Background

The epicenter of the December 26 earthquake was located 250 kilometers off the northwestern coast of Aceh province. The underwater earthquake was followed by massive tsunami waves. According to estimates from the Indonesian government, more than 100,000 bodies have been retrieved to date and over 132,000 people remain missing in Aceh province. According to the same sources, there are currently an estimated 394,285 displaced persons in Aceh, with approximately 260,000 being accommodated by relatives or friends.

MSF Activity Overview in Aceh

• Total current MSF staff: Over 277 (127 international staff and over 150 national staff)
• Total relief materials arrived: 1213 metric tons
• Total consultations: An average of 4,000 per week since 29 December, totaling over 15,000 by the end of the month
• Total mental health consultations: Over 250
• Transport means: 6 contracted helicopters; chartered cargo planes; Greenpeace ship "Rainbow Warrior"; 1 barge; fishing boats; and numerous vehicles MSF teams currently based in: Banda Aceh, Blankpidie, Lamno, Lhokseumawe, Medan, Meulaboh, Peribu, Sigli, Simeulue Island, Tapaktuan.

Emergency Response

An MSF team of eight people, including three nurses and two doctors, arrived in Banda Aceh on December 28, two days after the tsunami struck, on a chartered aircraft also carrying 3.5 metric tons of medical and relief materials. They immediately set up a medical clinic in the city and began assessments and relief operations in Banda Aceh and, by helicopter, in locations along the western and northeastern coasts of Aceh province. Nearly 200 metric tons of additional medical, water/sanitation and relief materials, as well as dozens of additional MSF personnel, arrived in Aceh in the week following the tsunami. During the first ten days of operations, MSF provided medical and sanitation support in one of the main hospitals in Banda Aceh and ran three mobile medical clinics to camps for displaced people in the city. In numerous locations along the hard-hit western and eastern coasts, including Batee, Bireuen, Breueh, Chalang, Lamno, Lampe-Ngo, Lam Teungoh, Legan, Lhok Timon, Meulaboh, Puleu-I and Sigli, MSF teams provided emergency medical care; donated rice, tarpaulins, and other medical and relief materials; carried out mental trauma counseling; and evacuated wounded people in urgent need of care. Between January 1 and January 9, mobile medical clinics in the Cot Keung, Darussalam, Small Msjid, Desa Lam, Kota Baru and Leumpeng areas of Banda Aceh, as well as in the surrounding Aceh Besar district, provided over 1,200 consultations, mainly for people suffering from wounds, respiratory tract infections, diarrhea, and skin diseases. MSF water and sanitation teams set up water bladders and water systems in IDP (internally displaced people) locations in the city as well as in one of the main hospitals. Over 500 body bags were distributed to workers collecting human remains in the city.

In the second week of operations, MSF began supporting the main hospitals in Meulaboh and Sigli, and began running mobile medical clinics in Lamno, Meulaboh, and Sigli, in addition to those continuing in Banda Aceh. Water and sanitation activities were carried out in all locations. Additional assessments and donations of medicines and relief materials were carried out between Bireuen and Lokseumawe on the eastern coast, where an estimated 38,000 IDPs had gathered, as well as in Aceh Selatan district, Krueng, Pulau Nasi, and 25 locations along the western coast.

Current activities

Currently, MSF medical activities include running mobile clinics in Banda Aceh, Lamno, Meulaboh and Sigli. These clinics will have provided over 15,000 consultations by the end of January. In the main hospital in Meulaboh, MSF is providing support to the post-op, medical, and pediatric wards, donating medical supplies and providing tetanus vaccinations and human tetanus immune globulin (HTIG) for all wounded patients. In Sigli hospital, MSF is working in collaboration with the Medical Surabaya Team and hospital staff to support the dressing room, post-op ward, and intensive care unit; providing tetanus vaccinations and HTIG for all wounded patients; and has donated medical supplies. As vaccination coverage in Aceh is relatively low, MSF carried out a measles vaccination campaign in 51 IDP camps in Sigli for 6,500 children between the age of 6 months and 15 years. MSF is now investigating the need for vaccination campaigns in other locations. Since approximately 91 cases of tetanus have been reported in Aceh following the tsunami, MSF is also providing tetanus vaccinations and tetanus awareness information. MSF is running mental health programs (linked to medical consultations) in Banda Aceh, Lhokseumawe, and Meulaboh, and is rehabilitating and providing staffing support in the main psychiatric hospital in Banda Aceh. MSF psychologists have provided over 150 individual counseling sessions as well as group therapy for over 100 people. As the mental health needs of tsunami victims are high, MSF is preparing to establish "drop-in" listening centers for providing longer-term psychosocial support in Banda Aceh, Meulaboh, and Sigli, and other locations where MSF is currently present.

MSF is carrying out epidemiological surveillance in the main locations where it is working. So far, the teams have not found any incidents of major outbreaks of communicable diseases, although the risk is still real, particularly in areas where the water/sanitation and shelter situation remains poor. The main health problems seen by MSF medical teams are respiratory tract infections, diarrhea, skin infections and suspected psychosomatic illnesses. MSF is working with Epicentre, MSF's partner for epidemiological research, and coordinating with local health authorities to set up an early warning epidemiological surveillance system and is ready to respond to possible disease outbreaks.

MSF is also prepared to treat malaria and carry out malaria prevention activities. Water and sanitation activities remain a priority in all locations where MSF is working, with the main focus on improving the quality and quantity of the water supply to IDP locations by setting up water bladders and distribution systems; water trucking; cleaning and rehabilitating wells; and improving sanitation and waste collection, as well as vector control in camps and health facilities. MSF is currently targeting over 50,000 displaced people for distribution of non-food items, including tents, plastic sheeting, jerry cans, soap, mosquito nets, sleeping mats, underwear, sarongs, tools, and other essential items. MSF non-food item distributions are targeting 16,000 families in Meulaboh and Sigli and an estimated 24,000 displaced persons in locations along the western coast, as well as thousands of others in need on Simeulue Island and locations along the northeastern coast.

Current situation and plans

MSF medical teams have found the health of people coming for consultations in tsunami-affected regions of Aceh to be generally good. No epidemic outbreaks have been detected.

However, the risk of epidemics remains present given the large numbers of displaced persons still living with inadequate water and sanitation facilities, the poor hygiene conditions and shelter in certain IDP sites, and the generally low vaccination coverage in the province.

MSF will now orientate activities towards supporting the local capacity to provide quality medical care, psychosocial support, necessary relief materials, and adequate water and sanitation to those most affected by the tsunami in all locations where MSF is present, including Banda Aceh, Lamno, Meulaboh, and Sigli, and in a numerous other locations along the western and eastern coasts of Aceh as well as on the island of Simulue.

MSF operations by location

Banda Aceh (est. 110,000 IDPs) 

Mobile Medical Clinics

• In first two weeks, ran as many as three mobile medical clinics in various locations in destroyed areas of city and IDP camps providing an average of 1000 consultations per week
• Currently running mobile clinic providing over 200 consultations per week with a primary focus on tetanus prevention program offering dressings of wounds, vaccination, boots and gloves, and tetanus awareness information

Mental Health

• Psychologist traveling with mobile clinics offering individual and group therapy for tsunami victims
• Establishing "drop-in" center for psychosocial support
• Rehabilitating main psychiatric hospital, improving water and electrical systems, securing hospital grounds, and providing hygiene materials, as well as beds and mattresses
• Providing psychiatrist and psychologist for in-patient department in main psychiatric hospital as well as psychologist for out-patient department
• Developing mental health outreach activities to IDP camps and host populations affected by tsunami

Water and Sanitation

• Installed emergency water system in Fakina hospital
• Improving water systems and hygiene conditions in main psychiatric hospital

Non-Food Item Distribution

• Distributed 500 pairs of boots and 1500 gloves to help prevent tetanus
• Distributed 1000 body bags for collection of human remains

Lamno (est. 8,000 IDPs)

Medical Activities

• Running medical clinic in SMP camp, a school where up to an est. 2,000 IDPs are living
• Carrying out average of 40 consultations per day
• Responsible for epidemiological data surveillance & malaria case referral in SMP camp

Mental Health

• Exploring psychosocial support for tsunami victims

Water and Sanitation

• Installed 30,000 cubic liter water tank and improving water capacity in camps and town
• Installed water bladders and providing water trucking for 4 IDP camps for 8000 displaced people
• Cleaned SMP camp, improved drainage and installed 20 latrines and showers in camp

Meulaboh (est. 31,000 IDPs)

Meulaboh Hospital

• Providing medical support in post-op, medical, and pediatric wards
• Carrying out approximately 70 dressings per day for tsunami-related injuries
• Vaccinating patients with wounds against tetanus and providing immune globulin
• Donated over 130 mosquito nets

Mobile Medical Clinics

• 2 mobile medical clinics providing basic care for est. 15,000 displaced
• Each clinic staffed by 1 doctor and 2 nurses
• Traveling to 6 locations 2-3 times per week in Kuala, Meureubo, Kaway XVI, Samatiga, and Bubon subdistricts
• Averaging 80 consultations per day per team; 750 consultations per week

Mental Health

• Offering individual and group therapy in mobile clinics

Water and Sanitation

• Installed water bladder tank at water treatment plant
• Installed 15,000 liter water bladders with pump system at 4 locations for 4000 displaced persons
• Providing water trucking to IDP locations
• Improved waste management and vector control, and installed 15,000 liter water bladder in Cut Nyak Dien Hospital Distribution
• Targeting 2950 families in villages from Meulaboh South from Naga Bridge to PK 29 (Jeuram)
• First phase: tents, jerry cans, soap, plastic sheeting, mosquito nets, rope, sleeping mats, buckets, and sarongs
• Second phase: "basic help kit" containing tools, nails, cooking pots, etc. Sigli (est. 32,000 IDPs)

Sigli Hospital

• Working in collaboration with Medical Surabaya Team and hospital staff
• Provided surgical care in first days of emergency
• Currently working in dressing room (est. 80 dressings per day), post operative ward, and intensive care unit
• Co-responsible for following treatment of 7 tetanus patients in intensive care unit
• Vaccinating patients with wounds against tetanus and providing immune globulin

Mobile Medical Clinics

• Running 2 mobile medical clinics providing basic care for est. 11,000 IDPs in 16 camps
• Each clinic staffed by 1 doctor and 2 nurses
• Traveling to 6 locations (in Batee, KB Tanjong, and Pante Raja) 2 times per week
• Providing an average of 1000 consultations per week
• Donated medicines to "Puskesmas" health clinics in Batee and Mutiara districts
• Donated medicines, infusion materials, and medical supplies in Bireuen

Vaccination

• Carried out measles vaccination campaign: 17 - 20 January extra day 23 January
• Vaccinated 6,500 children between ages of 6 months and 15 years in 51 camps (est. total population: 23,400)
• 3 teams worked for 5 days
• Provided vaccination, vitamin A, MUAC screening, and vaccination card
• Carried out mobilization campaign in targeted camps and communities
• Trained vaccination campaign staff

Mental Health

• 2 psychologists traveling with mobile clinics
• Offering individual and group therapy for tsunami-related mental trauma

Water and Sanitation

• Improved water/sanitation systems in main Sigli hospital
• Assessed water/sanitation conditions in 30 out of 52 IDP camps
• Providing water trucking from water treatment plant to IDP locations
• Installed water bladder in Pasi Rawa village
• Installed water bladder and 10 latrines in Kulee camp (200 IDPs)
• Improving water/sanitation facilities and drainage in Diaturia camp (960 IDPs)
• Starting water bladder installation and water trucking in Batee subdistrict
• Working with French Red Cross on water supply and waste disposal in tent camps

Non-Food Item Distribution

• Distributing tents, jerry cans, nets, and plastic sheeting in Diaturia camp
• Targeting 8000 families in villages and IDP locations around Sigli
• First phase: tents, jerry cans, soap, plastic sheeting mosquito nets, rope, mats, buckets
• Second phase: "basic help kit" containing tools, nails, cooking pots, etc.

Pulau Nasi (est. 1400 pop.)

Medical Activities

• Carried out assessment of humanitarian needs 16 January
• Medical consultations provided for two days starting 19 January
• Treated 18 confirmed cases of malaria
• Surveyed extent of malaria and need for vector control

Simeulue Island (est. 21,000 IDPs)

Water and Sanitation Support

• Cleaning of wells contaminated by sea water
• Setup of water tanks in IDP camps Distribution
• Distribution of 3000 hygiene kits
• Distribution of 5000 mosquito nets

Medical Activities

• Carrying out humanitarian needs and health assessment
• Supporting hospital with drugs and medical equipment
• Supporting health clinics
• Providing epidemiological surveillance

Vaccination

• Carried out measles vaccination campaign
• Target population: est. 19,500 children between ages of 6 months and 15 years in the 2/3 of the Island.
• Provided vaccination, vitamin A, albendazole, MUAC screening, and vaccination card
• Trained vaccination campaign staff
• Re-establishing cold chain in the island
• Mental Health
• Exploring & providing mental health support

Eastern Coast: Additional IDP Locations in Aceh Utara and Bireuen Districts (est. 30,000 IDPs)

Assessments

• Assessed humanitarian needs (medical, wat/san, shelter) in 16 IDP locations in Aceh Utara district and around Bireuen
• Focusing MSF activities in temporary IDP camps in 11 locations in following 8 subdistricts of Aceh Utara district: Lhokseumawe, Muara Batu, Syam Bayu, Samudera, Syam Aron, Tanah Pair, Lhoksukon, Baktiya Barat
• Operating out of base in Lhokseumawe

Medical Activities

• Facilitation of referral of critical patients to Bireuen and Lhokseumawe hospitals
• Provided basic training in aspiration pneumonia treatment
• Providing health training on communicable disease
• Providing epidemiological surveillance, including follow up of suspected cholera case in Klimbengtu camp, near Bireuen
• Supporting emergency preparedness

Vaccination

• Supporting outreach and mobilization for measles vaccination campaign targeting 7,350 children (between 6 months and 15 years old) in Aceh Utara district

Mental Health

• Supporting mental health trauma center in Aceh Utara with medicines
• Exploring providing additional training of mental health trauma center staff and establishing mobile mental health outreach activities to IDP camps and tsunami-affected villages

Water and Sanitation

• Rehabilitating water systems, water tanks, and water distribution systems to augment water supply
• Constructing and managing latrines where needed in temporary camps
• Spraying of 150 tents for vector control

Non-Food Item Distribution

• Distributing 4200 hygiene kits and other relief materials in Aceh Utara and Bireuen
• Setting up 100 family tents.

Western Coast: Additional IDP Locations in Aceh Barat Daya and Aceh Selatan Districts

Assessments

• Assessed humanitarian needs in 25 locations, focusing activity on 10 with est. 24,000 IDPs: Peribu (pop 690), Padang Kling (est. 1200), Kuta Tuha (pop 1500), Arun Pata (pop 250), Datarluas (800 households), Lhok Timon (pop 600-1000), Lagan, Korong Turong (1200), Lhoong (7215 people in 7 sites), as well as additional locations along the coast from Bangpidiie to Tapakktuan
• Running activities out of bases in Peribu, Tapakktuan, and Blangpidiie

Medical Activities

• Supporting quality access to health and medical supplies
• Provided 43 medical consultations week of 17 January
• Providing medical consultations, training and supervision, reproductive health, health education, and measles vaccination in "Drinrampak" in Simpantigisubdistrict, Aceh Barat district
• Supporting medical care in Ministry of Health structure in Peribu
• Supporting care management of tetanus cases in Tapakutan hospital: providing training to the MOH staff.

Vaccination

• Will offer support to or carry out measles vaccination campaigns in all locations
• Will carry out tetanus vaccination campaigns to 30,000 people in Blankpidie and Tapaktuan.

Mental Health

• Will provide psychosocial support to tsunami victims on west coast

Water and Sanitation

• Teaming up with Oxfam for one week (until 25 January) and then continuing on own as MSF to improve water/sanitation conditions in 10 locations
• Main activities to include cleaning of wells, providing water storage tanks, and improving water distribution systems
• Cleaning wells contaminated with sea water in Peribu
• Providing water/sanitation and shelter support in points southward from Tapakktuan, in Blangpidiie, and along coast of Aceh Selatan

Non-Food Item Distribution

• Distributing jerry cans for family use
• Distributing tents, family kitchen, hygiene, and construction kits, sleeping mats, oil lamps, matches, and oil, 10,000 pairs of undergarments, 24,000 pairs of flip-flops, etc, in 10 locations
• Distributing hygiene kits & mosquito nets to 4000 families in Blankpidie and Tapaktuan.

Food Distribution

• Facilitation of ACF airlift of food and food distribution

Epidemiological Surveillance

• In cooperation with Epicentre, carrying out epidemiological surveillance in all major sites present
• Prepared for outbreaks of cholera, malaria, dengue fever, and other communicable diseases