ICMH ARTICLES

Humanitarian relief has traditionally concentrated on highly visible issues such as the need for clean water and sanitation, emergency feeding and shelter, primary care, management of injuries and death, and prevention of communicable diseases. Such interventions were the main focus of relief operations after the Tsunami of 26 December 2004. Since the war in the former Yugoslavia, however, there has been increasing interest in the psychosocial dynamics of both natural and man-made disasters, and in the wake of the Tsunami more than three hundred psychosocial projects of various kinds were initiated. The way in which people will respond to a disaster cannot be predicted with precision: psychosocial outcomes are influenced by personal, social and cultural factors. Not all people will respond in the same way or even suffer from trauma as conceptualized in Western models. It is also important to keep in mind that disasters can affect people who do not experience them at first hand.

The past ten years have seen increasing attention paid to the impact of man-made disasters (conflicts) on reproductive health. Far less attention has been given to the consequences of natural disasters such as floods, landslides and earthquakes for reproductive health. One public-health imperative is to understand and respond to the reproductive health needs of women and girls, men and boys, and lessons should be learned from the effects of the Tsunami that struck Indian Ocean countries on 26 December 2004. Reproductive health covers pregnancy and motherhood, gynaecological care, child spacing and family planning, sexually transmitted infections, HIV/AIDS, and adolescent reproductive health. Other issues that merit consideration in the wake of disasters are gender vulnerability, gender violence and poor access to care.

The tsunami was a tragic reminder that some people are always more vulnerable than others. The vast majority who lost their lives were people living in poverty and living in inadequate housing along the shoreline. In the Maldives it was also the poor, who did not have bank accounts and so kept money at home, who lost the most. In all the affected countries initial responses to the tsunami were shaped by fears that accumulation of dead bodies would be a major threat to public health as well as a source of emotional stress. Efforts to explain to people that corpses do not represent an immediate health threat were half-hearted and many traditional ritual practices were set aside, leading to a sense of guilt that will need to be addressed through counselling. There was insufficient recognition that in the case of many tsunami-affected populations poverty was already linked to poor access to food. Reports of nutritional anaemia from the Maldvives, parts of Sri Lanka and India were accompanied by reports of food aid being insensitively provided. Wheat flour was sent to rice-eating communities in Indonesia and Thailand , and there were reports of elderly people being unable to chew nutrition supplements given as part of emergency food aid packages. There were also reports from Thailand that an influx of milk powder led to a decrease in breastfeeding.

The 9+ Richter-scale earthquake that occurred off the coast of Northern Sumatra on December 26, 2004 triggered one of the greatest human disasters and international relief efforts in recent history. As many as 180'000 people are estimated to have been killed and at least 1,633,000 people were displaced in the countries that were hit by the Tsunami. The humanitarian relief operation that followed brought over 660 countries, agencies and NGOs together in one of the largest humanitarian operations ever seen. Natural disasters affect people and communities in complex ways. In the case of the Tsunami disaster, the impact will be felt for years to come and the demographic and socio-economic profile of the regions involved may never be the same again. How and to what extent the public health implications of the Tsunami will continue to affect the people of the region is not clear, but unless the evolutionof these public health aspects is understood in a timely fashion it will be difficult to prepare longer term strategies to assist people and prepare for any new disasters in the future