The tsunami: A window of opportunity for policy impact
On the 26th of December 2004, a magnitude 9.3 Mw earthquake occurred along Northern Sumatra and the Nicobar and Andaman Islands, this resulted in a catastrophic tsunami which affected 12 countries; of these, four countries (Indonesia, Sri Lanka, India and Thailand) were hit the worst.
The human impact due to the tsunami, with more than 175,000 lives lost, was enormous in terms of families affected, displaced or reported missing. Almost two million people lost their homes and had to find shelter with family, friends or in temporary settlements.
The majority of Asians who died, were buried or cremated without being identified. However, most developed nations endeavoured to selectively identify citizens who had died as a result of the tragedy.
The psychological impact could not be quantified immediately after the tsunami. Although varying estimates have been offered by different schools of therapists and ideologies, everyone would agree that there will be some degree of long-term impact on the mental health of populations affected the tsunami. Unfortunately, most of the counties affected by the tsunami did not have a mental health policy at that time.
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Tsunami as a Window of Opportunity – Working for Policy Impact
Stress reactions are a normal and recognized feature following disasters. These can be behavioural, cognitive, emotional and physical. Bereavement and grief can complicate the emotional reaction to a disaster. Bereavement is defined as an objective state of having experienced the loss of a loved person through death, while grief is a subjective state of psychological and physiological reaction to that loss. It is to be expected that sadness, suffering, and grief will arise after the death of one or more loved ones.
Grief is an extension of the natural human response to separation. Just as physical trauma to the body evokes the inflammatory response (redness, swelling, heat and pain) so the psychological trauma of loss leads to a sequence of natural experiences, as detailed below: Phases of normal grief reaction.
- Phase I: Shock and protest – includes numbness, disbelief and acute dysphoria.
- Phase II: Preoccupation – includes yearning, searching and anger.
- Phase III: Disorganization – includes despair and acceptance of loss.
- Phase IV: Resolution.
The grieving period is when a person assimilates what has happened, understands it, overcomes it, and rebuilds his or her life. This is a normal process that should not be hurried or discouraged; nor should it be regarded as an illness. In Asian cultures, there is a practice to remember the loved ones and to commemorate their life and death as a way of expressing that they ‘will not be forgotten’, while dealing with one’s own feelings of sadness. The grave, a headstone, a photograph, or flowers in the home are common ways of expressing this. Performing rituals established by one’s culture and community forms an important part of the recovery process for the survivors.
In all societies there are rituals, norms, and forms of expressing grief that are derived from different conceptions about life and death. In different cultures different rituals have evolved; different forms of burial and performing religious ceremonies after the burial and observing anniversaries of the death. Grief may be avoided or it may be exaggerated and prolonged.
Similarly, people may need permission and encouragement to grieve. Therefore, to go through the grief process one has to be certain that the loved one is no more. Otherwise, searching may go on for the missing, alleging that they are out there somewhere. As explained before, it can be a part of phase II preoccupation. This was witnessed during the tsunami, when newspaper advertisements appeared months afterwards requesting to hand over children if they were with someone, and also asking for a report if they knew the whereabouts of the missing.
The use of psychosocial interventions to address trauma-exposed populations is a new & developing field. Although the term ‘psychosocial interventions’ became popular and was used more frequently after the tsunami, it appears to have had different meanings to different groups and individuals.
The Oxford English Dictionary defines ‘psychosocial interventions’ as ‘pertaining to the influence of social factors on an individuals mind and behaviours’. This is also interpreted as ‘social intervention that has secondary psychological effects and psychological interventions that have secondary social effects’. The term ‘social intervention’ is used for interventions that primarily aim to have social effects, and the term ‘psychological intervention’ is used for interventions that primarily aim to have psychological effects. It is acknowledged that social interventions have secondary psychological effects and that psychological interventions have secondary social effects as the term psychosocial suggests.
The term ‘psychosocial interventions’, in the context of disaster management, does not refer only to highly specialized interventions by mental health experts. In fact, most psychosocial interventions for disaster-affected people can be carried out effectively by community level relief workers, if they are trained and supervised to do so.
The psychological impact of the uncertainty about the fate of a missing relative and the related socio-economic consequences, have been discussed by a conference panel (ICRC, The Missing Conference, 2003).
To our knowledge, only a few organizations stressed the importance of identifying dead bodies as an essential part in ‘psychosocial interventions’; especially as a public health intervention to prevent long-term consequences. The International Committee of the Red Cross (ICRC) was one of them.
The WHO (2005c) has also discouraged the unceremonious disposal of corpses ‘to control communicable diseases’. Dead bodies carry no or extremely limited risk for communicable diseases.
The bereaved need to have the possibility to acquire the body, in order to conduct ceremonious funerals and say goodbye (assuming it is not mutilated or decomposed). In any case, death certificates need to be organized to avoid unnecessary financial and legal consequences for relatives.
Although it is clear that every effort should be taken to identify bodies, the tsunami revealed that Sri Lanka had neither policy nor capacity to identify dead bodies.
The State has a critical role in standardizing and guiding the task of handling dead bodies (recovery, identification, transfer, and final disposal). It must ensure that ethical, social and legal norms are followed, while guaranteeing that the dignity of the deceased and their families is respected in accordance with their cultural values and religious beliefs.
Developing adequate capacity (including human resources) along with a political commitment for implementing such a programme, is an important and challenging task.