Rebuilding a ravaged East Timor and averting new disaster

In Dili, where people are dying from disease and near-starvation, there are only 40 patients in the 250-bed general hospital

In Dili, where people are dying from disease and near-starvation, there are only 40 patients in the 250-bed general hospital. This is because the people of the East Timor capital have always been nervous about going there for treatment, especially with wounds which might identify them as victims of militia violence and therefore pro-independence.

The hospital was run by the Indonesian Ministry of Health, and the staff were all Indonesian. Today they have gone, the flag of the International Committee of the Red Cross (ICRC) has been hoisted over the building in the eastern suburbs, and word is getting round that things have changed. Officials from the Red Cross are in fact starting the work of building it up as the reference hospital for East Timor.

In the hospital lobby, Acasio Da Costa, a pro-independence activist who has been trying to get help for the refugees in the mountains south of Dili for several days, was waiting patiently to find a Red Cross official to ask for help. "We need food and medicine, people are dying," he said.

People like Acasio (25), an agriculture student, will be vital to the future of the ravished country. During the 24 years of Indonesian occupation, East Timorese were largely excluded from participation in the running of the hospital, the schools, the administration, the electricity system, the telephone network, the water supply, the food distribution network: everything that makes a society work.

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All the primary school teachers in East Timor were Indonesian. They all have gone, leaving the former Portuguese colony with the task of finding a complete new set of people to be taught how to run basic services.

A senior aid official said he believed there was "an amazing window of opportunity" to rebuild East Timor because "international goodwill can be translated into continuing positive action".

The greatest, long-term need is for education and training, he said. This is an area where countries like Ireland, which have encouraged the East Timor independence movement, can make a significant contribution.

From their initial assessment Red Cross officials also believe that a humanitarian catastrophe can be averted. "Cholera is not round the corner like in other emergency situations we have dealt with around the world," said an official. But the medical situation is dire for a society where disease is on the increase and there has been a massive displacement of the population. The rains will begin to fall next month on an island without roofs, and urban people sheltering in huts made from banana and papaya leaves and will be particularly at risk.

The only other treatment centre in Dili is the tiny Motael clinic, where an American general practitioner, Dr Dan Murphy, coped as best he could with few resources until he was barred by the Indonesian authorities in August during the referendum campaign.

Dr Murphy returned to Dili on Friday to resume his work. He warned of an increase in the number of people contracting tuberculosis, a highly contagious disease which can only be cured by antibiotics during lengthy treatment. The clinic, he said, had been treating 250 people for TB, so these people were all without treatment and crowded into conditions with poor sanitation.

"TB was a ready epidemic. I can't imagine what it is doing, right at this point, as far as spreading to large numbers of the population," he said, "and to get a grip on that is going to be an immense problem. I estimate that even when everything was functioning well, 50 to 100 people died every day from diseases that are easily preventable, so can you imagine what is happening now?"

Dr Murphy said the medical infrastructure outside Dili was "pretty much non-existent" and non-governmental organisations would have to take up the slack.

Gunmen killed nine people, including two nuns, and dumped their bodies in a stream in the latest attack. The bishop of Baucau, East Timor's second-largest town, said the attack took place on Saturday afternoon on a rural road minibus from an aid assessment visit to Los Palos, 18 miles to the east. The dead also included two seminarians, the local head of the charity Caritas, two girl volunteers, the vehicle's driver, and an Indonesian journalist working for a Japanese news organisation.

A ship with 230 tonnes of relief supplies has been sent by GOAL to East Timor and is expected to discharge its cargo in Dili tomorrow.