Tsunami response one year later

tsunami response: one year laterphoto: Jodie Willard

DIRECT RELIEF BY THE NUMBERS (THROUGH DECEMBER 15, 2005)

$14.3 million in cash received to aid tsunami victims. Direct Relief maintains a strict policy of using 100 percent of all tsunami contributions exclusively for direct tsunami expenditures. The organization is absorbing all administrative costs associated with the tsunami response.

$50 million in direct aid provided in the form of donated medical products and cash grants

4 million courses of treatment of specifically requested medicines, supplies, and medical equipment through 42 shipments to Indonesia, India, Sri Lanka, and Somalia with a wholesale value of $41.7 million

$8.3 million in cash grants provided to 55 emergency and ongoing medical needs and to rebuild housing, water systems, and health facilities

70.2: percentage of tsunami funds expended

Millions of lives were devastated by the massive Indian Ocean earthquake and resulting series of tsunamis that ravaged coastal communities throughout the Indian Ocean in December 2004.

Direct Relief International’s emergency response and ongoing recovery activities in this enormously complex tragedy have been structured around two basic principles. The first is that our organizational role in the area of health is to support, strengthen, and enable local people and organizations in the affected communities. It was they who lost the most, have the most at stake in the long-term outcomes, and for whom the resources we received were intended to benefit. The second is that designated money and resources received following the tsunami were for the benefit of people in affected areas, and that our responsibilities in responding are those of trustees accountable both to those who gave generously and those for whom the resources were given. This report reflects our adherence to these principles, which will continue to guide our activities to assist communities and people who still face tremendous challenges going forward.

With long experience in emergency response and a strong network of partner facilities and organizations in the affected area, Direct Relief was able to respond quickly, effectively, and on a large scale. Emergency medical shipments were airlifted within 72 hours. Within the first two weeks, 48,000 lbs. of material aid had been sent to hospitals, clinics, medical outreach programs, and healthcare professionals through 13 separate air freight shipments. The response was supported by FedEx, which provided extensive air transport and logistics assistance.

Overall, Direct Relief has furnished over $8.3 million in cash grants from the total of $14.3 million in total tsunami contributions received. Complementing a massive infusion of essential medical resources - all of which were specifically requested by end-user health professionals -- these targeted investments have been made in locally managed efforts designed to serve communities now and in the future.

In reporting on our organization’s efforts over the past year, we recognize that the faith, resiliency, and hard work of the people in countries affected by the tsunami are the most important factors in recovering from this tragic event. We remain committed to helping them in the months and years ahead.

HOW YOUR MONEY WAS SPENT

photo: Jodie Willard

photo: Jay Farbman

IMPLEMENTING PARTNERS FOR:

PROVISION OF HEALTHCARE SERVICES/MOBILE MEDICAL INITIATIVES

Amrita Institute of Medical Sciences

Hindu Mission Hospital

Meenakshi Mission Hospital

Madhar Nala Thondu Niruvanam

Shuddham

RECONSTRUCTION OF HEALTHCARE INFRASTRUCTURE

Bharitiya Jain Sanghatana

Hindu Mission Hospital

Madhar Nala Thondu Niruvanam

Vishranthi Charitable Trust

WATER & SANITATION

Shuddham

Tsunami waves traveled hundreds of miles across the Bay of Bengal to strike the southern coast of India, devastating coastal towns and fishing villages in the states of Tamil Nadu, Kerala, Andhra Pradesh, and the Union Territory of Pondicherry. Also hard hit were the Andaman and Nicobar Islands, an island chain located between India and Myanmar, roughly 700 miles from Calcutta. Direct Relief’s 45–year history of disaster relief and medical assistance work in India allowed us to engage immediately our extensive grassroots partner network and to provide healthcare organizations and facilities throughout the region with critically needed medical material resources.

On December 28, 2004, Direct Relief’s first tsunami-response shipment, consisting of over 3,705 lbs. of anti-infectives, analgesics, cardiovascular agents, oral rehydration salts, first aid, surgical, general hospital and clinic supplies, nutritional supplements, rescue blankets, dermatological products, and personal care products was shipped to a partner facility providing medical outreach services in the severely affected district of Nagapattinam in southern Tamil Nadu. Over the following days, weeks, and months, Direct Relief shipped an additional 111,116 lbs. of specifically requested medical products, with a total wholesale value of $26,189,963, to assist Indian healthcare institutions and agencies with their provision of emergency and on-going medical care to hundreds of thousands of tsunami survivors.

In addition, over $2.4 million in grant funding has been invested in specific locally managed projects aimed at meeting the immediate and ongoing medical needs of people and communities in tsunami-affected areas. These projects have focused on the provision of medical diagnoses and services, including the purchase and operation of ambulances and mobile medical vans, the coordination of hundreds of medical outreach camps, and health facility reconstruction and rehabilitation including the construction of six community health clinics in coastal Tamil Nadu, and 34 primary care centers and sub-centers on the Andaman and Nicobar Islands.

| INDIA |



The Andaman and Nicobar Islands are a chain of 572islands stretching over 500 miles in the Indian Ocean. The island chain, one of India’s Union Territories since1947, is located in the Bay of Bengal between India and Myanmar, roughly 700 miles from Calcutta. The 36 inhabited islands have a population of approximately 370,000, with a large percentage of islanders belonging to one of twelve distinct indigenous tribes, each with its own clearly-defined locality, dialect, and traditions. These tribes have been living on the islands for thousands of years with little contact with the outside world. Few, if any, other living human populations have experienced such long-lasting isolation.

Many of these islands were hit particularly hard by the tsunami due to their close proximity to the earthquake epicenter. Over 3,500 people were killed, tens of thousands were displaced, infrastructure damage was extensive, and thousands of acres of agricultural land were rendered unusable. Many tsunami survivors continue to live in camps scattered across the islands.

Direct Relief partnered with Bharatiya Jain Sanghatana (BJS), a nonprofit Indian assistance organization, to help rebuild the healthcare infrastructure in the Andaman and Nicobar Islands. Established in 1985, BJS focuses its efforts on making improvements in education, providing vocational training, conducting medical and surgical camps, and providing immediate and long-term assistance to disaster-affected communities including post-disaster reconstruction.

In response to the tsunami, BJS focused their initial relief work on providing food and shelter for six camps in Tamil Nadu. After completing site visits to the most affected areas of the country, BJS decided to focus

their long-term assistance efforts on school and healthcare facility reconstruction on the Andaman and Nicobar Islands. BJS representatives met with the Indian Government Planning Commission, local government officials, and the Tribal Council for the Andaman and Nicobar Islands, and received approval to rebuild four primary care centers and 30 primary care sub-centers that had been completely destroyed by the tsunami. Direct Relief approved a $1.7 million grant to BJS to rebuild the centers and sub-centers which have been redesigned to resist damage by earthquakes, floods, and cyclone level winds as well as expanded in size to include living quarters for a trained health provider/midwife. For the first time, a trained health provider will be available full time to care for and treat island residents, including pregnant women. Over one-half of the facilities have been completed with the rest scheduled to be finished by January 2006. All centers and sub-centers will be handed over to the Andaman and Nicobar Secretariat of Health Services which is responsible for the administration and ongoing costs of the facilities.

In addition, Direct Relief has provided four containers of pharmaceuticals, medical supplies, nutritional products, and medical equipment, with a total wholesale value of over $2.1 million, to equip and stock the centers and sub-centers.

Andaman and Nicobar : Rebui lding Primary Health Services for Is landers



| INDONESIA |


PROVISION OF HEALTHCARE SERVICES/MOBILE MEDICAL INITIATIVES

Acehkita Foundation

Community, Habitat, Finance International

International Medical Corps

International Relief and Development Yayasan Peduli Kesechatan Aceh The Center for Humanitarian and Social Empowerment Embun Pagi Foundation Islamic Medical Association and Network The Indonesian Planned Parenthood Association-Aceh Persatuan Perawat Nasional Indonesia Pusat Kajian dan Perlindungan Anak Wahana Amal Sesama Mahluk Allah Solidaritas Perempuan Bungoeng Jeumpa Aceh InfoAceh


International Relief and Development Sisters of Charity of Our Lady Mother of Mercy

PSYCHOLOGICAL SERVICES

International Relief and Development Psikodista Foundation

International Medical Corps; Psycho-social Program

WATER & SANITATION

International Relief and Development Gardamadina Institute

VECTOR-BORNE DISEASE CONTROL

International Relief and Development Bulan Sabit Merah Indonesia - Indonesian Red Crescent Hospital

TECHNICAL ASSISTANCE & EQUIPMENT PROVISION

Community, Habitat, Finance International

At the year anniversary of the tsunami that killed an estimated 169,000 people and left over 500,000 displaced along the coast of Sumatra, Indonesia, people continue to work towards recovery and rebuilding lives. Solutions for permanent housing have been slow to materialize, leaving thousands of families in temporary shelters for displaced persons throughout the Nangroe Aceh Darussalam Province. The medical response to the tsunami was greatly hindered by the destruction of hospitals and clinics that, under normal circumstances, struggled to meet the needs of the population. With a lack of undamaged facilities, extensive mobile medical initiatives were undertaken, bringing doctors and medicines to the affected coastal villages.

Direct Relief has sent 137,355 lbs. of specifically requested medicines, supplies, and equipment designed to treat acute injury often preventing amputation and severe disability, which were a high risk during immediate post-tsunami recovery. These medical conditions included blunt chest trauma, broken bones, severe lacerations, dehydration, respiratory and gastro-intestinal problems, and a range of bacterial and fungal infections. Medical product filled the needs of mobile medical camps, community clinics, and referral hospitals, all working to meet the emergency and on-going needs of the residents of Banda Aceh, Aceh Besar, Pidie, Nias Island, and other affected regions.

To date, Direct Relief has provided nearly $3.2 million in direct cash assistance to jumpstart emergency relief and sustain ongoing initiatives in Indonesia.

photo: Jayne Kulzer

photo: Jayne Kulzer

photo: Jayne Kulzer

Direct Relief cash grants to Indonesia aim to support sustainable medical initiatives providing services to residents of displaced persons camps, to rebuild damaged or destroyed health facilities, to educate residents of relief camps on preventive health measures, and to prevent the spread of water-borne and vector-borne diseases. Rebuilding a structure to provide basic medical services for people in the tsunami affected areas has been a priority. In addition, the significant emotional trauma that many experienced created the need for mental health services. Grant funding has been provided to train public health workers and volunteers to identify and treat people with post-traumatic stress disorder and other psychological conditions. The tsunami also severely damaged essential water and sanitation systems. Direct Relief funds are working to restore access to clean water for thousands of families.

Direct Relief provided the financial resources for a local Indonesian organization, Garamadina Institute (GI) to clean water wells (the main water source) contaminated with salt, muck, and debris in the Banda Aceh community of Syiah Kuala. By October, GI had cleaned 1,970 wells, surpassing the project’s goals by more than 700 wells and providing access to clean water for 4,800 people. This project has employed 705 workers living in nearby relief camps.

photo: Ana Fuentes

photo: Jayne Kulzer

photo: Jay Farbman

With nearly 40,000 deaths and more than 500,000 people displaced, Sri Lanka was deeply affected by the tsunami. The waves wrapped around Sri Lanka’s coastline to the south and north, hitting areas as far as the country’s west coast near the capital city of Colombo. Hardest hit was the eastern coast, which has undergone twenty years of civil conflict. Entire neighborhoods were washed away, resulting in tens of thousands of deaths and injuries as well as widespread infrastructure destruction. The flooding and contamination of water sources created a high risk for widespread water-borne and vector-borne disease outbreaks. Coupled with a lack of functional healthcare facilities, international health experts feared the worst.

The prompt action of the Sri Lankan Ministry of Health, along with local nonprofit health organizations and international NGOs, curbed the occurrence of disease on an epidemic scale. However, the emergency medical needs of the affected population were vast. In the weeks and months after the disaster, Direct Relief worked closely with the Ministry of Health, and a number of Sri Lankan and U.S.-based NGOs, to provide thousands of pounds of critically needed medical goods including endotracheal tubes to treat victims of saltwater aspiration, wound dressings and surgical instruments to care for acute traumatic injuries, anti-infective and antifungal agents to address bacterial and fungal infections, and oral rehydration salts to fight dehydration. Over the past year, Direct Relief provided 56,897 lbs. of medicines and supplies with a total wholesale value of over $4.4 million to public health facilities and outreach programs, Sri Lankan nonprofit healthcare and social service organizations, and U.S.-based relief organizations conducting mobile medical camps in displaced persons camps and affected communities.

Direct Relief also has provided over $2.4 million of targeted aid in the form of cash grants, supporting the provision of medical services, reconstruction of healthcare facilities, psychological counseling initiatives, water and sanitation improvements, and the rebuilding of healthcare workers’ homes. In addition, Direct Relief has focused on preventive health, including the procurement of 143,000 insecticide-treated mosquito nets for use in relief camps and affected neighborhoods.

| SRI LANKA |

One-fourth of the nearly 40,000 tsunami casualties in Sri Lanka occurred in the eastern coastal communities of the Ampara District. The extensive structural damage that closed five hospitals in the region left Ampara General Hospital as the only functioning referral facility providing health services for hundreds of miles. To expand the hospital’s capacity to provide services, Direct Relief provided a grant of $169,000 to purchase a CAT scan machine, the first in Sri Lanka’s Eastern Province, and a grant of $155,500 to outfit the ICU with new life-saving equipment.

Ampara General Hospital


PROVISION OF HEALTHCARE SERVICES/ MOBILE MEDICAL INITIATIVES

American Refugee Committee


Sarvodaya

World Federation of Occupational Therapists

St. John’s Ambulance Brigade, Sri Lanka

Foundation for Social Welfare

International Relief and Development Foundation of Goodness Jaffna Diocese of the Church of South India EMACE Foundation of Sri Lanka Family Planning Association of Sri Lanka Mutual Assistance International


American Refugee Committee

Foundation for Social Welfare

International Relief and Development Global Action BECT Foundation

PSYCHO-SOCIAL SERVICES


VECTOR-BORNE DISEASE CONTROL

TEDHA

WATER & SANITATION

International Relief and Development Community Trust Fund Guardian Foundation Project Sri Lanka

TECHNICAL ASSISTANCE & EQUIPMENT PROVISION

I-Freed

Hambantota Base Hospital

Ampara General Hospital

SHELTER

Galle Medical Association


Thousands of people were severely affected by the tsunami, which hit the country’s southwest coast. Thai residents, migrant workers, and foreign tourists were killed and injured, and structural, economic, and environmental damage was widespread throughout six coastal provinces (Phang Nga, Krabi, Phuket, Ranong, Trang, and Satun). The tsunami’s impact on the natural environment dealt a heavy blow to the fishing and tourism sectors, which employ a large percentage of coastal inhabitants.

Fortunately, the Thai government’s initial response was effective, providing immediate disaster relief and moving quickly to create temporary housing for displaced persons. The Southern Disaster Victim Relief Collaboration Centre, established in Phuket to act as the coordination center for relief to all affected areas, opened on December 26, and deputy prime ministers were given responsibility for essential relief activities in specific provinces. The Department for Disaster Prevention and Mitigation in Bangkok was very involved in the response as well and greatly supported local efforts. Other Thai Government agencies and NGOs also responded, including the Armed Forces and the Thai Red Cross, supported by large numbers of national volunteers.

Thailand did not put out an appeal for international financial assistance but it welcomed external expertise and equipment. Many of the issues that affected relief and recovery efforts in other countries, have either not been experienced or experienced on a small scale in Thailand, making it easier to restore services, relocate displaced populations, and begin to rebuild.

| THAILAND |

The Sustainable Development Foundation (SDF) was founded in 1996 with efforts focused on making livelihood, socio-economic, and environmental improvements for marginalized groups. In response to the tsunami, SDF, along with other local Thai NGOs that had been working in the affected area pre-tsunami, banded together and provided rapid assistance to the communities (searching for people, mobilizing communities, organizing funerals, and establishing temporary shelters). On December 28, 2004, 34 NGOs formed the ‘The Collaborative Network for the Rehabilitation of the Andaman Community and Natural Resources’ to further assist tsunami-affected communities through long-term rehabilitation efforts. SDF is the Secretariat Office for the Collaborative Network.

Direct Relief provided a cash grant of $250,000 to SDF to set up a Community Fund which will support long-term community–based rehabilitation activities along the Andaman coast such as water system development, holistic community health promotion, educational system development, occupational development, and natural resource rehabilitation. Communities set their own project priorities, develop concrete proposals, and coordinate project implementation. The Collaborative Network has been working with these villages since the tsunami and so far has provided 83 villages with direct support.

In addition, the funds will be used to develop a database system and an interactive website. The database will provide and track information on tsunami victims that will help identify appropriate measures and plans for rehabilitation efforts. The website, called “Save Andaman”, will highlight problems and issues faced by people and communities marginalized as a result of natural disasters and will bring awareness to the broader community.

Sustainable DevelopmentFoundation

photo: Damon Taugher


• 90 villages located along the southern and eastern coastline of Sri Lanka have access to healthcare services through 30 Direct Relief-funded rural health posts and dispensaries

• Construction of 13 community clinics in India, Indonesia, and Sri Lanka, including those that specialize in maternal and child health services, now provide medical services to tsunami-affected people and communities

• Over 168,800 families in Sri Lanka and Indonesia are being protected from malaria and other insect-borne diseases through the provision of 170,300 insecticide treated mosquito nets and fogging devices

• Thousands of people living in relief camps and isolated villages have received critically needed emergency and general medical services through the provision of three mobile medical units, 10 ambulances, 16 medical support vehicles and the financing of hundreds of outreach programs and medical camps

• In the Andaman and Nicobar Islands, twelve indigenous tribes living in relative isolation before the tsunami, now have access to primary medical services through the reconstruction and expansion of 34 primary care centers and subcenters

• A Direct Relief-purchased CAT scan installed at the Ampara General Hospital in Sri Lanka will enable accurate diagnoses for internal injuries and unidentified abdominal pain that will greatly reduce morbidity and mortality rates

• Public health radio programs in Aceh, Indonesia helped improve healthy living through targeted and tailored health messages (for both literate and illiterate populations)

• Over 5,000 people have access to clean water and sanitation through the construction of 345 latrines and toilets, 54 water tanks, 125 water wells, and the cleaning of 1,970 water wells in tsunami-affected areas of Sri Lanka and Banda Aceh, Indonesia

Direct Relief’s tsunami response efforts, consistent with the organization’s overall philosophy, help to strengthen and rebuild the local health infrastructure. During the last year, the results of Direct Relief’s tsunami-response efforts include:

The one-year milestone provides an opportune moment to reflect and report on the activities and expenditures that occurred following the enormous tragedy of the tsunami. The scale of both devastation and the outpouring of generosity in response were extraordinary, and those who sought to help by trusting our organization with their money are owed a full explanation of how their money was used. Additional information, including a description of how much, where, for what purposes, and with what results money has been spent is published on our website.

But the one-year milestone is also merely a snapshot in time. Significant progress has been made in many areas, but people whose lives were upended by the tsunami will continue to face significant difficulties in the months and years ahead.

Over the past 58 years, Direct Relief International has worked tirelessly to strengthen the health systems of the world’s most vulnerable populations, to lift them up and assist them in building productive lives. Responding appropriately to emergency situations such as the Asian tsunami is one important aspect of our work, but it is our long-term commitment to communities around the world that truly makes a difference. As the people in tsunami-affected areas move ahead to overcome the tremendous challenges that persist, Direct Relief will remain long after the headlines have faded, to continue to help in the most respectful, efficient, and productive way possible.

GOING FORWARD

healthy people. better world. s ince 1948.direct relief international 27 s. la patera lane santa barbara, ca 93117 t: (805) 964.4767 f: (805) 681.4838 www.directrelief.org

Health Services & Medical Equipment: $5,046,106

Health Facility Construction & Rehabilitation: $2,026,121

Psycho-social Services and Training: $1,177,439

Shelter: $130,000

Clean Water and Sanitation: $292,522

Disease Control (including insecticide treated mosquito nets): $956,982

53%

21%

10%

3%1%

12%

Allocation of Cash Grants and Medical Procurement by Purpose($9,629,170 in grants and medical procurement expended through December 15, 2005)

Total Tsunami Cash Expenditures by Function($10,047,557 expended through December 15, 2005)

Cash Grants: $8,367,228

Procurement of Medical Supplies: $1,261,944

Warehousing of Medical Supplies: $85,259

Program Management-Salaries: $83,418

Program Management-Travel: $42,585

Telecommunications/Telephone: $1,369

Transportation of Medical Aid: $205,754

83%13%

2%2%

Indonesia: $3,321,532

Sri Lanka: $3,110,365

India: $2,722,422

Thailand: $250,000

35%

33%

29%

3%

TSUNAMI EXPENDITURESOver 70 percent of $14.3 million in tsunami funds expended through December 15, 2005

A detailed summary of each grant is available on our website describing where, why, how much,for what purpose, and results of money spent.

Direct Relief spent no money on fundraising for the tsunami and is absorbing 100% of all administration costs from other sources.Interest on unspent tsunami funds accrues to the tsunami account and may only be spent on direct tsunami expenses.

All figures above are unaudited.

Cash Grants and Medical Procurement by Country($9,629,170 in grants and medical procurement expended through December 15, 2005)

Tsunami response one year later

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