Destruction was rampant in Aceh Province, Indonesia

"In every disaster, we learn something new," said Jennifer Leaning, professor of international health in the Department of Population and International Health and director of the Program on Humanitarian Crises and Human Rights at the François-Xavier Bagnoud (FXB) Center for Health and Human Rights.

The tsunami may have been impossible to prevent. Yet, the speakers pointed out that people have made themselves increasingly vulnerable to natural disasters by living in susceptible habitats.

From left to right, Michael VanRooyen, Jennifer Leaning, and Hilarie Cranmer at the HSPH lecture

On the morning of the disaster, a magnitude 9.3 earthquake hit off the coast of Sumatra. The resulting surge of water traveled 500 miles an hour, flooding and wrecking coastal areas, causing widespread death and injuries, displacing tens of thousands, and wiping out homes and livelihoods. On March 28, the area was rocked by another powerful earthquake, measured at a magnitude of 8.7, but a large tsunami failed to materialize.

In other ways, the tsunami shared characteristics with other major models of humanitarian relief efforts–namely, war. The intensity, geographic extent, and demographic scope were akin to a major armed conflict, Leaning said. Similarly, the tsunami is expected to have long-term economic and social effects.

"The tsunami borrows from both [natural disaster and war models] in a singularly bad way, which created one of the biggest challenges facing the humanitarian community in recent times," Leaning said.

Simple filtration methods using chemical packets and cloth helped clean crucial water supplies.

That attention helped drive public perception of the depth of the disaster, said Michael VanRooyen, associate director of the Program on Humanitarian Crises and Human Rights at the FXB Center and chair of the Division of International Health and Humanitarian Programs at Brigham and Women’s Hospital Department of Emergency Medicine.

Coverage, among other things, spread the word that people who wanted to help should donate money, not food and clothing.

"It’s not enough to want to help," said VanRooyen. "You have to do so intelligently and appropriately."

Yet, media coverage can have its shortcomings, such as perpetuating the myth that disasters are random killers, when they actually disproportionately affect the poor and other vulnerable groups. "Mobilizing and moving things quickly in event of disaster is important, but prevention is key in all of this," VanRooyen said. "Let’s look at the root causes of the vulnerability of populations and how we can improve our ability to mitigate those."

Coverage can also typically miss the heroics of people in communities directly hit, shedding too bright a spotlight on well-intentioned international aid workers.

"Local efforts are often undertaken long before the international community can mobilize a response," VanRooyen said. "We might do some good work, but the real heroes come from the local community. They take responsibility and act generously. They pull people out of the rubble. They drag people out of the water. They save each other."

In fact, local health staff provided the crucial link to the community for Hilarie Cranmer and her International Rescue Committee (IRC) team during the month they spent in Aceh Province, Indonesia, the most densely affected region, where more than 107,000 people died.

Many of the staff had lost family members, "but they came to work every day," said HSPH alumna Cranmer, an attending physician and clinical instructor in the Division of International Health and Humanitarian Programs at Brigham and Women’s Hospital Department of Emergency Medicine.

	Massive flooding piled up debris.

Cranmer eventually saw hundreds of cases of diarrhea and respiratory and skin infections, typical of overcrowded conditions, but her first patient was a child with a fever, rash, conjunctivitis, and cough–measles. The discovery was worrisome. It only takes one case of measles to define an epidemic, she said, because the disease is so contagious. "One case can mean hundreds, if not thousands, of cases," she said. "When kids get measles in crowded conditions, one in every four children can die in camp."

She started an ad hoc vaccination campaign, first informing the Indonesian health minister and then the World Health Organization (WHO). The local Indonesian health department had the necessary cold storage and limited supplies. Cranmer and her team provided personnel and additional supplies to vaccinate 2,000 children. On the day that she left, WHO and UNICEF were sitting down to develop an overall vaccine strategy for the affected regions.

Although the media attention has died down, the longest, most complex phase of recovery still lies ahead. "Restoring boats and the capacity to fish and farm are very important right now," Leaning said. "It requires a fine-grained understanding of social connections and networks in communities. We know very little about how we can translate the goodwill and money gathered."

--CCM