JAKARTA, Indonesia, Jan. 22 -- The massive relief operation along the remote west coast of Aceh province, one of the areas hit hardest by the Dec. 26 tsunami, has brought food and medicine to most large population groups but continues to be hampered by insufficient coordination nearly a month after the tragedy, according to a draft report that offers the first detailed assessment of the effort.
Highly trained medical professionals abound -- at one point there were 20 surgeons in the west coast city of Meulaboh -- but primary health care workers are lacking, according to the report, compiled by 14 government and private agencies taking part in the work. There is an abundance of antibiotics but a shortage of dressings for wounds, stethoscopes and childbirth equipment.
Aid workers "do what they think is best, and sometimes a particular country or a particular agency may well send materials or equipment that may not be what is required at that stage," Rob Holden, worldwide operations manager for the World Health Organization, said in an interview in Jakarta, the Indonesian capital, on Saturday. "Or it may be that they haven't asked the wider question -- Is someone else sending that, do I need to send something else?"
The six-day survey, which was led by Holden, found that despite poor coordination, the number of cases of malaria, measles and diarrhea was lower than expected. Food was reaching most large population groups through civil authorities and the Indonesian military, but it was often not targeted at the people who most need it, such as pregnant women. Schools are ready to reopen in a few areas and markets are again selling locally produced food.
The report said that local and international aid groups needed to plan their efforts jointly. "If agencies . . . decide to set up an operation in a certain location, and you know nothing about it, it's very difficult to get coordinated," Holden said. The United Nations needs to send more personnel to areas with major concentrations of survivors, he said.
The report, which is still in draft form but was obtained Saturday, surveyed aid work at 25 sites along a 106-mile swath of coast where at least 35,000 people died and 125,000 were displaced. The survey did not include the area around the provincial capital, Banda Aceh, which was more accessible for aid groups.
Indonesia's official death toll now stands at more than 150,000. The country is a principal target of the largest humanitarian relief operation since World War II.
The 14 organizations helping to compile the report included two U.N. agencies -- the World Health Organization and the Office for Coordination of Humanitarian Assistance -- as well as the Indonesian and U.S. militaries, and private relief agencies.
Thirty-four people collected the information. They divided into four teams and operated from the USS Abraham Lincoln, an aircraft carrier.
Holden said there were "enough resources" in the coastal area "or in the pipeline. . . . "What we've got to do is make sure we better target the assistance based on need, to make sure we get the biggest impact."
The relief effort is now moving from saving lives to reestablishing primary health care clinics, he said. Field hospitals have recorded a drop from 120 to 30-45 patients a day, the report said.
Indonesian officials said that 44 of the province's health centers were destroyed. In some areas, 50 to 70 percent of the staff members died, Holden said.
Aid groups have largely been executing "hit-and-run missions, just basically to get supplies going," Holden said. "What we're saying now is, take a step back and start to prioritize."
Sanitation is also a significant concern, particularly because the rainy season will last two more months and the region has virtually no viable waste disposal systems, the report said. Clean water is available, but not in the quantities needed.
The devastation of road networks is hampering aid delivery, the report says. Holden said 57 bridges on the west coast were damaged or destroyed, and repairs will take time. Access by sea has been difficult because the tsunami destroyed ports. As a result, teams have delivered much of their supplies and personnel by air, Holden said.
With foreign military units, including those of the United States and Singapore, beginning to scale back operations or withdraw from Indonesia, the organizers are working to "civilianize" relief delivery operations, Holden said.
He noted that the United Nations, World Vision, Doctors Without Borders, Save the Children and Oxfam have helicopters in the region or on the way. He said he expected the international relief presence to continue into next year.
According to Indonesian officials, more than 50 international organizations and more than 8,000 volunteers are engaged in the effort. Separately, the U.S. military has 8,000 people in the area -- on land and at sea.
Holden said he thought the relief effort has generally gone well: "We have 150,000 people dead [and] several hundred thousand people displaced. . . . Of course it's chaotic. Have we managed to make sense of the chaos? . . . This has been a good effort."