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From the Archives: The South Asian Tsunami of 2004 – Politics & Emergency Aid (EMS & Recovery)
Tsunami Rescue & Recovery: Inter-Agency Politics in a Disaster Zone
by Jeremy Zakis
Immediately following a disaster, international aid agencies react quickly, preparing situation reports to guide rescue and recovery operations followed by monetary, logistical, and medical assistance. A 6.5 magnitude earthquake in Bam, Iran, on December 26, 2003, resulted in the solicitation of thousands of aid workers to the region operating under the direction of the United Nations and local authorities to assist the 60,000 people directly affected by the disaster. Ultimately 40,000 people died in that disaster, but many more were saved due to the swift response and disaster coordination of assets on the ground by all agencies involved.
Exactly one year to the day, another earthquake struck about 60 miles off the west coast of northern Sumatra, west Indonesia, reaching a magnitude of 9.0 and destroying many structures in the nearby province of Banda Aceh. The events that followed would eclipse the Bam rescue operation several-fold and demonstrate how even the best-laid plans for international cooperation can change rapidly once put into effect because of international and local politics.
Shortly after 10 AM on December 26, 2004, several tsunamis reaching an average height of 15 feet struck the coastline of Banda Aceh without warning and at an estimated speed of 300 miles per hour, destroying everything in their path. People in buildings above the second level generally survived, but for those in the street, many of whom had rushed outside fearing that subsequent aftershocks from the earthquake would cause further structural collapses, were swept away. Over the next five hours similar waves would strike Thailand, Malaysia, Bangladesh, India, Sri Lanka, the Maldives and the east coast of Africa with a similar ferocity and damaging results.
The first international agency to respond was the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), which swung into action within hours, dispatching teams to Sri Lanka and the Maldives, which at that time were reporting to have received the worst damage and that “at least 500 [people] had lost their lives.” Damage to critical infrastructure prevented most other countries in the region from communicating their pleas for assistance and therefore it would be nearly 12-hours before the world learned the true extent of what had occurred.
Banda Aceh, the worst affected city on the northwest coast of Sumatra, Indonesia, as seen from the window of the first Royal Australian Air Force C-130 Hercules that delivered humanitarian aid and a medical assessment team to the devastated area after the tsunami, arriving on December 29th, 2004.
COURTESY AUSTRALIAN DEFENCE FORCE
An Unimaginable Mass Casualty Incident
For even the most experienced emergency personnel, confronting a mass casualty incident can be daunting especially when it was a disaster on a scale unprecedented in modern history. However, within days, thousands of emergency workers were descending on the region through chartered flights and military airlifts, loosely coordinated by the United Nations. The governments of each country involved in the relief effort initially determined where they would send disaster response teams based upon UN and aid agency reports or where their own foreign interests were and which areas they could reach the quickest.
The downside to this was it created a series of choke points at airports generally not built for high-intensity air traffic. Another problem was that a lot of guesswork was involved in where to deploy the emergency aid because information about the true situation on the ground in many areas remained hazy at best. To alleviate this the UN Disaster Assessment Coordination (UNDAC) teams fanned out to every country in the region and began releasing regular updates via open sources such as the media, about what medical material and supplies were needed.
Petty Officer 2nd Class Brandon Spegal unloads relief supplies near Banda Aceh, Indonesia, on Jan. 15, 2005. More than 15,000 service members are deployed with Combined Support Force 536 to work with international militaries and non- governmental organizations to aid those affected by the Indian Ocean tsunami in support of Operation Unified Assistance. Spegal is assigned to the aircraft carrier USS Abraham Lincoln (CVN 72). DoD photo by Staff Sgt. Aaron D. Allmon, U.S. Air Force.
For emergency workers on the ground, these international coordination issues were of little consequence to their immediate situation. The waters had destroyed almost all the critical infrastructure in low-lying coastal areas around the Indian Ocean and most food and water within a couple of miles of the shoreline had been contaminated, leading the World Health Organization (WHO) to issue an international plea for clean drinking water and purification equipment. The United States and Australia were the first to combine forces in the southeast Asian region by organizing massive airlifts of purification equipment, which undoubtedly saved lives by providing clean drinking water for victims who had no alternative in some cases but to drink the contaminated water from their own supplies, running the risk of contracting diseases such as pneumonia or cholera.
Much of the actual rescue efforts in places like Thailand and Malaysia had originally been undertaken by ordinary citizens and tourists because local emergency workers were stretched beyond their capabilities and fears of more tsunamis created a sense of urgency and panic in the affected areas. Fearing that the bloated bodies of the victims would pose a serious health risk to the living, Thai authorities began almost immediately digging large pits in the nearby countryside to serve as mass graves. Formal identification of the victims would be attempted but in most cases proved impossible because many were disfigured beyond recognition. Hundreds of victims were buried in the first few days alone, thousands more were still to be discovered.
Left: The ward at Fakina Private Hospital in Banda Aceh, where may patients were treated. Supporting Medical staff from Australia dressed in clothes customary to the region, which helped put many local patients at ease.
Photo: Dr. Gerry Neumeister (via Jeremy Zakis)
First In: Response from Australia
Upon learning of the mass graves and inadequate identification procedures, the Australian government mobilized its Disaster Victims Identification (DVI) team on December 31. The team had gained international praise for their work in the aftermath of the Bali bombing two years earlier. Comprised of 17 forensic experts from the Australian Federal Police and local law enforcement agencies, the DVI were deployed to the town of Wat Yang Yao near Phuket, where they established a temporary mortuary complete with refrigeration facilities. Their task would be to identify the bodies of foreign nationals, while assisting local Thai authorities to identify local victims wherever possible. A team of 10 New Zealand forensic scientists joined them a few days later to help with the mammoth task.
The Australian Army Medical teams from the 1 Health Support Battalion (1HSB) were among the first western aid groups to arrive after the tsunami in Banda Aceh, one of the most remote areas of the region, despite arriving on the ground some two weeks after the disaster. Surgeons from the Parachute Surgical Team (PST) were also deployed because of their experience working in the July 1998 tsunami that struck the town of Aitape, Papua New Guinea. Australian HSB Executive Officer Major Eraine La Gelle said that despite having to treat broken bones and wounds associated with the impact forces from the tsunami, they had to counter bouts of pneumonia caused by victims inhaling filthy waters contaminated with sewerage. Major Gelle said that many victims were dying weeks after the disaster because of massive lung infections, underlining the UN’s plea for water purification equipment.
Medical Aid in Banda Aceh
Dr. Gerry Neumeister, a 38-year-old anesthetist who was sent to Banda Aceh with the South Australian Medical, found that in the capital city Medan that there was a strong competition between agencies and foreign teams for prestige. “There was a lot one-upmanship by the different countries” he said shortly after arriving back in Australia. Dr Neumeister’s first impressions were that aid agencies were involved “pretty much in an invasion” of Banda Aceh and held little regard for local customs or authority.
“It was an absolute nightmare,” he said. “The airport tower was gone and people were undirected. There were crates of rotting food and disorganized rescue personnel everywhere.” Even getting basic transport was proving to be a challenge with all trucks in the city contracted out to those who were able to negotiate the best deal. Luckily for Dr. Neumeister and his colleagues, a friendly American aid worker who managed to acquire a truck before they became scarce was able to transport their 11 tons of medical equipment to Fakina Private Hospital where the previous Australian team had also operated.
Rubble remains in downtown Banda Aceh, Indonesia, in the aftermath of December’s cataclysmic tsunami. The incalculable mass casualty incident prompted an enormous relief effort from government, public safety, and private organizations. AUSTRALIAN DEFENCE FORCE
Yet even after two weeks, the hospital could really only provide basic surgery and medical care facilities and a sanctuary for the injured to rest and recover. The team had to manage patients with no intensive care, X-ray, or transfusion services. Provision of basic medical services was further hindered by a lack of clean running water and unreliable electrical supply.
Right: Australian Army medical officer Captain Mark Hanley, on his way to treat injured residents, walks past the collapsed shopping centre in Banda Aceh, Indonesia. COURTESY AUSTRALIAN DEFENCE FORCE
While local politics continued to frustrate the team, especially the reluctance of the Indonesian police to turn over control of the hospital to the Australians, Dr. Neumeister and colleagues found an ally in Lutfi, their designated contact in the Indonesian police. They also befriended a fellow Australian who was a professor at the University of Sydney and had majored in Indonesian culture and language. His input and ability to communicate with the locals not only put many of the patients at ease, but allowed the Australian team to gain the confidence of local police to such a degree that they were eventually given control of the operating rooms and wards.
Curiously however, the Russian, German, and Danish field hospitals remained virtually empty throughout the entire two weeks that the Australian team was in Banda Aceh. Dr. Neumeister attributed this to the fact that locals associated the army-style tents with the military and were too frightened to approach them for assistance. This was partly the reason for other hospitals in the area remaining crowded. The skill level of staff from other countries also proved to be of serious concern, with many junior surgical teams finding themselves literally thrown into the worst case scenarios imaginable and expected to “learn as they go.”
After a fortnight the medical staff were rotated back to Australia and made way for another Australian team to carry on. While some of the surgeons were happy to leave and return to their own hospitals, Dr Neumeister said in reality, two weeks was probably not enough because it took some time to acclimatize to the situation and by the time the team was working efficiently together, it was time for them to leave.
Operating room. At the Indonesian Military hospital, Indonesian and Australian surgeons work side by side in cramped conditions. Despite the inter-agency and international politics, when it came to giving care to patients, all everybody learned to work together. Photo: Dr. Gerry Neumeister (via Jeremy Zakis)
Having experienced working in a major disaster zone, Dr. Neumeister said he was able to give some advice to others finding themselves in a similar situation. “Get a grip on local customs and habits,” he said, explaining that this will lead to greater cooperation from locals and authorities. “Work on a system that was already there… don’t try and change things.” And “always look after yourself and your team.” He was surprised to learn that in the preparation to send teams to Banda Aceh, the governments of many countries had forgotten to do basic things such as immunizing their medial staff against tropical diseases common to the region.
Additionally, governments providing support should only send items of use and ensure their resources are properly used once in the disaster zone. For example, thick blankets sent by well-meaning European countries lay rotting beside the tarmac at
Medan Airport; they were of no use in the tropical heat of west Indonesia.
While the international response to the tsunami disaster may have been hastily organized during the first few weeks, many important lessons will be garnered from the experiences of thousands of medical staff and rescue workers sent to the region. Dr Neumeister’s experience was no doubt similar to many others in the region and demonstrates the ingenuity of human beings faced by challenging situations. Ultimately the mission for every aid worker is to save and help rebuild lives, regardless of the limitations posed by international disaster-zone politics.
Based in Sydney, Australia, Jeremy Zakis possesses nine years experience working as a counter-terrorism analyst and Asia/Pacific correspondent for the Emergency Response and Research Institute in Chicago. He is the author of the Annual Report into International Terrorist Activity and works as editor for the ERRI daily EmergencyNet News Service. Zakis is also a regular guest on The John Batchelor Show broadcast from New York City and syndicated across the ABC radio network.
See our other archived Asian Tsunami stories:
The Hungry Sea: An International Response for Global Public Safety
by Shawn Alladio
Are We Safe? Tsunami Dangers on America’s Coasts
by Ron Eggers