December 26 2004 will stick in people’s minds in much the same way that September 11 2001 has – the images of devastation and suffering, the confused news reports, the gradual unfolding of the scale of the disaster as the days turned to weeks, and the initially slow but suddenly torrential outpouring of aid.

You may also have been surprised (positively or negatively) by the amount of coverage given to different religious responses to what happened – all starting with different variations on the ‘how can a God of love let something like this happen?’ question. In many ways this strikes one as ironic, as it seems that we can sit by and, for example, quietly let 150,000 Africans die every month from malaria; but when a disaster unfolds on our TV screens, we are all struck by the fragility of our existence and ask eternal questions. It would appear that until we see it on TV and in garish full colour spreads in the Sunday papers, it’s not real!

A biblical response

Even so, the outpouring of support in terms of financial aid and people willing to volunteer and help across the globe is greatly encouraging. Nor should we downplay the human cost of this disaster – at the time of writing the death toll in Indonesia alone stands at more than 220,000, and the overall loss of life at around 380,000, with around five million made homeless, orphaned, and with their livelihoods taken away.[1] But we do have to put this disaster into a wider perspective. It is not the biggest disaster in living memory – it ranks as the eighth biggest catastrophe in recorded history, and probably only the third or fourth of the 20th century.[2] In addition, every day thousands die from preventable illnesses, 8,000 from AIDS alone. War and other armed conflicts claim another 3,000 lives each day – a twin towers atrocity on a daily basis across the globe.

Much of this suffering and loss of life is down to human folly and sin (let us not shrink from the word). AIDS is preventable – sexual behaviour is the biggest cause of spread; chastity before, and fidelity in marriage are the best means of preventing HIV infection. War, corrupt governments and unjust trade rules are the major causes of poverty. Political inertia and an unwillingness to invest money and time on affordable therapies and prevention strategies make malaria still one of the biggest global killers. The list goes on and on and the only reason it is acceptable is that we do not see it, or have come to see such human induced suffering as inevitable and unavoidable. If these crises happened here in the UK, there would be such outcry that something would have to be done.

But what of natural disasters like tsunamis and earthquakes? Human sin does not cause these, so why does God allow (or cause) them?

This is a hard question; some may feel that it expresses doubt and is therefore a sinful question to ask. However, the Bible writers showed no such qualms in asking God to account for his actions. Read the books of Job, Lamentations and Ecclesiastes, not to mention most of the Psalms, and you will see the writers wrestle with God time and again over the issue of suffering. Even Jesus had his time in Gethsemane, asking his Father ‘why?’ and ‘is there another way?’[3]

Of course, the answers are not always what we want to hear. Job was never given an answer to ‘why’, but did gain a new understanding of just who God is, and that some questions are unanswerable.[4] Jesus still had to go through with the cross; Paul never had the thorn in his flesh removed, despite his fervent prayers.[5] Without these trials, salvation and our understanding of who we are in Christ would never have been possible.

But this still does not answer the question about why the tsunami happened. Yes, suffering may help us to understand God better, but what of the hundreds of thousands who died, many without knowledge of Christ? Either God caused it to happen, or God held back and did not stop it from happening. Why would he do that? Jesus warned us:

Nation will rise against nation, and kingdom against kingdom. There will be famines and earthquakes in various places. All these are the beginning of birth-pains.[6]

Paul reiterates, ‘We know that the whole creation has been groaning as in the pains of childbirth right up to the present time.’[7]

Disasters are part of a fallen creation, still out of sync with its Creator.

Furthermore, while God does not want anyone to perish,[8] this creation is a battleground, and, ‘Your enemy the devil prowls around like a roaring lion looking for someone to devour’.[9] It would seem that so-called ‘natural’ disasters are to some extent part of the outworking of this spiritual conflict.

However, struggle as we may to come to terms with this, the gospel leads us to ask another, even more profound question. Not ‘why?’ but ‘what?’ What should our response be to disaster and suffering? The disciples were often stumped as to causes of the suffering of those who came to Jesus, but he just got on and healed them[10] – it was a practical, not an existential response to suffering that Jesus embodied and modelled.

Our first response then must be to mirror the heart and mind of Christ in all situations.[11] If we look through the Gospels, we see Jesus time and again reach out to those who suffered and were in need, to heal, forgive sins and offer hope. Those rejected by society he accepted, those who were hated he loved, those cast out he welcomed in.[12] In short, where he was presented with a human need, he responded.

Moses and the prophets too urge us to do the same, over and over again.[13] It’s hard not to get the message that we should do something when we see need, because that is what God would have us do.

So perhaps the answer to the question of ‘why disasters happen?’ is not to do with why God allows these things to happen, but rather how he would have us show his love and care to those who are affected.

Practical responses

Obviously, the first thing most of us did when we learnt of the tsunami was to find out how we could give help. It is interesting that the main thrust of all the appeals was for cash, not goods. We had people ring the CMF office asking if they could donate drugs near their expiry date, and medical equipment, but in reality, the aid agencies need cash in a disaster situation, so that they can source the drugs, equipment and materials appropriate to the local situation. In fact, giving goods can do long term damage – it may sound like a compassionate response to send clothes and blankets, but those items can be sourced locally, more quickly and cheaply than shipping them halfway around the world by air, and without taking away from the incomes of local manufacturers and retailers. Cash puts food in people’s stomachs and clothes on their backs, and puts much needed foreign exchange into the local economy.

The huge generosity of the British public (among others) seems to have caught our government by surprise, and indeed it seems that individuals around the world have shamed their governments into giving more and more – or at least pledging it. The current total pledged across the globe stands at nearly £7bn at time of writing.[14] The £300m given to the Disasters and Emergency Committee by the British public[15] will reach the people who need it though credible agencies – many of which are Christian (eg Tearfund and World Vision). However, governments sadly have a reputation for pledging and then not trumping up the cash (very little of the money pledged by wealthy governments to aid the survivors of the 2003 Bam Earthquake in Iran ever turned up; estimates vary at 2-11%).[16] There is a sense that we have a responsibility to hold our governments to account for the aid that they pledge (bearing in mind it is our taxes that this money ultimately comes from).

The other response is to ask if we can help in person. This is more complicated, and the answer very much depends on the affected country.

In India, teams from Christian hospitals all over the country were on the scene in the affected costal regions within 24 hours, and will remain long term, not just to provide emergency medical care, but also to help with long term public health issues and in providing mental heath care for the many traumatised and bereaved adults and children who survived the tsunami. India has plenty of health professionals, resources, good roads, army and air force helicopters and amphibious vehicles to get supplies to cut off areas, etc. Money is the main need, to help cover costs of supplies, transport and staff.

In Sri Lanka and Indonesia, the situation is different – the infrastructure was already less established, and the devastation was much worse. Health professionals are a real need, especially in Indonesia. However, in an emergency situation, the need is for experienced doctors and nurses – students and the newly qualified have limited roles, as no one will have time to supervise and train them. Still, volunteers are always welcome to help out in other, non-medical ways (eg shifting supplies, clearing rubble, handling administration, etc).

CMF has been linking people in with medical teams from India and Singapore who have been going into this region. At the time of writing though, the Indonesian authorities are putting severe restrictions on the work of foreign aid agencies, as the Aceh province of Sumatra that bore the worst of the devastation is also an area in which a long-running civil war is still underway, and for political reasons as well as safety reasons, the government want to keep outside interference to a minimum. Similar problems are to be found in Sri Lanka for the same reason. It seems that wars wait for nothing!

Wider issues

One of the big concerns with a disaster like this is that it diverts attention and resources away from other problems. 26 million people in other regions of the world need aid just to survive day to day.[17] The Darfur crisis in Western Sudan is no nearer a resolution, and the humanitarian needs there and in other conflict areas such as North Eastern Congo, remain enormous. Worldwide there are 18 million refugees, and a similar number of people displaced within their own country due to war, famine or natural disaster. Meanwhile the long term issues of fighting poverty and disease simply do not grab the headlines in the same way as wars and disasters, but as we have seen they are causing comparable (if not even greater) levels of human misery and suffering.

Yet if similar levels of aid as have gone into the tsunami went into tackling malaria, AIDS and issues such as clean water supplies, the impact would be enormous. Likewise, if issues to do with trade and debt relief were addressed, the chances for many hundreds millions of people worldwide to begin the slow climb out of poverty would be greatly increased. Campaigns like this year’s Make Poverty History[18] and the Micah Challenge[19] are chances for us as Christians to influence decision makers to change this situation. Aid alone is not enough to save lives, and in the long term creates dependency, which does not help the poor. What is needed is justice.

The Hebrew Scriptures are full of laws and provisions that ensured that the desperately poor were cared for, but also those provisions encouraged them to stand on their own two feet and not remain dependent on the generosity of the rich.[20] God’s concern is that people have dignity and a chance to care for their own families and communities, but that in a crisis or time of desperate need, provision is made by the wider community to avoid total destitution for the vulnerable. So it is that many of the harshest condemnations in Scripture are reserved for those who obstruct and deny justice or aid to the poor, who trade unfairly and use power to extort money.[21] Aid helps in the immediate crisis, but without wider changes globally, injustice will keep hundreds of millions in poverty, a situation that Scripture tells us repeatedly is abhorrent to God.[22]

It should also be borne in mind that even in natural disasters, there is an issue of justice that affects who survives and who does not. The poor invariably live in the places upon which the rich will not build – often areas prone to earthquakes and flooding. They are least able to build homes to withstand natural disasters, and where there is poverty across a whole region, there is even less infrastructure to provide help. Inevitably, when disaster strikes, the poor bear the brunt disproportionately. Consider that comparatively wealthy Thailand and India have coped far better than Indonesia, which is not only poorer, but where the region affected was isolated and denied any help with infrastructure because of an ongoing civil war.

Thus it is that we need to think not only in terms of acute crises and their aftermath, but also for the long-term issues facing the world’s poor. As Christian doctors the challenges are to do with how we use our wealth – is it just for ourselves, or do we hold our money and material possessions in stewardship for God, to use as he directs us? It is the same with our gifts and abilities, and for some of us that means sacrificing time, income and career options to go and serve the poor. With 36 million refugees worldwide, it is not too hard to see that provision of health services in refugee camps is going to be both an acute and an ongoing need.

Most nations should have enough medics of their own not to need us to send doctors to serve in public and church hospitals, but the truth is that doctors are in short supply where they are needed the most – among the poorest communities of the developing world. Serving in a mission hospital may not be as exciting as working in a disaster relief situation, but it is still an essential service.

The aftermath of natural disasters like the Boxing Day tsunami require swift responses, which are usually best led locally – as has been the case in India. But where this is not possible, outside agencies can be vital in saving many lives, especially in the first few days – dealing with acute trauma, helping to advise on public health issues in temporary camps to avoid the spread of infectious diseases, dealing with the acute post-trauma mental health needs of survivors so that there are fewer long-term mental health sequelae, etc. All this requires skill, and for a qualified doctor, gaining experience through volunteering (especially once past your house jobs) is a good idea. Christian aid agencies like Medair[23] run specialist training courses for health professionals going to work in disaster situations, and it is essential to get training of this sort before going. It will stretch your clinical skills and test you spiritually, physically and professionally.

Conclusion

As Christian doctors, the challenge that disasters raise for us is how to respond compassionately and appropriately. Often the main need is to support those already working locally, with cash in the first instance and, if locally requested, by going and using our skills in service of the survivors.

As medical students the challenge is to look at your career and your plans for the future. Are they yours, or are they God’s? Do you see yourself focussing on a successful career in medicine, getting a nice house and living in a nice area of the country, or do you see your plans submitted to God? Are you ready to let him take you where he will? Are you concerned for the lost, the poor, the unloved and marginalised? Do you care about justice, poverty and compassionate care for those most in need? The challenge that disasters like the Boxing Day tsunami throws at us is to ask what our priorities and values are, and how God would have us respond to a world in such desperate need.

CMF has links in most countries of the world, and we can usually get a fair idea of what is needed on the ground fairly quickly, but there are many other Christian and secular agencies that are highly skilled in responding to disasters like this. If this is an area of work that interests you in the longer term, then talk to the HealthServe team at CMF (healthserve@cmf.org.uk).

As students, there is less that you can offer now in terms of medical skills, but a willingness to serve and help out in any way possible means that there is no shortage of practical ways you can help out as a volunteer in an emergency relief situation. But above all, ask what God wants you to do with your life, your skills, your money and your career.