World Health Organization and UN representatives talk to Indonesian nationals at camp in the town of Alue Bilie, Aceh, Indonesia. U.S. Navy Photo by Photographer's Mate 2nd Class Elizabeth A. Edwards.
Expert panel looks at political problems in relief work, priorities in rescue and reconstruction efforts, and what aid workers and NGOs actually do.
Several hundred UCLA students, staff, and faculty attended a panel January 13 where four specialists laid out many of the long-term issues in the rescue and reconstruction efforts in the wake of the December 26 tsunami disaster in South and Southeast Asia.
- UCLA historian and human rights activist Geoffrey Robinson warned of potential human rights violations by the Indonesian army as it combines relief work with a long-standing counter-insurgency campaign.
- Professor Vinay Lal pointed to systemic inequities in the world trading system that penalize developing countries and leave them without the same kind of infrastructure as the industrialized nations and makes them the perennial victims of natural disaster that rarely have the same impact in richer areas of the world.
- Dr. Alina Dorian, senior program manager at UCLA's Center for Public Health and Disasters, outlined the priorities and steps local and international relief workers have to take to best save lives and get the gross disruption of the tsunami under control.
- Richard Walden, president of Operation USA, a major California disaster aid organization, spoke on the relations between local relief workers in the affected countries and the role that outsiders can and can't play, and what his own organization is doing in Sri Lanka and India.
The meeting was held in the Ackerman Student Union second floor lounge. It was chaired by Professor R. Bin Wong, director of the UCLA Asia Institute. The meeting was sponsored by the Asia Institute, its affiliated Center for Southeast Asian Studies, the UCLA International Institute and the International Institute Student Association. A website has been built at www.international.ucla.edu/tsunami to help coordinate information about the UCLA response. An evening of South and Southeast Asian music and dance will be held at UCLA on February 9 to raise awareness of the rich cultures of the region and to raise funds to aid the relief and reconstruction effort.
Geoffrey Robinson: The Indonesian army has been waging a counter-insurgency campaign in Aceh for thirty years. Trusting them to direct the relief effort in the same area will result in new human rights violations.
Geoffrey Robinson, associate professor of history and director of the UCLA Center for Southeast Asian Studies, began by summarizing the known toll of the tsunami. In Thailand, "at least 5,300 people killed; another 3,000 at least missing." In Aceh, a province of Indonesia, "a staggering 110,000 dead." Some 650,000 people have been displaced from their homes.
While the tsunami was a natural disaster, Robinson charged that its effects in Aceh were magnified by acts of the Indonesian army, known by the initials TNI. Robinson is a specialist on Indonesia and has a strong background in human rights issues in that area. He served as Head of Research for Island Southeast Asia at Amnesty International headquarters in London, 1989-95. From June to November 1999, he took leave from UCLA to serve as a Political Affairs Officer with the United Nations in East Timor. "The TNI has an exceptionally poor human rights record over the past forty years, and its human rights record has been especially poor in Aceh where it has been waging a counter-insurgency campaign for the last thirty years. In the course of that campaign tens of thousands of people, most of them civilians, have been killed."
Martial Law and How It Contributed to Aceh Being Unprepared
As part of that campaign the military declared martial law in Aceh in 2003. This cut the people of Aceh off "from international humanitarian aid agencies and from journalists." Because the humanitarian agencies were not there, Robinson said, "there was no disaster preparedness. Aceh was utterly unprepared to deal with this disaster. There were none of the usual humanitarian networks in place. The logistics, the translators, the buildings, the warehouses, the transportation simply weren't there."
The military prohibition on journalists in the period before the disaster hit also hampered relief efforts, as the world was very slow to find out just how bad things were in this worst-hit part of the tsunami catastrophe. "In the early days we heard that Sri Lanka and Thailand were the worst hit and for several days there were only 7,000 or 5,000 people killed in Aceh. It was only later, in some cases I think as much as seven days later, before we understood the true magnitude of the problem in Aceh."
Geoffrey Robinson added that local people were afraid to cooperate with the military because of its recent history of hunting down and killing oppositionists and this has hindered the distribution of relief supplies. And the disaster has not led the army to place a hold on its campaign. Instead, "the Indonesian army, has undertaken to combine two missions. First of all, to undertake humanitarian action, but simultaneously to continue its counter-insurgency campaign. So you have soldiers purportedly undertaking humanitarian work but doing so while conducting a brutal counter-insurgency campaign. This provides an extremely dangerous opportunity for the TNI to attack its enemies effectively under cover of humanitarian work."
New Restrictions on the Movements of Relief Workers
The TNI has imposed restrictions on the movement of international humanitarian relief agencies. "This has happened just in the past few days. Humanitarian agencies now must seek permission from the Indonesian army to move anywhere outside of the two main cities, Banda Aceh and Meulaboh, and as a consequence we can expect not only confusion, which now prevails, but also the disruption of the movement of humanitarian assistance to those most in need."
Robinson said he was also concerned that the United States military mission to Indonesia to participate in the relief work may lead to a resumption of American ties with the Indonesian military, broken off in response to killings by the Indonesian military in East Timor in 1999.
Robinson called on the Indonesian government to halt interference with free and independent work by international and local relief organizations. He said domestic and international human rights monitors needed to be dispatched to Aceh and possibly Sri Lanka to protect local populations from military abuse.
Vinay Lal: 96% of the fatalities in "natural" disasters are always in the developing world. That is not natural.
History Associate Professor Vinay Lal, chair of the South Asia Studies Interdepartmental Degree Program, cited the World Disaster Report of 2000 published by the International Federation of Red Cross Societies which reported 96% of the fatalities caused by natural disasters every year are in the developing world. "It seems to me that is an extraordinary fact that we need to try to comprehend."
Lal conceded the common argument that the poorer countries are badly prepared, but said that needed to be explained. He pointed to the Kobe earthquake in Japan in 1995, which killed 5,500 people and did $200 billion in damage. Bad as this was, it was nowhere near as severe as the consequence of the current tsunami, because Japan uses construction materials and standards designed to resist earthquakes.
In comparisons, he said the in India "there have been violations that should never have been permitted. For example, the coastline is governed by what is called the Coastline Regulation Zone, which stipulates that buildings cannot be built within a certain distance of the ocean, and almost invariably, particularly in tourist resorts, these guidelines are violated. Sea walls have not been built."
Most Disasters in the Developing World Are Ignored
Vinay Lal contrasted the extensive press attention and worldwide aid efforts in the current tsunami to the virtual indifference of the developed countries to many other catastrophic events that have devastated parts of the Global South. "I want in this vein to give you a number of illustrations. Six million displaced. That sounds like a figure from the tsunami. It isn't. It's a figure from the floods that took place in India in 2000."
He recalled a cyclone in East Pakistan in 1970, the year before it was renamed Bangladesh: "That cyclone was estimated to have taken the lives of a minimum of 200,000 people. Some estimates go as high as a million. Nobody really knows, but at least 200,000."
In 1999 there were floods in India "which left about 5 million homeless. The Brahmaputra River which flows through Assam in northeast India, damaged 2.5 million homes when the river flooded, and displaced in that single state 3.2 million people. And I could go on and on. The number of illustrations I could give could be multiplied endlessly."
Lal cited a 1999 Oxfam study that said 56 million people in India had been affected by floods that year, "which was not an exceptional year mind you." 11% of the land was flooded. Not only is the most common reaction in rich countries to developing world disasters indifference, Vinay Lal said, but wherever politics is part of the picture the outside world is still more inclined to look away. "Another form of tsunami, in slow motion, has been going on. And I am referring here to Iraq. Now if you think that Iraq is way off let me give you some data and you can match that against the data that you have heard from the tsunami. Because some of you may have read that in Sri Lanka, for example, 40% of the fatalities, which are now estimated to be, they don't have a real count at this point, the count at this point is still about 30,000, but the more reliable estimates offered by the Center for National Operations office in Colombo, Sri Lanka, which has been monitoring the whole thing for the government, is that 38,000 will be the final tally. It is estimated that 40% of the 38,000 people dead in Sri Lanka are children.
"Now if you look at Iraq, since the occupation began in March 2003, one eighth of the entire Iraqi population under five has died. One out of every 8 children. These figures, by the way, are from UNICEF. These are not figures from some outlandish left-wing NGO or organization. These are figures from UNICEF. The UNICEF report also points out that one out of every four children under five in Iraq is chronically malnourished."
He noted a report in the respected British medical journal Lancet in late 2004 that concluded that not less than 100,000 Iraqis have died of war-related causes since the American invasion in March 2003.
What Is the Responsibility of Rich Nations?
"What is the politics of aid and what is the responsibility of the rich nations? Vinay Lal asked. It is, of course, good that the industrialized countries are sending aid to disaster victims in the less developed world. But this does not begin to even the disparities caused by current policies, leaving aside those caused by comparative levels of development. "If individuals here are contributing more money we also need to understand that the United States consumes 27% of the world's oil with 4% of the world's population, contributes 32% of greenhouse emissions. So I would suggest that if you really want to help the tsunami victims and those who might become victims in the future, give up your SUVs. That would be a good start. A very good start. And it would be a lot more helpful than putting $25 on the website on Google, or $50 or $250 for that matter.
"UNICEF itself has estimated that a child raised in the United States takes up 56 times as many natural resources as a child raised in the global South. And I am suggesting that there is a relationship between all of these things. If you look at the question of aid, in 1992 at the Earth Summit in Rio it was agreed by the 22 countries that are classified as industrialized that the minimum baseline for aid would be 0.7%, that is, seven tenths of 1% of a country's national income or gross national product. Among these 22 industrialized countries the only five countries that have in fact actually met their obligation are Norway, Denmark, Holland, Luxembourg, and Sweden. I don't think you need to know who the worst offender is -- the United States. That's pretty predictable: 0.12% of the GNP, that is a little more than one tenth of 1%. Although it has also been demonstrated by a number of polls that there are some Americans who believe that the United States contributes 25% of its GNP towards aid to foreign countries.
"Now there are several other ways in which you can complicate this. I will give you one last illustration. That is if you look at UNCTAD, the United Nations Conference on Trade and Development, UNCTAD did a very detailed study published in 2002 and it pointed out that rich country protectionism, involving low-technology industries only, cost developing nations approximately $700 billion per year. That is, by the way, fourteen times greater than all the aid that is given by the 22 industrialized nations to the rest of the world."
Alina Dorian: The highest priority after tending the injured is clean water.
Dr. Alina Dorian, senior program manager, UCLA Center for Public Health and Disasters, works to prepare health care professionals to respond to disasters and contributes to UCLA curriculum on health systems management and disaster response capacity. She said her contribution was to explain the perspective of an aid worker in the field.
"A disaster is defined as that a community cannot respond to the impact. So what is defined as a disaster in one country may be defined completely differently in another country." Natural disasters don't only kill and injure people and destroy property. "You also get destroyed local infrastructure, especially hospitals or clinic-based infrastructures. So at the point that you need more services you have the capacity to provide less services."
The survivors, many of whom are displaced from their homes, are "extremely vulnerable and susceptible" to health problems. Many need mental health care as well. Dorian refuted the common belief that disaster victims suffer from post-traumatic stress disorder. This is not common because they don't usually feel personally singled out for attack as in a war. "But you do get generalized anxiety and depression." Often in relief efforts "mental health is put on the back burner, and it's not something that should be. It should be incorporated into every type of activity that is taking place in the field."
There are frequently food shortages, either obvious ones if there is a drought and a harvest failure, or local ones caused by lack of transportation or political decisions that divert food from those who need it most.
The biggest problem, Alina Dorian said, "is large population movements. You see that a lot in complex emergencies, which we can picture. We see people moving. We see refugees, internally displaced populations. But here we have large displaced populations. What happens is they start crowding together, usually in camps, which are sort of self-setup. And usually you have less services, overcrowding, poor water sanitation conditions. So you are exacerbating the conditions that existed."
So what do you do when there is a disaster? "Obviously we need to go in and do an assessment," Dr. Dorian said. "That sounds very basic but a lot of times people overlook the assessment. If you don't know what's going on in the field there is no way you can give appropriate interventions." She conceded that in emergency situations there can't be house-to-house surveys, but general and valid information is essential.
The goal, she added, is not only to immediately provide food and medical care, but to get back to sustainable local institutions as quickly as possible. "It's building local capacity again. It's to work the aid agency out of there. We are only there to provide assistance for the locals to stand on their own two feet the way they culturally feel is appropriate for them. . . . The most important resources are locals: local capacity, local NGOs, local doctors, local nurses, what is there already."
International players need to coordinate their efforts to avoid duplication and waste, always a major problem when many agencies come in from outside. "In Nagorno Karabakh where I've been working it was very difficult to find out what money was coming in and what really needed to be done and what USAID wanted to be done versus what we wanted to be done." There is also the problem of sensitivity to local cultures in what is provided and how.
What Is the Biggest Health Problem?
Dr. Dorian said there is a lot of misinformation repeated in the mass media. "The first thing I heard on the news was that there were dead bodies everywhere and people were going to be dying from the dead bodies. I turned to my husband and said, I knew they were going to putting that myth up. He said, what do you mean it's a myth? Well, dead bodies are not the big problem out there. The big problem is lack of water and sanitation. The big problem is food. The big problem is lack of health care services.
"The problem with handling dead bodies, even the medical problem, isn't the thing you should be considering. You should be considering how to culturally, appropriately handle the dead bodies so that people don't have the additional stressors when it comes to burying their dead and doing it the way that they would find appropriate."
The World Health Organization's Priorities
Dorian reviewed the priority list issued by the World Health Organization January 11 for tsunami relief workers. The first priority is treating actual injuries. "A lot of untreated injuries have been left that are going to cause a lot of secondary problems and a lot of long-term consequences for people. And that is something that we really need to pay attention to.
"The next thing is water, both quantity and quality. They just don't have enough clean water right now. You cannot sacrifice quantity of water for quality. I don't want to have 100% great quality if I'm only going to get a liter of water. But you do have to make sure that you have appropriate quality of water. Think about how much water each person utilizes. Drinking, cooking, bathing, and washing your clothes. So there is a lot of water that is needed. And a lot of the water sources have been contaminated.
"Sanitation and vector control have become really big health risks in the area. Disposing of excreta has been the biggest problem right now. They are working everywhere from creating defecation fields to creating pit latrines to trying to fix the family toilets as much as possible, but the entire infrastructure has been either disturbed or completely disrupted. The other thing is there has been a wide distribution of excreta due to the flooding, so that is causing a big problem there."
Next comes the problem of disposing of solid waste and its connection to communicable diseases. "A lot of these are urban areas and solid waste starts building up and we know that is a really big problem. Accumulation of waste, what it really does is increase vector breeding grounds: flies, mosquitoes, rats, and those are the vectors for most of the communicable diseases."
There is also stagnant sea water in many places. As this is diluted and becomes less saline "it will be perfect sites for mosquitoes. Malaria is endemic, Japanese encephalitis is endemic in some of these areas." Dorian commented that it is unlikely that diseases will appear that were not already common in an area. "That's not usually how it works. What happens is endemic diseases are the ones that get exacerbated. So you have a bad water sanitation system, if cholera was present in the country, cholera will rear its ugly head. If cholera was not present it's not going to be introduced due to the tsunami. New exotic diseases are not popping up. It's just reemergence of diseases that were already there."
It is especially important, she said, that known figures from the local community become involved in immediate health education to help minimize the heavy environmental health threats of the disrupted environment. "They will know what the right messages are. They will know how to speak to the mothers. They know how to speak to the fathers and the kids."
There needs to be a direct transition from aid to reconstruction. "The biggest part is going to be right after this emergency phase. People don't have homes. How are we going to get adequate shelter, adequate infrastructure for water and sanitation back together again?"
The last point, Dorian said, "is about coordination and collaboration. The biggest problem in the field is always lack of coordination and lack of collaboration between all the partners. You have NGOs, PVOs, UN agencies, multinationals, everybody is out there, but if you don't collaborate then you are not putting together a cohesive package, a cohesive program for the communities you are working in. And even more important is the collaboration with the locals. It's local communities, local government, local structures."
Richard Walden: The locals do the work. Our job is to give them the resources, the training, and sometimes the materials.
The final panelist was Richard Walden, president and founder of Operation USA, an important California NGO with long experience in working with health care and civil rights issues. Walden was California Commissioner of Hospitals (1977-82). Operation USA was founded in 1979. It has worked in 89 different countries and has helped to deliver more than $200 million in relief and development help. Operation USA received a share of the 1997 Nobel Peace Prize for its work in helping to ban land mines.
Walden recalled how he became involved in international aid work when he and some other members of the Jerry Brown administration in the California governor's office went to Malaysia for a brief effort to try to help Vietnamese boat people. They thought of the trip as part vacation "until we got to Malaysia and got to a camp on an island called Pulau Redang and we realized that the 30-day caper that we had engaged in was dead serious, in the form of dead children."
On the way home they visited other Vietnamese refugee camps in Thailand and on the Cambodian and Laos borders. When they got back they canvassed acquaintances in Hollywood and raised money to airlift supplies into Cambodia, where they were the first Westerners after the end of the Vietnam War. Walden never went back to his career in law and politics.
"My background in public health told me that there were certain do's and don'ts, of not taking expired pharmaceuticals, trying to figure out what was needed in advance, getting a clearance from the field -- today it is very easy with email; in those days it wasn't. We picked up some good habits in the beginning." Operation USA decided not to accept U.S. government money because of all the red tape involved. Also because they did aid work in a lot of countries Washington disapproved of: Cuba, Ethiopia, Cambodia, Vietnam, Nicaragua, and North Korea, and Iran among many others.
Operation USA has been doing relief work in Iran following the earthquake at the ancient Iranian city of Bam of December 26, 2003, which killed between 26,000 and 40,000 people according to different estimates. "We have five days left of our license to work in Iran from the earthquake a year ago. There are only five American groups that are licensed by our own government to continue doing aid in Iran, and then they pull the plug. So we have been in the midst of the tsunami response, and we have only ten staff -- one's in Nicaragua, one's in San Francisco, two are in the warehouse, and six of us are in the office on Melrose Avenue. We are trying to finish up in Iran, or at least get it going so it doesn't collapse when we leave while dealing with the tsunami."
The Problem of the Aid Agencies: Deluged with Donations but How to Deliver Them?
Richard Walden said his agency has received three or four thousand calls and an equal number of Internet donations for the tsunami victims. "The input has been amazing. That includes corporate contributions of supplies and fund raising events. But in terms of going back out again, that is where you have to ask the significant question of can you take a deep breath. This morning we killed the offer of a 747 that is on our website, of a donated 747. We love those. We recently had them to India and to Turkey and Iran and Iraq in the last three years. But we called the airline and said, you know what, guys, Indonesia is not going to cut it. The airline won't fly to Medan. It will only fly to Jakarta. We can't possibly get this stuff out of Jakarta soon. Nothing is moving. We have the CEO of a New York company who is our board member who has been sitting there for two weeks trying to work miracles, going in and out of Banda Aceh and Medan on UN flights and other flights. He's in Jakarta now. It's just not going to work.
"And so at some point you have to say, what value is it for a Los Angeles group with a full warehouse to just join 200 other flights a day that are landing with some stuff? It makes us feel good, especially if you gave us some of that aid, but it doesn't really help anybody. So what we did instead was we realized that except for Sri Lanka among the major targets of the tsunami you could probably do well by spending money there carefully through partners. Operation USA has had long-term partners in Sri Lanka. The Tamil Rehabilitation Organization in the north and east, the Sarvodaya Buddhist movement island-wide, a new one that we are helping in one of the tourist towns. And in India we've worked on the Gujarat quake and an earlier quake in Maharashtra, so we had a mobile medical clinic that was driven from Ahmadabad to Chennai in the south and we just stocked it with more medicine. Then we gave some more grants to some Indian partners whom we know and who we think are pretty competent."
Walden like the other speakers stressed the centrality of local relief workers. "One of the things I can point out to you: the myth of this world relief is that there are some fresh-faced Americans who are just going to get on a plane and somehow make everything okay. 99.9 percent of the relief workers in the world are from" the country where the disaster happened. The locals do the work, he said. "Our job is to give them the resources, the training, and sometimes the materials. In our case we are one of a half dozen major suppliers because we go out to American companies and we get stuff for free and then we get airlines to fly it for free and we make sure it is the appropriate stuff when it gets there. But our partners implement it."
Operation USA is sending two UCLA post-traumatic stress counselors to Sri Lanka later this month to do crisis intervention training for several weeks. They "will train mental health staff in Sri Lanka in their techniques which they developed with UNICEF and with us in four countries so far. There is another team of therapists going in about three weeks; about ten people. There are some doctors doing needs assessments. We had a couple of businessmen from our own board of directors doing needs assessments. So we are sort of doing the small version of what the bigger agencies are doing, but we are trying to be clever about how we stay the course. You and your friends and families expect all of us to do something immediately, so we do something immediately that is effective. But he longer-term thing is what is important to us, the water system, not the bottled water."
Operation USA is one of five large California aid relief agencies. They are located at 8320 Melrose Avenue, Suite 200 Los Angeles, California, 90069 Tel: (323)658-8876; Fax: (323)653-7846. www.opusa.org
Richard Walden said that his organization has had several generations of UCLA volunteers. "And when a staff opening appears we often hire these volunteers. It is a traditional way of breaking into the field without a medical degree, to do volunteer work. So I encourage all of you to think about it."
Published: Thursday, January 20, 2005