Thanks for your invitation, I am very honoured. You are all
professionals in the field of traumatic stress, so I would like
to tell you the story of the tsunami in four parts: describe
and characterize the event, the unique response, some specific
psychosocial aspects based on our experiences but also some
concerns regarding the state of this field, and finally some
conclusions.
But let me begin by showing you a short video which will also
serve as a kind of table of contents of this presentation.
I. The event
We have difficulties finding words for the tsunami; we tend
to repeat expressions such as "unique" and "unprecedented".
What was so special was the combination of factors:
1. An extremely strong earthquake - 9 on the
Richter scale, shifting tectonic plates on the bottom of the
sea that rose, creating a wave of enormous force, travelling
in concentric circles from the epicentre east of Aceh in Northern
Sumatra in Indonesia, its deadly energy contained in a few waves
that rose as they reached shallow waters near the shores, after
only a few minutes in Aceh and islands along its coast, then
in Malaysia and Thailand, moving with less strength north towards
Myanmar and Bangladesh, but with much conserved energy westwards
across the Indian Ocean, striking Sri Lanka, India with the
Nicobar and Andaman islands, the Maldives, and further west
the Seychelles, Somalia, Kenya and Tanzania. All in all 12 countries.
2. No warnings were issued - only in Bangladesh
with a well established early warning system and Kenya where
the police actually evacuated people from the beaches. Interestingly,
the only other people who were saved were those on islands where
the stories of tsunamis experienced by their forefathers had
been passed down orally through generations. That was where
people understood the sign when the sea suddenly receded. But
there was no system for early warning in the Indian Ocean.
3. It was 26 December, known as Boxing Day
in many countries. This is why there were many Western holidaymakers
on the West coast of Thailand, and also in Sri Lanka, people
with cell phones and digital cameras. In their countries of
origin people were also on holiday and could follow all the
news on radio and TV as they started to build a picture of a
horrific event. The tsunami was captured as an event of cinematographic
qualities.
4. Impact was extraordinary - the tsunami waves
surged 8, 10 up to 12 kilometres in Aceh, went across whole
islands in the Maldives, the grotesque images of the train Queen
of the Sea that runs along the coast of East and South East
Sri Lanka, thrown off the tracks by the tsunami with more than
800 trapped inside and drowning, showing the collision between
ordinary, every-day life in the form of a train ride and the
sudden and ruthless forces of nature.
5. The figures summarising the tsunami are numbing:
228,000 dead or missing and more than 2 million displaced. The
highest numbers are in Aceh, followed by Sri Lanka, India and
Thailand. In the Maldives, only 108 are dead or missing and
21 000 displaced, but the small island state with 300,000 inhabitants,
completely relying on tourism, now faces a very severe economic
crisis.
The enormous force of the tsunami from which only the strongest
could survive, striking at a time of day when communities were
separated along gender lines; fishermen on the sea while women
and children were at their homes on the coast, or the elderly
out on fields on higher land as in parts of Aceh, led to an
impact with a clear demographic dimension. More men than women
survived, more children than adults died.
6. This was a disaster affecting the whole world, including
the West. In Sweden, the country most affected with
some 20,000 tourists spending their Christmas holiday in Thailand,
543 are dead or missing, remarkably 523 of these have been identified.
Together with the Estonia ferry disaster in 1994, when 501 Swedes
out of 852 died, these are without comparison the worst tragedies
in Sweden in modern times.
Along with the slow process of victim identification, with regular
sending home ceremonies in Phuket, with a streak of nationalism
almost as if the victims were soldiers killed in action, week
after week of obituaries on the family pages of Swedish papers,
whole families, children, parents, grandparents, newly wed couples
on their honeymoon - a cross section of middle class Sweden
on holiday. Sweden has been in mourning along with the directly
affected countries.
7. A regional disaster, completely
unexpected, on a major holiday, captured and repeated
on TV screens across the world, leaving behind overwhelming
death and destruction affecting many countries beyond the region,
this was indeed a unique disaster. And a unique disaster created
a unique response.
II. The response
1. This was seen by many people as an Act of God against the
innocent. It was easy to understand and identify with those
struck by this blind force of nature. For the West, it was easy
to identify with the victims as westerners were among them.
And there were many stories of selfless Thais who assisted tourists
who were stranded, showing a generosity that seemed to further
make us understand a fundamental predicament in many of the
affected countries - that of insecurity as a key aspect of poverty.
Those of us who had been working for years to promote disaster
reduction, an often abstract concept, were struck by the insights
of politicians and media who had seen what it meant to be prepared
as the islanders in Semelou or the Andamans, the importance
of protection offered by mangrove and other coastal vegetation,
and of course, the logic of early warning.
2. Immediately, large fundraising campaigns began all over the
world. Rather than looking for donors, individual citizens were
looking for organisations they could fund to help the victims.
Governments gave, corporations gave, everybody gave. Countries
like the Solomon Islands, Mozambique and Lithuania appeared
on the list of donors. Organisations, the Red Cross and Red
Crescent Societies in particular, received volumes of funding
that we could only have dreamed of.
Some organisations, MSF in particular, started to decline further
funds declaring that they had received all they could use.
Others, such as the Red Cross Red Crescent, kept collecting
funds on the basis that they would be engaged in the recovery
effort for the long haul. For us, the list of contributing member
Societies now includes more than 90 and the total amount collected
over 2 billion USD, approximately 25% of the total amount pledged
globally for the tsunami. This is indeed unprecedented in the
history of this organisation.
The fact that so much money came from the individual public
has had implications for the way recovery programmes are implemented,
as we will see.
3. As is always the case, the first response was local. Family
members, neighbours, volunteers, local government and organisations
provide the first life-saving assistance. But soon NGOs, international
organisations and the UN started arriving in numbers almost
never experienced before.
The result was a lack of coordination, a fragmented picture
of needs, and an early response that can only be described as
chaotic. Some poor practices could be observed - arrival of
relief items that had not been asked for, competition for survivors
to help, and a disregard for the role of national authorities
and organisations.
Still, we can regard the relief phase as a great success - the
survivors survived, there have been no outbreaks of communicable
disease and no starvation. The UN Relief Coordinator Jan Egeland
has called it nature at its worst and humanity at its best.
We managed to help.
4. For us, early response meant deploying all our tools and
resources. So called Emergency Response Units, held on stand-by
by our members, for water and sanitation, health services, logistics,
telecommunications and relief distribution were quickly put
to use. We estimate that some 30,000 of our national and international
staff and volunteers were mobilised.
5. The generous volume of funding meant that the International
Federation could very early start its work on a regional strategy
and operational framework to guide the long-term response for
tsunami recovery and reconstruction. Psychosocial support was
included as a prominent area and one where the Federation and
several of our members had significantly developed their capacity
during the past 10 years.
III. Psychosocial support as part of the Red Cross Red
Crescent response
1. Our policy
states that psychosocial support should be an integral part
of all interventions.
We view it as a long-term intervention; it addresses needs of
the affected population as well as of volunteers and national
and expatriate staff. It addresses communities rather than individuals,
taking their particular cultural characteristics into account.
It builds on the contributions provided by volunteers, trained
and guided by professionals.
We emphasize the need to work in collaboration with other actors,
not least government services for referral of individual cases
with needs beyond the scope of our interventions. When we work
in Sri Lanka it may look something like this (see
video clip from Sri Lanka).
2. Just as there was a lack of coordination of the immediate
emergency response, with good practice not always followed,
the same can be said for interventions in the psychosocial field,
although I have seen no effort towards a broader mapping of
what has been provided.
However, there seems to be a wide range of external actors,
many with no previous experience from the affected countries,
some with pre-conceived ideas of what was needed. This is problematic,
not least in an area where there is no consensus on what is
best or at least good practice. There is anecdotal evidence
of competition and conflicting approaches from different actors.
Outsiders, with a more therapeutic approach are contrasted with
those who had already been working for a long time among conflict-affected
communities in Sri Lanka, who emphasised meeting social and
material needs, informed by previous experiences.
3. For a layman like myself, looking at a kind of intervention
where you would expect extreme sensitivity towards people who
are in their weakest and most exposed moments, extremely vulnerable,
it is difficult to understand that this field is characterized
by "a lack of consensus on goals, strategy and best practice"
, or as expressed by someone who was involved in support to
victims of the conflict in Sri Lanka before the tsunami: "The
polemical nature of the debates in the field, has made the accommodation
of diverse perspectives and methodologies within a single framework
difficult".
It seems that the differences relate particularly to a more
individual, counselling or therapeutic approach contrasted with
a more community-based approach, where a range of activities
and interventions are seen to contribute to reorientation and
psychosocial wellbeing, and the possibility for referral of
serious individual cases.
4. To us, the conceptual framework developed by the Psychosocial
Working Group makes much sense. It looks at individuals as part
of families or households who are located within an affected
community. Their psychosocial wellbeing is defined through the
core domains of human capacity, social ecology and culture and
values. These in turn correspond to the human, social and cultural
capital available to people to respond to external challenges.
Interventions can be provided in all three domains, or using
the corresponding capital which of course are interlinked. The
framework also acknowledges that the intervening external community
also comes with its human capacity, social ecology and culture
and values. Ultimately, a successful intervention will build
on open communication and negotiation between the two.
5. Let me mention three examples with psychosocial implications
that I have come across which emphasize the need for good contextual
understanding. First, one agency, Help Age International, has
observed very worrying signs of deteriorating mental health
among elderly survivors in Sri Lanka, a clearly neglected group,
including clinical cases of depression.
The loss of sense of individual value and dignity as assets
meant to be inherited by younger relatives have been lost; the
loss of meagre means of making a living, leading to dependency
on relatives and agencies; the inability to grieve and come
to closure in cramped IDP camps - all contributed to deteriorating
mental health, particularly when put in relation to the capacity
of overwhelmed mental health services.
But Help Age International also pointed to the success of organising
a pilgrimage to a holy site in Sri Lanka. Those attending spoke
of the tremendous importance and impact of completing rituals
and religious duties to the dead, how the clouds of depression
had lifted.
6. Second, in the Maldives more than 20,000 homeless were brought
together under camp-like conditions likely to last for at least
a year as new housing projects were planned and implemented.
A country, little known by outsiders except as a tourist resort,
revealed other situations of concern. High and increasing levels
of drug - particularly heroin - addiction among youth, frequent
incidences of domestic violence and child abuse became apparent,
where the cramped living conditions for the displaced seemed
to exacerbate the situation. Social capital and the strength
of cultural values seem insufficient in a changing society under
great strain.
7. And third, and somewhat unexpectedly, it seems that the large
volumes of funding from the public have led agencies to neglect
their obligation to be accountable to their beneficiaries, particularly
in Aceh.
Keeping media and the donors informed about their actions, best
of all the rapid construction of houses, seem to have been the
main focus of the organisations. But the people still in tents
or living with host families remain uninformed. A UNDP study
in Aceh showed that much of the population, women in particular,
were unaware of what was going to happen to them, of the plans
of agencies and the government and why they were still waiting
for a home. This obviously made the psychological stress already
experienced worse.
IV. Conclusions
So let me try to conclude. The tsunami graduated as a global
disaster through the overwhelming response, showing what humanity
is capable of. In spite of a partly chaotic relief phase, people
received the help they needed.
The tremendous generosity of the global public has enabled us
to engage in a long term programme for recovery and reconstruction.
This includes psychosocial recovery - we can only remotely sense
the pain of all those who lost everything. But questions remain.
Why do external agencies intervene without knowledge of a community's
history and values, claiming they know how to address its grief?
Why is there no agreement on good practice of psychosocial interventions?
Where is the evidence on which we can agree and use to plan
our programmes?
The steadily increasing number of disaster victims should have
a right to expect these questions to be answered. You who are
active in the area of trauma and stress have a very important
task before you.
The IFRC and its worldwide network of Red Cross and Red Crescent
member societies are committed to this goal.
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