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Remembering the Indian Ocean tsunami On Dec 26, 2004, several powerful tsunamis caused huge loss of life in the Indian Ocean region. A decade on, Chris McCall speaks to survivors and experts about the legacy of the disaster.

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of another tsunami disaster hitting the Indian Ocean in the future are 100%. It is just a matter of when and where. In 2012, two strong earthquakes hit Banda Aceh on the same day, and rather than fleeing to the purpose-built tsunami refuges that now dot the city’s shoreline, residents panicked and fled in droves to the city centre. There were traffic jams and accidents. The tsunami that day was tiny, but seismologists say the earthquakes were strong enough to generate a much larger one.

“...many aid workers quietly admit...that a lot could have been handled better and it remains to be seen whether preparations will be adequate next time.” In fact, Acehnese folk history suggests the 2004 tsunami was not the first. There is an expression for this phenomenon in the Acehnese language—ie benah—which translates as “the water vomits”. For most Acehnese, this was the work of God, not that of the Earth’s tectonic plates.

Changed landscape Now aged 50 years, Yuliawati lives in a shack near the Banda Aceh shoreline. She lost her mother, father, and many other relatives in 2004. The house she once held a title to and the land it stood on are now part of the sea. The shoreline retreated hundreds of metres in places. Rice handouts have long stopped. “If you ask, I will cry again. We sell corn on the roadside. We are forced to find money for ourselves selling corn. A long time ago, the rice stopped”, she said, adding that she might make 30 000 rupiah (about $2·50) a day from selling corn. Search the internet for the effect of the tsunami and you will rarely hear

the voices of people like Yuliawati. Instead you will find a large number of congratulatory articles about successful projects and improved protection. The reality, many aid workers quietly admit, is that a lot could have been handled better and it remains to be seen whether preparations will be adequate next time. Aceh has got one good thing out of the tsunami and that was peace, agreed between the rebels and the government in the months after the disaster. Former rebel leaders now run the province as an autonomous region, and one thing they have provided is free health care, something most Indonesians do not have. In Sri Lanka, peace has also come, but only as the result of a bitter and controversial government campaign in 2009 to defeat the rebel Liberation Tigers of Tamil Eelam.

Red tape Down the coast from Banda Aceh are regions where entire villages have been wiped off the map. The town of Meulaboh, virtually flattened in 2004, has been rebuilt. When the sea retreated 2 km after the earthquake, survivors say people thought it was a bonanza and

Chris McCall

Tsunami survivors in Banda Aceh are still selling corn by the roadside to make a few rupiah. A few metres away are temporary lodgings where they have been for nearly a decade. Aid handouts stopped long ago. Mention the tsunami that killed around 220 000 people around the Indian Ocean to the Achenese, and many of them still collapse in tears. All the foreign aid agencies have gone. The tsunami of Dec 26, 2004, is retreating into history. These people will live with it for the rest of their lives. There is a tsunami museum in Banda Aceh now, but few locals visit it. It is just too painful to re-live all over again. The people of Indonesia’s Aceh province are a proud people, proud of their history as a Muslim sultanate that resisted Dutch invaders for 70 years in colonial times. In 2004, a separatist war was raging for independence from Indonesia. The massive 9·1 magnitude earthquake that triggered up to seven massive destructive waves, some as high as a two-storey building, brought them to their knees. The epicentre was just off the coast in the Indian Ocean and the earthquake was heard like a bomb going off. Apart from Indonesia, the most lives lost were in Sri Lanka, India, and Thailand, but the effects were felt and deaths recorded as far away as Somalia and South Africa. The figures are staggering. Around 1·8 million people displaced. Around 460 000 homes damaged or destroyed. Even a decade on, many of those figures are still semi-provisional. It was just too big to ever assess the full truth. Since then, a lot of effort and money has gone into ensuring such a mega-disaster is not repeated. As of 2009, pledges were put at around US$13·6 billion. One day the world will find out if it was enough. The chances

Banda Aceh tsunami survivor Yuliawati still lives in temporary accommodation


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Burma Thailand Phuket Isand

Sri Lanka


Malaysia Indonesia

Maldives Seychelles


Countries most affected by the tsunamis


The tsunamis were triggered by a major earthquake off the coast of Indonesia

rushed out to pick up the stranded fish. When the tsunami arrived, those people had little chance of escape. Few knew what a tsunami was. Afterwards survivors were wandering around trying to locate their families. The limited medical services were overstretched. Muzakir, now aged 32 years, delivers concrete in Meulaboh by becak—a type of Indonesian rickshaw. He lost his entire family including wife and two children. His leg was broken and doctors tried to persuade him to have it amputated, a decision that might have left him unable to work. “They wanted to cut my leg off. I didn’t want to let them”, he said. He went away, bandaged his leg up, hobbled around on a crutch for 5 months and eventually his leg healed. After a period working for aid agencies, he is back working at his old trade and he has since remarried to another tsunami survivor. For foreigners seeking to help, there were language barriers, cultural barriers, and red tape barriers. Many aid workers became frustrated with bureaucratic delays. However, one Swiss orthopaedic surgeon suggests others could learn from his story. The organisation that helped Andreas Messikommer get in was not an aid agency. It was a small charity 2096

working to save the endangered Sumatran orangutan. However, it had good local connections in Medan, Sumatra’s main city, and knew enough about local customs not to go in heavy handedly. As a result, it was able to arrange introductions to Indonesian officials who needed his help. He came with a hand drill, as he knew the electricity might be unreliable. “When there is an unexpected situation, it is tremendous stress for everyone. The equipment is lacking. The money is not here”, he said. “Many people had very badly injured legs and arms. Many people went first to the village doctor. They came in with infected legs. Antibiotic protection was sometimes lacking.”

Lesson one: be prepared Ask WHO regional director Poonam Khetrapal Singh for one big lesson from 2004 and she answers with one word: “preparedness”. One of the problems in Indonesia, Sri Lanka, and India was bureaucratic delays. Most of the health facilities in the affected areas were damaged. Both Aceh and parts of Sri Lanka were war zones and there was official reluctance to allow outside aid in early on. In Indonesia, the most critically injured had to be flown out of Aceh to Medan. Relief officials say there were not enough helicopters and other aircraft in the early days. Aceh was technically under the control of the Indonesian military and although their soldiers worked hard, a disaster of this scale was beyond their means. In 2004, as WHO’s deputy regional director Khetrapal Singh was tasked with travelling to Aceh to help organise relief immediately after the tsunami. Around 250 aid organisations worked in Aceh following the disaster, she says, and coordination between them was not always good. Work was duplicated. Things were needed but not done. Some supplies sent were not needed. Things that were needed were not sent. And there were a lot of delays in the

early, crucial period when most lives could be saved. “It was just total rubble and nothing else. Different messages go out from different agencies and that can cause a lot of fear and panic. I wanted to get them to speak with one voice. I remember that I tried to get them together. They would not come”, she told The Lancet. Khetrapal Singh says the experience has led to fundamental changes in the way major disasters are handled within the UN. One has been the creation of a special regional fund from which WHO can dispense up to $175 000 on request immediately, just with a phone call or an email. “When we have a disaster there is a lag and that lag goes for 5 days to a week, because governments have their own internal processes, like the finance minister having to approve it”, she said. “I can release that money within 24 hours. With this, now countries can manage the first few days.” This fund has already been used several times, she says. Another change has been a cluster approach, where each UN agency has clearly defined roles and responsibilities. It needs detailed planning because, for example, immunisations might be supplied and delivered by two different organisations. However, the work is not duplicated. Logistics experts now play a bigger part—professionals dealing in the world of freight who can ensure what is in the box delivered is actually what it is supposed to be and that it is properly stored and handled on arrival. Attempts have been made to extend this planning to agencies outside the UN.

Warning the Indian Ocean Since 2004, a lot of work and money has gone into developing something a few quieter voices had already proposed—a tsunami warning system for the Indian Ocean. It has cost close to $500 million to set up. It was recently tested and performed well in a simulation, according to Tony Elliott, an oceanographer tasked with overseeing it. www.thelancet.com Vol 384 December 13, 2014

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The Indian Ocean contains two major areas that could generate tsunamis, the Sunda trench to the south of Sumatra, Java, and Bali, and the Makran trench, which lies to the south of Iran and Pakistan. However, the seismology is still not well understood. It might be that seismic activity comes in bursts in the Indian Ocean, Elliott said. Although the 100 years before 2004 was comparatively quiet, the decade since has been less so. “There was no tsunami warning system in place because the need for it was not perceived”, Elliott told The Lancet. “Like any system it cannot be 100% but we definitely want to strive to attain that. The entire Indian Ocean region benefits from this system.” Detecting a tsunami and getting the message out fast enough to save lives is not simple. Furthermore, organisers want to minimise false alarms, which encourage complacency. This system can provide a tsunami risk assessment within 20 minutes. An initial assessment that there has been an earthquake can be generated in as little as 5 minutes. Around 140 sensors have been placed in the sea floor to detect movement and relay that by hydrophone— acoustic sound waves—to floating buoys carrying instruments that relay the information on to land. It is then compared with shore-based measurements to detect surface water level changes, often using radar. Warnings might need to be issued before all the data is available to analyse the seismic event. Aceh’s west coast had around half an hour between the earthquake and the tsunami, but the tsunami took a lot longer to reach Sri Lanka, India, Thailand, and other affected countries like the Maldives. With the right planning, this much warning could be enough to save many lives. The system needs to be maintained and each country needs ways to pass on the warnings to its endangered citizens. Elliott says the danger is that as memory of the tsunami fades, so www.thelancet.com Vol 384 December 13, 2014

does interest. If the region enters into another quiet phase, over time and over generations the memory of the 2004 earthquake, like that of the 1883 eruption that destroyed the island of Krakatau, will slowly disappear. “When there is a disaster, there is a lot of interest. That tends to tail off as the memory fades. We are in that phase at the moment and I think we need to find ways to maintain the interest and the commitment of the member states to maintain this system for the future”, he said. Tsunami warning systems have now also been developed in the Mediterranean and northeast Atlantic Ocean. A system is under development for the Caribbean. Both coasts of the USA are monitored. The one major part of the world still without any such system is the southern Atlantic. But every system can fail. Despite a longstanding tsunami warning system in the Pacific Ocean, in 2011 history repeated itself, and around 19 000 people died as another tsunami hit Japan, one of the world’s most developed countries.

Identifying the dead Identifying the dead after the India Ocean tradegy was a task which was beyond the authorities’ ability in Aceh. Fauzi Husaini, who works with the Indonesian Red Cross in Banda Aceh, says many of the faces were completely blackened, probably partly as a result of the filthy water they had come into contact with. “There was no camera to take pictures. The victims faces were all black. There are still many who are missing, who were not found. Some were taken by the sea”, Husaini said. In Islam, bodies are supposed to be buried on the day of death, or as soon as found, and they are supposed to be washed first. This was impossible, and a special decree had to be sought from the Islamic scholars council in Aceh to the effect that the seawater had already washed the bodies. This was essential, as mass burials were needed to prevent outbreaks of disease.

In the Red Cross offices in the city, there is a small collection of identity cards found after the tsunami that no one has ever claimed. In reality, no one is really sure how many people died in Aceh, although an estimate of around 170 000 people has been widely quoted. It was a different story in Thailand. There, many of the victims were foreign tourists, many of them from western Europe or north America, and families wanted their remains repatriated for burial. The world’s largest ever disaster victim identification programme involved forensic dentists from around the world. As it happened, the identified dead in Thailand included some migrant workers from neighbouring Myanmar (Burma). The military government there proved reluctant to receive their bodies, asking why they had left the country illegally.

Children of the tsunami With no remains of their loved ones, for some, it became a lingering question as to whether their relatives had survived. Many children were orphaned. One Indonesian family this year was finally reunited with two children who they thought had perished. Their tale is illuminating. They had actually survived thanks to the quick thinking of their father who had placed them on a floating wooden board on which they sailed out to sea and were eventually rescued. It is a bitter-sweet tale, however. The children’s mother, Jamaliah, now aged 42 years, says her son, Arif Pratama Rankuti, was abused after he was rescued. He is now 17 years old but still carries scars on his legs from hot water scalds as well as a big scar on his forehead. Ultimately, the two children were separated and were found in two different parts of Sumatra. The boy was living as a street child in Padang, down the west coast, and was in that city when it was hit by another earthquake in 2009. He can barely read and is obviously very 2097

Mike Alquinto/epa/Corbis

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An Indonesian woman stands at the site her home used to be, January, 2005

traumatised. He has just gone back to primary school. His experience begs the question of what happened to the many other tsunami children whose faces did not get into the newspapers.

Money misused Money has been very much an issue in all aspects of the recovery. In Tamil Nadu, the worst affected state in India, the Prasad Chikitsa charity noted that not only had people lost their homes and families, their livelihoods had also gone. It found that fishermen in the coastal villages lacked equipment to go fishing again. The simple solution was to replace their boats and nets. “They had lost everything. They had lost their boats. They had lost their fishing nets. Morale was really low”, said charity trustee Udayan Bhat. “We really gave them the economic tools to get back on their feet. Once you have the economic side of things in place a lot of other things fall into place.” The charity also built new homes and donated jeeps to ensure they could get their catch to market. At the last report, Bhat said, the communities seemed to be doing quite well again. This, he said, was preferable to handouts, which would create an atmosphere of dependence. But large sums of money and handouts inevitably breed a desire for more. In these places, some of the victims had never before seen the quality of things they were being 2098

provided with. “We did get the sense that people were asking for things that they did not necessarily need”, Bhat said. Not every aid effort worked out well. Although the road down Aceh’s west coast has been rebuilt to improved standards, water supplies restored and so on, landslides have occurred around many of the new homes that were built. Officials say that corruption involving aid funds was less of an issue in Aceh because of intense international pressure and close monitoring by Indonesia’s Corruption Eradication Commission. In Sri Lanka, however, the national branch of anticorruption lobby Transparency International later investigated after complaints from some foreign donors. In 2007, it said more than $500 million in aid money was unaccounted for. The government was dismissive of the claim.

“One of the biggest problems was persuading people to relocate to higher land, away from water that could threaten them in another tsunami or a bad storm.” Questions also arose about the motives of some. Some organisations seeking to help were religious in nature, including Christian missionaries in India and Islamic fundamentalists in Aceh, with a religious agenda separate from their aid agenda. Some Muslims said the tsunami was a punishment from God, an interpretation that did not particularly help traumatised victims cope with their losses.

Unused lessons “My biggest fear is not on the lessons that have been learned. It is always the lessons people learn and did not use. That is the bigger concern”, said Satya Tripathi, UN recovery coordinator, who worked with former US President Bill Clinton to lead the UN response in Aceh. “When these things happen we bring in the best brains. One of the challenges is how do you institutionalise change? How do you

make sure the lessons that you have learned translate into better practices?” Disaster risk reduction and health education sound good, but some of the challenges were simple habits that were hard to change. One of the biggest problems was persuading people to relocate to higher land, away from water that could threaten them in another tsunami or a bad storm. In fact, in Aceh, some of those who received new homes on higher ground sold them and resettled back to their devastated home areas. In some cases, the reasons were understandable. If you are a fisherman and that is your trade, making a living from somewhere on high ground is not all that easy.

Post script: Somalia Whether or not the Indian Ocean is ready for another major tsunami disaster will be tested one day. It might not be for a century or longer, but it will definitely come—just as it is certain that the Earth’s tectonic plates will continue to grind against one another. Access, preparation, and speed of response are all lessons from 2004. As a footnote, one Indian Ocean country is notably absent from the new tsunami warning system. It is Somalia, which has been ravaged by war for more than two decades. Although tsunami events can be detected relating to Somalia, the country has no really effective government and no tsunami warning centre. There is really no way to warn people there that a tsunami is on its way. Somalia was hit by the 2004 tsunami and according to the UN around 300 people died there. It is also potentially at risk from a tsunami generated south of Pakistan and Iran. Mounting a major humanitarian response there could be an even bigger challenge than it was in Aceh. Will its vulnerability be tested again one day? That, Somalians and their fellow Muslims in Aceh believe, depends on the will of God.

Chris McCall www.thelancet.com Vol 384 December 13, 2014