Emergency on the Subcontinent

This article was written with assistance from Beth MacNairn and Lea Radick 

John Lancaster is a member of the Board of Handicap International’s U.S. national association and serves as the Treasurer of the newly formed Handicap International Federation. He recently served as the executive director of the National Council on Independent Living in Washington, D.C.  John was the executive director of the President's Committee on Employment of People with Disabilities under the Clinton administration. He spent four years in Vietnam working with the Government and National Assembly to develop laws to protect the rights of persons with disabilities. He and his wife, Christine, live in Potsdam, New York. 

On December 26, 2004, at 6:58 am, an earthquake measuring 9.0 on the Richter scale struck Indonesia off the west coast of northern Sumatra. The earthquake triggered a tsunami, which caused extensive damage in Indonesia, Sri Lanka, Thailand, India, the Maldives, some parts of Malaysia, as well as Myanmar, the Seychelles, Somalia and Tanzania. In total, 12 countries were affected by the disaster, according to the United Nations Office for the Coordination of Humanitarian Affairs, with Indonesia and Sri Lanka suffering the highest casualties and the greatest devastation. In the Aceh province of Indonesia along the archipelago’s Indian Ocean coastline, an estimated 200,000 people died and 400,000 were left homeless, according to Handicap International.

The international humanitarian aid community quickly launched a massive and, at times, poorly coordinated emergency response to support the victims and help the most affected regions rebuild and recover. UNICEF’s 2008 Humanitarian Action Report highlighted the unprecedented challenges faced by the international humanitarian assistance community in response to the 2004 Indian Ocean earthquake and tsunami and the resulting lessons learned, such as the need for “greater predictability, accountability and leadership in humanitarian action.” A report completed in May 2006 by the United Nations General Assembly Economic and Social Council confirmed the coordination challenges faced by governments and humanitarian actors, but characterized the relief response as disjointed given that it was “not predicated on joint needs assessments by agencies, bilateral donors, and governments.”

Although a massive humanitarian crisis, such as the Indian Ocean tsunami or Haiti’s January 12 earthquake, results in suffering and loss of life, infrastructure and livelihoods, the scale and scope of such crises are also opportunities for the international relief community to analyze the weaknesses of previous responses and to apply the lessons learned to current and future crises. 

Eleven days after the tsunami struck, Handicap International’s assessment team arrived in Aceh on a fact-finding mission.  Ten days later, other professionals joined the effort to launch an urgent medical response for the injured. Initially, activities were conducted in the main hospitals of the province with some later follow-up in the first provisory camps and settlements. The initial objective was to provide physical rehabilitation to people who were most in need of post-medical rehabilitation and to strengthen the local capacity to meet these specific needs. Part of the objective was also to assist persons with disabilities who were affected disproportionately by the disaster. 

Over the course of 2005, Handicap International’s activities changed from direct intervention by expatriate physical rehabilitators in hospitals to decentralized health care in camps, community health care centers or “puskemas” and even in homes.  The organization’s focus shifted to providing training to reinforce the skills of local personnel. This transition from direct intervention to decentralized health care occurred over the duration of three distinct, yet interconnected, phases of intervention: An emergency phase (January 2005 through February 2005); a post-emergency phase (March 2005 through early October 2005); and a longer-term development phase, which began in October 2005 and continues today.

After the tsunami, health authorities in Banda Aceh were unable to cope with the large number of people affected and injured by the tsunami because of their own human and material losses. Handicap International’s first assessment missions in early January 2005 identified a significant need for physical rehabilitation in the hospitals the staff visited for patients suffering from lower-limb wounds, hand injuries, fractures, severe infections with a high risk of further amputation and respiratory infections. National and international medical staff confirmed this need. During this part of the emergency response, Handicap International was the only nongovernmental organization (NGO) providing rehabilitation.