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Tsunami Mortality in Aceh Province, Indonesia Shannon Doocy,A Abdur Rofi,B Claire Moodie,C Eric Spring,C Scott Bradley,C Gilbert Burnhama & Courtland Robinson A

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Tsunami Mortality in Aceh Province, Indonesia Shannon Doocy,A Abdur Rofi,B Claire Moodie,C Eric Spring,C Scott Bradley,C Gilbert Burnhama & Courtland Robinson A Tsunami mortality in Aceh Province, Indonesia Shannon Doocy,a Abdur Rofi,b Claire Moodie,c Eric Spring,c Scott Bradley,c Gilbert Burnhama & Courtland Robinson a Objective Nine tsunami-affected districts in Aceh, Indonesia, were surveyed between February and August 2005 to characterize tsunami mortality. Methods The surveys employed a two-stage cluster methodology with probability proportional to size sampling, and encompassed 1653 tsunami-displaced households with a pre-tsunami population of 10 063 individuals. Findings Of the original pre-tsunami population, a total of 1642 people, or 17%, were reported as dead or missing in the tsunami. Crude mortality rates in the four survey areas ranged from a high of 23.6% in Aceh Jaya district on the west coast to 5.3% on the east coast. Age-specific mortality rates followed a similar pattern across the four survey areas, with the highest mortality concentrating in the youngest children (aged 0–9 years) and oldest adults (70+). The risk of mortality was significantly greater among females than males; this difference was most pronounced among individuals between ages 10 and 69 years, and diminished among younger and older age groups. Conclusion Mortality risk in the 2004 Asian tsunami varied by geographic location, age and sex. The districts of Aceh Jaya, Banda Aceh and Aceh Besar experienced the greatest mortality. Risk of death was highest among females, and among the oldest and youngest population subgroups. While the full human impact of the Asian tsunami in Aceh Province, in terms of lives lost or damaged, may never be fully measured, the resulting female deficit will likely be the tsunami’s most deeply felt and prolonged impact. Bulletin of the World Health Organization 2007;85:273-278. الرتجمة العربية لهذه الخﻻصة يف نهاية النص الكامل لهذه املقالة. .Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español Introduction tsunami mortality and injury as well IDPs were excluded due to inaccessibil- as the needs and current status of the ity and reported insecurity. The March On Sunday morning, 26 December surviving displaced population, and we survey of Banda Aceh and Aceh Besar 2004, an earthquake registering 9.0 on report our results in this paper. the Richter scale struck off the west- was limited to two districts because of ern coast of north Sumatra, triggering the large reference population of 215 379 massive waves that devastated coastal Methods IDPs residing in those districts. The July survey encompassed Pidie, Biruen, Aceh regions throughout the Indian Ocean Assessments of tsunami-displaced popu- Utara and Lhoksumawe, with a total rim. Indonesia’s Aceh Province suffered lations aimed to characterize the tsuna- the greatest mortality, with widespread mi’s impact as well as the status and needs reference population of 152 348 IDPs; destruction extending along more than of surviving internally displaced popula- the subdistrict of Maura Batu in Aceh 1000 km of coastline. Approximately tions (IDPs). All surveys employed a Utara was excluded because the survey one year after the tsunami, Indonesian similar design and survey instrument so team could not obtain permission from government estimates indicated 129 775 that results from the different survey areas local authorities to conduct interviews. deaths, 38 786 missing and 504 518 could be aggregated. Separate surveys The final survey, in August 2005, was in tsunami-displaced in Aceh Province.1 were conducted for logistical purposes the district of Aceh Jaya with a refer- Beginning in February 2005, Johns and were based on the best available ence population of 40 422 IDPs; the Hopkins Bloomberg School of Public information on displaced populations subdistrict of Teunom was excluded Health, with the local support and coop- at the time of implementation, which because it was difficult to reach by road eration of Mercy Corps, conducted four usually included information from the and NGOs working in the area reported rounds of household surveys in nine Humanitarian Information Centre that few IDPs remained there. tsunami-affected districts of Aceh Prov- (HIC) and district officials. Two-stage cluster surveys employ- ince. The surveys covered essentially the The February survey encompassed ing probability-proportional-to-size entire coastline from Nagan Raya and the districts of Aceh Barat and Nagan sampling methodologies were used. Aceh Barat districts on the south-western Raya, which had reference population Sampling was conducted based on lists of coast to Aceh Utara on the eastern coast of 26 905 IDPs²; four subdistricts within known locations of IDPs using standard (see Fig. 1). The study aimed to measure the survey area with an estimated 4428 cluster sampling methods to identify a Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21153, USA. Correspondence to Courtland Robinson (e-mail: [email protected]). b Mercy Corps, Indonesia. c Formerly Johns Hopkins Bloomberg School of Public Health. d Irvine Medical School, University of California, USA. doi:10.2471/BLT.06.033308 (Submitted: 8 June 2006 – Final revised version received: 22 August 2006 – Accepted: 24 August 2006) Bulletin of the World Health Organization | February 2007, 85 (2) 273 Research Tsunami mortality in Aceh Province, Indonesia Shannon Doocy et al. locations where interviews would occur. Fig. 1. Tsunami-affected areas of Aceh and survey regions In the case of the first survey in Aceh Barat/Nagan Raya, the sample was ap- portioned equally between households living in IDP camps and households living with host families, based on the best available local information at the time of the survey. In later surveys, when Banda Aceh displaced populations were reported by settlement type, clusters were identified N strictly on the basis of probability sam- pling from lists of known IDP locations, which included host communities. Aceh Lhoksumawe In the Banda Aceh/Aceh Besar sur- Besar vey, a 20×24 cluster design was used; in all other surveys, a 20×20 cluster design Pidie Bireuen was used. Upon implementation, it was Aceh Aceh Utara observed that the actual IDP populations Meulaboh Jaya were significantly different from the of- ficial estimates. In cases where displaced Aceh populations could not be identified in Barat the selected IDP locations, the closest known IDP populations or settlements Nagan Raya were sampled; to maintain appropri- Meulaboh survey ate geographical distribution, sampling Banda Aceh survey was always conducted in the originally East coast survey selected subdistrict. IDPs were residing West coast survey in IDP camps (typically, temporary tent communities), in barracks (semi-perma- nent wooden structures) or in homes within host communities. these four categories were reduced to Results Displaced population information a dichotomous variable of alive or pre- The four surveys of tsunami-displaced was always reported by settlement type, sumed dead (dead or missing). populations included a total of 1653 and interviews were conducted propor- The questionnaire was developed households (Meulaboh n = 388, Banda tionally to subdistrict estimates from in English and translated into Bahasa. Aceh n = 478, east coast n = 400, west local authorities. For households residing Back-translation and field-testing were coast n = 387) with a total pre-tsunami in IDP camps or barracks, within-cluster carried out with local assistance by population of 10 063 individuals, of sampling was conducted by estimating Mercy Corps. Most of the interviewers the total number of households in an were Acehnese university students. All which age and sex were reported for IDP site and then selecting every nth interviewers received two days of train- 9451. Of the original pre-tsunami popu- household. Self-settled IDP households ing before the survey and participated lation, 1642 people, 17% of household that were residing in host communities in field-testing the questionnaire. Data members, were reported as dead or were identified by randomly selecting analysis was performed using STATA missing in the tsunami. A total of 597 a direction from a central point within Version 8 and SPSS Version 12.0. households, 36.1% of the total, reported the community (usually the mosque), Cluster-level summary measures 3 were one or more persons dead or missing. proceeding to the nearest house, and en- used to calculate standard errors that al- Crude mortality rates in the four quiring if any IDPs were being hosted. lowed for clustering of observations due survey areas varied significantly. The Each adjacent house was visited until to the survey design; 95% confidence highest mortality rate (here expressed the requisite number of households was intervals (CIs) were developed based on as a percentage of household members interviewed. these standard errors for point estimates exposed to the tsunami who died or went IDP household information was of mortality. missing during the tsunami) was 23.6% collected using questionnaire-based Permission to conduct the surveys (95% CI: 17.8–29.4) in Aceh Jaya interviews. Mortality information was was obtained from local authorities in district on the west coast. In the Banda collected by asking respondents to list Aceh province, including both the Min- Aceh/Aceh Besar districts, crude mortal- all household members on the day pre- istry of Foreign Affairs and the police de- ity was 22.9% (95% CI: 19.0–26.8), ceding the tsunami and then to provide partment. Informed verbal consent was while in the Meulaboh survey, covering their age, sex and post-tsunami status. obtained from each respondent before Aceh Barat and Nagan Raya districts on Post-tsunami status was recorded as alive interviews were conducted. The study the south-western coast, overall mortal- and residing in the household, alive and was approved by the Johns Hopkins ity was 13.9% (95% CI: 8.4–19.4). residing outside of the household, dead Bloomberg School of Public Health’s The lowest mortality, 5.3% (95% CI: or missing.
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