. It has 170 beds in medical, gynecological, pediatric, neurological and surgical wards. MSF first started involvement in the hospital in January 2005, supplying both medical expertise (doctors, surgeons, nurses) and technical supply (drugs, medical material, logistics). In March, an agreement was signed for a one-year involvement of MSF in the structure. MSF will concentrate its activities in three departments : ER, ICU, and surgery. Watsan activities are also planned. Despite the extensive structure of the hospital with plenty of trained staff and technical support, the quality of health care given to the population is seriously lacking, in this civil war context. Psychological support also given via consultations.
  • Beurenoun Health Center. After having done small donations of drugs to Beurenoun pukesmas, MSF began to work in a health center facing the pukesmas. The aim is to be able to hospitalize emergency cases there (15 beds), or to stabilize and then refer to Sigli hospital the most severe patients. Medical material is being brought in by the teams. Psychological support also given via consultations.
  • Mental Health care Mental health activities continue in 10 displaced camps and in health centers through individual consultations. The situation is confusing because some people are moving from the emergency camps, either into relocation camps or back to their villages. A psychological support is also given, via consultations, in Sigli hospital and in a health center in Beurenoun. The MSF team in Sigli has been asked to train doctors with regard to psychological disturbances and trauma. Distributions Two rounds of distributions were set up : a first round answering to basic needs, a second round giving tools for cleaning up and reconstruction of family houses. All distributions were done directly to the affected persons, with as much flexibility as possible, adapting the distributed items to the needs as much as possible. In Pidie District, 6 500 family tents, 8 000 first necessity kits, 7 500 tool kits have been distributed. 3 boats a week are being build by MSF-supported factories. 40 boats have already been given. Reconstruction of health structures MSF was requested by local health authorities to support the building of temporary pre-fabricated health centers in Pante Raja and Trienggadeng sub-districts. MSF has started conducting primary health care activities in the Pante Raja center. Medical material and drugs are being provided by MSF and training of health staff is also ongoing. In other less damaged health centers, MSF has supported necessary repairs which became evident during its medical activities. The rehabilitation and reconstruction of water and sanitation facilities, including for waste management, is planned in all health centers where MSF works. MSF is implementing water and sanitation activities in 16 displaced camps where approximately 13,000 people are staying. Latrine construction is ongoing. MSF provides the camps and health centers with water storage facilities. Simeulue Island Medical
  • Rebuilding three health centers in the northern part of the island
  • Provision of medical materials and drugs
  • A large-scale measles vaccination campaign covering 5 districts has ended this week. Mental Health
  • An MSF psychologist has been evaluating the needs and will be putting into place social activities for persons still suffering from traumatic disorders. Water & Sanitation
  • 271 wells have been cleaned or rehabilitated.
  • Two water treatment plants with 15,000 liter capacity have been installed
  • Safe water provision to 9,285 people in isolated villages in eight sub-districts
  • Construction of latrines Distribution
  • of non-food items and water and sanitation materials is on-going (including tents and shelter, blankets, mosquito nets, kitchen items, hygiene kits and construction kits.)
  • Northeastern coast: Aceh Utara, Lhokseumawe and Bireuen districts Target population in Aceh Utara, Lhokseumawe and Bireuen districts: approx. 50.000 displaced and local vulnerable population Medical Training seminars on standard case definitions and epidemiological surveillance completed for 47 staffers in 22 health centers. Mental health
  • Support to four trauma centers and their eight psychologists
  • Outreach to villages and displaced camps to provide support and/or supervision to community mental health volunteers
  • Individual consultations by international staff (psychologists), but also group counseling, childrens' activities sessions, group training for key staff (midwives, trauma centre psychologists...). Water & Sanitation
  • a total of 49 drinking water tanks, 94 latrines and 12 wells set up, 247 wells cleaned and 1 borehole repaired.
  • Average of 85.000 liters of drinking water per day provided through water trucking
  • Water and sanitation support to temporary displaced camps was extended to villagers returning to their homes with set up of water and sanitation service points. Tapaktuan (Aceh Selatan district) Vaccination
  • Tetanus vaccination of more than 6200 people in Aceh Selatan and Aceh Barat Daya districts.
  • Measles vaccination in collaboration with the Ministry of Health (February to mid-April) Distribution
  • of non-food items and water and sanitation materials is on-going in the entire district (including tents and shelter, blankets, mosquito nets, kitchen items, hygiene kits and construction kits.) Water & Sanitation
  • initial water & sanitation support to small temporary displaced camps (including improvement of general sanitation and drainage) Blangpidi (Aceh Barat Daya district) Vaccination
  • Tetanus vaccination of more than 6200 people in Aceh Selatan and Aceh Barat Daya districts.
  • Measles vaccination in collaboration with the Ministry of Health (February to mid-April) Distribution
  • of non-food items and water and sanitation materials is on-going (including tents and shelter, blankets, mosquito nets, kitchen items, hygiene kits and construction kits.)