What were the stages of MSF's response to the South Asia tsunami?

All five operational sections of MSF were mobilized to carry out several exploratory missions. Within 24 to 48 hours, we were on the ground in several countries in the region. From our assessment, we quickly found out that Sri Lanka and Indonesia were the most severely affected countries, so that is where we concentrated our activities.

(My section of MSF) intervened on the east coast of Sri Lanka and in the province of Aceh, in the north of Sumatra. Our activities unfolded in three phases as we assessed the situation on the ground. The first phase – the medical emergency phase - was the shortest. It is generally known that natural disasters cause more immediate deaths than people with wounds and do not usually result in a widespread disruption of the health system, as is the case in situations like war.

In Sri Lanka as in Indonesia, it was the local health personnel, not the international aid organisations, that played a decisive role in the survival of the most severely wounded people.

As a result, MSF supported the hospitals in Meulaboh and Sigli, by ensuring the post-operative care of wounded for about two weeks. In parallel, our teams continued to explore the area, in order to have a more accurate idea of the situation faced by the disaster victims. This enabled us to measure the extent of the national and international reaction.

Food, medical care and drinking water were provided in massive quantities. On the other hand, disaster victims did not have adequate shelters. We therefore distributed family tents, allowing people to choose where they wanted to resettle: in camps where aid was most present, on their piece of land, or elsewhere.

We also distributed some small household items, such as tools, kitchen utensils, etc. This activity marked the second phase of our operations and occurred in a context where the distribution of aid had reached saturation.

In Sri Lanka, one of our teams was the twentieth team of aid workers to visit a village on the same day. Another MSF team in Indonesia was astonished, however, to find that three weeks after the catastrophe, to discover several hundred people not having received any external help.

Another need that was not fully met locally, and where MSF has experience, is mental health care. It still remains part of our activities to support people who have experienced such a traumatic event. The third phase of our intervention began once the most urgent needs were met.

What assistance can MSF offer after the initial emergency phase following a disaster like the tsunami?

The emergency phase was over quickly, and, in fact, with the large number of competent international and local aid organizations present, which is not the case in many of the places where MSF works, we could probably have left the region following the emergency phase. But, our teams did find innovative ways to providing additional support to the victims of the disaster.

In certain villages, for example, MSF started to help people find a way to earn a living. For example, we had the idea to invest in the construction of boats. Our goal was not to replace the entire fleet of these villages, but to support the development, to 'prime the pump' and to give the impetus to others to do the same thing.

After we were sure of the availability of the raw materials, 80 boats were made and launched.

There is a great need for rebuilding in the tsunami-affected regions now. Will MSF be taking part in this reconstruction phase?

When one talks about "rebuilding" after a disaster, it is important to understand what it means. Urban planning, socio-economic development, redefining of the demographic chart, land distribution, etc. – these all have political implications and are the responsibility of the government and local authorities. This puts into play the public actors and bilateral assistance between states.

It has little to do with setting up basic structures made out of wood, nails and four posts roofed with a corrugated sheet! The question is to know who will decide what the government plans to do, who will own what, where will the families who lived on the coastline be allowed to live, who is recorded on the land register, etc. And clearly MSF has neither the ability, nor the authority, to weigh in on these kinds of decisions.

That is not, in my opinion, the role of a medical humanitarian organisation like MSF.

Moreover, recent experiences in natural disasters (for example, Hurricane Mitch, the Bam earthquake) show that involvement of humanitarian orgs is marginal the rebuilding phase. This is why six months after the tsunami, there are still shocking situations: people under tents, even living in shallow water...

Land, finances and administration are such that they can slow down the process. Our volunteers returning from mission tell us the same story again and again when they describe life in Sri Lanka or Aceh today: meetings, negotiations, etc that slow down the process to the point that people have started rebuilding on their own initiative

Rebuilding will therefore take a long time and, when the direction is decided, it will be building firms and other qualified private operators who will get the bids and will play the most important part.

The aid organisations that collected money to be invested in rebuilding will have to run their programs with these operators.

As an emergency medical organisation, we prefer to focus our skills and resources on the forgotten acute crises, where people have been completely forsaken by the aid agencies - like Niger, where our presence in areas that have been severely affected by the food shortage makes it possible to save lives.