Direct Relief provided over $50 million in aid to tsunami-affected areas over the past year, including $41.7 million worth of donated medical products and $8.3 million in cash grants. They utilized a network of partners in Indonesia, India, Sri Lanka, and Somalia to distribute supplies and rebuild infrastructure. One project highlighted was using a $1.7 million grant to rebuild 34 primary health centers in the Andaman and Nicobar Islands of India to improve healthcare access.

1. photo: Jodie Willard
tsunami 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-response
PROVISION 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, rescue
Meenakshi Mission Hospital blankets, dermatological products, and personal care products was
Madhar Nala Thondu Niruvanam shipped to a partner facility providing medical outreach services
Shuddham in the severely affected district of Nagapattinam in southern Tamil
RECONSTRUCTION OF HEALTHCARE INFRASTRUCTURE Nadu. Over the following days, weeks, and months, Direct Relief
Bharitiya Jain Sanghatana shipped an additional 111,116 lbs. of specifically requested medical
Hindu Mission Hospital products, with a total wholesale value of $26,189,963, to assist
Madhar Nala Thondu Niruvanam Indian healthcare institutions and agencies with their provision of
Vishranthi Charitable Trust emergency and on-going medical care to hundreds of thousands of
WATER & 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 Willard
A n d aman and Nicobar : Reb u i l d i n g
P 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/ MOBILE
MEDICAL INITIATIVES
American Refugee Committee
International Medical Corps
Sarvodaya
World Federation of Occupational Therapists
St. John’s Ambulance Brigade, Sri Lanka
Foundation for Social Welfare
photo: Jodie Willard
International 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 people
RECONSTRUCTION OF HEALTHCARE INFRASTRUCTURE displaced, Sri Lanka was deeply affected by the tsunami. The
American Refugee Committee waves wrapped around Sri Lanka’s coastline to the south and
Foundation for Social Welfare north, hitting areas as far as the country’s west coast near the
International 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 and
PSYCHO-SOCIAL SERVICES
injuries as well as widespread infrastructure destruction. The
International Medical Corps
flooding and contamination of water sources created a high risk
VECTOR-BORNE DISEASE CONTROL
for widespread water-borne and vector-borne disease outbreaks.
TEDHA
Coupled with a lack of functional healthcare facilities, international
WATER & 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 were
I-Freed
vast. In the weeks and months after the disaster, Direct Relief
Hambantota Base Hospital
worked closely with the Ministry of Health, and a number of Sri
Ampara General Hospital
Lankan and U.S.-based NGOs, to provide thousands of pounds
SHELTER
of critically needed medical goods including endotracheal tubes
Galle 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. Over
One-fourth of the nearly 40,000 tsunami
the past year, Direct Relief provided 56,897 lbs. of medicines and
casualties in Sri Lanka occurred in the
supplies with a total wholesale value of over $4.4 million to public
eastern coastal communities of the
health facilities and outreach programs, Sri Lankan nonprofit
Ampara District. The extensive structural
healthcare and social service organizations, and U.S.-based relief
damage that closed five hospitals in
organizations conducting mobile medical camps in displaced
the region left Ampara General Hospital
persons camps and affected communities.
as the only functioning referral facility
providing health services for hundreds of Direct Relief also has provided over $2.4 million of targeted aid
miles. To expand the hospital’s capacity in the form of cash grants, supporting the provision of medical
to provide services, Direct Relief provided services, reconstruction of healthcare facilities, psychological
a grant of $169,000 to purchase a CAT counseling initiatives, water and sanitation improvements, and the
scan machine, the first in Sri Lanka’s rebuilding of healthcare workers’ homes. In addition, Direct Relief
Eastern 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 camps
saving equipment. and affected neighborhoods.

8. photo: Damon Taugher
Sustainable Development
Foundation
The Sustainable Development Foundation
(SDF) was founded in 1996 with efforts
focused on making livelihood, socio-
economic, and environmental improvements
for marginalized groups. In response to the
tsunami, SDF, along with other local Thai
NGOs that had been working in the affected
area pre-tsunami, banded together and
provided rapid assistance to the communities
(searching for people, mobilizing communities,
organizing funerals, and establishing
temporary shelters). On December 28, 2004,
34 NGOs formed the ‘The Collaborative
Network for the Rehabilitation of the Andaman | THAILAND |
Community and Natural Resources’ to
further assist tsunami-affected communities
through long-term rehabilitation efforts. SDF
is 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, and
Direct 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 natural
based 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 health
promotion, educational system development, Fortunately, the Thai government’s initial response was effective,
occupational development, and natural providing immediate disaster relief and moving quickly to create
resource rehabilitation. Communities temporary housing for displaced persons. The Southern Disaster
set their own project priorities, develop Victim Relief Collaboration Centre, established in Phuket to
concrete 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 given
has 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 Bangkok
with direct support. was very involved in the response as well and greatly supported
local efforts. Other Thai Government agencies and NGOs also
In 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 track
information on tsunami victims that will help Thailand did not put out an appeal for international financial
identify 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 experienced
issues 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 broader
community.

9. photo: Jodie Willard
Direct Relief’s tsunami response efforts,
consistent with the organization’s overall
philosophy, help to strengthen and rebuild
the local health infrastructure. During
the last year, the results of Direct Relief’s
tsunami-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 S
Over 70 percent of $14.3 million in tsunami funds expended through December 15, 2005
Total 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: $205,754
Direct 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): $956,982
A 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