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Three Months After The Asia Tsunami Disaster Following the earthquake in the Indian Ocean and subsequent tsunami on 26th December 2004, Médecins Sans Frontières (MSF) offices worldwide sent over 200 international staff and more than 2000 metric tons of supplies to the region in support of the victims. The first MSF teams arrived in the affected areas within 72 hours of the tsunami hitting. They carried out needs assessments in Myanmar, Malaysia, Indonesia, Sri Lanka, India and Thailand, which resulted in MSF operations in the latter four. Assessments in Myanmar and Malaysia did not reveal any serious unmet medical needs. Operational situation Start-up chronology: Over the last three months MSF's activities focused on: Except for a tetanus outbreak which resulted in MSF engaging in both prevention and care of patients, no other major outbreaks or life-threatening diseases (cholera and other diarrheal diseases, measles, dengue fever, malaria...) occurred. The risk of epidemics has considerably diminished, but the development of seasonal diseases such as malaria and dengue fever needs to be monitored. After the initial emergency response, the emphasis today is on guaranteeing quality medical care via hospitals, health centres and MSF mobile clinics, as well as helping communities cope with post-traumatic stress, water and sanitation needs, and the loss of livelihoods. Targeted support is being given to particularly vulnerable groups through the provision of reconstruction tools and materials for rebuilding health centres, homes and boats. Because access to health care is unequal in certain areas of Aceh and southern Thailand, MSF remains committed to help the most excluded get affordable basic health care. Today, more than 100 MSF international staff work alongside more than 250 local staff in the Tsunami-affected areas. Financial situation However, spontaneous gifts continued to arrive topping at approximately 129 M$US (100 M€) three months after the disaster. MSF is extremely grateful for this generosity, a sign of solidarity, which has allowed our teams to bring medical, psychosocial, logistical, and water and sanitation aid to the most affected people and help them recover from the devastations. Still, the amount of donations greatly surpasses our financial requirements for emergency medical relief in the Tsunami-affected regions. 129 M$US (100 M€) is equivalent to the entire 2003 annual budget for MSF operations in Angola, Afghanistan, Democratic Republic of Congo, Liberia, Sudan and Ethiopia - six countries with the highest concentration of MSF interventions that year - or more than double the 2004 budget for emergency operations in the Darfur region of Sudan. To date, 33M$US (25.57 M€) has been budgeted for operations in Tsunami-affected countries, 15.5 M$US (12M€) of which has already been spent MSF Operational Budget Although MSF is committed to continue working in Aceh and in other Tsunami-affected regions in future, our interventions will not require considerable more funding than budgeted. This is why MSF aims to de-restrict 75% of the funds received. As MSF will not use earmarked tsunami donations for any other purpose without the consent of the donor, MSF offices worldwide have started to contact donors asking their consent to use gifts in other emergencies or forgotten crises. Overall, the reaction has been very positive and has enabled MSF to re-direct 30 M$US (23.2 M€) to other programs whereas $709,000 (550,000 €) was reimbursed on request. MSF is a needs-driven humanitarian emergency medical organisation dedicated to alleviating the most extreme suffering of the most vulnerable in the worst conflicts and disasters around the world. It would be unethical and inefficient to boost operations artificially in one context only on the basis of availability of funds, and leave urgent and massive needs unmet in less prominent crises where the immediate survival of tens of thousands of people continues to be at stake. The strength with which the tsunami hit the worst affected regions meant help arrived too late for many who died during or immediately after the disaster. When MSF teams arrived in the worst affected regions within 72 hours, the local relief effort was already well underway. Many of the emergency needs were covered by capable national medical staff. In the absence of major epidemics or life-threatening diseases except for tetanus, MSF found post-traumatic stress, water and sanitation and the loss of livelihoods the most urgent needs to be addressed in order for people to rebuild their lives. However, when it comes to long-term development programs or more large-scale rehabilitation, reconstruction or infrastructure works, MSF is convinced that other organisations, specialised in development aid or state actors are better suited to undertake these essential tasks. MSF runs programs in more than 70 countries and continues to need funds for its medical assistance in areas largely forgotten by the media, such as the Democratic Republic of Congo, Somalia or the Caucasus.
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Sri Lanka - 27 December:
simultaneous assessments and relief 
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