Lessons from the Sichuan earthquake

At 2:28pm on 12 May 2008, a powerful earthquake struck China’s Sichuan Province. Some 87,500 people were killed, 45.5m affected and 14.4m displaced. Economic losses were estimated at $86 billion, with 21m buildings damaged. According to a recent DFID report, the earthquake drove an estimated 10m people below the poverty line, with overall poverty in badly affected areas increasing from 11% to 35% of the population. Despite the extent of the devastation, this earthquake was not China’s first experience with natural disaster. In fact, four of the ten most destructive earthquakes on record have occurred in the country, giving China extensive experience in coping with such emergencies – experience that was put to good use in the response to the Sichuan earthquake.

The role of the state in the earthquake response

The response to the earthquake was dominated by the Chinese government. Although the government invited international humanitarian assistance, few international NGOs engaged directly in emergency response, for a number of reasons. First, Sichuan was probably not a priority for organisations already involved in responding to concurrent disasters including Cyclone Nargis, which made landfall in neighbouring Myanmar just ten days before the earthquake. Second, lack of access and local experience may have prevented some INGOs from initiating operations in Sichuan. Third, in the context of an economic boom with over 10% annual growth since 2002, it is possible that international actors believed that the Chinese government had the capacity to respond. Although full recovery remains a distant reality for many, the Chinese state-led response to the Sichuan earthquake has generally been characterised as efficient and comprehensive. According to the government, despite the extent of the devastation, disease outbreaks were avoided, populations in danger from subsequent flooding or landslides were safely relocated, medical services were generally restored rapidly and a return to the baseline mortality rate was achieved relatively quickly. The direct provision of aid by the Chinese military was a key element in the emergency response phase. Officials reported that, within 14 minutes of the earthquake, the central government had dispatchedthe People’s Liberation Army (PLA) to the affected areas, and within days 113,000 soldiers and armed police had been mobilised. Of the nine government working groups set up for the relief effort, six were supported by the military.

One challenge to learning from the earthquake response is that data has not been made widely available by the government. For example, in the health sector Xinhua News reported that, as of late May, 45,000 medical workers were contributing to care following the earthquake, with 650 devoted to epidemic control. A Health Ministry representative also announced that the relief effort had eliminated the risk of a disease outbreak, and had even brought about a decline in infectious disease incidence in the worst-hit areas, compared to previous years. Unfortunately, evidence is not offered to support this statement, or similar statements in other sectors. Information from the few active organisations (including Médecins Sans Frontières, UNCEF, AmeriCares Foundation and Oxfam-Hong Kong) only capture the relatively small-scale activities of these agencies.

While working for a US-based organisation in two of the worst-affected counties in Sichuan directly following the earthquake, over the course of three months I encountered no other international NGO working on the ground. This is consistent with the general pattern of minimal INGO engagement in the emergency response. To accomplish our mission to re-establish referral care and provide urgently needed medical supplies, I coordinated all efforts in direct partnership with government agencies and the provincial and county-level Health Bureaus. In my day-to-day work, it became clear that the overall success of the government’s response was made possible by its authoritarian position, its experience of managing large population movements and natural disasters and the rapid deployment of the military. These three elements enabled the government to avoid or minimise many of the problems common to disaster response.

Mitigation strategies included an immediate emphasis on controlling infectious disease through widespread medical care and surveillance, the provision of tents for shelter (albeit insufficient in number at the outset and eventually upgraded to temporary, prefabricated structures), maintenance of security and the rule of law through substantial police and military deployments, traffic and supply-chain management at the regional and local level, as well as the triage of patients, the deployment of qualified volunteers and the efficient management of in-kind donations. For instance, as large quantities of unsolicited foreign medicines and supplies accumulated in airport warehouses (donated primarily by organisations without a physical presence in Sichuan), the provincial health bureau coordinated with the government body in charge of volunteers to assign pharmacology students on holiday to sort, translate and test these donations. Additionally, the movement of people was strictly regulated in the affected areas. For months, police and military roadblocks prevented non-essential personnel from entering the disaster zone (personnel also sprayed traffic passing through with disinfectant in the belief that this would reduce the risk of disease). These authoritarian measures largely succeeded in saving lives and reducing the secondary disasters of disease, flooding and damage from strong aftershocks; however, these results came at the expense of personal liberties, access to affected areas and, in some cases, the unquestioned acceptance of sub-standard living conditions.

Although the Chinese and foreign press have reported outrage among some parents who lost children in collapsed schools, the overall reaction of direct beneficiaries as regards the government aid they received was outwardly positive. Affected populations worked to reconstruct markets and establish a home in their government-issued tents, while awaiting further instructions from the local authorities. This differs from my experience in the North-West Frontier Province (NWFP) in Pakistan following the 2005 earthquake, where there was an elevated sense of anxiety, especially in remote rural areas. For example, in the Allai Valley of NWFP (population around 100,000), insufficient assistance saw virtually every family electing to migrate to camps at a lower elevation or moving to live with relatives elsewhere. Although some seasonal migration takes place annually in the region, post-earthquake migration occurred on a large scale, and was even encouraged by some NGOs. By contrast, the millions of people affected by the Sichuan earthquake, even those living in mountainous rural areas, stayed in close proximity to their destroyed homes.

In the days and months following the earthquake, many familiar disaster response tools and mechanisms were not utilised: there were no cluster meetings, and the Sphere Standards and other guidelines common in the humanitarian community were not in evidence. Instead, a coordinated response was achieved through the government’s hierarchical approach, and decisions followed the chain of command from national to provincial and down to the prefecture and county levels. In terms of coordination, after working side-by-side with my health bureau counterparts daily for nearly three months, I did not observe a single complaint about unwarranted time spent meeting donors or international aid groups (though there were complaints about the unaccompanied relief material pouring into the provincial airport and bonded warehouses). Unlike the direction eventually chosen by the government of Pakistan following the 2005 earthquake, the Chinese authorities did not immediately establish a parallel relief agency. Instead, relief activities were partitioned along the lines of the cluster approach, with the formation of working groups roughly corresponding with government agencies – an important approach for ongoing coherence in policy and practice.

Another partnership strategy used in the aftermath of the earthquake which may prove a model for long-term recovery was the ‘twinning’ of several badly affected counties and cities with other Chinese provinces and municipalities. These partnerships aimed to assist affected areas with resources, personnel and moral support for recovery. Teams of doctors, public health professionals and sanitation and disease control experts were immediately dispatched to the affected partner county; a reported 1–3% of the annual gross domestic product of sponsor provinces was pledged towards long-term recovery efforts in the affected county for at least three years. For example, Wenchuan County, the epicentre of the earthquake, was paired with wealthy Guangdong Province for long-term reconstruction assistance, including the provision of medical personnel to replace staff lost in the earthquake, and the training of Wenchuan-based staff in teaching hospitals in Guangdong.

The state-led response focused on efficiency in providing resources and services to the largest number of people possible. However, this came at a price; for instance, in order to get food to everyone who needed it nutritionally deficient instant noodles were provided for days on end in some locations. Shelter could not be manufactured quickly enough (despite temporary state seizure of suitable textile factories), resulting in up to 12 individuals sharing one family-size tent. The absence of water-borne diseases may actually be attributed to a culture of boiling water, rather than the government’s pervasive disinfection campaign. It is clear that action to protect against a secondary disaster did not come from abroad but from within China. Although the state deserves praise for its handling of the response, there are areas for improvement.

Lessons for the future

In the aftermath of every major recent natural disaster, from the Indian Ocean tsunami to the Pakistan earthquake and even the cyclone in Myanmar, a deluge of assistance from international non-governmental organisations has had a significant impact. This was not the case in China, where very little international assistance was provided and the response was very largely state-led – a vast relief effort launched by the Chinese government and carried out by hundreds of thousands of soldiers, civil servants and civilian volunteers. The government’s approach to the emergency response was effective in several respects; the setting of clear criteria and appropriate restrictions on unsolicited in-kind medical or other supplies, for instance, led to the more efficient use of resources and eased the supply-chain bottlenecks common in other disasters of similar magnitude, and overall the response was crucial in saving many lives. At the same time, however, greater efforts could have been made to enlist the support of specialised international agencies in specific areas, including emergency shelter, livelihoods and health. In the health sector, for instance, very little attention was paid to psychosocial and mental health programmes, especially among elderly people, who may well have benefited from specialised support from the humanitarian community. Finally, although the state deserves praise for its handling of the response, a lack of transparency in terms of specific data and details of the response have concealed many of these successes, as well as obscuring areas for improvement.

Brian Hoyer is an independent consultant. His email address is brianhoyer@hotmail.com.