» Humanitarian Relief
        » Organization
                » Central Agency
                » Funding
        » Supply Transport
                » Food
                » Water
        » Health
                » Health Organization
                » Tracking Individuals
                » Healthcare Availability
                » Medical Staffing and Training
                » Medical Preparations
                » Health Hazards
                » Handling Outside Aid
        » Search and Rescue


»Central Agency

   In any disastrous occurrence the social structure changes spontaneously to adjust to the new circumstance1. Immediate organization is key to providing timely aid after a tsunami. During the 2004 Indian Ocean Tsunami there were reports of an overflow of aid, yet bottlenecks were abundant. More than anything, the lack of coordination between groups hampered the effective use of supplies and workers that were available 2. With this in mind, the first goal after a tsunami hits is to form an agency that would oversee all tsunami relief efforts and ensure that each task is being accomplished efficiently and effectively.
   With all relief efforts carried out through this one agency, resources could be easily managed, multiple organizations would not undermine one another's efforts, and people would know where to go to address their needs and/or concerns regarding the disaster. Dynes proposes a classification system of four types of social structures that form after a disaster event. The classification, described below, is helpful to analyze the components of a good prospective organization:
   Type I groups play a role that they have been trained for and are formed by people who are already part of the organization even before the disaster. Some examples of Type I groups are security forces and healthcare officials. These organizations do not take volunteers.
   Type II groups are formed mostly by volunteers, yet they play a role even before the disaster occurs. The Red Cross is one of these groups.
   Type III organizations change their roles but not take new people into them. These could be other NGO's that do not traditionally deal with disasters and eventually do, but not through new volunteers.
   Type IV structures are formed spontaneously by new people with new roles.
   Although the fastest and most controlled reaction comes from Type I organizations1, these do not comprise the bulk of manpower and other economic resources available after a disaster. The other organizations are a potential source of help, as well as of troubles. Volunteers in general do not have the technical skills that are sometimes needed and third party organizations may or may not have agendas of more priority than those of the community as a whole. A good post tsunami organization is the one that would bring the advantages of each group to make the relief process much more effective. This organization is designed for the period of immediately after the tsunami strikes, until few months after. A longer term organization would be formed as the society goes back to normality and many of the groups go back to play their customary roles.
  A core group that would be sufficiently staffed to tackle most foreseen challenges related to short-term and long-term tsunami relief and reconstruction follows:
   -Significantly highly ranked government officials would add to the agency's ability to make important decisions without extensive bureaucracy. Vice presidents, infrastructure and health related ministers, and other officials from the executive branch of the government would be good candidates for the organization to facilitate the speed of creation and implementation of major decisions.
   -Scientists and scholars to provide a technical perspective on the impacts of certain decisions. The fields of study would range from ecology to economics and sociology.
   -Engineers are key leaders in the reconstruction process. Inclusion of engineers on this team would allow plans made by the agency to be reviewed for feasibility and sensibility. Engineers specifically important in this case would be civil engineers, electrical engineers, and environmental engineers.
   -Management specialists would deal with the logistics involved in carrying out the plan. These people would organize all the people involved, monitor the money flow, and solve other problems to ensure that the plans made and approved by the scientists, politicians, and engineers actually get carried out. People from the executive branch of the government, as well as representatives from the private sector, would be able to fulfill this role.
   -Religious and otherwise social leaders would also be needed to give legitimacy to the authority of the group1. Other relevant figures, such as heads of related NGO's, must also be included in this category.
   Since the organization should be ready to react with celerity, the actual group should exist even before the tsunami with already established guidelines and procedures. This organization should, in short, be a Type I organization. Should the tsunami occur, this organization would be in contact with other more local organizations that are the ones taking the plan into action. Through this agency also, negotiations between different groups would be taking place. The idea is to make the whole organization of kinds I and II, in which goals are well defined and are the same for all.
   In the case of tsunami, the agency would be in charge of assembling this team of workers, assigning jobs to each, briefing them on the procedures to be taken, and paying any non-volunteer workers. The first task of this agency would be to lead an assessment of damage. The purpose of this damage assessment would be to gauge the extent of the damage and set priorities accordingly. This assessment should include the conditions of power, transportation, and water in various areas, as well as the extent of damage to infrastructure. Damage assessment in general is made at grassroots levels1, but all data collected would be reported to the agency to facilitate distribution of aid.
   Negotiation through communication lines will be needed between type III organizations for them to work effectively and for transmission of orders. For this reason, the repair telephone lines, radio stations, and antennas should be prioritized. A gathering of representatives of all people who will be in the agency should occur before there is a tsunami in order to facilitate the mobilization of the agency immediately after the tsunami.


  The principle method of funding during the after segment will remain the international community, with some contribution from the nations themselves. The guide to contributions is still the budget laid down by the International Pacific Relief Director, with the balance needed updated as contributions came in. NGO's would still be involved in the effort, and their activities would be monitored by the Relief Director.
  In addition to aid, the nations affected by the tsunami would start to take out loans from the World Bank and USAID to help cover some of the costs of reconstruction. This would mostly be in the case of if nations did not contribute enough to cover the full cost of recovery.

Supply Transport

» Food

   Once the tsunami warning is activated, emergency personnel such as administrators, cooks, security officials, and other workers (see section in Before) should report to the evacuation centers to be prepared for the evacuees. These workers should be financially compensated in the case of false alarms, so that they will report for the real disaster. In Micronesia, the locally stored food will already be at the evacuation centers, but in Peru, where the centers are in pre-existing complexes, trucks will take the locally stored food to the centers. Another option here would have been by train, but due to the mountainous terrain, Peru's rail network is poor compared to the road infrastructure.
   The evacuation centers must immediately start distributing food. They could serve prepared food, or hand out dry rations. Prepared food is preferable since the evacuees will not have any cooking implements, and for this very initial stage, serving food is cleaner and more efficient than trying to distribute stoves and rations. Thus, each evacuation location will set up one mass-feeding center for every 1000 people. The center can serve 1000 people/hr with 2 supervisors, 4 cooks, 8 assistant cooks, 24 helpers, 12 servers, and 4-6 garbage collectors4.
   The Relief Director will tour the affected areas by helicopter to assess damage. A helicopter will ensure the Relief Director can quickly access the various regions in which debris might be obstructing the roads. To determine how many people are within each affected area, the Director will have census data available. It is essential that the main storage depots immediately ship food to those regions deemed needy by the Relief Director, since the local areas will have food for three days.
   Meanwhile, the Relief Director's deputy will appeal for international relief. The deputy will contact the World Food Programme4, Euronaid5, which goes between EU and NGO's, and USAID6. The deputy would also contact the US Military for high-protein bars for extra supplementation7 for at-risk groups such as the elderly and infirm, and the UN Children's Fund4 for food for those 6mo.-3 yrs since this group has traditionally addressed the unique food needs of infants. The Peruvian deputy would also contact Chile, since they sent food after the 2001 tsunami. 4
   Once the national or international food begins to arrive, the camp should switch to distributing dry rations, which evacuees receive much better than hot, prepared food. 7 Each family, as chosen at arrival, should receive one solar cooker and a 13,650 kcal ration per family member (1950kcal/day/person for one week8).
   Strict inventory must be taken to help prevent lost food. After the first three days of mass feeding, each head of household or unattached individual will come weekly to the food distribution area of each center with the card given at check-in. The distribution worker should crosscheck the name on the card with the database of evacuee's pictures taken at check-in. A second worker should then give each head of household a week's worth of dry goods for the number of family members designated in the database.

» Water

   The Relief Director should assign officials to be responsible for at least 3 to 5 emergency response sites. This official will survey the area surrounding the camp and decide on the source of the water for the prepared well. This site should be at least 60 m away from any contaminating areas such as latrines and rubbish dumps. 9 Also, the well must have a 1.5 meter wall to prevent runoff water to enter the well. A water proof lid will serve as a cover to prevent contamination from the top of the well. A hand pump or a bucket should be placed of the top of the well for easy access. 9
   The well must be accessible to all individuals of the shelter. Special accommodations will be made for those suffering from HIV/AIDS, the elderly, and children. 10 Moreover, queues should be minimized by setting up different times of use.
   The BioSand filters will be distributed along with buckets after a water source has been selected. The public will be educated while distribution of these materials occurs. One of these filters can be shared for about 20 individuals.


»Central Agency

   The medical infrastructures of Peru and Micronesia are very underdeveloped. 11,12 The few hospitals available, all in major cities, are below recommended standards. Micronesia, for example, has only four hospitals distributed among the four major islands. 13 In order to effectively deal with the health crisis associated with a tsunami, these countries need to improve their existing healthcare system in general. It is more efficient and cost effective for existing hospitals to react in a disaster than for foreign groups to set up field hospitals14. However, in cases where it may not be financially feasible to build a hospital, mobile clinics will be deployed. This would include isolated areas in Micronesia and along the Peruvian coasts. The Relief Director will determine what areas are in need of a field hospital, and should find the necessary manpower to staff said clinics.

» Tracking Individuals

   An electronic database of the population must be kept and maintained regularly for the purpose of tracking individuals in the event of a tsunami. The information will include the legal name, birth date, residence, and family unit affiliation of each person. This information would be used to reunite family members in case of involuntary separation. Customs and immigration will be in charge of maintaining a database of people entering and leaving the country to track nonresidents within the country. The database will include the name, birth date, country of citizenship, and address of places each person will be staying. Information about citizens leaving the country will also be available on the database.
   In case of a tsunami, the databases will be made accessible to only to appropriate personnel dealing with the tracking of survivors. One member of the central agency should be appointed to determine the release of the databases to appropriate officials. In addition to officials in charged of tracking survivors, the databases would be made available to authorities of each evacuation sites for administrative purposes. Also, the implementation of such a database would also aid in the identification of orphaned children and the dead.

» Healthcare Availability

   Medical treatment centers must be at an accessible distance from the evacuation sites. 15 However, medical centers should not occupy the same area as the evacuation camp because witnessing medical operations may cause psychological distress among evacuees. The primary medical treatment centers will consist of existing hospitals and clinics. If such establishments are not at an accessible distance, field medical units will have to be deployed to treat injuries in the first 48 hours. 16
   Family members should request medical assistance at the designated local field clinic or hospital in the vicinity for individuals unable to leave their homes. In addition to keeping track of everybody who receives medical aid, hospital records should be reviewed to see if any individuals who do not have family to make their need known may be in need of assistance. In all cases, the Relief Director will determine the appropriateness of the deployment of such aid. 17
   A healthcare discussion would not be complete without the inclusion of psychological health. Psychological help in the aftermath of a tsunami is a must, although most psychological help is best provided outside of hospitals. Religion would play a key role in promoting mental health. In Micronesia and Peru, most people are Christian18,19. Therefore, religious leaders would likely have the means and experience to provide most of the moral and psychological help that people need. For those who choose not to seek solace in religion, psychiatric wards should be made available through hospitals. Until the psychiatric wards are completely set up, mental health services should be provided in temporary healthcare camps.

» Medical Staffing and Training

   Hospitals will be the Central Health Facilities during the tsunami. The following are the standards set by the Sphere Project Handbook on Minimum Standards in Health Services. For a population of approximately 50,000 people, the medical staff should include at least five qualified health workers (physicians, nurses, clinical officers, and/or medical assistants) plus one doctor, one qualified health worker per 20-30 beds for in-patient care, one qualified health worker per 50 consultations per day, and one non-qualified health work for administering oral rehydration therapy.
   At such times as these, however, it a shortage of doctors and other healthcare professionals may be likely. In such a situation, the devastated area(s) would need to rely on the help of other countries to send in additional healthcare professionals as well as provide training to volunteers to assist as non-qualified health workers. In addition to being qualified medically, healthcare professionals involved in post-tsunami healthcare must be well informed and trained for large-scale emergency response. This is heavily reliant on the success of the previous part of our plan involving the education of local doctors. A well trained force will allow for immediate and effective local response to the disaster which will be crucial in providing primary services before international aide is available. As much as possible, international aide should not be relied upon because it may be slow and lacking appropriate relief items. 20

» Medical Preparations

   As mentioned above, our plan calls for improvements in the current medical infrastructure of Peru and Micronesia. The change of the medical infrastructure takes time and large amounts of funding. 17 In the meantime, however, Peru and Micronesia still need to be ready for a tsunami. Therefore, hospitals and clinics should be prepared with the New Emergency Medical Kit outlined by the World Health Organization21. Each hospital will be stocked with an Emergency Medical Kit and a Supplementary Unit. The medical kits are designed for the aid of 10,000 people for 3 months. This kit, developed by the World Health Organization to contain essential drugs and medical supplies for disaster response, has been adopted by many organizations for its effectiveness in emergency situations. 16 This will minimize the need to rely on donated resources, which may not be up to standards (e.g. poorly labeled or expired drugs). Some essential contents of the kit include gauze and bandages to dress wounds and general antibiotics and analgesics. 21

» Health Hazards

   Many health hazards present themselves after a natural disaster, particularly in a hospital environment. Proper management of hospital wastes must be practiced in order to prevent exacerbation of the disease situation. All medical wastes must be collected and kept in secure stainless steel bins until proper disposal procedures can be followed. Field hospitals in disaster areas tend to generate human wastes (i.e. blood, bodily fluids) and chemical wastes (i.e. formalin, formaldehyde, phenol). 22 These wastes pose some environmental and health risks and need to be properly disposed. Disposal methods outlined by the Centre for Disease Control (CDC) shall be met.

» Handling Outside Aid

   Undoubtedly, the Red Cross and other organizations will be eager to help in this endeavor. The central organization would be in charge of coordinating the efforts of the various groups to ensure that all citizens have access to nearby, competent healthcare/health advising. In addition, the central agency would need to recruit workers and volunteers to meet the demand for health attention.

Search and Rescue

   Once the affected area is declared safe from further waves by the local government agency (in contact with the International Pacific Tsunami Warning Center), search and rescue teams will enter the area to find any tsunami victims who were not evacuated before the tsunami struck. The Peruvian military will provide its own search and rescue teams. Micronesia-which has no standing army-must depend on US government forces, in accordance with current political agreements24. Community organizations may volunteer to become part of rescue operations; this often leaves survivors with a sense of purpose and willingness to become involved in additional relief activities25. Each local team should be headed by trained government rescuers so that a uniform rescue protocol is established. However, citizen groups should not be assigned to body collection duties or other highly traumatic tasks involving prolonged proximity to the dead. The local government agency handling tsunami activities will determine the number of teams to deploy in each area, when an area may be open to search and rescue operations, and when the chance of finding survivors is zero.
   We recommend that all search and rescue teams follow US Federal Emergency Management Agency (FEMA) protocol. One FEMA team consists of four rescue squads: one commander, five rescue specialists, and several search dogs. Each rescue squad possesses 72 hours' worth of provisions and the supplies to care for ten critical, fifteen moderate, and twenty-five moderately injured patients26. The remaining seven individuals in each team will coordinate the teams' efforts from a base location and handle the identification and proper burial of the bodies. Each team must be ready to deploy within six hours of a tsunami event, increasing the chance of finding survivors. 27
1. Dynes, R. R. (1974) Organized behavior in disaster. Columbus, Ohio. Disaster Research Center, Ohio State University.
2. Tsunami relief effort 'chaotic'. (2005). BBC News world edition. Retrieved 19 November.
3. Silberner, Joanne. (2005). Workers say tsunami aid distribution sporadic. National public radio. Retrieved 19 November 2005.
4. Masefield, G. B. (1967). Food and nutrition procedures in times of disaster. Rome, Italy: Food and Agriculture Organization of the United Nations.
5. Peru: Earthquake Fact Sheet #3 - OFDA-03 (2001). U.S. Agency For International Development Bureau for Humanitarian Response (BHR) Office of U.S. Foreign Disaster Assistance(OFDA) PERU. Retrieved October 1, 2005.
6. Eade, D., & Williams, S. (1995). Oxfam handbook of development and relief: Volume 2. Oxford, UK: Oxfam.
7. High-energy, nutrient-dense emergency relief food product(2002). In Subcommittee on Technical Specifications for a High-Energy Relief Ration, Committee on Military Nutrition Research, Food and Nutrition Board, Institute of Medicine. (Ed.), . Washington, D.C. , U.S.: National Academy Press.
8. Sklaver, B. (2003). Humanitarian daily rations: The need for evaluation and guidelines. Disasters, 27(3), 259-271.
9. Murcott, Susan. Talk delivered on February 22, 2005 at the Association for India's Development. Slide 33 out of 77.
10. The Sphere Project. Electronic reference handbook. Retrieved October 23, 2005
11. Micronesia. (2005). Hospital for Tropical Diseases. Retrieved 23 September 2005
12. Peru. (2005). Hospital for Tropical Diseases. Retrieved 23 September 2005.
13. US Department of State (2005, July 19). Consular Information Sheet: Micronesia, Federated States of. Retrieved October 29, 2005.
14. Humanitarian charter and minimum standards in disaster response. Geneva: Project, 2004.
15. WHO (2002). Environmental Health in Emergencies and Disaster: A Practical Guide. World Health Organization 2002, Geneva, Switzerland.
16. WHO (-) The New Emergency Health Kit. Retrieved October 29, 2005
17. The Sphere Project. Electronic reference handbook. Retrieved October 23, 2005.
18. US Department of Homeland Security (2004, March 1). National Incident Management System. Retrieved October 1, 2005.
19. Federated States of Micronesia.(2005, August 30). CIA The World Factbook: Retrieved 22 September 2005
20. Peru.(2005, August 30). CIA The World Factbook: Retrieved 22 September 2005. 21. Smith, Keith (2001). Environmental Hazards: Assessing Risk and Reducing Disaster. London, England: Routledge.

23. CDC (2005, January 14). Disposing of Liquid Waste from Autopsies in Tsunami-Affected Areas: Interim Guidance from the Centers for Disease Control and Prevention. Retrieved September 23, 2005.
Agreement to Amend Article X of the Federal Programs and Services Agreement Between the Government of the United States and the Government of the Federated States of Micronesia, United States-Micronesia, February 26, 2004, (Retrieved November 1, 2005)
25. United Nations World Health Organization. Environmental health in emergencies and disasters (Ch. 14). Retrieved November 19, 2005
26. Federal Emergency Management Agency. (2003). FEMA urban search and rescue task force 2003-2004 equipment cache list. Retrieved October 23, 2005.
27. Federal Emergency Management Agency. Urban search and rescue: Commonly asked questions. Retrieved October 30, 2005.