FROM THE OFFSHORE PLATFORM - USS ABRAHAM LINCOLN
Reporting Period 16:00hrs 13 January - 22:00hrs 14 January 2005
KEY HEADLINES
- The inter-agency rapid health assessment
team accompanied by officials from TNI and MOH transferred from Banda Aceh
to the aircraft carrier USS Abraham Lincoln on Thursday, January 13. US
military personnel have augmented the team. We have received a first class
reception onboard. This has given us the best possible start.
- We have divided the disaster along the
west coast area into four geographic zones extending approximately 10 km
inland beyond the immediate disaster area (map to follow). Each zone has
in turn been divided into grids, to enable the four assessment teams (one
per zone), to make the most effective and systematic assessment.
- Assessment criteria (using the HIC framework)
has been developed for this mission.
- Information management system for transferring
data (all sectors) from US military to OCHA HIC being put in place.
- First assessment mission undertaken.
Details below.
- Although numerous needs have been identified in the locations assessed below, this represents the first field visit of this mission. We expect to identify even greater needs at other locations and by even larger populations as this assessment mission progresses. OCHA Banda Aceh and other agencies will be in a position to conduct an ongoing comparative analysis of the big picture and determine response priorities accordingly.
Situation assessment by location
This afternoon one team visited two locations in the sub-district of Keude Teunom for approximately three hours. During the mission the team met GoI officials and representatives of the NGO International Service Partners. The team also had the opportunity to visit and speak with affected families. All population figures provided here are based on our best estimations. Lat/Long for all relevant locations are provided separately to HIC.
Location #1: Tanoh
Anau
Sub-district: Keude Teunom
District: Aceh Jaya
GENERAL OBSERVATIONS
Coordination: There is good coordination between local health staff and the International Service Partners NGO in delivery of health services in Tanoh Anau. Two nurses from the local health post are working with ISP at their clinic. Deliveries of food and water to IDP populations are the result of cooperation between U.S. military and TNI. However, better coordination in distributing food items to individual families must occur for the sake of more equitable distribution, especially to widows and other vulnerable persons.
Damage Assessment: The village was at the edge of the tsunami and was not heavily affected. Since the tsunami, however,electricity has been cut off in Tanoh as well as in all nearby communities.
Assistance delivered: Food is being delivered by U.S. Marines to Keude Teunom and transported to Tanoh Anau by TNI vehicles. Currently only rice, water and crackers are delivered every three days. Medical care is being provided by American NGO International Service Partners who have 6 medical staff and 5 support staff present. Two nurses from the local health post are working with the NGO.
Assessments: As far as the team could determine, no formal assessments have been conducted on the health situation in this area. One NGO, however, looked at the water supplies in the village and may be considering a water supply intervention in the area. We were unable to determine which NGO made this assessment.
Other: According to health staff and community leaders interviewed, many of the IDPs would like to return to their original villages but either have nothing to return to or are afraid of returning. Main obstacles mentioned were lack of shelter and livelihood, fear of another earthquake and lack of infrastructure in their former communities.
PUBLIC HEALTH ISSUES
Population size and structure: According two local nurses, the host population consists of 713 people. In addition, a total of 879 IDPs (259 families) are living in Tanoh Anau, 126 (or 14.3%) of these were children under five years of age. Two new births have occurred since the tsunami. No further details regarding age or sex distribution were available at the time of the visit. One unaccompanied minor and two widows with no remaining family members were identified as vulnerable members of the population. There was some concern expressed by the health staff that these and some elderly persons were not receiving adequate food rations.
Energy resources/supply: There has been no electricity in the area since December 26. Fuel for vehicles is also extremely limited and the price has increased more than 10-fold (from Rp2,000 to 25,000 per litre) over pre-tsunami levels.
Water supply: Drinking water is supplied either in the form of bottled water from airlifts or from open, hand-dug wells. According to several persons interviewed, well water is routinely boiled prior to consumption. We could not quantify the number of wells in the area or the quantity produced. However, the quality of hand-dug wells was varied: some were well protected and provide clear water while others were poorly lined and lack protective aprons. According to our interviews there is sufficient quantity of water in the area although disinfection of well water should be considered to reduce potential transmission of waterborne pathogens. There is also a shortage of jerry cans or other water storage containers, as many of these were lost during the tsunami.
Sanitation & Hygiene: There are insufficient sanitary latrines in Tanoh Anau given the large number of IDPS in the community. This is especially apparent at the school, which is housing approximately 100 persons and has one public latrine. Main obstacle to digging new latrines is a lack of basic hand tools / shovels. According to the nurses no hand soap or laundry soap is available. Considering the poor sanitary conditions, delivery of hand soap should be given high priority to improve overall personal hygiene.
Food security: The IDP population is dependent on food deliveries, as nearly all family assets have been destroyed. Moreover, in villages heavily damaged by the tsunami there is likely to be little or no rice harvest in coming months. According to persons interviewed the villages inland will harvest their rice fields in March. It is not clear, however, if the yield will be shared with IDPs living in the area. It is likely that food airlifts will be required throughout the medium-term future, depending on ability to repair road to Meulaboh.
Malnutrition: No cases of severe or moderately acute malnutrition were detected during the assessment. This was confirmed by the local and NGO health workers present.
Health facilities: The health post in Tanoh Anau was not affected by the flooding but the inpatient facility in Padang Kleng was partially damaged and according to the nurse, 3 midwives were reported to have died and two are still missing. International Service Partners have set up a temporary clinic with 11 staff (6 medical and 5 support staff). The NGO is reportedly rolling staff over every three weeks, and it is unclear how long they will remain in Tanoh, hence the need for additional support to local healthcare facilities and strategic planning for the recovery phase.
Main diseases and conditions: A total of 175 patients were received at the NGO clinic in the 3 days since it opened. The number of patients was much lower on the day of our visit. A majority of patients had soft tissue injuries, associated cellulitis, cuts and lacerations, PTSD as well as chronic illnesses such as hypertension. No cases of measles or acute watery diarrhea seen thus far. Apparently two cases of bloody diarrhea with high fever were seen at the International Service Partners clinic although the specific agent was not determined. Five cases of tetanus and two suspected cases of tuberculosis were also diagnosed. There were suspected cases of malaria reported although there were no diagnostics on hand to confirm. The nurse mentioned that the number of mosquitoes present were much higher than normal and may indicate that the number of malaria cases will soon rise. Measles vaccine coverage was estimated at 50% in the community and surrounding areas.
Current mortality: We were unable to obtain information on post-tsunami mortality in the community.
Shelter: Most displaced persons in Tanoh Anau are living with host families in the community. Approximately 100 persons are living in the school compound. None were seen living in the open or in camps.
Logistics Issues
Site Accessibility: The only means of access at the current time is via helicopter.
Infrastructure (general)
The village was not heavily affected in a direct way by the tsunami.
Location #2: Tui Kareng
Sub-district: Keude Teunom
District: Aceh Jaya
General observations of the location
The administrative centre for the sub-district has been moved inland to Tui Kareng, a small town about 12 km from Keude Teunom. Coordination on the ground is provided by TNI, who are working closely with members of the local community. Nearly all structures up to 2km inland have been destroyed. Parts of the town (a cluster of small villages) that extended further inland escaped tsunami damage but suffered moderate to heavy damage from the earthquake.
There is no power although small generators have been provided by an international NGO for the health centre. Villagers reported they had no electricity, kerosene, or other source of power supply. They use wood and debris for cooking. Wells, which had been the main source of water prior to the tsunami, are now heavily contaminated with salt water, mud and debris. Local villagers stated that many bodies remained in the devastated rice fields. There was a noticeable stench of death when walking through these areas.
PUBLIC HEALTH ISSUES
The health centre (located at the roundabout near Padang Kaleng) is relatively unscathed but heavy debris must be removed. Supplies are limited. Most staff survived. Two NGOs have established medical clinics in the town, but neither provides outreach health services to the community. We understand that no immunization activities or spraying of residual anti-malaria chemicals has taken place. It is not known whether any other humanitarian needs assessments have been done in this area.
We were unable to ascertain the size of the former population or the number of IDPs and remaining residents. However, a local soldier informed us that there had been approximately 18,000 people in the Kecamatan (Sub-district), and that only 6,000 had survived. Almost all the people from 7 coastal villages (names unknown) are reported to have died. The team observed approximately 200 people, including some 30 women and 70 - 100 young people (6 - 20 years old). A number of people were seen collecting wood, scavenging materials, and engaging in reconstruction activities.
One local doctor, at least 2 local midwives, and some local nurses were still present in the Tui Kareng settlement. The team did not observe cases of acute malnutrition. People reported gastro-intestinal problems - diarrhea (no further details available yet). A number of babies have been born since the disaster - none had died since.
Water Supply: Wells were in use in the town of Keude Teunom. People living in the temporary settlement at Tui Kareng collected water from a river near the camp. They used jerry cans that had been dropped with the early distribution of materials. Many people were in need of more jerry cans. Apparently some water purification tablets were distributed with the jerry cans, but these were now finished. River water was muddy. They were not boiling the water.
Sanitation & Hygiene: At the main IDP camp at Tui Kareng the river was used for washing and defecating. People said they also defecated in the bush. Others reported skin itchiness. Many residents reported diarrhea and gastro-enteritis. There was a lack of soap for washing.
Food Security: Food had been dropped at the township of Keude Teunom. This was the only source of food staples. Some jackfruit was being consumed. A limited amount of green vegetables was available (Kangkung - ipomea aquatica). Some children had caught small fish in streams and ponds. Prior to food drops they survived on sago - a traditional staple in the area.
Keude Teunom receives approximately four airlifts of food a day. This mostly consists of rice, sugar and noodles. People stated that TNI collected all the food and managed the distribution. They reported that in the past 15 days there had only been 3 distributions to the community.
Prior to the tsunami most coastal dwellers here worked as fishermen; some 2km inland the main occupation was rice farming. In town residents were mainly engaged in trading and government service.
Rice fields up to 3km inland were destroyed. All villages, boats, and nets along the coast had been destroyed. However, when asked whether they would return to fishing or farming in the affected area, all respondents insisted they eventually would. The main impediment was lack of accommodation near the coast - they would require at least tents for shelter.
Host families were sharing their own food supplies but these were nearly finished. Rice farmers anticipated the next harvest would be ready in 2 months. Depending on equipment and fertilizers, an additional crop could be planted within a month of the next harvest. Existing sago crops could serve as an emergency harvest.
Logistics Issues
The site is only accessible by air. The TNI have at least three 10-ton trucks for transporting goods that are delivered at the landing zone back to Tui Kareng.
Recommendations for Immediate Action (next 7 days)
- WFP should coordinate/provide adequate
quantities of balanced general rations (2100kCal/person/day including cereal,
oil, pulses, and fortified cereal blend, sugar, salt) for entire affected
population (including host population)
- WFP should encourage an NGO to undertake
a food distribution operation to the affected populations to ensure access
to all, in particular vulnerable groups (female and child headed-households
etc).
- UNICEF to clarify whether this area
is part of their intended measles vaccination program; Provision of measles
vaccine to the German Red Cross - who have agreed to undertake a vaccination
campaign if required. UNICEF to follow up.
- WHO to work through agencies/NGOs and
health clinics to include this area within its early warning disease surveillance
system.
- Provision of water chlorination tablets through U.S. military for treatment of hand dug wells. Provision of soap; hygiene kit; jerry cans and basic tools (shovels) for digging latrines. Distribution should be negotiated with operational agencies on the ground.
Recommendations for Short-Medium Term Action (30 days)
- Malaria treatment and control (provision
of artemesinin-based combination therapy for malaria, rapid diagnostic
tests and new emergency malaria treatment protocols to medical NGOs; indoor
residual spraying with pyrethroid insecticide);
- UNICEF should coordinate the rehabilitation
and disinfection of hand dug wells in tsunami-affected areas, through NGOs
on the ground
- Detailed sectoral needs assessments
to be undertaken, with particular emphasis on road condition and access
from Meulaboh.
- A shelter project should be undertaken
by most appropriate agency to provide temporary housing for those rendered
homeless and wanting to return to their coastal villages.
- WHO, in partnership with local MoH officials,
should help put in place a strategic plan to support local health facilities.
- OCHA/JLC should prepare a re-supply contingency plan in case road access is still not possible in next 30 days.
AIR CREW OBSERVATION
The following information was obtained from a debriefing with a US Military medical team that had undertaken 'look & see' medical assessments (15 -20 minutes on the ground) during this afternoon's assessment.
Site 1 - Arongan (Zone 4): Total population estimated at 75, and 31 IDPs in the village. IDPs were living in either makeshift dwellings or with host families. Main needs described by the villagers were food, water, and medications. The water source is the local river (reported as being "not very clean") and a mountain spring. Humanitarian supplies have not been delivered. No local medical care available. Locals deny diarrhea, trauma, fever, or respiratory illness.
Site 2 - Unknown village name (Zone 4): Aggressive/agitated crowd during attempts at food drop. People attempted to climb into the helicopter and run under the aircraft while in hovering. It was therefore not possible to touch down.
Site 3 - Ranto Jabon (Zone 3): This area consists of multiple small villages including Sesky Ntok, Lorngeh, Ligan and Cot Punti. The total combined population the villages is approximately 2000 with an IDP population reported at 250. The IDP population consists of 150 males and 100 females living in tents and with host families. Main needs are thought to be food, sugar and salt. Water supply is a contaminated well. Water has been provided by the U.S. military (amount unknown). No medical care available in the area.
Site 4 - Santiantok (Zone 3): Santiantok consists of 6 villages (Ligan, Lhok Kruet, Koala Caknoh, Blangyn Melung, Krung No, and Santiantok). Total population is approximately 1200 with a reported IDP population of 200. Most IDP are living with host families. Assistance (commodity and amount unknown) was last delivered on January 12. Reported needs include food and water. There is no electricity and no clean water source. It is reported that U.S. military humanitarian assistance support is the only source of safe water (amount unknown). Sanitation is poor and includes defecating in the river. There are reports of a few cases of mild diarrhea. No medical care exists in these villages.
Note: Despite a general misconception, not all areas are accessible by helicopter. Landing zone conditions (hard versus soft ground) are what primarily dictate the drop areas. Given the onset of the rainy season on top of already saturated ground we must be aware that some of the helicopter landing zones may become inoperable owing to inability of the ground to support the weight of the helicopter.
Forward Plans
Tomorrow (Saturday, January 15) we will deploy assessment teams to the following locations: Team 1 - Lamno; Team 2 - Rueben; Team 3 -Calang; Team 4 - Suak Kaumude