The massive influx of aid into regions hit by the Asian tsunami will miss the opportunity to tackle long-standing, urgent public health crises such as tuberculosis, malaria and HIV, experts say.

Temporary patch: Permanent clean water may be neglected in aid efforts. Credit: Jewel Samad/AFP/Getty Images

Money, medical assistance and personnel flooded into affected areas of India, Sri Lanka, Indonesia and other countries in the wake of the 26 December disaster. These helped rescue survivors and ease initial concerns that infectious disease would boost the death toll.

But within South Asia, experts now fear that governments will devote most of these emergency funds to temporary health services and the establishment of sophisticated natural disaster warning systems—and overlook much-needed improvements in basic health infrastructure that might tackle endemic killer diseases such as tuberculosis and malaria. “This is an opportunity to address the gaps [in public health]. But we are yet to see the government intelligently planning for using the funds,” says Vinya Ariyaratne, executive director of Sarvodaya, a public health organization based in Moratuwa, Sri Lanka.

Prompt relief efforts in camps across the tsunami-hit region curbed early outbreaks of diarrhea, cholera and measles. But fears linger that malaria and dengue could still erupt if stagnant waters turn into breeding grounds for the mosquitoes that carry them.

To prevent such outbreaks, the World Health Organization is strengthening its disease surveillance system and supplying insecticide-impregnated bednets and fogging machines to spray insecticides in the air.

While welcoming these efforts, local experts say that they are only a short-term patch against infectious disease. Authorities would have a far greater impact on public health, they say, if they spent some of the aid money fortifying fragile public health infrastructure. This could be done by creating permanent clean drinking water supplies, improving sanitation and building up clinics, diagnostic equipment and drugs.

“It is up to the national governments to channel some of this aid into strengthening public health mechanisms to address future emergencies and ensuring the services do not vanish once the aid is withdrawn,” says epidemiologist Krishna Kamal Datta, former head of the New Delhi-based National Institute of Communicable Diseases.

Even before the tsunami, public health systems in much of South Asia were in urgent need of repair. Many areas lack sufficient qualified health workers and suffer shortages of basic supplies, such as oral rehydration salts for babies with diarrhea.

Some medical workers fear that the tsunami may also indirectly heighten the risks of HIV in badly hit areas. The destruction of clinics and medical supplies could lead to a shortage of safe blood, condoms and clean injecting syringes.

Those in the region say that the ongoing threat from HIV could be better tackled if long-term reconstruction efforts included prevention and care programs. “The present models of humanitarian response to natural calamities may not help in [fighting] HIV,” says Joe Thomas, a specialist in AIDS prevention at the Northern Territory AIDS and Hepatitis Council, based in Darwin, Australia.