Providing care in the tsunami's wake: MSF organizes emergency assistance

Helping to heal invisible wounds

"She was so tired of crying she just didn't know what to do," says MSF Indonesian psychologist Ferdy Fabian as she remembers Nur, a 52-year-old mother of 11 who came to see her at one of MSF's drop-in counseling centers in Aceh. "She had lost one of her daughters in the tsunami and simply wasn't able to get over it. In that first session with me, she just cried and cried."

"Nur came back saying she had stopped crying, and had finally accepted her daughter's death. She felt she was now ready to move on and was already feeling much better," says Ferdy. "I think simply coming here was the first step. She'd made up her mind she wanted to get over this. She just needed some help getting there."

Two days later, MSF started, in conjunction with national efforts, to provide emergency assistance to individuals in need of medical care, food, clean water, shelter and other basic necessities. The majority of MSF's work was carried out in devastated communities in Indonesia and Sri Lanka, although staff also provided help to people in Thailand and India. Initial exploratory teams assessed the need for aid in Malaysia, Myanmar, Bangladesh and Somalia, but did not find any serious unmet medical needs.

"At nine in the morning I received a message from a former colleague in Bireuen on Aceh's east coast. Flooding everywhere, it said. Then I saw the first reports from other countries hit by the disaster and realized this was something very big. We put a team on standby, looked at emergency stock in our warehouse, started negotiating clearance with the authorities, and of course, had regular contact with the emergency desk in Brussels." says Ibrahim Younis, member of MSF's emergency pool, who led the first team arriving in Aceh, Indonesia.

Responding to a disaster

The first MSF team of eight people, including two doctors and three nurses, arrived in the hard-hit Indonesian regional capital of Banda Aceh on 28 December. They brought with them 3.5 metric tons of medical and relief materials. The team immediately set up a clinic and began assessments and relief operations in the city. Shortly thereafter, members of the team took to the air, renting helicopters to bypass washed-out roads to conduct assessments and deliver aid to isolated communities along the country's western and northeastern coasts.

"In my 12 years with MSF, I've never seen so much get done in so little time." says Rémi Carrier, MSF logistical director.

In the week following the tsunami, MSF staff brought in nearly 200 metric tons of additional medical, water/sanitation and relief materials. Cargo shipments continued to arrive. Soon more than 200 international volunteers and over 600 national staff including doctors, nurses, psychologists, logisticians, and water and sanitation experts were working in the area. Teams found many survivors suffering from injuries and wounds (many of them infected), respiratory tract infections, skin diseases and mental trauma.

In various locations, MSF ran mobile clinics, performed surgery, conducted vaccination campaigns against measles and tetanus, distributed supplies, evacuated patients by helicopter, organized aid deliveries by boat and carried out counseling sessions. The organization also donated food, shelter and medical equipment. In a few weeks, MSF was supporting hospitals and distributing more household items including tents, kitchen kits and tools.

The exceptional nature of the situation required an exceptional response. As needed, teams organized small-scale boat-building, land clearing and house construction projects. By mid-2005, teams had conducted approximately 28,000 medical consultations.

The tsunami had washed away whole villages and towns. Thousands who were left homeless were encouraged to move to displacement camps. Maintaining water and sanitation facilities in these camps was crucial in the first few months after the tragedy, particularly during heavy rains.

MSF staff trucked in clean water, built latrines and cleaned and disinfected wells. As people began to return to their villages in the months after the disaster, MSF slowly handed over the majority of its water and sanitation projects to other groups but continued to monitor the camps for disease outbreaks.

Focusing on trauma

Once emergency needs had been met, MSF closed many of its tsunami-related projects in the belief that it was not the organization's role to conduct the long-term development work and reconstruction work that would be required in many places.

MSF has now reoriented most of its work to provide mental health care to those still haunted by the tsunami and its tragic consequences. In July 2005, 93 international staff and more than 650 national staff continued to work in affected areas of Indonesia and India. In some areas, MSF has been able to organize networks of local doctors to provide psychosocial support or has transferred responsibility for mental health activities to local organizations.

In addition to doing psychosocial work with tsunami survivors, MSF started providing basic health care to some isolated communities in Aceh that have little or no access to quality medical care because of the region's long-standing conflict between government and opposition forces.

"Donors have given us money to be spent on the tsunami and we consider it an ethical responsibility from our side to tell them where and how we spend it. Now that we have received sufficient support for our foreseen operations, we have asked them if they would agree to continue to help us in other crises." says Marine Buissonnière, MSF Secretary-General explaining MSF's decision to stop accepting funds for tsunami-related activities

Overwhelming public support

"The solidarity has been exceptional and has allowed MSF to deploy teams in the worst-hit areas and provide care to survivors and displaced populations in Sri Lanka and Indonesia. At this point, however, we feel the need to be open and transparent with our donors and let them know that we have received sufficient support for our foreseen operations in Southeast Asia.

In an extraordinary show of support, the public contributed 109 million euros in donations to MSF to provide emergency relief to people affected by the tsunami. By the end of August 2005 MSF had spent 20.9 million euros on tsunami-related operations. The organization expects that, by the end of 2005, it will have spent a total of 24.6 million euros for activities in the region affected by the tsunami. (For more financial details, see page 86-87.)

Within a week of the tsunami, MSF had deployed many teams on the ground and estimated that more than sufficient funds had been received to support its wide range of foreseen emergency activities. MSF decided that, in the interest of public transparency and honesty toward its donors, it would halt its call for donations for this particular crisis.

MSF offices around the world began contacting individual donors requesting their permission to use their funds to support MSF's work in other emergencies and "forgotten" conflict areas such as the Democratic Republic of the Congo, Niger, Somalia and the Darfur region of Sudan.

An overwhelming majority of donors have agreed to have their donation used elsewhere.

This generosity has enabled MSF to support activities in forgotten areas that receive far less public and media attention but where humanitarian needs are staggering.