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Lessons from the Indian Ocean Tsunami

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The aim of the Conference on the Health Aspects of the Tsunami Disaster in Asia was to examine the lessons learnt from the health sector response to the crisis and the early phase of recovery. The conference, convened at senior policy and expert practitioner level, was organized by the World Health Organization (WHO).

In his opening address, WHO Director-General Lee Jong-wook reported that the tsunami had affected over ten countries in Asia and Africa and killed well over 200,000 people. "This heavy loss has made the world realize that something must be done to prepare ourselves for future disasters," he said.

According to David Nabarro, special representative of the WHO Director-General for health action in crises, "the tsunami has shown that countries can prevent disease outbreaks but that the world must be prepared to deal more effectively with psychological trauma, the health needs of women, and mass fatalities. By applying what we have learned, we can be better prepared. When disaster strikes, more lives will be saved and affected communities will recover more rapidly."

Delegates at the conference identified the problems that had been experienced in responding to the Indian Ocean tsunami.

One of the main issues discussed was how to manage more effectively the many offers of assistance in the immediate aftermath. The WHO reported that it had been hampered by having to find uses for offers of military assistance and by having to build working relationships and establish ground rules. Clear roles, responsibilities and operating procedures need to be sorted out ahead of any disaster. The conference also concluded that uncoordinated needs assessments are counterproductive.

"The coordination was inadequate," agreed Rear Admiral Robert Hufstader, Command Surgeon for the United States Pacific Command. "But the management of something this overwhelmingly complex - 30 militaries, UN agencies and hundreds of NGOs - had never been attempted before," he continued.

Barbara Butcher, director of investigation for New York City, stressed the need for improved aid for the survivors. "Death is not the end of suffering. People left behind still suffer a great deal from the loss," she said. It was reported that up to ten per cent of the people affected by the tsunami, potentially half a million people, had mental health problems so severe that they required professional treatment. The conference called for simplified procedures and better guidance to improve the treatment of those suffering from psychological trauma and other forms of mental illness.

Participants also called for a greater focus on women's health. Women are particularly vulnerable in disasters and maternal, obstetric and gynaecological services should be given special priority.

Serious problems had been encountered in identifying bodies, with only 60 per cent of bodies found in Thailand identified at the time of the conference. The WHO will encourage health ministries to invest in forensic techniques and discourage mass burials because of the identification problems and the psychological damage that are created by this approach.

On the positive side, participants concluded that action taken at the earliest opportunity had prevented epidemics, despite the loss of water supplies and sanitation and overcrowding in camps. A reporting system for disease outbreaks and mobile protection teams had contributed to this success. WHO publicity regarding health threats also resulted in aid being given specifically to restore water supplies and sanitation.

The following areas for action were identified:

1. strengthening national capacity for risk management and vulnerability reduction;
2. improved information for post-disaster needs assessments and programme management;
3. guidance on best public health practice in vulnerability reduction and disaster response;
4. the need for benchmarks, standards and codes of practice;
5. better management and coordination of disaster responses;
6. capacity building in supply systems, communications and logistics;
7. the key role of voluntary bodies in preparedness and response;
8. donors and donorship principles;
9. the potential contribution of government military forces and the commercial private sector;
10. persons working within local, national and international media;
11. accountability and ethics; and,
12. developing capacity for disaster preparedness.

The conference ended with the WHO and other groups calling for a fundamental change in crisis response. "What we're proposing is radical. If we don't change things then more lives will be unnecessarily lost," said Mukesh Kapila, a senior WHO adviser.

WHO officials have set an ambitious six-month deadline to reform WHO operations and the priorities of the national health ministries it supports.

Further information
Further information regarding the outcome of the conference can be found on the conference website.

News sources
This article draws on news reports from the Boston Globe and Environmental News Service.