There is debate among language scholars on the two Chinese language characters for the word crisis; one represents danger and the other possibility or opportunity. This has led to the often quoted cliché that "in every crisis, there is opportunity" when in fact these two characters define a crisis: the opportunity or the possibility of danger.
Recalling that late morning of Dec 26, 2004, when the Asian tsunami hit some countries of the World Health Organisation's (WHO) Southeast Asia region, I remember receiving phone calls from our country offices in the region describing the emergency as water entered the office compound in the Maldives to waves rising as high as 40 metres lashing Sumatra, Indonesia, the Andaman, the sea coast area of Thailand, Myanmar, the eastern shoreline of Sri Lanka and South India. The story evolved quickly for the world to see — the final death toll reached over 200,000. Around 800 primary and secondary health facilities were destroyed; coastal villages and people's livelihoods were wiped out; the tourism sector suffered a major blow in the Maldives and Thailand. The total damage was estimated at US$11 billion (362 billion baht).
The response to the health needs was overwhelming. Coordination of response was rushed. For many countries the systems to deal with the disaster were built as WHO responded.
The WHO Regional Office for Southeast Asia deployed over 160 people over a period of three months to respond to the initial health needs. Every essential public health function — surveillance, maternal child health services, immunisation, psychosocial support, management of dead bodies — was conducted on a massive scale tailored to the needs of each of the affected countries. Field offices were set-up, logistic requirements put in place and technical experts were deployed wherever needed. It was a response and recovery operation the WHO had not seen or committed to in its history.
Today, a decade later, the important question before us is: how do we prepare ourselves if such an event were to happen again? More importantly, how prepared is prepared? Measuring preparedness should be the basis for addressing risks, no matter what the cause. A series of meetings, evaluations, review of responses, culminated in 2005 with a set of Benchmarks for Emergency Preparedness and Response which includes standards, indicators and guide questions.
This tool measures in detail what is in place for legal frameworks, plans, finance, coordination mechanisms, community capacities, and early warning for health events. The Hyogo Framework for Action (HFA) was developed in 2005 along with the UN Humanitarian Reform. This brought about a better approach to coordination in response, accountability and rapid predictable funding. Countries have used the WHO Southeast Asia benchmarks for capacity assessments and development for better risk management in the health sector.
This also helped countries that were not affected by the tsunami. The tsunami was the turning point for countries to see that risk management is an essential public health function and crucial for protecting people's health and investments. Countries also use HFA targets across sectors. Humanitarian reform has been applied in several emergencies with varying success but with systematic documentation of gains and gaps providing a clearer way for corrective action.
On April 11, 2012, an earthquake of 8.7 on the Richter scale rocked Aceh in Indonesia for four minutes. Tremors were also felt in neighbouring countries. It seemed like a repeat of 2004. But specific actions of that day clearly demonstrated that we had learned since then. There were evacuations to higher ground by all coastal communities from Aceh, Nias Island, Sri Lanka, Maldives and Thailand. Indeed, it pays to invest in making risk management capacities pervasive in all levels of society — in all sectors. We have seen India, Indonesia,Maldives, Sri Lanka and Thailand continue to improve systems they set-up with knowledge and tools developed through the lessons of the tsunami. Other countries have also done the same using the same knowledge. The death tolls in various events have decreased over the past years as preparedness and response capacities have increased phenomenally. Today, as we look back at the devastating tsunami, we can say that it taught us valuable lessons.
It seems though that no effort is ever enough, the world is facing another global health emergency requiring resources from everywhere. The Ebola outbreak is another event we need to learn from. We must continue to invest in prevention and preparedness to save more lives. This will eventually decrease the resources needed for the response and recovery in a future event.
We live in a world where there is always a possibility for danger, and in every crisis there is an opportunity. Knowing what we know now, we must look ahead and use that knowledge as an opportunity to keep getting better at saving lives, preventing diseases, and protecting health.
Dr Poonam Khetrapal Singhis WHO regional director for Southeast Asia. As deputy regional director (2002-2012), she was overall lead in the tsunami 2004 response.