Community health and disease control programs focus on rehabilitating and installing water and sanitation systems, providing school- and clinic-based health and nutrition programs, promoting and carrying out mass vaccination and disease prevention campaigns and offering psychosocial support to address survivors' emotional needs.

Water and Sanitation
Clean water and functioning waste and wastewater disposal systems are vital to community health and disease prevention. In many communities, the tsunami destroyed or damaged water and sanitation infrastructure, increasing survivors' vulnerability to disease. Throughout the tsunami-affected region, the American Red Cross and its partners work with local Red Cross and Red Crescent National Societies to reconstruct the water and sanitation infrastructure and promote good hygiene practices in the affected communities. Hygiene promotion is an essential component of any health promotion program and is especially important after a disaster like the tsunami destroys infrastructure, leaves standing water and results in crowded living conditions.

Here are some examples of water and sanitation programs already underway.

Pulo Aceh, Indonesia, Clean Water and Sanitation
Over the last several months, the American Red Cross has begun a program to help 140 villages-more than 86,000 people-throughout Indonesia's Aceh province by rehabilitating and reconstructing wells and latrines and promoting hygiene. Five of those 140 villages are located on the island of Pulo Aceh, where the tsunami's waves forced survivors to camp for days in the hilltops above their former homes, depending on helicopter food drops for their survival.

In those five remote villages, the American Red Cross and the Indonesian Red Cross Society have helped establish and train water committees. These committees, with input from their community members, village leaders and Red Cross technical experts, choose which water and sanitation projects will best benefit their village and where the infrastructure-pipes, dams, springs, wells and latrines-should be located. This infrastructure complements permanent housing being constructed by the British Red Cross and meets survivors' immediate needs while they live in government-constructed temporary barracks. The committees also receive and provide training on hygiene promotion in their communities. This community-based approach to water and sanitation programs reflects the American Red Cross commitment to sustainable long-term development and helps ensure that projects meet the unique needs of each village. These water and sanitation projects will immediately benefit approximately 1,200 people in the five remote villages on Pulo Aceh island and ensure a safe water supply for future generations there.

Elsewhere, the American Red Cross is providing water and sanitation infrastructure for 11,000transitional shelters-including 5,000 shelters funded by the American Red Cross-that are being constructed by the International Organization for Migration (IOM) in Indonesia's Aceh province. This water and sanitation infrastructure project will serve homes, schools and health clinics and is expected to assist approximately 77,000 people.

An American Red Cross Worker's Mission to Motivate

Bimo Khairul Fahmi works as a project engineer for the American Red Cross in many villages, including those on the island of Pulo Aceh. Originally from Aceh, Fahmi was working as an engineer in another part of the country when the tsunami struck. He lost 17 family members, including two brothers, in the disaster. In his grief, Fahmi recounts, "I thought, what can I do for my father's village?" Eager to help with the recovery efforts, Fahmi and his wife left their jobs and returned to Aceh with their infant daughter. With a dedication characteristic of Red Cross workers worldwide, Fahmi remembers, "I thought I must go back to my father's village. They need someone who has engineering skills. Why could I not give a little of my skills?" At first, Fahmi recalls, the survivors in Pulo Aceh seemed discouraged. "They lost their families, they lost their livelihoods, they lost their spirit." But, he says, "I give them motivation every day." He tells the workers under his supervision, "You must wake up and do something for your country, do something for your village." Now that work is underway, Fahmi says, "The community supports me and I support them. We motivate the villages and the water committee for the leaders in the future because they will maintain everything, and they can be leaders from this village." Reflecting another aim of the Tsunami Recovery Program, Fahmi says of his water and sanitation work with the Pulo Aceh survivors, "We teach them to do this themselves."

Water and sanitation programs are underway in other tsunami-affected countries as well.

• In Sri Lanka, American Red Cross water and sanitation experts have conducted damage and needs assessments that are serving as the basis for programs focusing on rehabilitating wells, constructing latrines and providing clean water to houses and schools. These activities are designed to benefit approximately 774,000 people over the next four years as well as generations to come.
• The American Red Cross delegation in the Maldives has begun a partnership with national water board and Ministry of Health staff, local contractors and villagers to rehabilitate, construct and maintain sewage systems and water supplies. As part of this program, the American Red Cross will work to control rodent-borne diseases and implement a hygiene promotion program expected to benefit approximately 3,000 people.
• The American Red Cross has a water and sanitation expert working in Thailand and, in coordination with the Thai Red Cross Society, is beginning water and sanitation programs there. These will include rebuilding and rehabilitating wells and latrines and promoting hygiene. The programs will be carried out in several of Thailand's most affected southern districts.
• An experienced American Red Cross water and sanitation expert has begun work in East Africa. Together with local Red Cross and Red Crescent National Societies, the American Red Cross is designing water and sanitation programs to benefit tsunami-affected countries in this region.

Community Health and Nutrition
The American Red Cross has developed a partnership with the World Food Programme to establish clinic- and school-based educational and development programs that will complement food distributions. Such programs include health, nutrition and hygiene education; water and sanitation; and livelihood restoration. The integrated program also provides access to larger health initiatives, such as immunization campaigns. Activities will promote awareness and provide services for school authorities, parents, caregivers and communities about the importance of good health and nutrition practices for pre-school and school-aged children.

Psychosocial Support

A Teacher's Perspective

For the past 15 years, Gaeli Viteki has taught English in the village of Talala, on the southern coast of Sri Lanka. After the tsunami, Viteki saw firsthand the children's struggle to recover emotionally. She says, "We can understand the children's thoughts and feelings. We are very close to the children, as [if they were] our own children." She explains that, although most children continue to sing and play, the emotional impact of the tsunami affects their school performance. Viteki notes that some children lost parents or other family members, some lost belongings and some lost homes and still don't have permanent places to live. "With these problems," she says, "they come to school. . .. Because of these reasons, they can't do their work very well." Although school was not in session when the tsunami took place, the waves had washed over the school grounds, and some children felt unsafe returning to school. After the tsunami, American Red Cross workers trained the teachers to provide psychosocial support to their students through activities such as helping the children paint murals with positive messages on the walls of their school. Viteki says the paintings help teachers and students feel happier at school. The students, she says, "want to express their own ideas through these pictures. I think it is quite helpful to rebuild their minds through these pictures."

The critical needs of tsunami survivors go beyond food, water and shelter. Many survivors lost loved ones, homes, belongings and their sense of place and normalcy. To help families and communities recover psychologically and socially, the American Red Cross, together with local Red Cross and Red Crescent employees and volunteers, facilitates community and school activities, leadership strengthening and creative expression. By training teachers, local leaders and permanent members of the community-including Red Cross and Red Crescent National Society volunteers-to provide psychosocial support, the American Red Cross helps to ensure that programs will continue in the future. Through individual and group activities, survivors can express their feelings, recount their experiences and work together to reestablish their communities' well-being.

In Sri Lanka, the American Red Cross has begun a comprehensive psychosocial program to benefit approximately 200,000 people in the southern and western provinces. Together with the Sri Lanka Red Cross Society, the American Red Cross:

• conducts community focus groups.
• helps plan ceremonial activities that will help reestablish a sense of community.
• establishes community- and school-based psychosocial support programs in villages andinternally displaced persons (IDP) camps throughout the provinces.
• works with the Sri Lankan Ministry of Education to develop a psychosocial curriculum for nation-wide use.
• trains Sri Lanka Red Cross Society workers, community leaders (including leaders in IDPcamps) and more than 2,000 teachers-including all new teachers graduating from theNational College of Education-to provide psychosocial support and training to others.

In Indonesia, American Red Cross psychosocial experts are working with the Indonesian Red Cross Society and institutions of higher learning to design a nationwide psychosocial curriculum. Their comprehensive psychosocial program will benefit more than 216,000 people in 172 communities in Indonesia's Banda Aceh and Aceh Besar districts. The program is designed to train Indonesian Red Cross Society volunteers, teachers and community leaders and focuses on building community resiliency. It will be implemented by Indonesian Red Cross Society employees and volunteers, with technical assistance from the American Red Cross.

A similar comprehensive program has begun for 38 islands in the Maldives as well.

Helping Reestablish Community Traditions

Along the coast of Aceh Besar in Indonesia, the villages of Pasi, Menasah Ihokand Pudeng were virtually washed away by the tsunami. A bridge that once led to their villages now leads into the ocean. Village residents, whose numbers decreased from more than 2,000 to 400 after the tsunami, were forced to move further inland. The loss of homes, loved ones and the actual land where their villages once stood has had a serious impact on their psychological wellbeing and sense of community. American Red Cross and Indonesian Red Cross Society employees and volunteers consulted village leaders to learn what community activities they enjoyed prior to the tsunami. They then helped the villages to hold such activities again. The activities include children's boat races, inter-village soccer matches, tug-of-war and community meals. Sitting down together in the temporary mosque that also serves as a community center, adults watch as children perform traditional Acehnese music and songs they have composed about the tsunami. Through these types of activities, the American Red Cross and its Indonesian Red Cross Society partners are helping communities recover and move forward together.

Disease Control
One of the biggest concerns following the tsunami was preventing the spread of infectious diseases. Crowded conditions in relief camps could be a perfect breeding ground for diseases like measles and polio. During the emergency response phase, the American Red Cross vaccinated survivors-particularly children, who are most vulnerable to disease. Disease control efforts continue in the recovery phase.

The Measles Initiative

Begun in 2001, the Measles Initiative is a long-term commitment to decrease measles deaths by vaccinating children in high-risk countries. Measles is the leading vaccine-preventable child-hood killer in the world. Each year, 23 million suffer and die from the disease. Measles Initiative partners include the American Red Cross, the United Nations Foundation (UN Foundation), the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO)and the United Nations Children's Fund(UNICEF). Through the Measles Initiative, more than 200 million children have been vaccinated in 33 African countries, preventing more than 1 million deaths. Now the Measles Initiative is expanding into Asia as well.

Due to its lead role in establishing the Measles Initiative in Africa, the American Red Cross had partners and trained experts who could help prevent the spread of measles in the tsunami-affected region. The same successful model that the Measles Initiative has used to vaccinate more than 200 million children in Africa since 2001 is being employed in areas affected by the tsunami.

Another highly contagious disease, polio, had been virtually wiped out in Indonesia. After the tsunami, however, it reemerged as a serious health concern. The American Red Cross and its Measles Initiative partners have conducted repeated mass vaccination campaigns to prevent the spread of polio.

The American Red Cross and its partners are providing measles and polio vaccinations, vitamin A and de-worming medication in Indonesia, Bangladesh, Somalia, Kenya, Tanzania, Myanmar and the Maldives. These programs in these countries are targeted to reach 105.1 million people by 2007. The American Red Cross is also distributing insecticide-treated bed nets to protect people, especially children under five, from mosquito-borne malaria.

In 2005, the disease control portion of the Tsunami Recovery Program-

• reached 1.2 million children under 15 with measles and polio vaccines, vitamin A and de-worming medication in Indonesia.
• conducted "mop up" polio campaigns (which include house-to-house visits to immunize children who were not vaccinated in the initial campaign) in areas of Indonesia that had low polio vaccine coverage.
• helped provide emergency stockpiles of malaria control materials throughout Indonesia.
• In Tanzania, provided 6.6 million children under five with follow-up measles vaccines, vitamin A, de-worming medication and insecticide-treated bed nets.
• vaccinated 150,000 children under 15 in the Maldives against measles and rubella.
• reached 3.5 million children under 15 in Somalia with measles and polio vaccines, vitamin A, de-worming medication and insecticide-treated bed nets.

During 2006 and 2007, the American Red Cross and its partners will continue to provide immunization and other disease control in Bangladesh, Indonesia, Kenya and Myanmar.