By Michael Klaus
BANDA ACEH, Indonesia, 4 March 2014 – Cut Adelia had not even been born when the Indian Ocean tsunami hit Aceh province in Indonesia’s far west. But to meet Cut Adelia is to catch a glimpse of the long-term outcomes of the massive relief effort that followed – after the tsunami devastated large parts of Aceh, including her home of Sabang island, on 26 December 2004.
In 2011, Cut Adelia had malaria. It would be the last indigenous case in Sabang, which had once had one of the highest rates of the disease in Aceh.
After devastation, ‘building back better’
The Indian Ocean tsunami was one of the worst disasters in living memory. It affected nine countries. It killed about 170,000 people in Aceh province, alone.
The tsunami triggered one of UNICEF’s largest emergency operations, funded by a variety of donors. UNICEF National Committees contributed US$328 million.
UNICEF Executive Director Anthony Lake recently visited Banda Aceh and Sabang to learn about the results of recovery and reconstruction based on the principle of ‘building back better’, as well as the province’s investment in disaster risk reduction (DRR)*. Mr. Lake was joined by Chair of the U.S. Fund for UNICEF Peter Lamm and Vice-Chair of the Japanese Committee for UNICEF Yoshihisa Togo. Both Committees had been among the biggest donors after the tsunami.
With support from UNICEF and other partners, Indonesia invested heavily in emergency preparedness and DRR. The goal was to reduce risks that stem from the natural hazards that affect the archipelago of more than 17,500 islands on a regular basis. Programmes included strengthening the country’s health system by integrating immunization, antenatal care, malaria control and other health interventions that build the resilience of children and their families.
The elimination of malaria in Sabang is an enormous achievement made possible thanks to an integrated health programme that includes highly effective malaria control. The programme was originally financed through tsunami relief funds.
UNICEF and partners selected Sabang island as the starting point for a targeted programme whose ultimate aim is to eliminate malaria in Indonesia. Activities included extensive indoor residual spraying, large-scale distribution of nets treated with long-lasting insecticide, mapping of confirmed malaria cases, and a change in policy towards artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated cases.
The aim was to eliminate the danger of malaria outbreaks by eradicating the parasite, itself. A combination of high-level political commitment, effective surveillance through systematic blood screening, and community involvement made the success possible.
The incidence decreased from almost 88 infections per 1,000 inhabitants in 2004 to less than 1 case per 1,000 in 2011.
“Thanks to these programmes, children are no longer lost to malaria in Sabang. We need to build on these lessons and replicate the Sabang success story in other malaria-prone areas in Indonesia and beyond,” said Mr. Lake, who visited Cut Adelia and her family.
Reintroduction of the parasite remains a constant threat. Just two days before Mr. Lake’s trip to the island, a visitor from Banda Aceh had been diagnosed with malaria in one of Sabang’s health centres. Going door to door to collect blood samples, volunteer health workers or ‘kaders’ continue to play an important role in ensuring Sabang, with its 30,000 inhabitants, remain malaria free.
Building schools built to last
Meanwhile, the government’s investment in DRR includes emergency education and the construction of hundreds of earthquake-resistant schools. About 300 of these schools, in Aceh province and on the North Sumatran island of Nias, which was hit by a major earthquake three months after the tsunami, have been built with support from UNICEF.
Muhammadiyah primary school, in Banda Aceh, was completely destroyed by the tsunami. Only 17 pupils survived the disaster of the some 300 who had attended the school. Muhammadiyah was the first permanent school rebuilt in Banda Aceh, based on safety standards to withstand earthquakes of up to 8.0 on the Richter scale. The new schools have well-ventilated classrooms with wide exit doors. The buildings are built on an elevated platform to prevent flooding during the rainy season.
In 2013, an earthquake of 6.7 on the Richter scale left hardly a scar on the school walls.
Mr. Lake witnessed one of the regular emergency drills at Muhammadiyah school, which include training in first aid and songs to remember what needs to be done when the earth starts to shake. “Some of the children here probably wouldn’t be alive today if their school hadn’t been rebuilt that way,” he said.
Children at the heart of DRR
One key topic of Mr. Lake’s discussions with the Government of Indonesia, in Jakarta, was lessons learned from the tsunami. He congratulated Foreign Minister Raden Mohammad Marty Muliana Natalegawa for the country’s investment in DRR, stressing that UNICEF will continue to work with the Government to leverage knowledge gained from the post-tsunami reconstruction work, in Indonesia and other countries. “Indonesia has shown the world how to build back better after disasters to strengthen children’s protection from the impact of humanitarian emergencies,” he said.
Referring to Indonesia’s strong economic growth in the years after the tsunami, he highlighted the need to put children at the heart of the DRR and development agenda and to ensure that all children benefit from the progress.
“Investment in children, in their education, health and protection, should not just be seen as a dividend of economic growth,” he said. “It is a driver of growth. If the next generation of children, especially the most disadvantaged, are not well educated and healthy, how will you have a healthy economy and society?”
*Following the premise that there are no ‘natural’ disasters, only natural hazards, DRR aims to reduce the damage caused by such natural hazards as earthquakes, floods, droughts and cyclones through an ethic of prevention.