Natural disasters – typhoons, floods, vulcanic eruptions, tsunamis, among others – can have devastating impact on entire communities. Hundreds or even thousands of people can be injured, and homes and livelihoods destroyed. Access to clean water, healthcare services and transport can be disrupted.
From large-scale catastrophes to local emergencies, Doctors Without Borders/Médecins Sans Frontières (MSF) is always ready to respond. We have 50 years of experience in responding to emergencies, and a large network of aid workers and supplies around the world that can be mobilised as needed.
In Manila and its surrounding areas, MSF teams are working to provide medical care and distribution of non-food items to the most vulnerable people affected by three typhon and tropical storms in October and November 2009. Dozens of thousands of people still live in flooded areas in critical conditions in the slums near a canal east of Manila and in the north and south-east Laguna de Bay area. These people are particularly vulnerable because either they live in crowded evacuations centers or in partially flooded houses. © Benoit Finck/MSF
On 8 November 2013, typhoon Haiyan, one of the strongest and deadliest typhoons ever recorded, laid waste to the Philippines.
“This sort of disaster is unprecedented in the Philippines. The effect is something like a massive earthquake followed by huge floods,” says Dr Natasha Reyes, Doctors Without Borders/Médecins Sans Frontières' (MSF) emergency coordinator in the Philippines.
A day after the typhoon's landfall, we had teams on the ground coordinating our relief efforts. It was the biggest emergency response of Doctors Without Borders / Médecins Sans Frontières (MSF) in the Philippines and the region. We conducted:
- 11,624 surgical interventions;
- 29,188 vaccinations for tetanus, measles, polio and hepatitis;
- 27,044 mental healthcare and/or counselling sessions;
- 2,445 babies were delivered;
We also distributed:
- 71,979 relief kits;
- 50,000 food packs;
- and 14,473,500 litres of water.
Mobile clinics were setup in 133 different locations and we constructed of one semi-permanent hospital. Seven hospitals were rehabilitated.
Stories from the field: Responding to the triple disaster in Central Sulawesi
When a devastating earthquake and tsunami hit Central Sulawesi in Indonesia, Doctor Rangi W. Sudrajat joined Doctors Without Borders/Médecins Sans Frontières' (MSF) emergency response team dispatched to reach communities cut off by the disaster.
It was 7 October, nine days after a 7.5 magnitude earthquake followed by a six-meter high tsunami struck and paralysed Central Sulawesi. The death toll has risen to 1,900 and climbing, the TV at Makassar airport blared just before Dr Rangi was to board the plane going to Palu City.
When she arrived in Palu, there were lots of people waiting at the airport, trying to catch a plane to get out of the city. She saw a boy with a huge bandage on his head sleeping on his mother’s lap. The airport itself was busy, military aircrafts were parked surrounding the recently fixed runway, and the now infamous collapsed air traffic control tower standing in ruins.
Severely devastated. Talise Subdistrict in Mantikulore Subdistrict, Palu City is one of those badly affected after being hit by the earthquake and tsunami hit Central Sulawesi on 28 September 2018. © Dirna Mayasari/MSF
Cut off from the outside world
The next day, Dr Rangi, the nurse, and the water and sanitation (watsan)-logistics joined a mobile clinic, travelling to a community health center in the disaster-hit town of Baluase in Sigi – one of the three provinces that were damaged by the triple disaster of earthquake-tsunami-liquefaction. The head of the community health center told the team that usually people could reach the town in less than one hour. But, after the earthquake, it now takes double that time to get to the locations.
A sign reading "Need medical help" in Sigi © Rangi W. Sudrajat/MSF
From the car’s small windows, Dr Rangi could see tall grasses all around and the newly-created dirt road. The military had cut down the fields and poured sand on the ground to create this road as the earthquake completely cut off Sigi from the outside world.
Ruins and devastation were found everywhere she looked in Sigi. Grounds split open, houses crashed down, and buildings were torn in pieces. From afar, it looked like nothing happened to the building that used to be the Puskesmas Baluase, but if we come closer, it was obvious that the center of the district health service, providing services for more than 15,000 people, was badly damaged.
But MSF already had an action plan in place to restore health services to the area. By 15 October 2018, the foundation for a temporary Puskesmas was set on the ground by the MSF team.
While the logistics and watsan team was working hard to rebuild the health centre, Dr. Rangi and her medical team, supported by Puskesmas staffs, started their daily mobile clinic activities in all the 13 villages of the South Dolo District.
Dr Rangi has worked in emergencies with the organisation before, but treating people who are victims of a large-scale natural disaster that happened in her own home country is entirely different and heartbreaking. It definitely left a personal impact on Dr Rangi as an individual.
When this happened, she did what she usually does in her other missions, she spent time playing with her favorite people – the children.
Accessing a Disaster Zone
Doctors Without Borders/Médecins Sans Frontières (MSF) have emergency teams who are experts at doing quick assessments and organising the immediate response.
Medical and logistical supplies, in the form of pre-packaged kits ready for rapid deployment, are stored in warehouses in key locations worldwide.
A roster of experienced staff willing to drop everything and leave immediately to work in a disaster anywhere in the world means we can be there where people need us the most as quickly as possible. Urgent medical assistance cannot wait.
Stories from the field: Emergency response in Philippines after typhoons Goni and Ulysses cause widespread destruction in the Philippines
On 1 November, one of the strongest typhoons in 2020 struck the Philippines. Goni, or Rolly as it’s known in the Philippines, caused widespread damage throughout the Bicol region, particularly Catanduanes and Albay provinces, around 300 km south-east of Manila. Just before it made landfall, Goni was rated as a category 5 typhoon, the most severe level.
Impression from the outreach activities and health assessments in San Miguel Island, Catanduanes Province, Philippines, following landfall of typhoons Goni and Ulysses. Substantial damage to houses is visible, but very few deaths. © MSF
Impression from the outreach activities and health assesments in San Miguel Island, Catanduanes Province, Philippines, following landfall of typhoons Goni and Ulysses. Substantial damage to houses is visible, but very few deaths. © MSF
Three weeks later, large areas of Albay and Catanduanes are still without electricity, while cellular coverage and internet connection both remain unreliable. In the wake of damage wrought by typhoon Goni, Doctors Without Borders/Médecins Sans Frontières' (MSF) assessment teams were dispatched to each province.
However, both teams soon met a new challenge, as typhoon Ulysses made landfall on 11 and 12 November, suspending the assessment and MSF’s response. “Our teams had to stop working and wait for Ulysses to pass. It ultimately affected areas north of Manila the most,” says Jean-Luc Anglade, Doctors Without Borders/Médecins Sans Frontières' (MSF) head of mission in the Philippines.
“We first visited Guinobatan town, where the typhoons had caused violent lahars. It was the first time in living memory for locals that the San Francisco and Travesia villages had been struck by lahars. While surveying the area and walking over large boulders, we were told that there used to be a house where we were standing. That was quite upsetting,” says Dr. Rey Anicete, the organisation's emergency team leader in Albay.
Doctors Without Borders/Médecins Sans Frontières (MSF) started distributing jerry cans for storing drinking water and COVID-19 prevention kits, which include two washable face masks, hand sanitiser and one face shield per person, at both two evacuation centres. Training on infection prevention and control (IPC) around COVID-19, together with donations of personal protective equipment (PPE) for the staff in the evacuation centres is planned.
Families have to stay at evacuation centres where MSF provides jerry cans and PPE to prevent outbreaks of COVID-19 in the centres. © MSF
“COVID-19 has been severely affecting the lives of people in the Philippines since March, and in an evacuation centre, it’s especially important to maintain hygiene and social distancing measures to prevent outbreaks. Health staff and evacuees have a significant role to play in achieving IPC goals,” says Allen Borja, an MSF IPC nurse in Albay.
In Catanduanes, an island province, six of its 11 municipalities were severely damaged when typhoon Goni swept through it. The island suffered the most in terms of destruction and loss of livelihood. Fortunately, people in this province were able to leave the evacuation centres quickly to return to their houses and begin repairing them.
“The MSF team launched its response on 24 November in San Miguel, one of the four municipalities considered in the response. Together with Municipal Health Offices health workers, one MSF doctor and one nurse provided medical supplies for outreach activities in the most affected villages. The team started the distribution of and aqua tabs for water purification and jerry cans to store drinking water for around 2500 families,” says Dr. Hana Badando, emergency team leader in Virac, Catanduanes.
Treating the Wounded
One of our priorities is to evaluate whether there are many wounded and whether local health capacities have been hit by the disaster. If people suffering from cuts and fractures do not access treatment, including proper post-operative care, their wounds can quickly become infected.
Doctors Without Borders/Médecins Sans Frontières (MSF) will send medical units to perform surgical procedures, provide post-operative care and physiotherapy. We may deploy mobile hospitals, such as an inflatable hospital, which is particularly appropriate after an earthquake when there are aftershocks.
The restoration of routine health services and the distribution of shelter and basic relief items are also among the priorities. But it is not only the physical injures that are in focus. Providing mental health support is also necessary to help people recover from the trauma of the event.
Central Sulawesi: MSF’s Health Facility Still Serves the Communities Devastated by the Disaster
Six months after the triple disaster of earthquake, tsunami, and liquefaction that hit Central Sulawesi, the temporary health facility built by MSF in the Dolo Selatan Sub-District continues to serve the affected communities. When the health centre of Baluase was heavily damaged by the disaster, it left 12 villages without access to medical care.
Aside from providing medical and mobile health care services, the MSF local team, in coordination with the heads of the Baluase health centre and the Sigi District health agency, decided to construct a temporary centre with an outpatient, maternity, and emergency departments, and water and toilet facilities.
Dr Adelide Krisnawati Borman, or Dr Krisna is the head of the Baluase Health Centre, in South Dolo Sub-district, Central Sulawesi, said that “When MSF came and assessed the condition of the Community Health Centre after the earthquake, it was severely damaged. We could not even enter the building. MSF constructed a temporary building for us. It took only about a week or two, and then we moved here and we delivered our services from here.”
Dr Krisna emphasised that the Baluase temporary centre built by MSF has all the needed facilities. It has the outpatient, maternity, and emergency departments, even water and toilet facilities. This is one of the rooms at the temporary health facility, used for the inpatients.
Dr Krisna said that this health centre covers 12 villages. It receives around 20 to 30 outpatients per day and 5 to 10 are admitted as inpatients daily. Since November 2018 when medical services started, the facility received more than 3,000 patients in all.
Dr Krisna emphasised that the Baluase temporary centre built by MSF has all the needed facilities. It has the outpatient, maternity, and emergency departments, even water and toilet facilities. And she added that they can deliver health services every day, conduct outpatient care, and polyclinic for children. “There is a pharmacy, obstetrics, an emergency, and inpatients room. We also have a pantry where we can cook and there are also toilets. We thank God that we were helped by this temporary building built by MSF. We are very grateful and it is very useful for all of us and the people here,” she said.
This facility also has a pharmacy where the patients can get their medicines after consulting the doctor. © Eka Nickmatulhuda
According to Dr Krisna, her staff were happy to continue delivering health services to the communities using MSF’s temporary health centre. She said that at first, they did not expect that the building would be very well made. But after its construction, they were able to restart their medical services in less than a month. “We will probably use it for a year more,” Dr Krisna said.
Coordination with National Relief Efforts
Doctors Without Borders/Médecins Sans Frontières' (MSF) response is developed through extensive collaboration with national actors, taking into account the importance of local efforts and strategies, and the limitations of an international intervention in regards to time, quality and pertinence.
We analyse the added value of the assistance we can bring, and regularly question the pertinence of our continued presence. Our aim is to 'hand back' any medical activities to local authorities or partners once they no longer need our support.