BANDA ACEH, Indonesia -- From the air, the tsunami's mud-colored inundation zone gave northwestern Sumatra's shoreline the look and smell of an untended wound a hundred miles long.
Richard Brennan, a physician who heads health programs for the International Rescue Committee, thought two things as he looked down from the Navy helicopter. One was that the coastal villages were not only destroyed, but had also been swept clean of debris in a way that never happens with a hurricane or tornado. The other was that there were no people.
Richard Brennan, a physician who heads health programs for the International Rescue Committee, was part of a team dropped near Calang, on Sumatra.
(David Brown -- The Washington Post)
Where were the people? It was a question Brennan had to answer before he and his colleagues could hope to do much good for the survivors of the tsunami that followed an undersea earthquake on Dec. 26, killing more than 150,000 people in 11 countries.
Two weeks after the event, the number and location of the tsunami's survivors here remain a mystery. The IRC, like other relief groups, is moving ahead on the assumption that its efforts will find, or attract, people who need help.
On Saturday, organization members dropped a physician, a water-and-sanitation engineer and a team leader near Calang, a largely destroyed town about 60 miles south of Banda Aceh, the provincial capital. The Indonesian military has set up a field hospital there, and several relief groups have also arrived. There are reportedly thousands of displaced people nearby. The IRC sent a second team to the Calang area on Sunday.
The IRC presence in Banda Aceh has increased from two foreign nationals last Tuesday to 24. The organization plans to ultimately have six teams that will each include a leader, a nurse, a physician, a water-and-sanitation engineer, a child-protection specialist, a local professional, an interpreter and two drivers. A Norwegian organization is providing shelter expertise.
In the last week the IRC has rented four houses and hired 10 cars and drivers. It took delivery over the weekend of three wood-hulled, diesel-powered fishing vessels, each with a captain and five-person crew. Along with six just-purchased Zodiac inflatable boats and 40-horsepower outboards, the vessels will form a mini-navy to supply the organization's planned operations on the west coast.
Despite the frenzy of activity, IRC members this past week have felt under extreme pressure to make substantial contact with the tsunami's victims. The French group Doctors Without Borders -- sometimes criticized for not cooperating with other organizations, including the United Nations, in planning a coordinated disaster response -- has set an exacting standard for speed, here and elsewhere.
Two days after the tsunami, Doctors Without Borders had a clinic running in Banda Aceh that was staffed by two doctors and three nurses. It opened a similar clinic in the devastated city of Meulaboh 110 miles down the coast, arriving two hours before the Singaporean military, which went to set up a field hospital.
Last week, as the IRC team assembled on the floor of the first rented house -- a large table and chairs have proved difficult to obtain -- the relief coordinator, Gillian Dunn, reported on the gist of a phone call she'd just had with headquarters.
"We're getting pounded from New York. We need to start delivering services," said Dunn, a geologist by training who has worked on IRC missions in Africa and the Balkans. A theme of many news stories was that relief goods were pouring into Indonesia but not getting to survivors.
"I'm sorry that we have to pander to what the media is saying, but we have to get into the field today," she said.
Some aspects of the relief effort are expanding so quickly that it is not clear the services can be well used. The Australian military has a field hospital in Banda Aceh, and both the International Committee of the Red Cross and Danish emergency services are constructing their own. A Polish surgical team has been advised not to come, as its services probably will not be needed.
The Navy's relief operation, which is using more than a dozen helicopters, has been a haphazard affair. Pilots look for large groups of people visible from the air. Those people are interviewed briefly and given large plastic jerrycans of water and boxes of food. Sometimes, they bring out injured victims, whom the physicians then examine and treat or evacuate, if necessary. The injured, and their accompanying relatives, are then interviewed to determine where they came from and how many fellow villagers fled with them. In this way, a jigsaw-puzzle picture of the west coast is starting to emerge.
Brennan, an epidemiologist and emergency medicine physician who is a leader in the new specialty of emergency public health, has spent much of the last three days trying to get members of his staff into areas outside Banda Aceh, where they could assess survivors' needs systematically. The main impediment has been access to helicopters, for which relief organizations and journalists are competing.
"NGOs are going to have to be satisfied using other people's information," Michael L. Bak, head of the U.S. Agency for International Development's conflict prevention and response team, said Saturday as he stood between two alleys of relief tents at the military airport, fielding requests for helicopter rides.
Some information came from two physicians who had landed at a village called Tnwikayee: Its 250 residents have been joined by 800 people from coastal villages.
Lt. Cmdr. Ramon Cestero, 35, a general surgeon from San Diego, examined a man with both bones of one of his lower legs fractured. The leg had been splinted with sticks and wrapped in dirty cloth and mud. The man was evacuated. So was a woman who was eight months pregnant. Two midwives from the coastal villages had died in the inundation.
Cestero also treated about five people with "trench foot," a condition made infamous in World War I, when soldiers stood in cold water for days. Prolonged soaking and walking can cause skin to soften and slough off, in some cases down to muscle and tendon. Cestero bandaged the feet, which he said were not infected. But he said the encampment lacked the capacity to supply follow-up care and supplies such as bandages.
"There are rafts of opportunity," said Lt. Cmdr. Commander Scott Cota, 39, a family practitioner from Chula Vista, Calif.
"We'll be glad to put you guys in there," Cestero said.
What they couldn't commit to, however, was a promise to extract an IRC assessment team. Carrying people back who weren't round-trip passengers took up space that might need to be used for medical evacuations of tsunami survivors.
"My only concern is putting two teams on the ground with no way of getting them out," Brennan said.
Over a cup of coffee Saturday at the airport's makeshift and very busy cafe, he made a list of four different destinations. He had put the matter before the whole group at the regular 7 p.m. meeting. All he knew was that another IRC disaster assessment team would go somewhere the next morning.