Sunday, April 19, 2009

Supporting the well being of persons affected by disasters.....!!!

Supporting the well being of persons affected by disasters

Its survival with the bare necessities

By Jeevan Thiagarajah

The column travels this week to take a look at the conditions in the strip accommodating a large number of persons under difficult circumstances from Maththalan to Mullivaikka. Many families have lost one or more of their members. Quite a few have been transferred out by boat for medical reasons. Many have spent time in bunkers.

State of children

A significant number of school going children are affected with schools failing to reopen in Wanni from the beginning of the current year. An estimated 7800 children could reportedly have gained admission to grade one this year while 13,000 pre-school children could have gone into pre-school education.

Leaving behind their homes, schools and friends has deeply affected these children. Children have at times shown characteristics beyond their years. Games they play have martial overtones. Lack of sufficient nutritional content in the daily diet is liable to show up in new borns.

Many children have witnessed the death or injury of family members. Families and children have not been able to perform traditional customs and rituals associated with death. Rituals have been all but abandoned for now.

Care of the elderly and people with special needs

The elderly have become very vulnerable due to shortages of what would constitute among their essential needs. Many have been left behind and separated.

There were several institutions in Wanni that cared for children, the elderly, unwed mothers, people with learning disabilities and the mentally ill. In spite of the ongoing war these institutions were doing their best in taking care of their members. But currently those who manage these institutions are struggling to provide adequate food and other necessities to those in their care.

It is quite important to take into consideration that we are dealing with a society which has already been affected by a three decade long war and the tsunami which devastated the coastal belt of Sri Lanka in December 2004. People who had their own houses are now forced to live a sub-human life under tarpaulin sheets, exposed to extreme heat, in an area that is not at all conducive for the existence of a large number of people.

Having gone through multiple displacements in a short period of time, the people are left with depleted financial resources, shortages of essentials, uncertainty about their future well being, inadequate facilities for basic needs such as toilets which have brought frustration and has an effect on their physical and psychological wellbeing.


It is in that context guidelines to deal with disasters are presented (adopted by the Psychosocial Forum of CHA following the tsunami)

This segment is particularly applicable in dealing with those who have come to Vavuniya and Jaffna and those who remain in the safe zone.

Do listen to people who share their stories, concerns and solutions, if necessary again and again.

Do re-assure people that their feelings and reactions are normal.

Do recognise people’s strengths and resilience

Do be friendly, compassionate and caring, even if people are angry or demanding.

Do encourage and engage people in meeting their own needs.

Do understand the emotions of people who have suffered losses, and take them seriously. There is no right or wrong way for people to feel, given the horrific situation.

Do listen to people’s expression of their basic needs

Don’t force people to share their stories with you, especially very personal details. If they don’t want to talk much, do not disturb them.

Don’t tell people what you think they should be feeling, thinking or doing.

Don’t make promises about what you will do for them, if you are not sure about this.

Don’t give simple reassurances to people, saying ‘everything will be ok,’ or ‘at least you have survived’ or ‘others have suffered more than you.’

Don’t tell people why you think they have suffered, especially giving reasons about their personal behaviour or beliefs.

Don’t tell people what you think they should have or could have done, whilst in the critical situation, especially to save loved ones.

Don’t separate surviving family members and relatives from one another, if possible, especially children.

Don’t label people as traumatised or victims but refer to them as survivors and / or people affected.

Core values associated with humanitarian assistance found within sphere standards which govern humanitarian interventions are :

‘All possible steps should be taken to alleviate human suffering arising out of conflict and those affected have a right to life with dignity and right to assistance.’

Few easy steps

A few easy steps to meet basic needs for the support of well being of those affected is described below, drawn from recommendations of a mental health task force and their work in Jaffna after the tsunami.

Immediate (0 – 4 weeks post-disaster): Social interventions address basic needs, reunification of families, structured and normal activities, supporting coping mechanisms, with additional activities structured for children (games, schooling etc.).

Short-term (e.g. 1 – 6 months post-disaster): This period signifies a natural recovery from psychological reactions to the trauma. People who have lost relatives will still be grieving and the focus may be on practical issues related to rebuilding lives.

On a long term basis, the existing structures for health service provisions should be utilised, rather than independent services being established for disaster survivors, with such services being accessible via traditional resources at the community level.

A community level approach empowering local resources like family health workers, village leaders and government and NGO workers to handle the majority of psychosocial problems is the most effective way to address mental health consequences of the disaster.

Community level workers need to be equipped, through training in basic mental health, to identify the more severe cases for referral, as recommended by WHO. The manual Mental Health In The Tamil Community could be used for this.

It is vital that the psychosocial component be taken into account in all rehabilitation, resettlement and development programmes. An integrated and holistic approach including psychosocial and mental wellbeing will enhance the recovery process. Following needs assessment, decisions need to be developed on how existing services are to be altered to cope with increasing demands and how existing services will link with rehabilitation and reconstruction efforts.

If new counselors and psychosocial workers are to be trained, their long-term sustainability will need to be addressed with staffing and equipment costs requiring long-term funding, in addition to the short-term costs of training programmes.

(This column has used material generated by many professionals working in the north.)

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