Public health, emergencies and the humanitarian impulse.

The global response to the tsunami disaster in south Asia on 26 December 2004 has been overwhelming. Approxi-mately US 6 billion have been pledged in aid by citizens and governments, and authorities have offered military assis-tance and debt relief (W1). This outpour-ing of goodwill reflects the universality of the humanitarian impulse: an innate, altruistic urge to assist fellow human beings who are suffering (W2), which the President of MSF International recently described as “a visceral and practical response of one human being to the suffering of another” (W3). Codified in most cultures and all major religions, it is also found in the secular principle of “humanity” to which so many humani-tarian agencies subscribe (W4). The strength of the humanitarian impulse can be affected by various fac-tors, among them people’s closeness to the suffering (as the media brought the tsunami victims into our living rooms), the suddenness of the disaster, the num-ber of victims, and the ease with which people can empathize with the victims (for example, the many western tourists). Natural disasters are also much more likely to elicit a humanitarian impulse than are civil wars, because the victims are seen as blameless. Finally, professional perspectives are also influential: clinical doctors and public health professionals are both driven by humanity, but the reaction of public health professionals is also mediated by population-based mor-bidity and mortality statistics — which leads to a different response. The very strong humanitarian impulse to relieve the suffering of those affected by the tsunami was mainly very positive, but it may unfortunately have resulted in some undesirable side-effects. Much of the assistance was inappropriate, with health agencies not able to match their enormous resources to the modest immediate health needs of the victims. In some areas, the over-abundance of outside helpers added to problems of coordination. For example, one agency working in Aceh, Indonesia,