Bulletin of the World Health Organization

Tsunami wreaks mental health havoc

Survivors are likely to spend years wrestling with the mental health impact of the Asian tsunami and the earthquake off the Indonesian coast. Aid programmes will quickly reconstruct homes, schools and hospitals, but rebuilding the shattered lives and minds of the people who lost friends, family, homes and their livelihoods will take much longer.

1 June 2005

An Indian woman mourning the death of a relative who was killed in the Asian tsunami catastrophe. The photograph was taken in Cuddalore, Tamil Nadu in India, 28 December 2004. It won first prize in the World Press Photo of the Year competition 2004.
An Indian woman mourning the death of a relative who was killed in the Asian tsunami catastrophe.

After a huge earthquake on 26 December with its epicentre near the Indonesian island of Sumatra sent walls of water smashing into coasts of Indonesia and neighbouring countries, as many as 280 000 people lost their lives and more than one million people were displaced. Three months later, 1300 people were killed on the Indonesian island of Nias by the aftershocks.

“There are areas where everybody knew someone who has lost everything or who had one or more family members disappeared. The tsunami will be a landmark in the memory of many communities,” said Dr Pau Perez Sales, a consultant for psychosocial and mental health programmes for Médicos del Mundo-España (MdM-E).

Mental health experts now argue that governments in the region should grasp the opportunity not only to address the short-term mental health problems caused by the tsunami but use the influx of funds and assistance to develop mental health systems in the long term.

The precise demand for mental health services after the tsunami was unknown, but WHO said that the prevalence of mild and moderate common mental disorders in the general population is 10% and that this can increase to 20% after a disaster. Severe mental health problems, such as psychosis or severe depression, typically affect 2–3% of any given population but can increase to 3–4% after a disaster, WHO said.

Based on their experience of large scale disasters, aid agencies set about preparing for a rise in mental health problems. Disaster relief planners quickly drew up strategies to bolster national health services to help survivors cope with the aftermath.

Aid agencies feared a high burden of mental conditions after the tsunami and earthquakes, said Dr Daya Somasundaram from the Department of Psychiatry at the University of Jaffna, Sri Lanka, who has been training community workers to provide counselling and other forms of psychosocial support interventions.

“WHO estimated that 50% may have problems and 5–10% have serious problems needing treatment. One [non-WHO] survey found 40% post-traumatic stress disorder (PTSD) in children,” Somasundaram said, referring to people in Sri Lanka. Other data had suggested that the mental health burden in Sri Lanka was even higher.

Altogether at least five million people have been affected in India, Indonesia, Maldives, Myanmar, Thailand, Seychelles and Sri Lanka by the earthquakes and tsunami, and in addition to those who lost their lives or were displaced. As soon as the scale of the disaster became apparent aid agencies, the UN, governments and WHO mobilized relief teams and millions of dollars of aid were shipped and flown to the affected regions.

At first, agencies focused on helping national health authorities deal with vulnerable survivors and organizing the safe burial of the dead. Priority was also given to monitoring risks to health through early warning disease systems and supporting recovery of countries’ health systems.

Ministries of health, WHO and other partners quickly did health assessments to determine survivors’ most pressing needs. Surveys of the most affected regions Categorized peoples’ mental health into three groups.

First: survivors with mild psychological distress that resolved within days or weeks. Second: people with moderate or severe psychological distress that resolved with time or mild chronic distress. Third: people with mental disorders, divided into those with mild and moderate mental disorders and those with severe mental disorders.

Tsunami-affected countries were advised to urgently provide mental health care via general and community-based services. Mental health workers had to deal with grief reactions, depression with suicidal tendencies, PTSD and other conditions.

Bhava Nath Poudyal, a mental health expert with the International Catholic Migration Commission in Indonesia, said many survivors faced “economic loss, loss of loved ones, need for livelihood — and stress reactions, emotional issues related to loss — some anxiety, especially at night, demoralization and psychosomatic complaints”.

“In Sri Lanka, concepts like ‘mental health’ or ‘psychological problems’ are not part of the lexicon of the population. They expressed emotional distress through the body, e.g. headaches or bodily pain.” Dr Pau Perez Sales, a consultant for psychosocial and mental health programmes for Médicos del Mundo-España.