1. photo: Jodie Willardtsunami response: one year later
2. DIRECT RELIEF BY THE NUMBERS (THROUGH DECEMBER 15, 2005) $14.3 million in cash received to aid tsunami victims. Direct Relief maintains a strict policy of using 100 percent of all photo: Jay Farbman tsunami contributions exclusively for direct tsunami expenditures. The H OW YO U R M O N E Y WA S SPENT organization is absorbing all administrative costs associated with the tsunami response. Millions of lives were devastated by the massive Indian Ocean earthquake and resulting series of tsunamis that ravaged coastal $50 million in direct aid provided in the form of donated medical products and communities throughout the Indian Ocean in December 2004. cash grants Direct Relief International’s emergency response and ongoing 4 million courses of treatment of recovery activities in this enormously complex tragedy have speciﬁcally requested medicines, been structured around two basic principles. The ﬁrst is that our supplies, and medical equipment through organizational role in the area of health is to support, strengthen, 42 shipments to Indonesia, India, Sri and enable local people and organizations in the affected Lanka, and Somalia with a wholesale communities. It was they who lost the most, have the most at value of $41.7 million stake in the long-term outcomes, and for whom the resources we received were intended to beneﬁt. The second is that designated $8.3 million in cash grants provided to 55 emergency and ongoing medical money and resources received following the tsunami were for the needs and to rebuild housing, water beneﬁt of people in affected areas, and that our responsibilities in systems, and health facilities responding are those of trustees accountable both to those who gave generously and those for whom the resources were given. 70.2: percentage of tsunami funds This report reﬂects our adherence to these principles, which will expended continue to guide our activities to assist communities and people who still face tremendous challenges going forward. With long experience in emergency response and a strong network of partner facilities and organizations in the affected area, Direct Relief was able to respond quickly, effectively, and on a large scale. Emergency medical shipments were airlifted within 72 hours. Within the ﬁrst two weeks, 48,000 lbs. of material aid had been sent to hospitals, clinics, medical outreach programs, and healthcare professionals through 13 separate air freight shipments. The response was supported by FedEx, which provided extensive air transport and logistics assistance. Overall, Direct Relief has furnished over $8.3 million in cash grants from the total of $14.3 million in total tsunami contributions received. Complementing a massive infusion of essential medical resources - all of which were speciﬁcally requested by end-user health professionals -- these targeted investments have been made in locally managed efforts designed to serve communities now and in the future. In reporting on our organization’s efforts over the past year, we recognize that the faith, resiliency, and hard work of the people in countries affected by the tsunami are the most important factors in recovering from this tragic event. We remain committed to helping them in the months and years ahead.photo: Jodie Willard
3. photo: Jodie Willard | INDIA | Tsunami waves traveled hundreds of miles across the Bay of Bengal to strike the southern coast of India, devastating coastal towns and ﬁshing villages in the states of Tamil Nadu, Kerala, Andhra Pradesh, and the Union Territory of Pondicherry. Also hard hit were the Andaman and Nicobar Islands, an island chain located photo: Jodie Willard between India and Myanmar, roughly 700 miles from Calcutta. Direct Relief’s 45–year history of disaster relief and medical assistance work in India allowed us to engage immediately our extensive grassroots partner network and to provide healthcare organizations and facilities throughout the region with critically needed medical material resources.IMPLEMENTING PARTNERS FOR: On December 28, 2004, Direct Relief’s ﬁrst tsunami-responsePROVISION OF HEALTHCARE SERVICES/MOBILE MEDICAL INITIATIVES shipment, consisting of over 3,705 lbs. of anti-infectives, analgesics,Amrita Institute of Medical Sciences cardiovascular agents, oral rehydration salts, ﬁrst aid, surgical,Hindu Mission Hospital general hospital and clinic supplies, nutritional supplements, rescueMeenakshi Mission Hospital blankets, dermatological products, and personal care products wasMadhar Nala Thondu Niruvanam shipped to a partner facility providing medical outreach servicesShuddham in the severely affected district of Nagapattinam in southern TamilRECONSTRUCTION OF HEALTHCARE INFRASTRUCTURE Nadu. Over the following days, weeks, and months, Direct ReliefBharitiya Jain Sanghatana shipped an additional 111,116 lbs. of speciﬁcally requested medicalHindu Mission Hospital products, with a total wholesale value of $26,189,963, to assistMadhar Nala Thondu Niruvanam Indian healthcare institutions and agencies with their provision ofVishranthi Charitable Trust emergency and on-going medical care to hundreds of thousands ofWATER & SANITATION tsunami survivors.Shuddham In addition, over $2.4 million in grant funding has been invested in speciﬁc locally managed projects aimed at meeting the immediate and ongoing medical needs of people and communities in tsunami-affected areas. These projects have focused on the provision of medical diagnoses and services, including the purchase and operation of ambulances and mobile medical vans, the coordination of hundreds of medical outreach camps, and health facility reconstruction and rehabilitation including the construction of six community health clinics in coastal Tamil Nadu, and 34 primary care centers and sub-centers on the Andaman and Nicobar Islands.
4. photo: Jodie Willard photo: Jodie WillardA n d aman and Nicobar : Reb u i l d i n gP r i mar y Health Ser vices fo r I s l a n d e r s The Andaman and Nicobar Islands are a chain of 572 their long-term islands stretching over 500 miles in the Indian Ocean. assistance The island chain, one of India’s Union Territories sinceefforts on 1947, is located in the Bay of Bengal between India school and and Myanmar, roughly 700 miles from Calcutta. healthcare The 36 inhabited islands have a population of facility reconstruction on the Andaman and Nicobar approximately 370,000, with a large percentage Islands. BJS representatives met with the Indian of islanders belonging to one of twelve distinct Government Planning Commission, local government indigenous tribes, each with its own clearly-deﬁned ofﬁcials, and the Tribal Council for the Andaman and Nicobar Islands, and received approval to rebuild four locality, dialect, and traditions. These tribes have been living on the islands for thousands of years with littleprimary care centers and 30 primary care sub-centers that had been completely destroyed by the tsunami. contact with the outside world. Few, if any, other living human populations have experienced such long-lasting Direct Relief approved a $1.7 million grant to BJS to isolation. rebuild the centers and sub-centers which have been redesigned to resist damage by earthquakes, ﬂoods, Many of these islands were hit particularly hard by the and cyclone level winds as well as expanded in size to tsunami due to their close proximity to the earthquake include living quarters for a trained health provider/ epicenter. Over 3,500 people were killed, tens of midwife. For the ﬁrst time, a trained health provider thousands were displaced, infrastructure damage will be available full time to care for and treat island was extensive, and thousands of acres of agricultural residents, including pregnant women. Over one-half land were rendered unusable. Many tsunami survivors of the facilities have been completed with the rest continue to live in camps scattered across the islands. scheduled to be ﬁnished by January 2006. All centers and sub-centers will be handed over to the Andaman Direct Relief partnered with Bharatiya Jain Sanghatana and Nicobar Secretariat of Health Services which is (BJS), a nonproﬁt Indian assistance organization, responsible for the administration and ongoing costs to help rebuild the healthcare infrastructure in the of the facilities. Andaman and Nicobar Islands. Established in 1985, BJS focuses its efforts on making improvements in In addition, Direct Relief has provided four containers education, providing vocational training, conducting of pharmaceuticals, medical supplies, nutritional medical and surgical camps, and providing immediate products, and medical equipment, with a total and long-term assistance to disaster-affected wholesale value of over $2.1 million, to equip and communities including post-disaster reconstruction. stock the centers and sub-centers. In response to the tsunami, BJS focused their initial relief work on providing food and shelter for six camps in Tamil Nadu. After completing site visits to the most affected areas of the country, BJS decided to focus
5. photo: Jayne Kulzer IMPLEMENTING PARTNERS FOR: PROVISION OF HEALTHCARE SERVICES/ MOBILE MEDICAL INITIATIVES Acehkita Foundation Community, Habitat, Finance International International Medical Corps International Relief and Development Yayasan Peduli Kesechatan Aceh The Center for Humanitarian and Social Empowerment Embun Pagi Foundation Islamic Medical Association and Network The Indonesian Planned Parenthood Association-Aceh Persatuan Perawat Nasional Indonesia Pusat Kajian dan Perlindungan Anak Wahana Amal Sesama Mahluk Allah Solidaritas Perempuan Bungoeng Jeumpa Aceh InfoAceh RECONSTRUCTION OF HEALTHCARE INFRASTRUCTURE International Relief and Development | INDONESIA | Sisters of Charity of Our Lady Mother of Mercy PSYCHOLOGICAL SERVICES International Relief and Development Psikodista Foundation At the year anniversary of the tsunami that killed an estimated International Medical Corps; Psycho-social Program 169,000 people and left over 500,000 displaced along the WATER & SANITATION coast of Sumatra, Indonesia, people continue to work towards International Relief and Development recovery and rebuilding lives. Solutions for permanent housing Gardamadina Institute have been slow to materialize, leaving thousands of families in VECTOR-BORNE DISEASE CONTROL temporary shelters for displaced persons throughout the Nangroe International Relief and Development Aceh Darussalam Province. The medical response to the tsunami Bulan Sabit Merah Indonesia - Indonesian Red Crescent Hospital was greatly hindered by the destruction of hospitals and clinics that, under normal circumstances, struggled to meet the needs TECHNICAL ASSISTANCE & EQUIPMENT PROVISION of the population. With a lack of undamaged facilities, extensive Community, Habitat, Finance International mobile medical initiatives were undertaken, bringing doctors and medicines to the affected coastal villages.photo: Jayne Kulzer Direct Relief has sent 137,355 lbs. of speciﬁcally requested medicines, supplies, and equipment designed to treat acute injury often preventing amputation and severe disability, which were a high risk during immediate post-tsunami recovery. These medical conditions included blunt chest trauma, broken bones, severe lacerations, dehydration, respiratory and gastro-intestinal problems, and a range of bacterial and fungal infections. Medical product ﬁlled the needs of mobile medical camps, community clinics, and referral hospitals, all working to meet the emergency and on-going needs of the residents of Banda Aceh, Aceh Besar, Pidie, Nias Island, and other affected regions. To date, Direct Relief has provided nearly $3.2 million in direct cash assistance to jumpstart emergency relief and sustain ongoing initiatives in Indonesia. photo: Jayne Kulzer
6. photo: Ana Fuentes photo: Jayne Kulzer Direct Relief cash grants to Indonesia aim to support sustainable medical initiatives providing services to residents of displaced persons camps, to rebuild damaged or destroyed health facilities, to educate residents of relief camps on preventive health measures, and to prevent the spread of water-borne and vector-borne diseases. Rebuilding a structure to provide basic medical services for people in the tsunami affected areas has been a priority. In addition, the signiﬁcant emotional trauma that many experienced created the need for mental health services. Grant funding has been provided to train public health workers and volunteers to identify and treat people with post-traumatic stress disorder and other psychological conditions. The tsunami also severely damaged essential water and sanitation systems. Direct Relief funds are working to restore access to clean water for thousands of families.photo: Jay Farbman Direct Relief provided the ﬁnancial resources for a local Indonesian organization, Garamadina Institute (GI) to clean water wells (the main water source) contaminated with salt, muck, and debris in the Banda Aceh community of Syiah Kuala. By October, GI had cleaned 1,970 wells, surpassing the project’s goals by more than 700 wells and providing access to clean water for 4,800 people. This project has employed 705 workers living in nearby relief camps.
7. IMPLEMENTING PARTNERS FOR:PROVISION OF HEALTHCARE SERVICES/ MOBILEMEDICAL INITIATIVESAmerican Refugee CommitteeInternational Medical CorpsSarvodayaWorld Federation of Occupational TherapistsSt. John’s Ambulance Brigade, Sri LankaFoundation for Social Welfare photo: Jodie WillardInternational Relief and Development Foundation of Goodness Jaffna Diocese of the Church of South India | SRI LANKA | EMACE Foundation of Sri Lanka Family Planning Association of Sri Lanka Mutual Assistance International With nearly 40,000 deaths and more than 500,000 peopleRECONSTRUCTION OF HEALTHCARE INFRASTRUCTURE displaced, Sri Lanka was deeply affected by the tsunami. TheAmerican Refugee Committee waves wrapped around Sri Lanka’s coastline to the south andFoundation for Social Welfare north, hitting areas as far as the country’s west coast near theInternational Relief and Development capital city of Colombo. Hardest hit was the eastern coast, which Global Action BECT Foundation has undergone twenty years of civil conﬂict. Entire neighborhoods were washed away, resulting in tens of thousands of deaths andPSYCHO-SOCIAL SERVICES injuries as well as widespread infrastructure destruction. TheInternational Medical Corps ﬂooding and contamination of water sources created a high riskVECTOR-BORNE DISEASE CONTROL for widespread water-borne and vector-borne disease outbreaks.TEDHA Coupled with a lack of functional healthcare facilities, internationalWATER & SANITATION health experts feared the worst.International Relief and Development Community Trust Fund The prompt action of the Sri Lankan Ministry of Health, along Guardian Foundation Project Sri Lanka with local nonproﬁt health organizations and international NGOs, curbed the occurrence of disease on an epidemic scale. However,TECHNICAL ASSISTANCE & EQUIPMENT PROVISION the emergency medical needs of the affected population wereI-Freed vast. In the weeks and months after the disaster, Direct ReliefHambantota Base Hospital worked closely with the Ministry of Health, and a number of SriAmpara General Hospital Lankan and U.S.-based NGOs, to provide thousands of poundsSHELTER of critically needed medical goods including endotracheal tubesGalle Medical Association to treat victims of saltwater aspiration, wound dressings and surgical instruments to care for acute traumatic injuries, anti-Ampara General Hospital infective and antifungal agents to address bacterial and fungal infections, and oral rehydration salts to ﬁght dehydration. OverOne-fourth of the nearly 40,000 tsunami the past year, Direct Relief provided 56,897 lbs. of medicines andcasualties in Sri Lanka occurred in the supplies with a total wholesale value of over $4.4 million to publiceastern coastal communities of the health facilities and outreach programs, Sri Lankan nonproﬁtAmpara District. The extensive structural healthcare and social service organizations, and U.S.-based reliefdamage that closed ﬁve hospitals in organizations conducting mobile medical camps in displacedthe region left Ampara General Hospital persons camps and affected communities.as the only functioning referral facilityproviding health services for hundreds of Direct Relief also has provided over $2.4 million of targeted aidmiles. To expand the hospital’s capacity in the form of cash grants, supporting the provision of medicalto provide services, Direct Relief provided services, reconstruction of healthcare facilities, psychologicala grant of $169,000 to purchase a CAT counseling initiatives, water and sanitation improvements, and thescan machine, the ﬁrst in Sri Lanka’s rebuilding of healthcare workers’ homes. In addition, Direct ReliefEastern Province, and a grant of has focused on preventive health, including the procurement of$155,500 to outﬁt the ICU with new life- 143,000 insecticide-treated mosquito nets for use in relief campssaving equipment. and affected neighborhoods.
8. photo: Damon TaugherSustainable DevelopmentFoundationThe Sustainable Development Foundation(SDF) was founded in 1996 with effortsfocused on making livelihood, socio-economic, and environmental improvementsfor marginalized groups. In response to thetsunami, SDF, along with other local ThaiNGOs that had been working in the affectedarea pre-tsunami, banded together andprovided rapid assistance to the communities(searching for people, mobilizing communities,organizing funerals, and establishingtemporary shelters). On December 28, 2004,34 NGOs formed the ‘The CollaborativeNetwork for the Rehabilitation of the Andaman | THAILAND |Community and Natural Resources’ tofurther assist tsunami-affected communitiesthrough long-term rehabilitation efforts. SDFis the Secretariat Ofﬁce for the Collaborative Thousands of people were severely affected by the tsunami,Network. which hit the country’s southwest coast. Thai residents, migrant workers, and foreign tourists were killed and injured, andDirect Relief provided a cash grant of structural, economic, and environmental damage was widespread$250,000 to SDF to set up a Community throughout six coastal provinces (Phang Nga, Krabi, Phuket,Fund which will support long-term community– Ranong, Trang, and Satun). The tsunami’s impact on the naturalbased rehabilitation activities along the environment dealt a heavy blow to the ﬁshing and tourism sectors,Andaman coast such as water system which employ a large percentage of coastal inhabitants.development, holistic community healthpromotion, educational system development, Fortunately, the Thai government’s initial response was effective,occupational development, and natural providing immediate disaster relief and moving quickly to createresource rehabilitation. Communities temporary housing for displaced persons. The Southern Disasterset their own project priorities, develop Victim Relief Collaboration Centre, established in Phuket toconcrete proposals, and coordinate project act as the coordination center for relief to all affected areas,implementation. The Collaborative Network opened on December 26, and deputy prime ministers were givenhas been working with these villages since the responsibility for essential relief activities in speciﬁc provinces.tsunami and so far has provided 83 villages The Department for Disaster Prevention and Mitigation in Bangkokwith direct support. was very involved in the response as well and greatly supported local efforts. Other Thai Government agencies and NGOs alsoIn addition, the funds will be used to develop responded, including the Armed Forces and the Thai Red Cross,a database system and an interactive supported by large numbers of national volunteers.website. The database will provide and trackinformation on tsunami victims that will help Thailand did not put out an appeal for international ﬁnancialidentify appropriate measures and plans for assistance but it welcomed external expertise and equipment.rehabilitation efforts. The website, called Many of the issues that affected relief and recovery efforts in“Save Andaman”, will highlight problems and other countries, have either not been experienced or experiencedissues faced by people and communities on a small scale in Thailand, making it easier to restore services,marginalized as a result of natural disasters relocate displaced populations, and begin to rebuild.and will bring awareness to the broadercommunity.
9. photo: Jodie WillardDirect Relief’s tsunami response efforts,consistent with the organization’s overallphilosophy, help to strengthen and rebuildthe local health infrastructure. Duringthe last year, the results of Direct Relief’stsunami-response efforts include:• 90 villages located along the southern and eastern coastline of Sri Lanka have access to healthcare services through 30 Direct Relief-funded rural health posts and dispensaries• Construction of 13 community clinics in India, Indonesia, and Sri Lanka, including those that specialize in maternal and child health services, now provide medical services to tsunami-affected people and communities G O I N G F O R WA R D• Over 168,800 families in Sri Lanka and Indonesia are being protected from malaria and other insect-borne diseases through The one-year milestone provides an opportune moment to the provision of 170,300 insecticide treated reﬂect and report on the activities and expenditures that mosquito nets and fogging devices occurred following the enormous tragedy of the tsunami. The• Thousands of people living in relief camps and scale of both devastation and the outpouring of generosity isolated villages have received critically in response were extraordinary, and those who sought to needed emergency and general medical help by trusting our organization with their money are owed services through the provision of three mobile a full explanation of how their money was used. Additional medical units, 10 ambulances, 16 medical information, including a description of how much, where, for support vehicles and the ﬁnancing of hundreds what purposes, and with what results money has been spent of outreach programs and medical camps is published on our website.• In the Andaman and Nicobar Islands, twelve indigenous tribes living in relative isolation But the one-year milestone is also merely a snapshot in before the tsunami, now have access time. Signiﬁcant progress has been made in many areas, to primary medical services through the but people whose lives were upended by the tsunami will reconstruction and expansion of 34 primary continue to face signiﬁcant difﬁculties in the months and care centers and subcenters years ahead.• A Direct Relief-purchased CAT scan installed Over the past 58 years, Direct Relief International has at the Ampara General Hospital in Sri Lanka worked tirelessly to strengthen the health systems of will enable accurate diagnoses for internal the world’s most vulnerable populations, to lift them up injuries and unidentiﬁed abdominal pain that will greatly reduce morbidity and mortality rates and assist them in building productive lives. Responding appropriately to emergency situations such as the Asian• Public health radio programs in Aceh, tsunami is one important aspect of our work, but it is our Indonesia helped improve healthy living long-term commitment to communities around the world that through targeted and tailored health messages truly makes a difference. As the people in tsunami-affected (for both literate and illiterate populations) areas move ahead to overcome the tremendous challenges• Over 5,000 people have access to clean water that persist, Direct Relief will remain long after the headlines and sanitation through the construction of 345 have faded, to continue to help in the most respectful, latrines and toilets, 54 water tanks, 125 water efﬁcient, and productive way possible. wells, and the cleaning of 1,970 water wells in tsunami-affected areas of Sri Lanka and Banda Aceh, Indonesia
10. TS U N A M I E X P E N D I T U R E SOver 70 percent of $14.3 million in tsunami funds expended through December 15, 2005Total Tsunami Cash Expenditures by Function($10,047,557 expended through December 15, 2005) Cash Grants: $8,367,228 2% 2% Procurement of Medical Supplies: $1,261,944 Warehousing of Medical Supplies: $85,259 13% 83% Program Management- Salaries: $83,418 Program Management- Travel: $42,585 Telecommunications/Telephone: $1,369 Transportation of Medical Aid: $205,754Direct Relief spent no money on fundraising for the tsunami and is absorbing 100% of all administration costs from other sources.Interest on unspent tsunami funds accrues to the tsunami account and may only be spent on direct tsunami expenses.Allocation of Cash Grants and Medical Procurement by Purpose($9,629,170 in grants and medical procurement expended through December 15, 2005) 10% 3% 1% Health Services & Medical Equipment: $5,046,106 Health Facility Construction & Rehabilitation: $2,026,121 12% Psycho-social Services and Training: $1,177,439 53% Shelter: $130,000 Clean Water and Sanitation: $292,522 21% Disease Control (including insecticide treated mosquito nets): $956,982A detailed summary of each grant is available on our website describing where, why, how much,for what purpose, and results of money spent.Cash Grants and Medical Procurement by Country($9,629,170 in grants and medical procurement expended through December 15, 2005) 3% 29% 35% Indonesia: $3,321,532 Sri Lanka: $3,110,365 India: $2,722,422 Thailand: $250,000 33% All ﬁgures above are unaudited. h e a l t hy people. better world. since 194 8 .direct relief international 27 s. la patera lane santa barbara, ca 93117 t: (805) 964.4767 f: (805) 681.4838 www.directrelief.org