A silver lining of an Indonesian earthquake: Better women's services

PALU, Indonesia — A rural road in Central Sulawesi province, Indonesia, leads to a terraced archway of steel. Plastered on the left side of the arch is a wind-battered poster riddled with holes and adorned with photos of people in memoriam. Just beyond the arch, the road curves down like a gentle wave. On one side is an abandoned home with a mural depicting homes swallowed by the earth. A person trapped by the destruction is painted screaming “Tolong ..!'' meaning "Help …!” 

On the other side is another abandoned house engulfed in overgrowth. Through the yellow-stained windows, it’s clear to see that plants have begun their overtake of the inside of the home. The only sign of life is a dog chained to a tree, growling at passersby. A bit further down, the cement road comes to a jagged end and drops off. Lying ahead are vast rolling hills of overgrowth — what was once Petobo village is now a graveyard. 

On Sept. 28, 2018, the area was hit by a trinity of disasters: A 7.5 magnitude earthquake struck followed by liquefaction — a phenomenon where the soil churns, behaving like liquid. The coast was also hit by a tsunami with waves as high as 20 feet (6 meters). The three disasters claimed 4,340 lives, according to the regional government’s final count. 

And while the toll on these communities was immeasurable, the crisis did result in reproductive health services becoming better integrated into primary health care and reporting of gender-based violence turning to a community-based model.

It’s been over four years, but Elisabeth Sidabutar still gets chills every time she visits what once was Petobo village. 

“There is still life within these hills,” she said. 

Sidabutar was part of the humanitarian response, working with the United Nations Population Fund in partnership with government and local NGOs to set up reproductive health tents, as well as women and adolescent-friendly tents, working to ensure reproductive health services were maintained during the disaster and creating systems to report gender-based violence.   

Some humanitarians, when talking about their work, quote Winston Churchill's “Never let a good crisis go to waste.” And in many ways, the crisis in Palu didn’t. What were once tents set up as part of a humanitarian response have evolved into more permanent structures — working to re-create a sense of community, which the disasters had dismantled.

Indonesia is well-versed in crises. More than 97% of its population lives in disaster-prone areas. It’s also the fourth most populated country in the world, which means natural disasters can result in widespread carnage.

After the 2018 disaster, the government and local and international humanitarians rushed to provide aid, establishing a cluster system for coordination. 

In Palu, the internet and electricity weren’t working. Health facilities were damaged. Health workers either perished or left the area. Those remaining also had their lives in shambles — hardly able to serve others. Shops were looted. Food and water were scarce. Some people went almost two months without HIV treatment, Sidabutar said.

Cases of sexual violence began almost immediately, she said. With people crowded together in displacement camps, predators took advantage — when women and girls went to collect firewood and used communal toilets they were targeted. There were reports of incest and other abuse within crowded tents. Women delivered babies prematurely due to stress. Contraceptives weren’t available for the first two months. Youth were orphaned, making them vulnerable to abuse and child marriage. 

A subset of humanitarian responders focused on the most vulnerable: women, children, older adults, and people with disabilities. They created subclusters on gender-based violence and reproductive health. They set up antenatal and delivery services, as well as 12 dedicated women-friendly spaces to gather, process trauma, and report violence. They brought in health workers, including midwives. They also set up eight adolescent-friendly spaces and 15 reproductive health tents. Psychosocial support and contraceptives were provided. They handed out customized “dignity kits,” which included items such as menstrual pads, underwear, and soap. 

Yohana Morlain just returned from work, started to wash her clothes, and turned on the stove. The earth then started to shake. Her house spun in circles, almost as if it was in a food mixer. She scrambled to get everyone out of the house and by the time that happened half of their home was swallowed by the earth. Her family was saved by clutching onto an old tree with expansive roots that held its place despite the churning soil. That night she lost 17 close friends and their children. 

Her family moved to a displacement camp. She discovered women-friendly tents and became a regular attendee and volunteer.

The safe house for domestic violence in Palu was destroyed. The tents became the first referral spot for cases of gender-based violence, which would then be handled by the government’s Office of Women Empowerment and Child Protection. This is where the concept of community-based referral of such cases was born. The tents were also a forum for women to voice concerns. 

UNFPA supported the women-friendly tents for a year after the disasters. When donor funding ran out, the women continued to receive reports of violence. 

After liquefaction, the land was jumbled and closed off so people couldn't rebuild. About two years ago, the government resettled Yohana’s family to Pombewe — an hour's drive from Palu. The neighborhood of displaced families is rows of cookie-cutter homes. But her home stands out. It’s covered with posters, one of which advertises it as a women-friendly haven and place to report violence. 

Yohana decided to offer her home as a place where women could continue to report cases. The same group of women that once gathered in the tents, now gather at Yohana’s home with some support from the NGO Yayasan Libu Perempuan. She runs the women’s friendly space with her neighbor Siti Marwiyah. Yohana’s neighborhood consists of people who didn’t previously live in communities together — they've had to create new social structures. 

Gender-based violence reporting and health systems are overall better after the disasters, community members said. The subcluster focused on women evolved into a specific unit focused on gender-based violence at the provincial level and the districts affected by the disasters. And the subclusters on reproductive health continued their work. The reproductive health tents evolved into health posts and then permanent clinics, Euis Bianca, a head of Provincial Midwifery Institutions, said. The tents brought services together in one place, and now reproductive health services are integrated into primary health in a way that wasn’t happening before.

It’s late afternoon on an overcast day. About a dozen teenagers dance in front of a small building with rainbow-colored bars adorning the windows. 

They are at a community health center. This space also evolved from tents. Now it's a permanent structure that’s open every day, serving as a place for adolescents to socialize and access information on reproductive health and sexual abuse and receive psychosocial support.

One of those leading the dancing is 18-year-old Aulia Nur. While none of her close friends died during the disasters, they moved from the area. 

After the disasters, an NGO invited her to visit the tents for adolescents. There, Aulia made new friends. 

The idea around adolescent spaces and a youth-friendly forum was adopted by the Community Health Center Fund, or Puskesmas, supported by the provincial health office.  

The center hosts events, such as workshops on photography and cooking.

The community also now has specific health posts for teenagers, which were established in 2019. In Palu, there are now 56 health posts for teenagers — in 2019 it was just eight, said Chalvein Bunga Atto, the program manager at Perkumpulan Keluarga Berencana Indonesia Sulteng, a local NGO. 

Aulia now comes to the community center nearly every day. 

“Every night we gather to sing together. Gradually, we forget about what happened,” she said.

Among those at the center are three adolescents huddled in a circle laughing and speaking to one another in sign language. From its inception, these spaces aimed to create a welcoming place for adolescents with disabilities, Yospina Liku La’Bi, the executive director of Indonesia Planned Parenthood Association Central Sulawesi, said. When they host events, sign interpreters are available. 

Many humanitarians strive for these types of exits — a successful community handover. UNFPA’s Sidabutar said because it's a disaster-prone country, Indonesia can serve as a textbook for others. 

“Indonesia is a laboratory of disaster. We can show inspiring stories from the field,” she said. 

Note: The UNFPA facilitated travel for this reporting. Devex retains full editorial independence.

Photos by: Sara Jerving
Produced by: Janelle Cruz