A month after the tsunami hit South Asia, the extent of the damage is staggering. According to Reuters, as of January 25^th, 2005 over 234,000 people have died, many are missing and hundreds of thousands are homeless (Table 1). Those who survived had to start from scratch, with entire towns wiped out, roads and train tracks washed out, sewer systems rendered useless, and no electricity, clean water or adequate food. Due to the magnitude of the destruction, it has been nearly impossible to implement proper sanitization projects and waves of disease are affecting hundreds of thousands more. Communities have had their social and economic infrastructures torn down leaving entire populations in a sense of disarray and despair. In addition to the immediate physical trauma, victims suffer a psychological ordeal that is both crippling and long lasting.

Table 1. Number of deceased, missing, injured and homeless in affected countries

The disabled suffered the worst in the tsunami tragedy as they could not run away to save their lives and those who survived had to endure numerous obstacles to get relief materials, food, etc. On the island of Car Nicobar, 700 individuals, disabled from polio, are reported to have died and 3000 more are missing ¹. Those survivors who have lost their family support are unable to provide for themselves as most of the jobs are meant for able-bodied persons. Without the means to take care of themselves, many will succumb to malnutrition, disease and abuse from others. In the rush and panic of the calamity, many more people have sustained injuries, serious enough to cause permanent disabilities. Around 1,000-1,500 cases of injury - fractures, spinal injury, paralysis, etc - have been recorded on the islands of Andaman and Nicobar ². In Thailand alone, 800 people have sustained movement disabilities, with 33 who have become severely disabled ³. Sadly, the disabled are often overlooked in tragedies like this and in many areas, like the Andaman and Nicobar islands, little is being done to meet their needs. According to a report by the National Centre for Promotion of Employment for Disabled People (NCPEDP), New Delhi, no rehabilitation services are available for disabled people in the island region and not a single disability NGO is receiving any grant from the Government or from any other donor agency ⁴. Similar situations afflict the disabled in other countries. There is an immediate necessity to collect data on disabled people affected by the tsunami, to assess their needs and to incorporate these concerns into the rebuilding process. On January 22, major aid agencies said that the focus will now be on reconstruction and rehabilitation, and it is essential that rehab professionals are directly involved in this ‘phase two’.

There are several limiting factors that plague the disabled and hinder aid agencies that are trying to help them. Poor resource allocation and political red tape mean that much needed help will not reach the victims in time or not at all. Ongoing civil wars, which have already disabled a significant number of civilians in some countries, play a huge factor in determining where and how aid gets delivered. For example, it is a common practice among Indonesian doctors to ask their Acehnese patients to produce their red-and-white identity cards. Red and white are the colours of Indonesia's national flag. The cards were specifically designed for the Acehnese since the Indonesian government declared martial law in Aceh in May 2003, in its fight against separatist rebels. Before the Dec. 26 tsunami struck, Aceh was almost entirely closed to any international presence due to military operations there against the Free Aceh Movement, which has been fighting for independence since 1976. More than 10,000 people, mostly civilians, have been killed since then ⁵. In Sri Lanka, where civil war has ravaged the country for many years thousands of civilians are living with physical handicaps, victims of landmines and acts of war. Carson Harte, director of the Cambodia trust estimates there are 160,000 disabled people who need prostheses and orthoses, but there are only 5 trained specialists in the whole of the country. Approximately 115 prosthetist orthotists are needed in Sri Lanka, and with over 90% of the people who require artificial limbs or braces having no access, there is a significant void that must be filled ⁶. NGOs need to be aware of the political backdrop in these countries and work with these governments to ensure the needs of the disabled are met, to acquire the resources and freedom to operate effectively, and to direct the rebuilding process.

Unfortunately the number of disabled is only going to increase as contagious disease and infections ravage the population of survivors. World Health Organisation (WHO) officials are worried about an outbreak of measles as well as the risk of malaria, which is spread by mosquitoes. The United Nations Children's Fund (UNICEF) reports that measles still kills more children than any other disease that is preventable by vaccine. Measles can lead to brain damage, deafness, blindness and mental disorders. To help prevent an outbreak of measles, WHO has set up a program to vaccinate as many children as possible - up to 65,000. Currently, refugees in Aceh seem to be suffering from diarrhea, respiratory problems and skin infections. While these diseases are not considered life threatening, they can lead to more serious illnesses. Sanitation is still lacking and that alone can pose health risks. According to Handicap International physiotherapists working in the affected areas are facing a serious challenge: survivors who swallowed salty and dirty water are developing major lung infections and if not treated properly will die, only adding to the growing death toll. Improper proper wound care is causing gangrene, which is further debilitating survivors. Interventions are needed to increase the awareness of proper hygiene and personal health care to minimize this secondary wave of disability.

Listed below are a number of NGOs that are involved with providing relief work to the tsunami region:

Outlined below is the agenda of Handicap International to promote health and rehab in the tsunami region ⁷. It is both comprehensive and thorough and will serve as a useful template for future rehab projects: