Correspondence from Abroad Photographs by Gerald Martone, MS, RN

Tsunami Aftermath

Community regeneration is the focus of relief efforts in .

even months after an earth- quake-generated tsunami dev- astated coastal areas across the Indian Ocean, a massive inter- national relief effort is still Sunder way in several affected countries. In particular, Sri Lanka, Thailand, and Indonesia’s province, at the north- western end of the island of , sustained the heaviest toll of death and destruction. Gerald Martone, MS, RN, director of emergency response for the International Rescue Committee (IRC), a humanitar- ian aid organization, helped to organize an assessment team that went to Aceh in the immediate aftermath of the disaster, which occurred December 26. He trav- eled there in February and took the pho- tographs on these pages. The IRC, as part of a consortium of nongovernmental relief organizations, has been in Aceh since 2001 to provide aid to the 125,000 Acehnese displaced by an armed conflict between the Indonesian military and a local sepa- ratist movement that has lasted nearly 30 years. Because they were already in the area, the IRC and the other agencies were able to mount a quick response, but their relief workers and facilities had also been directly exposed to the earth- quake and tsunami. An IRC office and warehouse in , the capital of the province, were severely damaged; one local staff member was killed and many others lost family members and This woman and child live in a barracks-style displaced persons camp built friends. by the Indonesian government in Meulaboh, Aceh province. Like thousands of their neighbors, they lost everything in the tsunami. Strengthening the Gerald Martone is director of emergency response at the International Rescue Committee and an associate profes- coping skills of traumatized survivors, protecting children, and rebuilding sor at Columbia University, New York City. livelihoods are priorities for the International Rescue Committee, which has Correspondence from Abroad is coordinated by Martone ([email protected]) and Richard Garfield, brought in more than 50 foreign experts and hired more than 160 local DrPH, RN ([email protected]). people to help in the relief effort. Martone photographed them in February.

70 AJN M July 2005 M Vol. 105, No. 7 http://www.nursingcenter.com The initial rescue and relief efforts focused on revive a disaster-stricken society by developing emergency medical care (particularly for those economic opportunities and restoring livelihood with aspiration pneumonia from inhaling seawater and self-reliance to those affected. and those injured when the waves struck); infec- According to Martone, the generosity of donors tion control; and the provision of shelter, food, from around the world has given relief organiza- water, and sanitary facilities. But Martone says the tions like the IRC an opportunity to try new aid emphasis soon shifted to what’s known as “com- strategies and has provided a “teachable moment” munity regeneration,” the purpose of which is to that he hopes will apply to future relief operations.

Martone took this photograph while traveling along the coastline of Sumatra by helicopter. “We flew over one washed-out town after another for hours,” he says. “The scale of the devastation is unimaginable.” A cluster of tem- porary shelters made of plastic sheeting, near the center of the image, houses the few remaining survivors of this destroyed town. The epicenter of the Aceh–Andaman earthquake was 155 miles south-southeast of Banda Aceh; according to recent reports in Nature, its magnitude was 9.3 on the Richter scale, making it the second most powerful earthquake recorded in the past century. The World Health Organization claims that as many as 200,000 people may have died in Aceh province alone, two-thirds of the nearly 300,000 fatalities in the region. More than 1 million people have been displaced. [email protected] AJN M July 2005 M Vol. 105, No. 7 71 Correspondence from Abroad

than the distribution of bulk rations,” Martone says. “Giving small amounts of cash directly to the people who need it may be a better way to promote the recovery of local economies. It allows people to choose for themselves what to acquire, based on their particular needs, at the same time that it helps revitalize local businesses.” This cash grants program is to be implemented in Aceh province according to a detailed application process that includes disseminating information to the affected communities, group discussions, budget development, cash disbursement, and monitoring. Three phases of the program are planned. The first disbursement of $2 million has already begun and will continue through September. The funds are for “quick impact projects,” immediate recovery needs such as helping fishermen get back to work, and repairing infrastructure—for example, building boats, clearing debris, and rehabilitating water wells. The second phase, “community mapping and design,” will identify medium- to long-term needs in more than 60 communities where the IRC operates. Local community members, with help from aid workers, will collect demographic information and identify economic markets, vocational skills of the population, and other existing community struc- tures. Building on the earlier efforts, the third phase, “integrated community projects,” will focus on social and economic development, including voca- tional training and technical assistance. The empha- sis is on community development, promoting local decision making, basic social services, and environ- mental rehabilitation. This last point is especially important for com- munities who have relied for generations on subsis- tence farming and fishing and have lost boats, animals, farming equipment, seed stock, and other A child in Banda Aceh helps to make a ruined house a habit- essentials. According to the United Nations News able dwelling again. Water supplies were disrupted and contam- Service, 40,000 hectares of irrigated land—includ- inated, roads and bridges were washed out, and sanitation ing rice fields—have been flooded with salt water, facilities were damaged. Health workers still carefully guard 70% of the small-boat fishing fleet in Aceh against the outbreak of such diseases as typhoid, cholera, hepa- province was destroyed, and two-thirds of the fish- titis, tetanus, malaria, dengue, diarrhea, measles, and acute res- ermen in Banda Aceh were killed. piratory infections. Martone also notes one bright spot in the on- going story of recovery. “The Acehnese boil their One such strategy that encountered some resist- water as a matter of course,” he says, “so the epi- ance in the past is direct cash transfers to local demics of infectious diseases that everyone feared in communities and individuals. “There’s evidence to the aftermath of the tsunami haven’t materialized.” show that cash assistance is more cost effective —James M. Stubenrauch, senior editor M

72 AJN M July 2005 M Vol. 105, No. 7 http://www.nursingcenter.com