Independent Appeal: Hope amid the wreckage of the tsunami

In the city of Calang in Aceh, only one building was left standing by the wave that struck two years ago today. But the work of Merlin, one of the charities in our appeal, has helped the striken survivors rebuild their lives

When the tsunami struck two years ago today, Syamsidar Harahap, a midwife, had just delivered a baby girl at a health centre near Calang, on Aceh's west coast. "I was just finishing the last stitch on the mother when all of a sudden the water came in," she says. "People outside were yelling, and I ran, we all ran."

Everyone who was in the clinic, in the village of Lageun, headed for the mountains that overlook the heavily populated coastal plains. Syamsidar made it to safety, but a fellow midwife and a senior nurse were killed. So was the baby and her mother.

Syamsidar took refuge in one of the Indonesian military camps that dotted the area, then at the heart of Aceh's long-standing civil conflict. After three days she returned to her village, Lhok Timon, which was completely destroyed. Her house and all her possessions were gone, but she managed to find her husband and two sons, aged seven and 10, who were alive. When she saw them, she says, she forgot about everything she had lost. "I was feeling so happy that I just wanted to cry," she says.

The family foraged a small quantity of rice and water from the rubble. They waited for help to arrive, but none came. They decided to leave isolated Lhok Timon and walk to the nearest town, Lamno, mid-way between their village and the provincial capital, Banda Aceh.

The 65-mile journey took seven days, with nothing to eat but under-ripe coconuts. They slept "where we could, in the mountain, wherever". They saw helicopters carrying relief supplies fly overhead. "We hoped they would drop food, but they didn't," says Syamsidar.

For three months her family were nomads, staying in Lamno, then Banda Aceh, then Medan, the provincial capital of neighbouring North Sumatra. At times they lived with friends and family, at times in a tent. In March 2005 they returned to Calang, where Syamsidar had been offered a job at a temporary clinic built by Merlin, a British charity that has played a leading role in the reconstruction of health services in Aceh.

Aceh, on the northern tip of Indonesia's Sumatra island, took the brunt of the Indian Ocean tsunami. Of the 230,000 people who died, nearly 170,000 lived there. Settled areas covering hundreds of square miles were flattened, and 600,000 people were made homeless.

Worst hit was Aceh's west coast, which was close to the epicentre of the massive underwater earthquake that triggered the tidal waves on Boxing Day 2004. On the coastal plains, which were peppered with fishing villages and rice paddies, entire communities were wiped out, along with all the infrastructure - houses, roads, bridges, schools and health centres.

In the aftermath, along with shelter, food and clean water, many survivors required medical attention. But the health centres were gone, along with the equipment and medical supplies. Many health professionals had been killed.

Field clinics and mobile health teams staffed by local and international aid organisations filled the gap for a while, meeting immediate needs. Then it was time to confront the mammoth task of reconstructing Aceh's healthcare system from scratch.

Merlin, which is one of the charities supported in The Independent's Christmas appeal, has been working in four of the province's worst-affected districts. Over the past two years it has built or rebuilt a total of 82 health centres, including small local clinics and midwife posts.

It has also provided additional training for 548 doctors, nurses, midwives and other medical staff. Aceh's health service had suffered from years of under-investment, and most professionals had received no follow-up training since qualifying.

Enamul Haque, Merlin's project medical coordinator for the Aceh Jaya district, where Calang is situated, says it is difficult to retain doctors, so the strategy has been to focus on improving the skills of health staff like midwives and nurses, who are more likely to stay in the area.

Kurnia Rahman, from Banda Aceh, is one of the midwives to have completed Merlin's course in safe delivery techniques. Kurnia, who runs a mobile ante-natal clinic, says she now has "a better understanding of how to care for the mother".

In Calang, only one building was left standing in the wake of the tsunami. Beforehand, 50,000 people lived in Calang. Only 5,000 survived. In Aceh Jaya district, 42 of the 49 health centres were damaged or destroyed. They included the one in Lageun where Syamsidar worked. "There was nothing left, not a wall, not a cupboard, nothing," she says. "It was completely flattened and there was barely a floor left. And there was no equipment left either, no medical tools, no medicine."

Syamsidar now runs a new health centre in nearby Lhok Buya, which was completed by Merlin only last month. It serves four remote villages, whose inhabitants would otherwise have to travel to Calang. With health facilities still limited, local people depend on the centre, which employs a doctor, 11 nurses, eight midwives, a nutritionist and a community health worker.

Syamsidar's family are about to move into a new home in Sayeung, near their home village, where the land is still too muddy to build on. She is glad to have a job, and so is her husband, who works for an international agency. She says that "it's only with the grace of Allah that I survived".

She still finds it hard to talk about the events of 2004, when she did not eat or sleep for three days before she found out her family were alive. It turned out the boys had warned their father of the impending danger, after they saw the sea recede while they were playing outside.

Syamsidar still misses her two colleagues from the clinic. "It was really sad because there were only 10 of us working there and we were all very close," she says. She was also upset to learn that the last baby she had delivered at Lageun was dead. "It was a healthy baby girl, but only the father survived," she says. "I didn't know any of this until three months later, when I met up with the father and he told me."

While relief supplies poured into Aceh immediately, some remote areas did not receive airlifts of food and water for more than a week. Her family were among thousands of survivors who had to trek through the jungle for days to reach help.

Their hardship did not end there. When Syamsidar returned to Calang, leaving the children with her sister's family, she and her husband lived in a tent for four months. There was no sanitation, and no privacy. "It was very tough," she says. They then spent 10 months in a temporary "barracks" - a communal block built to house displaced people. It had no electricity, and conditions were cramped. She says: "I'm glad to have my own house again."

They are fortunate. In Aceh, fewer than half of the estimated 128,000 homes required to accommodate survivors have been built, and some people who have been rehoused complain that substandard materials were used. Certain homes built by international aid organisations had to be demolished and rebuilt.

Meanwhile, 50,000 people remain in the barracks, where large families live in one room, and washing and toilet facilities are woefully inadequate. According to a recent poll, more than 70 per cent of Acehnese believe that reconstruction is proceeding too slowly. The senior Indonesian official overseeing the rebuilding effort, Kuntoro Mangkusubroto, has blamed a lack of coordination between government departments, and issues relating to land titles, most of which were washed away. Indonesian authorities also say that some people are choosing to stay in temporary accommodation, where they receive guaranteed food and a daily stipend.

Within the wider community, chronic health problems persist, particularly malnutrition among babies and small children, upper respiratory infections and diarrhoeal diseases. The latter are caused by poor water and sanitation, which Merlin has been working to improve. It has built or rehabilitated 300 wells, and set up seven rainwater harvesting systems, on the roofs of mosques and health centres. Clean water is being piped to villages from mountain springs.

The agency has also launched a malaria prevention campaign, distributing more than 170,000 insecticide-treated bed nets in tandem with community education, and has played a key role in a polio eradication programme.

"The tsunami presented a challenge to aid agencies like no other," says Panos Katrakis, Merlin's operations co-ordinator in Indonesia. "Because it was matched by one of the greatest flood of donations ever known, it raised expectations that relief could be prompt. After two years, perhaps half of the reconstruction in Aceh has been completed. While some might say this is too slow, there is simply no other disaster to which it can be compared. In places like Calang, there was nothing, literally nothing, to put back together."

Mr Katrakis believes that mental health problems will have to be tackled more effectively in the longer term. "It's well documented that there is a lot of post-traumatic stress disorder among the population," he says. "It's the most important issue that is not being comprehensively addressed, because most organisations have targeted the immediate medical needs."

In the Calang area, transport remains a major challenge. The coastal road to Banda Aceh, which was destroyed in the tsunami, has been rebuilt but can still be impassable in the rains. The alternative route, through the mountains, takes 14 hours.

At the health centre in Lhok Buya, a steady stream of patients passes through. On a recent day, they included Riza Nurdin, who had brought in his seven-year-old son, Irfan, suffering from a sore throat and fever. Riza said that it was a relief to have the new clinic nearby, "because going to Calang, although it's not far, it can be stressful bringing a sick child there, especially in the rain".

Syamsidar says that life is slowly getting back to normal. But her two boys still take fright whenever there is an earth tremor, which happens frequently in Aceh.

Asked what has been her most difficult challenge in the last two years, she replies: "Having to start all over again from the beginning, for everything."