Day: December 24, 2014

Dr Poonam Khetrapal Singh is WHO Regional Director for South-East Asia. As Deputy Regional Director (2002-2012)-she was overall lead in the Tsunami 2004 response. She is a staunch advocate and practitioner of emergency risk management in the health sector.

Documentation and publications of the tsunami 2004 and its lessons available at www.searo.who.int

There is debate among language scholars on the two Chinese language characters for the word crisis; one represents danger and the other possibility or opportunity. This has led to the often quoted cliché that “In every crisis, there is opportunity” when in fact these two characters define a crisis: the opportunity or the possibility of danger.

Recalling that late morning of 26 December 2004, when the Asian tsunami hit some countries of WHO’s South-East Asia Region, I remember receiving phone calls from our country offices in the Region describing the emergency as water entering the office compound in Maldives to waves rising as high as 40 meters lashing Sumatra, Indonesia, Andaman, sea coast area of Thailand, Myanmar, the eastern shoreline of Sri Lanka and South India.

What was common about their stories was that the water receded from the shores till as far as the eye could see before it all struck back with a vengeance. From all the reports, it seemed only Indonesia felt an earthquake. The story evolved quickly for the world to see – the final death toll reached close to 200 000; around 800 primary and secondary health facilities were destroyed; coastal villages and people’s livelihoods were wiped out; the tourism sector suffered a major blow in Maldives and Thailand.  The total damage was estimated at US$11 billion.

The response to the health needs was overwhelming—there was no recollection of a tsunami in recent times so there was no preparation. Coordination of response was rushed. For many countries systems were built as we responded. Donations in cash and in kind from individuals to governments became an event in itself and hard to manage. The WHO Regional Office for South East Asia deployed over 160 people over a period of three months to respond to the initial health needs. Every essential public health function – surveillance, maternal child health services, immunization, psychosocial support, management of dead bodies – was conducted on a massive scale tailored to the needs of each of the affected countries.  Field offices were set-up, logistic requirements put in place and technical experts were deployed wherever needed.  It was a response and recovery operation WHO had not seen or committed to in its history.

Today, a decade later, the important question before us is: how do we prepare ourselves for such an event? More importantly, how prepared is prepared? Measuring preparedness should be the basis for addressing risks, no matter what the cause. A series of lessons learnt meetings, evaluations, review of responses, culminated in 2005 with a set of Benchmarks for Emergency Preparedness and Response which includes standards, indicators and guide questions.

This tool intended to measure in detail what is in place for legal frameworks, plans, finance, coordination mechanisms, community capacities, and early warning for health events. The rest of the humanitarian and development actors were also looking to advance in this direction. The Hyogo Framework for Action (HFA) was developed in 2005 along with the UN Humanitarian Reform. This brought about a better approach to coordination in response, accountability and rapid predictable funding.

Indeed, we can do better and we can measure our actions so we can objectively identify gaps and address them.  Countries have used the WHO South-East Asia benchmarks for capacity assessments and development for better risk management in the health sector.

This also helped countries that were not affected by the tsunami. The tsunami was the turning point for countries to see that risk management is an essential public health function and crucial for protecting people’s health and investments. Countries also use HFA targets across sectors. Humanitarian reform has been applied in several emergencies with varying success but with systematic documentation of gains and gaps providing a clearer way for corrective action. Even with all these tools, investments, new plans and building back better – the only proof of effective preparedness would be another event.

On 11 April 2012 an earthquake of 8.7 on the Richter scale rocked Aceh in Indonesia for four minutes. Tremors were also felt in neighbouring countries. It seemed like a repeat of 2004. But certain specific actions of that day clearly demonstrated that we had learned since then. There was evacuation to higher ground by all coastal communities from Aceh, Nias Island, Sri Lanka, Maldives and Thailand.

The clear link of the tsunami warning system (now in place in the Indian Ocean) and community relay of the communication was seen in many coastal areas such as Chennai where loudspeakers from local government representatives informed everyone to move to safer locations and heed the warning. Eight were reported dead and those injured were treated promptly and were accounted for. Hospitals in Banda Aceh evacuated their patients in an orderly manner- a result of their preparedness plans and drills. Although some health posts were damaged, the city infrastructure did not suffer from major destruction, in fact very few were damaged. The tourism sector in Sri Lanka was very organized in moving resort guests to higher ground.

Those initial 6 hours of response on 11 April proved that we have learnt what our risks are and know how to manage and continue confidently to live with them. Indeed, it pays to invest in making risk management capacities pervasive in all levels of society – in all sectors. We have seen India, Indonesia, Maldives, Sri Lanka and Thailand continue to improve systems they set-up with knowledge and tools developed through the lessons of the tsunami. Other countries have also done so using the same knowledge. The death tolls in various events have decreased over the past years as preparedness and response capacities have increased phenomenally. Today, as we look back at the devastating tsunami, we can say that it taught us valuable lessons. .

To further build on these lessons, we must remain insightful of the linkages of hazards, risks and capacities. Reducing our vulnerabilities require an iterative, honest process of correction in what we invest in, where we invest and what we do to further decrease the risks to our people.  Why? Because, even though our capacities increase, so do our risks. We are facing new risks today. Cities are sprouting unplanned, extreme weather events due to climate change are occurring with regularity; people are moving globally with much more ease – all of which contribute to another “perfect storm”.

Maybe our current capacities will not be enough for the next event so we need to keep questioning our status in order to improve. Global tools and mechanisms like the WHO South-East Asia Benchmarks will undergo regular use and review, the HFA will be updated in March 2015 and humanitarian reform has given way to the transformative agenda for the UN and partners to respond to mega-disasters.

It seems though that no effort is ever enough, the world is facing another global health emergency requiring resources from everywhere –Ebola is an old disease in new places.  An event where there is no obvious physical proof of destruction but it is just as destructive to individuals, families, societies and nations. The Ebola outbreak is another event we need to learn from. We must continue to invest in prevention and preparedness to save more lives. This will eventually decrease the resources needed for the response and recovery in a future event.

Meanwhile, what is clear is that both statements are true- we live in a world where there is always a possibility for danger; and in every crisis there is an opportunity. Knowing what we know now, we must look ahead and use that knowledge as an opportunity to keep getting better in saving lives, preventing diseases, and protecting health.

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