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 January 19, 2005
WHO Warns Of Widespread Psychological Trauma Among Tsunami Victims

 The World Health Organization (WHO) is warning that almost all of the people affected by the tsunami that hit Southeast Asia on 26 December will be suffering from some form of psychosocial trauma. Health workers report that virtually everyone in many of the affected communities is suffering from some degree of psychological trauma. WHO mental health experts fear that psychological trauma among the tsunami victims is more widespread than initially believed.

"The mental anguish of those who narrowly escaped the tsunami or lost close relatives is made far worse because many of them have lost their homes, their jobs and their possessions. These people urgently need support," said Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia. "Many can cope and will gradually come to terms with what has happened. But many others will either sit motionless or cry for hours on end. If support is not urgently provided, the long-term effect on these populations could be terrible."

The situation is further complicated by an acute shortage of health workers trained in mental health care and counseling. In Banda Aceh, Indonesia, for example, more than 150 people worked at the mental health hospital before the disaster struck. Today, only one psychiatrist, three trained counselors and six nurses remain.

WHO recommends that psychosocial support should be provided by community-based workers who understand the needs of disaster victims and have been trained in psychosocial support. According to Dr Vijay Chandra, WHO Regional Mental Health Advisor, "We must ensure that this is not trivialized by permitting any untrained person to do counseling, but is done by health workers who have been trained under WHO guidelines."

WHO has already begun to coordinate the appropriate training of community workers. Focus of the training is on role plays, empathizing with victims, providing support and encouragement to affected individuals to talk through their problems.

Given the acute need, WHO is rapidly increasing its support to countries to implement WHO Guidelines for Mental Health in Emergencies. The guidelines outline an increased involvement of community outreach, taking into account the needs of special groups such as children, women, elderly people and the severely injured, while offering a culturally-appropriate approach to any offered support.

The primary need is not medication, nor the labeling of individuals with a medical diagnosis which
suggests the need for psychiatric interventions, said Dr Chandra. "It would be inappropriate to fly in numerous psychiatrists to provide support," he said. "Health workers from the affected communities will be much more aware of what the victims are now going through. As such, they are in a position to provide much more empathic support than any external professional could."

Dr Chandra said that for the loss of a loved one under normal circumstances, there are social support systems built into community life, such as prayers, rituals, a role for each family member and neighbors sitting with the family members in support. "However," he continued, "in the unique circumstances of the present disaster, we must address the needs of people who have not only lost loved ones, homes, means of earning, but their entire neighborhood and with it their lives' context which essentially defines every individual. The best method of dealing with this would be to find people in neighbouring villages or communities, people of similar cultural background, who understand the cultural norms to help them."

WHO has already sent four mental health experts to Sri Lanka and Indonesia, to work with local mental health professionals and ministries of health, and provide the technical guidance to ensure psychosocial training focuses on: timely and appropriate interventions; honouring the dignity of survivors; identifying potentially high-risk populations; helping survivors reunite with friends or family; activities to re-normalize life as much as possible; and the importance of self-help information materials.

In one province in Thailand alone, local authorities are rotating 80 mental health workers on a weekly basis to support particularly-affected communities. "Some of these people are literally suffering a second tsunami," said Aphaluck Bhatiasevi of WHO in Thailand. "Today, we saw a son who was extremely distressed at the guilt he feels for not having been able to save his father from the force of the tsunami. Such people urgently need a support system to help them cope with this traumatic experience. If such support is not provided, it could very likely end in yet another tragedy for some of the families, and we simply cannot allow this to happen."

Providing support to countries to implement the WHO Guidelines for Mental Health in Emergencies is a key component of the organization's long-term strategy to rehabilitate the damaged or destroyed public health infrastructure. To implement the strategy, WHO urgently requires US$67 million for activities through the next six months.