A full charter for the tsunami earthquake zone - the second from MSF - with 40 tons is en route from France to Colombo, Sri Lanka. It includes water and sanitation equipment as well as medical and surgical material. There are three kits capable of setting up hospitals to care for 30,000 people for three months.

A third full charter, also with 40 tons of equipment, (watsan and medical supplies with food and plastic sheeting) will leave from Bordeaux early in the morning December 31 for Colombo, Sri Lanka. Another full charter, MSF's fourth in this emergency and the third to Sri Lanka, is being assembled and should leave in the next two days. MSF has teams throughout the tsunami earthquake region, with the largest concentration of staff and materials in Indonesia and Sri Lanka. In the Northern Sumatra province of Indonesia, the land zone closest to the earthquake that struck on December 26, MSF has already started working. Some 32 tonnes of material that went on the first cargo shipment, with medical and waster sanitation equipment, is in the country and being transported to the specific crisis area.

Indonesia

An eight person team is in Banda Aceh in north Sumatra, Indonesia. Three nurses, two doctors, one logistician, coordinator and translator make up the team. Reports are that 60% of Banda Aceh has been destroyed. The infrastructure is largely destructed. The MSF team slept in the hospital last night. The city is divided in two by a road and people from the lower, coastal side of town have fled to the higher ground on the other side of the road.

They are trying to make makeshift shelters, making tents on the streets with plastic sheeting. There are still many corpses on the streets, three days after the disaster struck. People are extremely stressed. There is a scarcity of food in some areas, a scarcity of fresh water in others. There is electricity in some parts of town. There is absolutely no fuel in the city. There are three main camps for displaced people. MSF has begun operations by giving consultations in one of the camps.

The team is continuing to assess Banda Aceh. Seven more expats arrived in Jakarta yesterday. Most of them will already be travelling on to Banda Aceh to reinforce the team. Malaria and dengue fever are anticipated to be serious problems.

The desalination of water supplies will have to be a priority because salt water is contaminating fresh water supplies. Plans to provide psychological support for survivors. There are still areas of conflict in Aceh. Some places are covered by mines.

Sri Lanka

The latest estimates are that 21,000 are dead and 745,000 displaced. The most affected areas: Ampara district, eastern province: 5,726 deaths, 193,000 displaced Batticaloa district, eastern province: 653 deaths, 40,166 displaced Trincomale district, eastern province: 710 deaths, 33,320 displaced Galle district, southern province: 2.500 deaths, 30,000 displaced. Mullativu district, northern province: 1.000 deaths, 15,000 displaced. Matara district, southern province: 667 deaths, no information on displaced. Kaluthra district, western province: 90 deaths, 12,258 displaced in 75 camps. (Source: UN) Some hospitals and health centres have been badly affected, Galle hospital amongst them.

Colombo airport is so busy that it is almost completely blocked. Coordination and communication is needed on the issue of land mines – as there is little information on how heavily the different regions are mined. A six person team has arrived in Colombo. The team includes one surgeon, one doctor, one nurse and two logisticians. They have met with a local logistician, who has already made some assessments and reports that the whole of the east coast has been affected.

MSF staff are on their way to the north east part of Sri Lanka, where MSF was working before, and are heading for the coastal town of Batticaloa in the first instance. They know that there was already a very vulnerable population there living in shacks in the area just south of Batticaloa, even before the tsunami hit. More MSF staff will arrive in Colombo in the next couple of days.

From another MSF team, yesterday an emergency coordinator and nurse went by car from Colombo to the south of Ampara. A second doctor has arrived in Colombo. Two more expats leave tomorrow and another two on Friday. Additional staff are already en route. Two moire staff are on the way to Colombo (a logistician and a nurse), Another three staff leave today (one doctor, two logisticians) and four more staff on January 1 (one logistician, two nurses and an advisor).

Thailand

Three MSF staff members carried out an explo to Ranong and north of Phuket. They visited three provincial hospitals and one district hospital. Each hospital received daily an average of 600-1,000 hospitalisations over the past three days.

They also visited the region of Takuapa, where fishing villages have been devastated and are almost completely empty. 18 ton fishing boats had been thrown by the force of the waves on top of buildings. There are still many people reported missing. In general, the emergency response has been fast and well organised, with enough resources and supplies reaching the region.

In general, need for MSF focus intervention seems to be very limited. The Takuapa provincial hospital requested some human resources assistance. Four MSF nurses will join the team soon. MSF has also donated some drugs to Phang Na provincial hospital. MSF will do an exploratory mission to Bangkok referral hospital tomorrow.

Malaysia

Two doctors from MSF have completed an exploratory mission from Penang up towards the Thai border. The death toll estimated on December 29 at 4pm was 65. There are still about 20 people missing. Six places seemed to have been affected. Langkawi : beach resort, Kuala Muda : fisherman villages, Penang island : holiday resorts and fishing villages, Parrit Buntar : fishing village, Bagan Datoh and Sabak Benam.

In the affected places MSF found people grouped in schools and mosques. The government water department is doing water trucking. The health facilities were not overwhelmed. Military and police together with municipal agencies were cleaning up debris and searching for missing persons. Civil society has been mobilised massively and funds and goods have been donated. Organisations like the Women's Federation, local Red Crescent branches etc are taking care of the displaced.

The Government has promised to start up a mental health support structure in the affected areas. Emergency phone numbers for concerned people have been set-up. The west coast of Malaysia is mainly mangrove, so the villages are behind a protective strip. The areas affected are fishing villages (typically houses build on the sea - ships have been thrown into these structures) or holiday resorts. In the holiday resorts the damage is mainly to the beach infrastructure (little sheds, watersport equipment). The hotels themselves are not touched. Most of the bigger hotels have a flood protection build in.

Myanmar

The Myanmar authorities have officially said that 90 people were killed. The most affected area is in the South around Kawthoung. Team of one expat MD, one watsan, one national staff doctor and five national staff logisticians arrived last night in Kawthuang, in the extreme south of Myanmar. They are hoping to do an air assessment of the Mergui archipelago where some islands are out of contact at the moment.. The team has reports of some 30 people dead,1500 displaced, 40 boats capsized and one bridge collapsed but these reports are unconfirmed.

India

MSF has a two person team carrying out an explo in parts of southern India. They arrived yesterday in Chennai, the capital city of Tamil Nadu. The situation is not as bad as expected – the damage on the beaches is not so great and the government and local people are organizing health care, food distribution and the cleaning up operation. Apparently there is no shortage of safe water in Chennai. 220 wounded arrived at the Government hospital in the last couple of days for minor injuries.

Two MSF expats arrived in Chennai yesterday morning - a nurse and a watsan expert- and have met up with the MSF team already there. They have authorisation from the Indian government to start assessing the two very isolated islands of Andaman and Nicobar, far off the Indian coast, north of Aceh, not far from the epicentre of the earthquake. They are sending two people to start an assessement mission and will set off in the morning.

Another team of two will leave in the morning to go to the southern tip of the cape in Kanniyakumari for an assessment. Yesterday the explo team went further south to Nagapattinam, the worst hit district. The coastal areas have been severely affected and families are still hunting for missing people. There has been a strong response from the Government and local communities. Bodies have already been collected and burnt.

They are re-establishing the electricity supply in order to get the water pumps running again with clean water. The Ministry of Health has mobilised extra staff and have set up 'health camps' – where access is free for everyone. After the first assessment, the hospitals seem to be well supplied with drugs and materials. The principal problem for the community at the moment seems to be psychological trauma. An epidemiologist will be sent from Epicentre to work on epidemics surveillance in the districts of Nagapattinam and Cuddalore.

At the medical level there is not a direct need to intervene at the moment, but we will set up a team to offer counselling and assist the population affected by trauma. A psychologist should be arriving in the area by next Tuesday.

Other

It is thought that about 200-300 people were killed in Somalia – mainly fishermen. From what teams have seen so far, there has been some minor destruction of houses. No plans for earthquake-related operations.