Asia-Pacific, Development & Aid, Headlines, Health, Human Rights

ASIA: ‘Post-Disaster Psychosocial Support a Must for Children’

B. C. Lee

BANGKOK, Jan 27 2010 (IPS) - When disaster strikes, acute stress disorders, especially among children, may follow. Yet the need for early psychosocial interventions is often overlooked, if not ignored.

The impact of disasters is especially severe on the children, said Aloysius Rego, deputy executive director of the Bangkok-based Asian Disaster Preparedness Center (ADPC), which organised an open forum on ‘Psychosocial Response to Disasters with Focus on Children in Asia’ in this capital on Tuesday with the support of the Norwegian Ministry of Foreign Affairs.

“They face recurrent images of the severity of the disaster, which continue to be traumatic for them,” he said at the forum proper, which was attended by mental health representatives from the Asian region.

“Psychosocial support will greatly assist people, especially children, in recovering mental health. This is why we need to build more effective systems, structures and mechanisms and this requires long-term support,” he said.

The challenges of treating post-traumatic stress disorder (PTSD) among child survivors of disasters are made all the more difficult by the lack of political will and preparedness of countries during times of emergencies.

“We can build capacity and have resources but unless there is a political commitment and framework that has been set, then nothing will work. Every disaster that happens, it means the same chaos follows,” Dr Satyabrata Dash, ActionAid Australia’s Bangladesh Head of Office project manager, told IPS during the forum.

Dash added that, even after the December 2004 tsunami that hit the Indian Ocean, people still think of psychosocial support as “a non-essential, luxury kind of thing.”

The Indian Ocean tsunami, which struck on Dec. 26, 2004, triggered by a 9.3-magnitude earthquake, killed more than 220,000 people in 13 countries surrounding the ocean, including Sri Lanka, India, Indonesia and Thailand. Reports say that more than 125,000 people were injured and over 1.6 million displaced.

In May 2008, Cyclone Nargis struck the southern part of Burma, killing at least 138,000 people and causing damages estimated at more than 20 billion U.S. dollars. In September 2009, Typhoon Ketsana inundated parts of the Philippine capital city of Manila, resulting in landslides and the displacement of thousands of families.

These and other disasters take a heavy toll on survivors’ psychological health. “There are less visible but no less severe psychosocial impacts of disasters on the population. These are, however, often neglected because we don’t assign economic values to them,” said ADPC’s Rego.

Dash said everyone must realise that economic rehabilitation is not likely to work if the person affected by the disaster is not sound psychologically. “If we are able to link this with, say, livelihood, then governments might listen more closely. For example, if I give you a sewing machine but you’re not mentally sound, how are you going to utilise it?”

For William Yule, professor emeritus at Applied Child Psychology, King’s College London, a comprehensive plan in times of crisis can never be emphasised enough.

“Every country in the world should have disaster plans ready in dealing with the mental health of individuals,” he said, adding that in large-scale disasters, no one has the luxury of individual counseling.

According to Dash, psychosocial efforts are a recent development in countries like Pakistan, Maldives, Burma and Bhutan. The Philippines and Indonesia, on the other hand, have a long history of psychosocial support in place.

“Children’s response to stress is different from an adult and more often than not their reactions to a crisis are influenced by the reactions of adults,” said Dr Benjaporn Panyayong, senior psychiatrist at Thailand’s Department of Public Health.

Benjaporn spent two years treating tsunami children survivors in the southern Thai province of Phang Nga, one of the worst-hit by the December 2004 tsunami.

“The first thing that we need to do is to protect children from further harm. But it is also important to help the parents first because they need help too,” she said.

The pediatrician and psychiatrist added that giving psychological first aids is a must in the initial stages of a disaster. Among the needs that should be met are stabilising the children’s emotions by getting them back to their family immediately or connecting them to a support group in the community.

Dr Atle Dyregrov, director of the Center for Crisis Psychology in Norway, stressed that the key elements in most disasters are information and care.

“The best way we can help people in times of disasters is to provide them with accurate and reliable information,” said Dyregrov, who is also a board member of the Children and War Foundation – an international research foundation based in Norway – and one of the founders of the European Society for Traumatic Stress Studies, a network of individuals in the field of psychotraumatology, or the study of psychological trauma.

He added that support from the larger community is crucial for survivors to “cultivate natural resilience.”

Citing as an example studies of post-traumatic stress disorder following an earthquake in northern China some years ago, Dyregrov said that 20 percent of the population that lived close to the epicentre suffered PTSD. Oddly enough, PTSD sufferers reached 30 percent of the population that lived 10 kilometres away from the epicenter.

“There was more community support and more volunteers working close to the epicentre, which lessened the number of those suffering from PTSD,” he said.

A 2008 study by Thai Prof Pichet Udomratn on the mental health and psychosocial consequences of natural disasters in Asia showed that up to 57.3 percent of disaster survivors suffered from PTSD.

Further, 30 to 40 percent of those directly exposed to disasters developed PTSD, while 10 to 20 percent of rescue workers likewise acquired the same disorder.

One of the challenges, at least in the Thai context, said Benjaporn, is how to help children verbalise the trauma. “Thai children don’t want to speak about their feelings or express themselves. When they feel sad or angry, they just smile,” she said.

While there is no big gap as far as Thai government support for mental health is concerned, Benjaporn admitted that it is difficult to find enough personnel who can deal with PTSD, especially in the local community affected by the disaster.

Another problem is the stigma attached to seeking mental health care in Thai society. “Too often, those who get treatment for PTSD are afraid of being labeled as ‘mad’ or ‘crazy’,” she added.

To make matters worse, Dyregrov said, problems in coordination among non-government organisations, bureaucracy, and humanitarian aids being misused, among others, hound most psychosocial support work.

ActionAid Australia’s Dash cautioned that psychosocial support should not be confined to PTSD. “Almost 150 million children are affected by natural and man-made disasters per year, including sexual abuse, gaps in education, and other psychological traumas that lead to deep-seated impacts with far-reaching consequences,” he said.

While there may be differences in the way individuals in the region face their trauma, Dyregrov still believes that at the most basic level, people, whether from the east or west, are all the same. “We’re much more alike than we are different and this is true even in times of disasters,” he said.