Indonesia

Background
Spread across some 13,000 islands in the western Pacific Ocean, between Asia and Australia, Indonesia’s 225 million residents are incredibly diverse. While the majority are Muslim, inhabitants come from a wide variety of ethnic backgrounds and speak more than 300 languages. Even before the tsunami hit in 2004, however, Indonesia had seen significant social and economic turmoil. It weathered the Asian financial crisis, held its first democratic elections since the 1960s, and experienced a bloody conflict brought on by demands for independence from some of its provinces. As a result of the conflict and a series of terrorist bombings, tens of thousands had been forced to flee their homes, putting enormous strain on the Indonesian health care system.

While exact figures will never be known, estimates put the number of casualties from the December 26, 2004 tsunami at more than 220,000 people. Shockingly, 160,000 of the victims were in Indonesia. The tsunami displaced half a million more in the region, and caused billions of dollars in damage. Two years later, Indonesians are still piecing together their lives, and IMC remains actively engaged in the recovery efforts.

What IMC Is Doing
When the tsunami hit, IMC was already in country, providing emergency, primary, and mental health care to victims of violence in the Malukus, West and Central Kalimantan, Madura Island, North Sumatra, and North and Central Sulawesi. This allowed local staff to travel to Aceh—an isolated province in the north already devastated by years of civil strife, and now completely cut off from the outside world—very quickly after the catastrophe. Once there, IMC provided critical, life-saving care to many of the tsunami’s victims. The speed of that response was only the beginning of a complex intervention, however, that would grow to include emergency medicine, trauma surgery, curative care, mass immunization, maternal and child health, clinic rehabilitation, mental health, and livelihood activities. Finally, to reach victims without the means to travel to seek health care—and there were many, since the tsunami had destroyed roads and bridges—IMC established mobile clinics, which were dispatched to deliver health care to residents in remote, rural areas.

More than two years later, IMC’s work focuses on helping the people of Aceh, which was neglected for nearly 20 years due to civil unrest and was among the hardest hit by the 2004 tsunami; providing emergency response to the May 2006 earthquakes in Yogyakarta in western Java; and building the capacity of a local partner organization to effectively respond to major disasters themselves. IMC’s initiatives include:

• Rehabilitating Aceh’s healthcare

system, which involves rebuilding village clinics, hospitals, and midwife posts and improving access to them via bridge and road projects; training staff for and re-equipping more than 60 community-based mother and child health centers; and the operation of mobile clinics throughout the province until permanent facilities are fully functioning;
• Rebuilding livelihoods by giving residents the chance to earn their own income through a variety of vocational programs such as boat-building, lobster fishing, goat breeding, carpentry, tailoring, and brick works, which has, to date, helped more than 250 families reestablish their livelihoods; and
• Improving emergency response by working with a local partner, Ambulan 118—a national organization of Indonesian health professionals—to transfer the skills and knowledge needed so that they will be able to rebuild their own health care system in case of future crises.

The programs have been effective. After the Yogyakarta earthquake in May 2006, for example, response teams were operational within hours. In the two weeks following, IMC and Ambulan 118 distributed emergency supplies to 2,800 families and, over the next several months, food supplements to an additional 6,000. Since the earthquake, IMC has supported healthcare for a population of 258,000. Mental health teams have consulted with hundreds of people, and trained 45 community volunteers in mental health awareness and identification.