March 27, 2014
Akira Nakamura, director general of the Secretariat of Japan Disaster Relief Team
By Akira Nakamura
Director General of the Secretariat of Japan Disaster Relief Team
In the wake of the immense damage caused by typhoon Haiyan in 2013, Japan dispatched a total of five disaster relief teams, namely, three medical teams to diagnose and assist in the diagnosis of victims, one expert team to conduct an early reconstruction assessment and another expert team to respond to an oil spill from a power barge that ran aground. In this article, we review the one and-a-half months of JICA's efforts performed in collaboration with many humanitarian actors on the ground.
Coordinating the International Community in the Aftermath of One of the Largest Typhoons Ever Recorded
Originating near Micronesia on November 3, 2013, typhoon Haiyan caused widespread damage in Palau, the Philippines, Viet Nam, China and other areas. The force with which it struck the Philippines was among the strongest ever recorded. At the time of landfall, it had a central pressure of 895 hectopascals, a maximum wind speed of 87 meters per second and a maximum instantaneous wind speed of 105 meters per second. The violent winds and massive waves caused widespread destruction, including 4.1 million displaced persons, 16 million other victims, 11 million collapsed homes and 8,000 people dead or missing. The images distributed by the on-site media transmitted to the world vivid images of how destructive the typhoon was. Houses and lifelines were annihilated, and there was no time to question whether aid was needed from the international community given the conditions in cities where food, water and other daily necessities had almost all been destroyed or swept away.
A young girl holds a balloon with a message expressing gratitude to the Japan Disaster Relief Team.
The United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), which upgraded its typhoon alert early on, decided to dispatch a United Nations Disaster Assessment and Coordination (UNDAC) team prior to the landfall of the typhoon, and sought deployable members on November 5. At the request of UNOCHA, Japan dispatched one person to the Philippines on November 7, followed subsequently by another. The UNDAC team assessed the damage caused and issued situation reports while managing incoming and outgoing aid teams from the Philippines and other countries, and providing information to the teams.
As many of the aid teams arrived without sufficient information, the UNDAC team played a vital role for combining efforts. The operations in the disaster area after the large-scale destruction could not be handled by one country, much less one team alone, and it became clear that coordination was needed. To date, there are only four Japanese people registered with UNDAC, and few people from Japan have ever participated in UNDAC actual missions. On this occasion, two Japanese people joined the UNDAC team, playing a role in international coordination and forming a partnership with the Japan Disaster Relief (JDR) medical team, two results that will continue producing positive effects going forward.
An aspect worth noting in the international cooperation was the cluster approach that the UN has been advocating. The cluster approach is a way to coordinate the operation activities carried out by the affected country and aid personnel from other countries by sector, of which there are 11. After the disaster struck on this occasion, there was a pressing need for medical assistance, and a health care cluster was formed early on, led by the Philippine Department of Health and the World Health Organization (WHO). On this occasion, the JDR medical team joined from the initial stage and worked to assess local conditions and ascertain the needs of the Philippine side. Without information sharing and coordination at those cluster meetings, the many aid teams that had assembled in a short period from overseas would have had trouble commencing their program as rapidly as they intended at the chaotic disaster site. In addition to providing care in the medical tent at the base site in the city of Tacloban, the Japanese medical team provided mobile medical care in the disaster area of Basey, Samar and the vicinity of Tacloban, loading their medical equipment into vehicles and travelling. Although many medical teams gathered in Tacloban, a number were unable to conduct mobile health care due to limited transportation means, medical supplies and testing equipment.
Emergency Aid Team Dispatch Operations Start with Domestic Mobilization
On November 10, the Government of the Philippines made a request for medical teams to be dispatched. On that very same day, the Government of Japan issued the decision to dispatch. A preliminary review of the situation had already begun for Tacloban, where the greatest damage had been sustained, and with that decision, the process got underway to make a dispatch as soon as possible to Tacloban.
The most important thing in the dispatch procedures was sending out the call to people registered on the JDR medical team roster. There are 1,140 people currently registered in all, and they were contacted by fax and e-mail, and the team members were selected from among the people who responded. Before making the call, an assemblage time of all members had to be set, and that required flight arrangements. For the first team dispatch, a charter airplane leaving from Narita Airport for Manila at 3 p.m. on November 11 was arranged, and an assemblage time was set for 12:30 at Narita Airport, two and-a-half hours before departure. The call went out to the registered people at 8:45 p.m. on November 10 with a deadline for response of 11 p.m. and the selection to be made by midnight. Although the registrants had already confirmed the possibility of emergency assistance leave with their workplaces and families, they needed to confirm whether they could be at the airport by the designated time, and November 10 was a Sunday, which doubtlessly made coordination difficult for many.
It was imagined that among even those with the full intention of going, there would be many who could not meet the short lead time and not join, but we had no choice in setting the parameters given the need to start work on the ground as soon as possible. Even with the abrupt notification, more than five times the nearly 20 people needed fortunately responded, making it possible to assemble a team. Without the efforts of the registrants to be prepared to mobilize at any time when there is a disaster, we would not have been able to act. I felt very proud of the sense of mission that these registrants have.
With this dispatch, the greatest challenge was how to transport more than 25 people and five tons of medical equipment and supplies.
The airport at Tacloban had sustained damage and getting there by airplane on a normal flight route would have been difficult. In addition, we were not able to secure the vehicles at Tacloban needed for our mission, so we had to choose a route with which we could procure vehicles even if it took more time. From the number of options we had, we wound up flying to Manila and from there going to Cebu on a domestic flight. In Cebu, we divided our team into two, with three people moving on to Tacloban by military aircraft as the advance team. On location, they gathered the information needed to start activities quickly and to coordinate, including selecting a base of operations and finding a place to stay. The rest of team procured ground vehicles in Cebu and a route was selected in which they moved by ferry to Ormoc on Leyte Island, a five-hour marine journey, and then took an overland trip of about 170 kilometers before arriving at Tacloban, the destination. The advance team arrived in Tacloban on the 12th, and the others arrived—after a number of incidents along the way—on the evening of the 14th. Work began right away on setting up the tents, and the next day, the 15th, the clinic opened as the first in the city established by an overseas aid team.
In the dispatch process, every step had difficulties: obtaining transportation, ensuring communication and procuring supplies. Even those foreign aid teams who arrived at the airport in Tacloban by military aircraft had difficulties in securing transportation means for the subsequent land trip. The importance of logistics has long been debated, and on this operation, team members received again an awareness of how important logistics indeed are. When the first JDR medical team came home and the second left Japan, the Japan Self-Defense Forces (JSDF) provided a C-130 aircraft for transportation between Manila and Tacloban, greatly reducing the transit time. In addition, the medical team and the JSDF team shared local information. This partnership with the JSDF in the disaster area had the benefits of stronger logistics, better safety and information sharing, which yielded better results down the road.
The Medical Team Framework as a Platform
A medical team volunteer (right) crouches down so as to be on the same level as the patients.
The JDR medical team was launched in 1982 with JICA as its secretariat. Since then, a total of 63 teams (approximately 1,000 people) have been dispatched to 30 countries, up to and including the dispatch for typhoon Haiyan in the Philippines. The medical team is composed primarily of individuals who register as volunteers without affiliation to private sector medical institutions or the like. Periodically, the volunteers attend training sessions, developing a capacity to respond when needed. Through a history of more than three decades since its inception, the JDR medical team has accumulated experience and knowledge of working in the field, and that intellectual property is passed on to new members. The administrative framework of the medical team is a platform on which people who do not necessarily have contact on a daily basis can communicate with others in medical or non-medical fields. Comprising registrants with various specialties, this platform forms an integrated force prepared for medical activities in the field.
A variety of curricula provide member training that imparts knowledge necessary for the field. Besides training in various specialist medical fields and industries, members receive training in areas such as logistics, "bedside manners" and how to handle problems that may come up. The attitude to take when working in the field is cultivated through such training, and proved useful in many situations in the Philippines during this work. Many innovative techniques have been developed, such as how to provide health examinations and treatment in a polite way while respecting the patient's feelings, adjusting relative height so as to be at eye level with the patient, giving adequate consideration to women and children, using visual aids to assist with explanations and creating posters in the local language. Although the stint in the Philippines did not last long, such experiences gradually bond disaster victims and team members, creating trust relationships, which I think lead to even stronger efforts going forward. After returning to Japan, many of the volunteers said that they were encouraged by the expressions of gratitude and smiles of the victims.
A medical worker looks at images on a computer screen that are transmitted wirelessly from the examination table (back).
During this aid effort, the advanced level of clinical examinations and testing equipment was one of the special characteristics of the JDR medical team. The new X-ray system which enables workers to obtain images with electromagnetic waves, echocardiography, and other testing equipment improved the quality of the team's activities. Also, with this state-of-the-art equipment, the team offered other teams medical testing services, promoting cooperation with other teams on the ground. The clinical examination setup that was used reflects findings that came out of various study groups composed of registered members. The preparations that the Japanese medical team did before the disaster were a valuable resource that the team drew on during efforts in the field.
Seamless Assistance for Establishing a Disaster-Resilient Community
The efforts by the series of emergency aid teams ended the following month, but additional time was needed before residents in the disaster area could return to their former lives. To secure a living infrastructure for disaster victims in the shortest possible time, restore and rehabilitate the community, and work toward a resilient community, much cooperation from the international community is still needed.
One of the objectives of these efforts was to provide seamless assistance. Immediately after a disaster, the purpose of emergency aid is to respond to urgent needs, but such aid alone is not adequate for disaster assistance. I have come to understand the importance of passing the torch along to those at the next stage in a smooth manner. Dispatching the expert team for early reconstruction therefore held a great significance in the overall effort. A partnership between Japanese Overseas Cooperation Volunteer nurse active on location, technical cooperation experts in the medical care field and the medical team not only contribute to activities of the medical team, but is, as I understand it, significant in creating a base for future efforts. In particular, the cooperation volunteer nurse who had herself evacuated to Manila as disaster victims returned to Tacloban, energetically cooperated with mobile health treatment and other activities of the medical team, a contribution that shows the potential for new ways of combining types of Japanese assistance.
The medical team shows posters they made in the local language to educate the general public about sanitary practices.
One issue that became apparent in the series of medical team operations was determining the extent that the emergency aid team, dispatched with the objective of responding to acute medical needs, should be involved in public health during a disaster. While the teams were on location, the doctors provided administrative recommendations for the medical team, but going forward, a separate venue should be provided to debate and study this issue.
In closing, I would like to use this space to express my appreciation for all who provided cooperation. The scope of the operations of the emergency aid team is not limited to activities on the ground. We all greatly appreciate the contributions of administrative people who provided backup support for our efforts when needed, and of the many registered members and those around them who provided support. With daily preparations, work in the preliminary stage immediately before dispatch, and efforts when working on the ground, they showed true commitment without which our mission could not have been accomplished. The Secretariat, in its position to administer this platform, should continue to question what should be done to further develop these experiences.
About the Author
His positions at the Japan International Cooperation Agency (JICA) include working at the JICA Philippines Office; director of the Social Development Study Division No. 1; deputy director general of transportation, urban and rural development of the Social Development Department; deputy director general of peace building and urban and regional development of the Economic Infrastructure Department; executive advisor to the director general of the Financing Facilitation and Procurement Supervision Department; deputy director general and executive advisor to the director general of the Operations Strategy Department; and more. He took his current post in July 2012. He is from Tokyo.