Indonesia: In the aftermath of disaster and conflict

MSF continues to run mobile clinics in remote areas of Aceh, where access to medical care is severely limited due in part to the protracted conflict between rebels and the government, including inland areas in the Aceh Barat district, in the town of Takengon in Aceh Tengah district, and in nearby Bener Meriah district in the central mountains.

The extent of death and destruction in Indonesia was severe - more than 100,000 dead, 120,000 missing and several thousand injured. MSF teams quickly assessed emergency needs, provided medical care and responded to outbreaks of diseases such as tetanus, which was caused by wounds sustained when survivors waded through sharp debris.

MSF has a history of emergency work throughout the archipelago in conflicts, epidemics and natural disasters, and in a variety of provinces including Maluku, West Papua, West Timor and Sunda.

This proximity enabled MSF to dispatch emergency teams to areas destroyed by the tsunami soon after the catastrophe. On 28 December, the first team arrived with 3.5 metric tons of relief supplies in Banda Aceh, the regional capital of Aceh province on Sumatra's northwest coast.

The team immediately set up a medical clinic and began assessments and relief operations. Soon more MSF staff and materials poured into Indonesia, bolstered by unprecedented support from international donors.

While the roads were still impassable, MSF teams traveled by helicopter to areas along the west and northeastern coasts, rapidly assessing needs, dropping emergency materials and mobile teams, and transporting the most seriously injured to hospitals.

Additional logistical support was provided by Greenpeace's flagship, the Rainbow Warrior, allowing MSF to reach isolated areas quickly. Nearly 200 metric tons of medical, water-and-sanitation and relief materials, as well as dozens of MSF doctors, nurses, psychologists, logisticians, and water-and-sanitation experts arrived in Aceh the week following the tsunami.

By the second week, MSF was also supporting two district hospitals in Aceh's devastated towns of Meulaboh and Sigli, and teams carried out assessments on Simeulue island and in the Banyak Archipelago, south of Aceh. When another undersea earthquake hit the island of Nias, located near Simeulue, on 28 March 2005, MSF teams distributed tents and relief items to the island's Tuhenberua district.

By March, the acute emergency phase had ended. Teams began focusing on rehabilitating health structures and addressing the basic health needs of affected communities. From the beginning of the disaster response, MSF psychologists had joined the emergency teams, counseling hundreds of patients, and now particular attention was given to communities' mental health needs. Educational sessions were also organized to help people understand the tsunami itself and the many possible physical and emotional reactions to it.

Between February and April, MSF also distributed approximately 80 boats to fishermen in Sigli after the community requested assistance in obtaining boats to regain their livelihoods.

Current activities

In the second half of 2005, medical care has become more easily available in parts of Indonesia hit by the tsunami. MSF's effort to distribute emergency aid and to provide water and sanitation largely have been completed or handed over to partners.

However, MSF continues to run mobile clinics in remote areas of Aceh, where access to medical care is severely limited due in part to the protracted conflict between rebels and the government, including inland areas in the Aceh Barat district, in the town of Takengon in Aceh Tengah district, and in nearby Bener Meriah district in the central mountains.

Teams also provide care in the Mane and Tangse areas of Pidie district. MSF is treating people in villages and camps for displaced people in areas affected by the disaster including Lamno and around Sigli.

Mental health care is one of the greatest ongoing needs in Aceh. A team of psychologists travels to camps, relocation centers, villages and schools, offering a combination of psychosocial education, group discussions and individual counseling. Teachers and health staff receive ongoing training to recognize common symptoms of trauma.

And MSF has set up mental health clinics in Banda Aceh and Sigli. In Aceh, more than 10,000 people affected by the tsunami have attended psychosocial and psycho-educational group sessions in Meulaboh and Lamno on the west coast, in Sigli and Lhokseumawe on the north coast and in Banda Aceh. MSF and local psychologists continue to offer treatment to hundreds of patients each month.

MSF also continues to monitor disease outbreaks and other emergencies in Indonesia. In May 2005, MSF responded to an outbreak of malaria in the Gorong Archipelago in the eastern part of Maluku province. MSF is also carrying out a malaria study in Indonesia to document the successful use of artemisinin-based combination therapy (ACT) in an effort to change national malaria treatment protocols.

MSF has worked in Indonesia since 1995.

INTERNATIONAL STAFF 36
NATIONAL STAFF 622