Survivors Picking Up Their Lives

Dr. Lee went to Aceh together with the WHO Regional Director for Southeast Asia, Dr. Samlee Plianbangchang, to help assess the damage caused by the tsunami, the relief efforts which are under way and how WHO can further assist in protecting the health of people in Aceh and in other parts of the region.

"It is clear that not one family in Aceh has been left untouched by this terrible event," Dr. Lee said. "But the spirit with which people are responding is extraordinary. Already, people are looking to the longer term and planning how they can reconstruct not just their homes but their communities."

"What is impressive is the way that people are starting to pick up their lives," Dr. Lee said. "Homes and communities have been destroyed even several kilometres from the coastline. There are still body bags and bodies for all to see. But people are now beginning to clear out the debris, clean out houses and hospitals and salvage what they can of their normal lives."

At the Zainul Abidin General Hospital, at least half of the staff have been directly affected by the tsunami. But medical workers from other provinces have stepped in to help and the hospital is planning to reopen at least its emergency service as early as Thursday. Dr. Lee and Dr. Samlee also visited another hospital where many of the people injured in the tsunami are being treated lying on mats on the mudstained floor by medical staff working with only basic equipment.

Early Warning System for Disease Outbreak

WHO's main effort now is focussed on establishing an early warning system for disease outbreaks with strong disease surveillance, for which WHO staff are already in Aceh to support the local health authorities. The second concern is to rapidly move laboratory support to Aceh to assist in identifying the cause of disease outbreaks. Lab support will also help to dispel rumours of disease.

Dr. Lee said that WHO would continue to work with the health authorities to ascertain the rehabilitation needs for the health system.

So far, although there are cases of diarrhoea, respiratory infections, skin diseases and clear physical and mental trauma, there have been no major outbreaks of disease in Aceh. Many people whose homes have been destroyed are living in relatively small camps, which means they are less exposed to the risk of respiratory and other infections. However, it is clear that the risk of water-borne and other diseases continues.

As the leading public health agency, WHO is providing guidance to national authorities, other UN organizations and NGOs to ensure the public health needs of the displaced populations can be met.

Emergency Public Health Strategy

WHO has published a public health emergency strategy focusing on five key objectives to ensure the rapid recovery and rehabilitation of public health services:

• Surveillance of disease

  Ensuring that national authorities are able to provide early warning of potential health threats, as they emerge, verify them, and trigger a prompt and correct response. Teams of experts have been deployed in countries through the WHO Global Outbreak Alert and Response Network (GOARN), producing daily epidemiological updates.

• Access to essential health care - through assessing and responding to need

  Collating information from reviews of the damage to the health service infrastructure and assessment of the health needs of affected populations - analysing the results, together with Health Ministries, as quickly as possible, and making this available to all who seek to save lives and support recovery.

• Essential public health

  WHO is providing technical guidance to national authorities, NGOs and all other humanitarian actors, on health policy - including the disposal of dead bodies, responses to disease outbreaks, maintaining water quality, dealing with excreta, sewage and chemical threats, managing chronic diseases, vaccination programmes and maintaining mental health.

• Strengthening supply systems

  Ensuring the supply of medicines, equipment, transport and other vital assets so that all in need can access the services they require (immediate replacement of lost health assets, supply of emergency health kits, vital vaccines): many of these items are obtained locally, though when external donations are carefully matched to local need, they can make a vital difference. WHO has focused on enabling the in-country health groups to procure these items themselves.

• Coordination of the international health response.

  The coordination effort must enable an effective health sector response, appropriate use of volunteer health workers and the fullest possible involvement of local communities (including women's organizations). WHO helps co-ordinate, manage assistance, and secure the best possible outcomes through briefing of donors and technical support - including common Logistical Supply Systems that are used by the UN system and NGOs.

Funds Urgently Needed

To fully implement the key activities of the public health strategy, a minimum of US$66 million is urgently required, according to WHO. With donor response generous throughout the world, the critical task now will be to rapidly turn pledges into resources.

An estimated three to five million people are currently displaced, and may be without access to adequate supplies of safe drinking water, sanitation, shelter, food and basic medical supplies.