MSF's Emergency Response to the Tsunami

MSF got here really quickly after the tsunami and within a few days we had a string of clinics down the most affected western coast. Now, three weeks after the disaster, we are in a period of consolidation – looking at meeting the most important needs for the people in the days and weeks ahead.

The only way to move around is by helicopter – we have two small ones already and are getting a third. With my colleagues I have been doing ‘exploratory' missions up and down the coast, looking at the needs of isolated communities of survivors. We have identified around 25 pockets where people are gathered among the devastation. The first thing to say is that really these people are amazing. They have nothing, yet they're already building shacks from materials scavenged from the debris, it's incredible.

Our psychologist here explains that people are still in the first ‘survival phase' where they're simply managing day-to-day existence. People have suffered massive losses – some villages of 2000 people have only around 300 survivors, people have lost all their families, friends, whole communities… We have some young men working in our warehouse here, lovely, helpful young men, and each of them is the sole survivor of their whole family – they come from a village up the coast that was totally destroyed. They're working so hard, it's like they can stave off the thoughts of what they've lost by staying active. One of them admitted to me today that he is unable to sleep. It's just so sad. There are times when everyone cries. Our psychologist Sue is going to have a few sessions with them to try and help them start to deal with their grief. It's something I suspect we'll have to expand in the weeks ahead with mental health programmes for the wider community.

We've done some mobile clinics to the most isolated communities but the medical needs here aren't as visible as one might expect. Most of the people wounded during the tsunami itself have already been collected by helicopter and transferred to one of the many ‘MASH-style' field hospitals that have been set up in Banda Aceh by various militaries and the ICRC. What we're working on now is reducing the risks of diseases. The risk of waterborne diseases in particular has increased rapidly. I have three ‘watsannies' (water and sanitation engineers) working in my team and they're working round the clock trying to clear wells that have been filled with salt water and filthy debris. The water reached up to 3km inland in places so there's a lot to do.

Peoples' needs are for the most basic things – soap, underwear, toothbrushes. The women ask us for sanitary items, so we've been distributing hygiene kits. Most people lost their shoes, and are in danger of cutting themselves and getting tetanus from scavenging through the mud, so we're distributing around 20,000 flip flops to villagers, and industrial-strength rubber gloves to protect them.

Other diseases that threaten people are mosquito-borne such as dengue fever and malaria, both of which are endemic here. Whilst most adults will have developed some form of resistance, children under the age of five and pregnant women are very vulnerable so we are going to concentrate on them. There is also likelihood that we will get involved in a large-scale measles vaccination campaign as there are already reports of cases, and a measles epidemic can quickly take hold in the crowded camps."

MSF is now working along the entire coastline of the Aceh province, assisting tsunami survivors from Singkil in the southernmost part of the west coast to Meulaboh, Lamno, Banda Aceh, Sigli, Bireun, Lhoksemauwe and down to Medan in the North Sumatra province.

MSF has a total of 122 international staff and 44 national staff in Aceh and has delivered nearly 190 tonnes of emergency supplies (not including many materials bought locally).