The tsunami's mental health legacy

By Jane Elliott
BBC News Health Reporter

It is now three months since a tsunami devastated thousands of Indian Ocean communities, and some of the emergency medical teams that flew to the region in the wake of the disaster are now packing up and leaving.

People will need help to recover

Much of the relief effort is now being directed at reconstruction work and there has been worldwide admiration for the way survivors have sought to restore normality to their lives.

But their resilience should not mask the huge mental health legacy left in the tsunami's wake, as many thousands try to deal with almost unimaginable tragedies.

In Aceh and the adjacent province of Northern Sumatra where the death toll is more than 120,600 and another 114,900 are missing, presumed dead, many have been so busy surviving that they have simply not been able to grieve.

Help

Mental health workers in the region say parts of the area are in a "state of mental emergency", and will need up to a year, maybe more, of help.

Kaz de Jong, head of mental health services for Medicins Sans Frontieres (MSF), spent eight days on the ground looking at services in Aceh.

Aceh is a mental health emergency and people are in great need of support Laetitia de Schoutheete

He said, that while most of the population was starting the recovery process, at least 20% would have longer term mental health problems and 5% of these would be severe, with people needing counselling for post traumatic stress disorder and anxiety.

"We have done the emergency intervention now. We hope to enable people to have more control.

"Everybody is reacting differently. Some people are doing pretty well, for others it will take longer," he said

"Some people say they do not want to live any more and they panic that it (the tsunami) is coming back and that when they wake up they get flash backs.

"Some people can't sleep, or can't stop crying and there are people with problems of guilt.

"They say: 'I could keep hold of two of my children, but I had to let the other one go, why did I chose the one I did?'"

Guilt

Laetitia de Schoutheete, co-ordinator of the mental health care projects for MSF in Aceh, agreed that guilt was a big problem for many of the survivors.

"I find it difficult when I talk with people who feel guilty about what has happened, like a 15-year-old-girl who couldn't hold on to her mother in the force of the waves because her mother was bigger than her, or mothers that have had babies torn out of their arms by the water.

Banda Aceh

"But again, the feeling of guilt is a normal reaction and we do our best to show that they did all that they were humanly able to do. Again, this comes as a relief."

She said others felt guilt because they thought the tsunami had been sent by God to punish them.

"People justify the events in many ways. For instance, some say that Allah has singled out Aceh for the tsunami because they were not pious enough. When we tell them that Aceh was not the only place that the tsunami struck, and that it is a known phenomenon which has happened before in other parts of the world, you can immediately see the relief."

Laetitia said that although many people had started to rebuild their lives, for some the scale of their loss was so great that they were not able to start the grieving process yet.

"Once their lives have regained at least some stability then the grieving process can begin.

"But for the moment, Aceh is a mental health emergency and people are in great need of support.

But she said she was impressed with the way many people were coping.

Faith

She said that for many their faith and rituals along with their strong sense of community were sustaining them.

People feel that those killed in the tsunami have been returned to Allah - that is why prayer helps them so much at the moment Laetitia de Schoutheete, MSF

"If anything, the tsunami has strengthened peoples' faith. Most of them pray three times a day with the community and twice individually.

"Not only is this a psychological support but it is also a ritual that brings some order back into their lives.

"Rituals give them the control over their lives that they lost during the tsunami. During the consultations we look at what gives people strength and keeps them alive, and for many here, that strength comes from God.

"People say that it is Allah who has given life and it is He who can take it away. In a way, they feel that those killed in the tsunami have been returned to Allah. That is why prayer helps them so much at the moment. It also helps people to re-centre themselves, it has a very calming effect."

Sex trade

Experts say the children in countries badly affected by the tsunami will also need long-term counselling and support.

Professor Sir Alan Craft, president of the Royal College of Paediatrics and Child Health said some children had lost one or both parents, others had witnessed family members and loved ones being washed away and many were severely stressed.

He said there had been isolated reports of survivors had also suffered the additional traumas of being kidnapped into the sex trade.

Professor Craft said UK child experts from his college were on hand to help run training courses for medics as part of a long-term initiative.

"We have made contact in particular with people in Sri Lanka. We have suggested that the College of Psychiatrists and ourselves will provide a course in post traumatic stress in children."

Experts agree that it is impossible at this stage to gauge exactly what the long-term after effects of the tsunami will be on mental health, but that they must be on hand to offer the most appropriate help when and where it is needed.

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