Disaster: Challenges and perspectives

Abstract

Disaster is a sudden, calamitous event, bringing great damage, loss, destruction and devastation to life and property. The damage caused by disasters is immeasurable and influences the mental, socioeconomic, political, and cultural state of the affected area. Disasters are events that inflict great damage, destruction, and human suffering. Their origin can be natural, such as earthquakes, floods, and hurricanes, or of human origin: accidents and terrorist acts. India has been vulnerable to natural disasters on account of its unique geo-climatic conditions. Floods, droughts, cyclones, earthquakes, and landslides have been recurrent phenomena. About 60% of the landmass is prone to earthquakes of various intensities, over 40 million hectares is prone to floods, about 8% of the total area is prone to cyclones, and 68% of the area is susceptible to drought. The loss in terms of private, community, and public assets has been astronomical. India has been struck by numerous disasters in the recent past including, among the major ones, the Bangalore circus tragedy (1981), Bhopal gas tragedy (1984), Gujarat cyclone (1998), Orissa super cyclone (1999), Gujarat earthquake (2001), annual flooding in large parts of the country during the monsoon, and the tsunami in 2004. The response to disasters has gradually improved over the years, as lessons have been learnt from each disaster and adapted. Factors that have inhibited the response to disasters in the past include, lack of a national-level plan policy, absence of an institutional framework at the center / state / district level, poor intersectoral coordination, lack of an early warning system, slow response from the relief agencies, lack of trained / dedicated search and rescue teams, and poor community empowerment. The World Health Organization (WHO) has been in the forefront of the response to emergencies, and mental health care is an important part of this response.[1] The importance that WHO attributes to dealing with psychological traumas of war and disasters have been highlighted by the resolution of the World Health Assembly, in May, 2005, when it passed the resolution of the WHO Executive Board, in January 2005, and urged support for the implementation of programs to repair the psychological damage of war, conflict, and natural disasters.[2 ] Human responses to natural hazards are assumed to be rooted primarily in the way individuals think, behave, and interact in the environment.[2] Disasters that are unexpected, occur suddenly, causing widespread damage, and are understood to be traumatic and associated with a high degree of psychological disturbance.[3 4]. The survivors are most often seen as having significantly disrupted lives, which require lengthy periods of recovery. The disaster management approach requires administrative support and medical intervention, apart from psychosocial intervention. As per Indian law, the District Collector has the overall authority for all the administrative issues in the district. The District Collector is the key focal point in the launch and implementation of any relief efforts in a district. The social context of healing is equally important and cannot be overemphasized, especially the unique aspect of the communities of the SEA (South East Asian Region), which influences their response to suffering, ability to cope with loss, time of recovery, and so on. Relief effort and disaster preparedness plans must take into consideration the ethnic and cultural aspects and needs. The mental health service needs of large proportions of the affected population can be served by relief and rescue workers and healthcare providers, as well as by strengthening and supporting the sociocultural coping mechanisms of the local communities. Relief and rescue workers are, as a general pattern, sensitive to the emotional and psychological needs of people in distress. In the Indian scenario the experiences of disasters, especially natural disasters, have yielded a wealth of information. The country has integrated administrative machinery for the management of disasters at the National, State, District, and Sub-District levels. The basic responsibility of undertaking rescue, relief, and rehabilitation measures in the event of natural disasters, as at present, is that of the concerned State Governments. The Central Government supplements the efforts of the State by providing financial and logistic support. Besides this, the Indian Armed Forces are called upon to intervene and take on specific tasks if the situation is beyond the capability of civil administration. In practice, the Armed Forces are the core of the government's response capacity and tend to be the first responders of the Government of India in a major disaster. The Armed Forces have historically played a major role in emergency support functions such as communications, search and rescue operations, health and medical facilities, transportation, power, food and civil supplies, and public works and engineering, especially in the immediate aftermath of a disaster. TYPES OF DISASTERS Broadly, disasters are of two types - ‘Natural’ and ‘Man-made’. Based on the devastation, these are further classified into major / minor natural disasters or major / minor man-made disasters. Natural disaster: Natural disasters such as earthquakes, volcanic eruptions, typhoons, and cyclones affect many counties in Asia. A review of the natural disasters and mental health in Asia highlighted the extensive, frequent, and damaging nature of such events. Man-made disasters: These include transport and industrial accidents, such as, air and train crashes, chemical spills, and building collapses. Not everybody responds to a disaster in the same way, as there are differences based on various experiential factors and circumstances. Pre-traumatic factors: The pre-traumatic factors could be the ongoing life stress, lack of social support, pre-existing psychiatric disorder; other pre-traumatic factors, including: low socioeconomic status reported abuse in childhood, play an report of other adverse childhood factors, family history of psychiatric disorders, or poor training and preparation for the traumatic event. Peri-traumatic or trauma-related factors: These may be severe trauma, type of trauma (interpersonal traumas such as torture, rape or assault, convey a high risk of post-traumatic stress disorder (PTSD)), high perceived threat to life, age at trauma (school age, youth, 40 – 60 years of age), community (mass) trauma, or other peri-traumatic factors, including: history of peri-traumatic dissociation and interpersonal trauma. Post-traumatic factors: These may be the ongoing life stress, lack of social support, bereavement, major loss of resources, or other post-traumatic factors including: children at home and female with distressed spouse.[5 ] There are certain possible reactions to a traumatic situation, which are considered within the ‘norm’ for individuals experiencing traumatic stress,[6] which are: Psychological response to disaster Psychological distress is defined as a serious and problematic emotional, cognitive, physical or interpersonal reaction to difficulties. Distress is of sufficient intensity to disrupt a person's normal life patterns. It can be distinguished from psychological stress, which is considered as a more benign response to difficulties that an individual is able to relieve through everyday coping responses. About 25% of people remain effective, with emotional continence and appropriate behavior. Some 50 – 75% are ‘normal,’ but bewildered, ‘numb,’ withdrawn, and anxious, and further, almost 15% are unaffected by the outset, with inappropriate ‘contagious’ behavior. The systematic study of 929 adult patients, examining the long-term psychiatric consequences, work loss, and functional impairment associated with the 9/11-related loss among low-income, minority primary care patients in New York City, found patients who had not experienced 9/11-related loss as compared to patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and posttraumatic stress disorder (PTSD; 17.1%). After controlling for pre-9/11 trauma, the 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that there is a need to emphasize disaster-related mental health care in the affected population.[7] Psychological effects of the disaster are as under: Emotional Effects: Shock, terror, irritability, blame, anger, guilt, grief or sadness, emotional, numbing, helplessness, loss of pleasure derived from familiar activities, difficulty feeling happy, difficulty feeling loved. Cognitive Effects: Impaired concentration, impaired decision-making ability, memory impairment, disbelief, confusion, nightmares, decreased self-esteem, decreased self-efficacy, self-blame, intrusive thoughts, memories, dissociation (e.g., tunnel vision, dreamlike or ‘spacey’ feeling). Physical Effects: Fatigue, exhaustion, insomnia, cardiovascular strain, startle response, hyperarousal, increased physical pain, reduced immune response, headaches, gastrointestinal upset, decreased appetite, decreased libido, vulnerability to illness. Interpersonal Effects: Increased relational conflict, social withdrawal, reduced relational intimacy, alienation, impaired work performance, decreased satisfaction, distrust, externalization of blame, externalization of vulnerability, feeling abandoned. PSYCHOSOCIAL RELIEF EFFORTS FOLLOWING A DISASTER The first attempt is always to restore the health services. Mental health and psychosocial support is not awarded high priority initially, but governments of the affected countries soon realized that this too was a crying need of the people. It was recognized that any neglect of psychosocial support could impair efforts toward physical rehabilitation. Psychosocial support became crucial, but to be effective, the support had to be appropriate and culturally sensitive. One of the important recommendations of the WHO was to have a strong community mental health system, which would serve the immediate as well as long-term needs of the community, provided it was sustainable and could become a part of the routine health care delivery system. Different countries have developed innovative methods of providing community mental health services. These efforts should be encouraged. At the same time, the impact of these services should be objectively assessed and changes made as necessary. The interventions immediately following a disaster occur in four phases: The rescue phase: This is the period immediately after the event and lasts about two weeks. On an emotional scale, this is also referred to as the ‘Heroic Phase’. People, victims and others alike, join hands to do whatever they can to prevent loss of life and property in a spontaneous display of altruism. There are many accounts of people who have been in the forefront of relief work, often working 48 to 72 hours at a stretch, and have sometimes risked personal injury and suffering to help save lives of others. However, there is a dark side to relief efforts too and care must be taken to ensure that there is no looting, plundering or exploitation of the vulnerability of the victims. The relief phase: This is a period lasting approximately two to six months after the disaster. This is the period when a huge outpouring of relief supplies and support from the community, voluntary agencies, and government result in a high level of optimism about problems being dealt with and the situation improving. There is a wave of compassion, goodwill, and care. The rehabilitation phase: This period continues up to one to two years or more after the disaster. Disillusionment about the efficacy of the relief efforts sets in at some point in time during this phase. Bureaucratic delays and legal barriers in providing relief and promises that are not kept or those that fall short of expectations can lead to frustration. Victims realize that they have to give up the wait for help and solve their own problems. The rebuilding phase: This may last years and sometimes even continue for life. Disaster preparedness, especially for high-risk and vulnerable areas, is also an integral part of this phase. Individuals and communities work together to restore normalcy. People begin to live life on their own terms and move on. The impact of disaster is long lasting, however, psychosocial intervention in the aftermath of a disaster is associated with a period of recovery .This can broadly be defined as a time of returning to ‘normalcy,’ and characterized by such processes as rebuilding, allocating resources, finding housing, and repairing or re-establishing social and economic networks in the community.[8] It is noted that people may benefit most from very concrete, explicit, and directive assistance, which enables them to attain the tangible goods and services required to overcome the material losses of a disaster.[9] Research has shown that the strains associated with restoring housing and patterns of life can have as much an impact upon the psychological well-being as acute and potentially traumatizing events.[10 ] CONCLUSION Disasters have substantial social and psychological impacts, which reflect not only the impact characteristics (e.g., magnitude and severity), but the pre-existing social and economic vulnerabilities, which intensify the loss and disruption. Effective disaster management, therefore, needs to ensure that the diverse interests and priorities of communal life are integrated into planning and response, especially those of vulnerable persons and groups. At the same time, it is important to take into consideration the psychological effects of disasters, particularly in relation to response mechanisms and processes. The level of psychological distress generated by a disaster may be either diminished or intensified by planning and management decisions, which in turn can enhance or impede recovery and reconstruction. The development of mental health care faces special challenges in developing countries. There is a need for mental health professionals to shift from a clinical to a public health focus; the development of training materials, case records, information systems, and the availability of adequate numbers of mental health professionals to implement the plan. There is a need for training all those involved in disaster relief work. The importance of trained Community Level Workers (CLWs) to implement an organized effort aimed at providing psychosocial relief has been well exemplified. There is a need in the Indian scenario to have community mental health teams trained for such events.