The tsunami and the dangers of goodwill

doi:10.1136/bmj.330.7485.261-a

BMJ 2005;330:261 (29 January), doi:10.1136/bmj.330.7485.261-a

reviews

PERSONAL VIEWS

The tsunami and the dangers of goodwill

Following the tsunami in South Asia, there was, as would beexpected, the rushing to the scene of a multitude of non-governmentalorganisations (NGOs), United Nations organisations, and otheractors providing emergency relief. There was also a remarkableoutpouring of public charity with massive funds being raisedfor the victims of the disaster. Many volunteers from abroadhave independently inundated the afflicted areas. Although notableand well meaning, the public "goodwill" is not without its drawbacks.

In Sri Lanka, where I was dispatched with a relief agency, wefound several issues for concern. Firstly, there were numerousforeign volunteer doctors operating makeshift clinics in thecamps for the survivors. However well intended, the unregulatedand uncoordinated activities of these health practitioners mayserve to undermine rather than support the existing health systemsin the affected countries. Several of the camps we surveyedreceived irregular and unpredictable visits by these independentvolunteers. Follow-up was non-existent and the distributionof medication haphazard and non-uniform. Antibiotics had beenprescribed liberally and it was not uncommon to find internallydisplaced persons who had received multiple drugs of unknownidentity.

Aid, which has come rapidly, mightdissipate just as quickly

Credit: SIPA PRESS/REX

Another concern was the distribution of relief—rarelywas it equitable, proportionate, or tailored to the needs ofthose affected. Some observers were also concerned that theaid, which has come rapidly and voluminously, might, just likethe tsunami, dissipate just as quickly.

Many of the key concerns on the ground for both NGOs and localauthorities were in keeping with those identified in the WorldHealth Organization's emergency strategy—namely, the needfor coordination, disease surveillance, and outbreak mitigation,and the provision of essential health care to displaced people.Although it is appropriate to prioritise water and sanitation,shelter and food security in the post-emergency phase, it isprobably also time now for all the major actors to considerthe longer term needs. It is perhaps disappointing that nowherein the WHO emergency strategy was the issue of mental ill-healthaddressed. The psychological trauma experienced by survivorswill in time surface, and will need addressing in a culturallysensitive and appropriate manner.

While millions of dollars are raised for the tsunami victims,and the various humanitarian aid NGOs are awash with funds specificfor the tsunami, other crises elsewhere in the world remainforgotten or overshadowed: Angola, Afghanistan, Sudan, the DemocraticRepublic of Congo, to name but a few. It is essential that themassive outpouring of public goodwill is harnessed, but moreimportantly, that it is directed towards areas of greatest needand not just the latest media hotspot. Unmet needs remain bothin the countries affected by the tsunami, and in many othercountries that were not.