The small village of Velankanni, on the southeastern coast of India, is thought to be a holy place. It draws Christian pilgrims to a Roman Catholic basilica there, as well as Muslims and Hindus seeking blessings and good fortune. In Velankanni, Christians, Muslims and Hindus together prayed for their dead last week–and all the while struggled desperately to save the living. In the wake of the tsunami, at least 75,000 people, half the population of the area affected, have crowded into hastily built refugee camps that became instant incubators for disease. Critical supplies–medicine, potable water, disinfectant–are sorely lacking. In one camp set up in a Hindu temple, 2,500 people are sleeping and eating next to their own excrement. Four days after the tsunami hit, some 4,000 people in Velankanni were already being treated for vomiting and diarrhea, according to the head of a local health charity. Relief workers fear an imminent outbreak of cholera, gastroenteritis and hepatitis B. “The situation is very, very serious,” says Dr. V. Ramani, director of the Gandheepam Global Foundation, an Indian health nongovernmental organization (NGO). “The government has to start moving to the villages [instead of] expecting people to come to them.”
For the entire world–governments, large NGOs, private charities and individuals moved to contribute to the massive relief efforts under way–getting to the villages is now the order of the day. In the first week after the tsunami, governments around the world pledged $2 billion in assistance to the devastated region, though in reality no one knows what the total cost of relief will be in the end. While the Bush Administration took heat for initially pledging only $15 million–a sum that has since increased to $350 million–private charities and relief agencies say they are stunned by the level of contributions from individual donors. During the first week of the crisis, the American Red Cross received more than $9 million in donations made through a single website, Amazon com Oxfam has raised at least $28 million worldwide and said it may be on track to collect more than it did in the wake of the 1984-85 Ethiopian famine that killed a million people. Pfizer, the large U.S. pharmaceutical company, said it was giving $10 million in cash to relief organizations and an additional $25 million in medicine. Mike Kieran, a spokesman for Save the Children, says that during the genocide in Rwanda 10 years ago–in which 800,000 people were murdered–the immediate outpouring of donations to relief agencies was generous, “but it doesn’t even come close to this.”
As with every disaster, though, raising money is one thing, but getting it to those who need it in time to stave off second-tier effects, such as hunger and disease, is a far more daunting proposition. As the spreading illnesses in the village of Velankanni demonstrate, providing immediate relief to vast numbers of displaced people is a vexing task. And the huge geographic swath affected by the tsunami, encompassing a dozen countries, only makes things more difficult. Despite the large amounts of cash pledged to help the victims, relief was still just trickling into many affected areas days after the disaster. “You’re the first person to stop and ask us how we’re doing,” S.M. Roshan, a fisherman in Sri Lanka, told TIME 30 hours after the tsunami hit. “We have got no food, water or medical supplies from anyone.”
If that situation persists, the world may witness an even greater human calamity. The U.N. World Health Organization (WHO) warns that millions of people could face life-threatening maladies unless aid is delivered effectively and disease is contained. The lack of clean water, aid officials say, is the first, most basic problem. Dirty water acts as a gateway to a hellish spectrum of risks. The salination of wells, rivers and other water sources means that people are far more likely to ingest contaminated water in the days and weeks ahead, which is a particular risk to already weakened children. Examples of the consequences already abound. In Banda Aceh, Indonesia, Nur Asni, 42, a mother of five, gave her children water from a contaminated well near where she and other refugees had fled. “It tasted funny–rather salty and strange,” Asni says, and now the children all have diarrhea. Also, standing pools of water left by the tsunami are “perfect breeding grounds” for mosquitoes carrying malaria or dengue, says Dick Vandertak, executive director of Doctors Without Borders in Hong Kong. Relief workers are monitoring affected areas for the possibility of a cholera outbreak, given that the disease spreads through dirty water and food.
So far, the U.N. has set up 200 relief centers throughout the region, with more opening daily. First responders from the Red Cross have distributed cholera-treatment kits, and WHO has dispatched scores of public-health advisers to help coordinate treatment efforts. Emergency-response units from international charities and NGOs have arrived in what Vincent Janssens, medical director for Doctors Without Borders in Brussels, calls the zero phase of relief efforts–the treatment of basic trauma among victims injured by the tsunami. His organization was the first to reach devastated areas of Aceh Province on the western coast of Sumatra, but what it could do was limited, in part because of a lack of able-bodied assistance. “It’s proved very difficult to rely on local providers because so many of them are dead too,” Janssens says.
The damage to critical infrastructure–everything from roads to pipes carrying clean water to local health ministries–is a double blow. Not only does it assist in the spread of disease, but it also makes getting assistance to victims harder. Even under the best circumstances, the roads to Banda Aceh “are hardly gorgeous North American highways,” says a UNICEF official. Now they have been badly damaged, which is why it took days for relief workers just to reach the area where Indonesian government officials fear that at least 80,000 may have died. Once they are on the roads, the lack of functioning fuel stations compounds distribution problems. Trucks carrying supplies and medical equipment have to carry enough gasoline to get them back to the nearest airport, limiting their capacity to deliver critical necessities and contributing to bottlenecks throughout the supply chain. The Indonesian military air base at Halim Perdanakusma in Jakarta last Wednesday was packed with tons of medicine and food, and more than a dozen trucks were waiting outside the base to be unloaded. The difficulty delivering supplies over land has prompted some aid agencies to try other means. Doctors Without Borders and UNICEF have been trying to rent boats to deliver supplies to the western coast of Sumatra, but even that has presented problems. Vandertak says some skippers, fearing another tsunami, are too shaken to head back out to sea.
In areas that are more accessible, coordination among governments and relief agencies becomes critical. In Velankanni, UNICEF official Paul Deveril says a lack of medicine is not the problem: “I’m quite surprised how much there is.” The problem, Deveril says, is “whether there is a system to deliver the stuff.” Where coordination is lacking, chaos results. In the southern town of Dodanduwa, Sri Lanka, H.P.P. Gamini, a diver whose mother was killed by the tsunami, says the aid distribution system “is completely chaotic. Whoever runs up to the truck and grabs gets food. The workers have no idea who actually needs aid.” In one affected area of India, there was, if anything, an excess of giving. Local aid agencies stopped accepting donations of clothing because relatively poor fishermen and their families had become picky about what they were receiving, preferring only new saris and dhotis (long pieces of cloth worn tied around the waist by Indian men). By late in the week, a giant pile of used saris collected at a relief office in the small city of Tiruvarur remained untouched.
Governments in the region are struggling to get hold of the problem, some more creatively than others. The Jayalalithaa state government in Tamil Nadu, India, which emcompasses Velankanni, hired IBM to set up a total management-information system to improve coordination among relief workers. “The system will get us critical information every day, mapping the data on a matrix to ensure that the supply of relief materials matches the demand,” says Vivek Harinarain, the state’s zonal relief commissioner.
Coordinating the global relief effort unfolding in South Asia is less a matter of technology than it is of bureaucracy. Getting a vast array of relief charities–from local faith-based organizations to large multinational NGOs like Doctors Without Borders–to work toward the same goals is never easy. The U.N. is playing the key role in sorting out who will do what as the relief effort gains traction. The U.N. Office of Coordination of Humanitarian Affairs (OCHA) “helps us figure out who is going to manage the medical clinics, who is going to provide food and who is going to run water and sanitation,” says Raymond Offenheiser, president of Oxfam America. This order of battle in the relief wars has emerged through bitter experience. A decade ago, during the genocide in Rwanda, he says, not only was there limited coordination between the U.N. and NGOs, but there was also confusion among U.N. agencies: UNICEF did not know what WHO was doing and vice versa. “Rwanda was a nightmare,” Offenheiser says. “We had these large refugee camps, and you would find lots of agencies milling around trying to do things large and small, duplicating efforts left and right. What you get is a lot of waste and a lot of anarchy.” In the decade since then, Offenheiser and other NGO members say, cooperation within the U.N. system has improved, in part because Secretary-General Kofi Annan saw to it that OCHA’s coordinating role was strengthened.
Though governments, charities and concerned individuals may have the understandable urge to offer immediate assistance, experienced aid workers know that patience is a virtue. With a calamity of this size, says Brian Grogan, a spokesman for OCHA, “it takes a long time to do the assessments and get everybody singing from the same song sheet.” The U.N. has called for contributions of $130 million so far, and a much larger appeal will be made after Jan. 6, when its agencies have a better understanding of how many people have been affected, what their needs are and how much relief will cost.
In this age of constant media coverage, the images of death and destruction that horrify us can be fleeting. But the region wrecked by the tsunami will need hundreds of millions–perhaps even billions–of dollars for recovery efforts. That is why U.N. and NGO officials alike last week stressed that the rebuilding just starting will be a long-term project. Oxfam’s Offenheiser says it will take years–and a lot more cash–to rebuild the communities and local economies destroyed by the disaster. “People think, when you’ve got the bodies off the beach, the job is over,” he says. “But the job has just begun.” –With reporting by Aravind Adiga/Dodanduwa, Neil Gough and Hanna Kite/ Hong Kong, James Graff/ Paris, Zamira Loebis/ Banda Aceh, Carolina A. Miranda and Deirdre van Dyk/ New York, Alex Perry/ Tamil Nadu and Baghwan Singh/ Madras, India
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