It is three years since the tidal waves swept away thousands of people and uprooted thousands more, but the health of the tsunami victims in coastal India continues to remain a matter of concern.

In the immediate aftermath of the tsunami, health took a backseat when confronted with more immediate problems of food, clothing and shelter. It was only after relief operations were completed and rehabilitation efforts were started that a more concerted approach to addressing health issues was adopted, says Ms Jaya, top official of the Chennai district administration. .

          But activists charge that the government did not take any serious account of the health status of the tsunami-affected individuals even during the second phase of rehabilitation -  "The temporary shelters were horrible. There was no proper sanitation. The quarters were too cramped. They had built shallow leach pits for the domestic sewage, which eventually flowed into the streets," says Arul of the Unorganised Workers Federation Federation., a non-goverrnmental organization (NGO).

 If we wanted to cross the street we had to carry our children on our hips and ferry them across. When the rains came , the stinking, sewage water used to come up to our hips. The kids used to paddle across the street in small thermocol rafts and we had to wade through the stinking water. Our clothes, vessels …..everything used to stink even after we were shifted to the nearby school," says Mrs Naguramma, resident of a settlement in northern Chennai

"The quarters were too narrow. Trucks could not even enter the area to clean up the place. The sewage used to regularly flow into the streets. We were lucky that no epidemic broke out. But then despite the regular vaccinations and medical camps conducted by the government and NGOs, there were quite a few instances of malaria and typhoid" says Dr Soundaraiya who has been working among the victims all these three years.         

"After a while due to the horrible sanitation arrangements of the government, people started openly defecating on the roads and the railway tracks. The worst came when two people were killed by a train when they were defecating on the tracks," remembers Arul, shuddering. Things have since improved though as the survivors were shifted to a relatively better place, with a modicum of sanitation arrangements in place.

However, it was the kidney racket that turned the attention of the rest of the world towards their plight.

A significant proportion of the tsunami survivors, in the state capital of Chennai, seem to live steeped in poverty and it was the women among them who were coaxed into parting with one of their kidneys.

They were ultimately paid a fraction of what they were originally promised, but the twice victimized could do little against the mafia that had duped them.

After media reports kicked up a furore last year, the government came down hard on the touts and also tightened up the procedures for organ donation. The government was forced to admit that its rehabilitation efforts were not enough.