The Lancet, Volume 384, Issue 9955, Pages 1656 - 1657, 8 November 2014
doi:10.1016/S0140-6736(14)62019-5Cite or Link Using DOI
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Scars of typhoon Haiyan still run deep 1 year on
A year after super typhoon Haiyan hit the Philippines, recovery remains slow, and locals, many of whom are still homeless, are asking where all the aid money has gone. Chris McCall reports.
The 2013 mega-typhoon and wall of black water that washed away entire buildings has left deep scars on the Philippines, a country well used to natural disasters. A year on from typhoon Haiyan, the Visayas islands and the devastated town of Tacloban are barely starting to recover.
Thousands are still destitute and homeless while a poor region of the Philippines has been plunged even further into poverty. Health workers say it has taught the country and the world some important lessons about how to deal with mega-disasters. As the world warms, many climatologists predict that such super-storms will become more common.
Among the key lessons, UN officials say, are the valuable role mobile phone networks can play to report and control communicable diseases, the importance of the military in gaining access to disaster-hit areas, and the massive toll in terms of mental health on the population. On the positive side, no major epidemic of infectious disease occurred, which health workers believe is remarkable.
However, a year on, many victims are still living in dread of another massive storm like Yolanda, as it is known in the Philippines.
Full-size image (96K) Dennis M Sabangan/epa/Corbis
Debris still remains from a house destroyed by the typhoon, Oct 31, 2014
Wall of water
Magina Fernandez had just arrived in Tacloban a few days before the morning when the storm hit. Of Filipino ancestry, she had come over from the USA to start an online business. Instead she witnessed the destruction of a house that her family had owned for decades. She was lucky to survive. “It was just surreal. In less than an hour the top level of my house was literally completely gone. Black water came in. We sat on the part of the stairs that had not been reached by the water”, she told The Lancet.
There were seven of them. They huddled there. Miraculously everyone survived. The worst of the storm lasted about 4 hours between 7 am and 11 am, and the water receded as quickly as it had come in. When the winds eased enough for them to emerge, it was onto a bizarre, dangerous wasteland. The building that had protected them was seriously damaged and now was a menace. They wandered through Tacloban, literally over rubble and dead bodies. The wall of water that had flooded their house, several metres high, had rearranged the entire town. “There were bodies all over the place”, Fernandez said.
But it got worse. Nothing was working and virtually no one could get in or out. Soon looting started. Initially, she said, it almost seemed normal for people to be taking soft drinks, after all there was little food or running water. After a while, though, people were tempted by other things as well. “I can understand looting for food. I can't understand looting for flat screen televisions.”
Today Fernandez is a senior official with Kusog Tacloban, one of several local aid groups that have sprung up. Tacloban had been swamped by foreign aid organisations, with all the advantages and disadvantages that brings. Children are still going to school in makeshift schoolhouses. Around 20 000 people are still living in bunkhouses and other temporary accommodation. A year after the disaster, large parts of Tacloban are still very dark at night.
The death toll now stands at more than 6300, with many others still missing. The storm was incredibly strong and caused pockets of damage right across the central Philippines. Haiyan was a category 5 storm, the highest rating, both when it entered the Philippines and when it left. It went on to hit Vietnam as well, but caused considerably less damage there. Although the eastern islands of Leyte and Samar took the worst brunt, nearly all the major airports in the region were damaged. Around 4 million people were made homeless. “It was huge. It really was. It made eight separate landfalls and did not really slow down at all. It was a monster of a storm”, said Julie Hall, country representative for WHO.
She says the fact that there has been no major epidemic of a communicable disease is a major success story. There were certainly some outbreaks, but they were largely kept under control.
An innovative SMS messaging system helped keep communicable diseases in check. Although much of the telephone network was destroyed, enough was in place to enable reports to be sent via SMS so coordinators could map where outbreaks were occurring, send antibiotics and other treatments to those areas and nip them in the bud. Where phones were not working, runners were organised to carry paper-based reports to places where the cellphone network was still operational. There were around 3000 alerts, including on measles, typhoid, hepatitis A, and dengue fever.
“The Philippines has quite good disaster response. But they have never dealt with such a mega-storm at all. So huge lessons have been learned. When you deal with a mega-storm it actually requires an entirely different strategy for response”, Hall said.
“This cut off a massive swathe of the country. There was no power, no electricity, no fuel, nothing. It meant that for teams trying to get in, it was very challenging to get access. On the ground, they had to be completely self-sufficient.”
There was a very high reliance on the military for access, she said, including military support from more than 20 other countries. Without the military, it would have been impossible, Hall said. They were the only ones with the kind of equipment needed.
But the issue that stands out for Hall is mental health. Large numbers of people have been affected by post-traumatic stress disorder and depression. Schizophrenia has become more of a problem than it was, possibly partly because sufferers who had been on medication ceased to receive it. As in many Asian countries, mental health problems are widely stigmatised in the Philippines. She hopes this could be a watershed, and help to de-stigmatise the issue.
A major effort was made to provide drugs to deal with mental health problems, and Hall said she sees signs that elements of this model might be copied elsewhere in the Philippines. This, she said, could ultimately be one positive legacy of such a terrible disaster.
Questions over aid
It is one thing analysing a problem and drawing lessons from it. It is quite another to be living on the ground with the aftermath. Not all of Tacloban's people are enchanted with the response. Many ask where the aid dollars have gone and why they still do not have homes. Corruption is a perennial issue in the Philippines and early on it became clear that the Haiyan response was turning into a domestic political football.
As it happened, Tacloban's mayor Alfred Romualdez is part of the clan of late former President Ferdinand Marcos. Current President Benigno Aquino III is the son of a prominent opponent of Marcos who was gunned down by Marcos's supporters as he returned to the Philippines in 1983. The two men could not really be expected to get on, and claims and counter-claims of poor preparation and inadequate response were soon flying, with the mayor eventually breaking down in tears in public.
UN sources say the reality is that many of the local politicians were victims themselves. They had also lost relatives or homes. They also say the Ministry of Health responded fairly well, in particular guaranteeing the needed supplies of drugs. Despite all the other problems, locals say the basic health system is one thing that is now by and large operational in the affected areas.
Retired teacher Efleda Bautista also lived through the storm. She had knee-deep water in the house at one stage. “It was horrible”, she said. “The sound of the wind, and we could not even see outside.”
Today she is leading a movement called People Surge, which is trying to bring pressure for better treatment of the victims. One of the biggest problems now, she says, is that the region's economy is in tatters. Many people in Tacloban lost their livelihoods. Farmers lost their trees. Fishermen lost their boats. Businesses were destroyed. Even today, she said, people in some remote areas of the worst affected islands are going hungry, and not all are getting aid any more. “It seems the relief has already stopped, so there is hunger”, she said.
Bautista also questions the aid spending. After all, the money was donated by people or organisations who wanted to help the victims. What she sees instead, she says, is opportunities for Filipino businessmen to profit from the reconstruction effort, or to move into areas left vacant after local businesses were destroyed.
Such criticisms are not popular with everyone and this is a country with an authoritarian past. Bautista says People Surge supporters have been harassed for daring to speak out. This part of the country has long harboured elements of the New People's Army, a long-running communist insurgency. People Surge supporters have been branded as supporters of this movement, which Bautista denies.
In the past few months, Bautista says, two People Surge supporters have been shot dead by armed assailants. She says witnesses identified the assailants as soldiers in plain clothes. The Philippines military was contacted for comment on these claims but at the time of going to press no response had been received.
After a year living near “no safe” or “no build” zones, the people of Samar, Leyte, and other affected islands have definitely not yet put this storm behind them. One thing Tacloban does have to look forward to is a visit by Pope Francis, who has included the town on a visit planned for January. It will be a major event for this deeply Roman Catholic region.
There are plenty of buildings in Tacloban now, although many were hurriedly put up by foreign aid agencies. Some are providing places for the children to go to school. Whether those children are getting their immunisations is less certain. A recent case of pertussis suggests many are not.
For many in Tacloban and elsewhere in the Visayas, it will be a difficult Nov 8, a year on from the worst storm anyone here can remember.
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