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Phases of a Disaster. Honeymoon. Reconstruction. Pre-disaster. Disillusionment. Threat Warning. Recovery. Impact. Time. ASSESSMENT OF NEED The Goal is to understand - How disaster populations differ from one another The key variables affecting survival and welfare
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Phases of a Disaster Honeymoon Reconstruction Pre-disaster Disillusionment Threat Warning Recovery Impact Time
ASSESSMENT OF NEED • The Goal is to understand - • How disaster populations differ from one another • The key variables affecting survival and welfare • How relief organizations can be most effective • How disaster management could be improved • Design a System • Which cannot be easily skewed by the perspectives of one individual or a political party • A process that is inherently more stable and reliable • Is “ground-truth based” and implies a consultative process • Engaging a wide variety of individuals from a variety of professional and personal vantage points
LARGE GROUP TRAUMA • Communities are confronted with the enormous consequences • Lives lost • Numbers injured • Societal insecurity and disruption • Destruction of Institutions • Economic burden • Psychological problems – long term • But, • Disaster affected communities are rarely homogeneous
HELPLESSNESS AND THE PERCEPTION OF WEAKNESS • A crisis could be an opportunity for genuine help or can lead to harm • Spectacle of helplessness may evoke strong emotions • Evoke everything from compassion to cruel exploitation - best and worst of human emotions and behavior • Profiting from the suffering of others is not unknown • Helplessness creates a need/fear dilemma - succumb to need satisfaction at the cost of fearing (hostile) dependency and control • “How About Us Syndrome” • HAUSis aroused in the needy whenever the needs of others are fulfilled • Communities with a self-help orientation recover much faster than those demanding external assistance while delaying to re-build on their own
HELPLESSNESS - THE PERCEPTION OF WEAKNESS People in crisis are highly malleable and easily influenced In the desperate search for safety and security the distressed are liable to accept almost anything that is offered to them After cataclysmic events like the Tsunami of December 2004 governments seemed willing to do whatever it takes to get aid, even if it meant: Making alliances with former enemies Racking up a huge debts Agreeing to sweeping policy reforms In crisis people tend to look to their leaders for guidance in much the same way that children turn to their parents when they are distressed. transference
THE DISASTER OF POVERTY • Poverty fuels conflict • When states are poor they cannot fully control their territory or Resources • Lack capable police and border control agencies • Lack well functioning judiciary or military • Officials are especially vulnerable to corruption • Tendency to apply draconian measures • Also, weak in other respects • Unable to meet their citizens basic needs, food, education and health care • Often are prey for extremist religious groups and charities • Deadly disease and the burden of mental distress falls heavily on low or middle income countries
AID ASSISTANCE: Managing the flood? In the wake of a disaster: The channels through which aid assistance both in material and services is received, are difficult to regulate, supervise or monitor. Everybody asks for coordination but many refuse to be coordinated
AID ASSISTANCE: Managing the flood Number of NGO’s multiplies whenever a disaster strikes BANDA ACEH, 250 after the tsunami. SRI LANKA was 1000. Add-on’s not been estimated? Massive NGO influx, Experts arrive, some invited, many come anyway ……. UN system, (WHO, UNHCR, UNICEF, WFP, etc). Intn’l Professional Groups (Medical Associations), World Bank, Expatriate organizations, University departments, Faith-based organizations, International rapid response teams, foreign military emergency relief operations, Red Cross and Red Crescent teams from different nations.
AID ASSISTANCE: Managing the flood Locally hired relief personnel may not assert themselves even when policies of the foreign organization are clearly lacking in cultural sensitivity. Biting the hand that funds you could cost the loss of your job The HAUS syndrome may create resentment and divisions within nations and communities. “Phuket got more publicity that Banda Aceh.” Inequity in aid distribution is a common feature (and complaint) in aid assistance that became the focus of internal tensions as evidenced in Sri Lanka over establishing a Joint Mechanism for tsunami relief efforts.
AID ASSISTANCE: Managing the flood Spontaneous Volunteers - Highly trained individuals can present a major logistical problem Tsunami Tourists? Expatriate Donors may have differing motivations? Security issues: Various nefarious activities may be channeled through seemingly innocent humanitarian programs, creating in addition, a serious security (terrorism, arms smuggling) risk
AID ASSISTANCE: Managing the flood Western NGO’s and “culture competence”? Local institutions tend to lose their cohesion? Credibility of mercy missions and aid donors could be compromised in an environment of suspicion or when the significance of offerings is not understood A military presence coordinated with established law enforcement agencies contributes to better emergency services
SPIRITUAL DIMENSION The centrality of religious beliefs in most cultures influences help seeking, finding social support, understanding adversity. This usually takes place in the context of the religious community But, Religion can be used to divide people as it could to unite them Religious and cultural beliefs become challenged in the face of unexplained crisis. Following an initial phase of anger, disillusionment, and loss of faith, stories of “miracles” to the faithful help to re-affirm their beliefs
MENTAL HEALTH The overall goal of all disaster mental health service workers is to provide emergency services and reduce the number of people who could develop psychological disorders. Measuring Trauma ? The psychological impact of any disaster must be measured from different angles across several disciplines – (psychology, psychiatry, sociology, culture, history and anthropology etc) Anxiety and depression are the commonest manifestations of disaster stress.
MENTAL HEALTH Trauma and PTSD (Post Traumatic Stress Disorder) Disaster victims may not fit the category of PTSD but show some typical signs. Treatment can occur in the context of social influence with limited “medical” intervention. Cultural Factors? The Singhalese, Tamil and Muslim communities along the tsunami damaged east coast of Sri Lanka showed significant differences in response to the tsunami and the relief efforts
MENTAL HEALTH: GRIEF IS THE INEVITABLE OUTCOME OF LOSS “Death Toll” is the first index of a disaster’s damage and how they are generally reported Grief is the single most common consequence of disasters, whether it is from loss of lives or of the non-human environment. The loss of one life can have far reaching repercussions on the lives and futures of several families. Novel rituals have to be invented to deal with new problems - funerals for victims whose bodies cannot be identified or are missing. Grieving (as an internal process) can be delayed or complicated by many external factors.
MENTAL HEALTH: CULTURE AND COUNSELING Signs and symptoms of psychological distress vary widely People of different civilizations have different views on: The relation between man and God What happens after death and how to grieve The individual and the group The citizen and the state Parent and children, husband and wife Liberty, independence, authority and hierarchy Shame and guilt, modesty and sexuality Saving face and humiliation Relative importance of rights and responsibilities
Lessons Missed A fund of creative strategies have evolved in countries that have faced severe tragedy. These developments in medicine, psychology and social sciences in the Eastern world have not been sufficiently disseminated. In the field of disaster management they include mobilization of social networks in the community, psycho-education, and practices such as yoga, meditation, massage, and traditional medicine. Because past experience of disaster may render a community better prepared for future disasters, their example and advice tends to be overshadowed by standard western practices.
