The Aftermath

Numerous weblogs have taken up the task of soliciting donations to support relief efforts for victims of the South Asia tsunami. In the midst of this humanitarian crisis, what I can do is to encourage you to turn to one of them and give what you can. Confined Space provides a resource guide for tsunami relief in this post.

The current assessment by the World Health Organization (WHO) paints a grim picture. It is estimated that as many as 5 million people have been directly affected, including those left homeless and those unable to meet basic health needs. WHO notes that groups particularly at risk include women, children and the elderly. Millions of people are threatened by disease outbreaks resulting from damaged water and sanitation systems and sea water contamination. The water-borne disease threats include cholera, typhoid fever, shigellosis, and hepatitis A and E. Vector-borne diseases such as malaria and dengue fever also pose a significant threat. Refugee camps crowded with displaced people increase the risk of outbreaks of measles, influenza and meningitis, acute respiratory infections and tuberculosis transmission. Leptospirosis may also become a risk. The UN (through the United Nations Environmental Program – UNEP) is also getting prepared for addresing human health and ecological risks from chemically-related hazards – chemical spills from facilities and releases of solids and liquid wastes.

I've read accounts of people here expressing surprise and alarm at the increasing death toll just from the flooding (I wonder what they expected - the counting of just the flood victims could go on for weeks). Even with the best response, we can expect that the worst is yet to come.

Though it has been blown out of proportion, as well as being erroneous, the story of a UN official accusing the U.S. of being stingy with relief aid deserves another look. Juan Cole has noted how the U.S. contribution has been small relative to our capability to give, and proportionally smaller than other wealthy countries. This led me to explore the question of how much aid is needed. Assessment of the immediate needs will be ongoing, although WHO has published its strategy for responding over the next 100 days.

The objectives of WHO's 100-day strategy are:

- Monitoring public health to provide early warning of emerging health threats and to enable the timely organization of any necessary response.

- Replacing lost assets, infrastructure, and supplies that are crucial to meeting additional health needs consequent to the disaster, as well as the reactivation of key previously-available health services.

- Providing technical expertise to health authorities to enable key gaps to be filled;

- Establishing and sustaining effective regional, national, and local health coordination arrangements, to enable efficient deployment of assistance resources;

- Ensuring adequate up to date communications on the health situation is available to all local and international stakeholders;

- Refining health needs assessments over the coming period, and facilitating early recovery and rehabilitation.

The strategy is intended to cover 4 million people in the region, including 2 million refugees and 100,000 injured. The priorities for now are providing safe drinking water, set-up or reactivation of communicable disease surveillance and response systems, and beginning to re-establish basic health care systems, including hospitals. The WHO has estimated that the public health response (this does not include anything else needed for disaster relief such as food, water, shelter, emergency generators) over the next 100 days will be approximately US $37 million.

I won’t get in the middle of the argument about whether or not we’re being stingy, though it is a bit small of us as Americans to quibble over the cost at a time like this. Juan Cole cites an article in the Washington Post stating that President Bush missed an important opportunity to reach out to the Muslims of Indonesia with his parsimonious and lackadaisical response to the disaster.

What we need to do is begin to face the magnitude of the costs that will be associated with relief effort, just in the near term. I’ve tried to do some benchmarking with Federal Emergency Management Agency (FEMA) expenditures for hurricane disasters. FEMA’s expenditures alone, not counting other agencies, for the worst hurricane disasters on record, range from $225 million to $2.25 billion. Those expenditures probably covered a lot of needs other than immediate disaster relief, but it provides some realization that relief and recovery from this obviously larger disaster will require billions of dollars, even in just the near term. Being seen as cheap isn’t the issue; not showing leadership in a time of enormous need is.