MSF teams did respond to specific medical needs and addressed people's needs on an ad-hoc basis. Four weeks after the tsunami, teams were active in Ampara, Batticaloa, Trincomalee, Hambantota, Vanni and Matara districts.

Though a lot of aid poured in, it was not necessarily adapted to people's needs, and coordination of activities was difficult. In the first weeks after the tsunami, some areas received disproportionate amounts of aid and relief items, while others received nothing.

In one case, the MSF mobile medical team was the 18th medical team to arrive in a displaced camp in the same day. In some villages people had received so many clothes that they no longer knew what to do with them. Conversely, in one village which had been cut off due to a broken bridge, the team found 975 families who had not yet received any assistance.

However, as time went by, some form of relief reached practically all affected communities and by mid-January more than 160 non-governmental organizations (NGOs) were present on the ground.

During the emergency phase, MSF focused on providing medical consultations through mobile clinics and existing medical facilities, distributing relief goods and improving the living conditions for the displaced people living in welfare centres and transit camps. Teams provided drinkable water and sanitation facilities, distributed tents, built temporary shelters and distributed non-food items such as hygiene kits, blankets, sleeping mats, mosquito nets and jerry cans.

In a second phase, teams focused on supporting some of the most vulnerable people in rebuilding their homes and lives. The main communities targeted were fishing villages as well as families living in L.T.T.E (Liberation Tigers of Tamil Eelam) controlled areas who had very little resources.

MSF helped with the clearing of land plots, the building of (semi) permanent housing, and the distribution of tool kits and non-food items such as kitchen utensils. MSF also started providing psychosocial support in collaboration with the local NGO Shade and the NGO Payasos Sin Fronteras ('Clowns Without Frontiers').

OPERATIONAL DATA

Main pathologies: respiratory tract infections and diarrhoea Mental health: performances to 7,700 people (Payasos Sin Fronteras); counselling services to 9,200 people (Shade) Main complaints: deep sense of hopelessness and fear, psychosomatic complaints, nightmares, suicidal thoughts. Water & Sanitation: water for 20,000 people (during 4 months) - over 700 latrines constructed. Temporary shelter: over 2,300 tents distributed - over 1,000 shelters built. Clearing of debris: over 880 land plots cleared (5,000 inhabitants) Housing: 60 semi-permanent shelters built - 105,000 bricks produced and two brick production sites reactivated in LTTE controlled areas. Non-food items: kits to over 6,000 families (hygiene items, blankets, mats, jerry cans...) Livelihood: 1,600 fishing nets distributed, 20 pirogues and 4 motor boats donated to fishing families. Operational budget: Mââ?š¬4.10 Staff at the end of Jan. 2005: 36 international

MSF activities ended in April 2005 (MSF worked in Sri Lanka from 1986 to March 2004, but returned later that year following the tsunami disaster).