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Emotional Well-being after Disasters
A Manual for Relief Workers
Moving ForwardTogether
Women’s Resource Centre
Copyrights © Shirkat Gah
The use of any material from this publication is to be acknowledged
Edited by Talia SheikhSpecial thanks Arifa Nazle & Farida Shaheed Designed by Muhammad Asim & Imran QureshiPrinted by Reality PrintersPublished by Shirkat Gah - Women’s Resource Centre,
P.O. Box. 5192, Lahore - PakistanE-mail
Lahore: [email protected], [email protected]: [email protected]: [email protected]
This publication has been made possible through the generous support ofThe Royal Norwegian Embassy, NOVIB and SDC.
Contents
Introduction 5
Design and methodology 7
Main idea of the manual 8
Section oneReactions and perceptions of survivors of the earthquake 9
Section twoDifferent nature of person - different reaction 15
Section threeSources of support for people in grief and despair 17
Section fourCoping strategies to recover emotionally from a disaster 23
Section fiveDifficulties helpers can encounter while working in a post-disaster environment 29
Section sixWhen the camps close & people move back to their places of origin 33
Section sevenRelief workers must be aware of the following post-disaster issues 35
Section eightSeizing the moment - let something positive arise from a disaster 39
7
Introduction
On 8th October, 2005, a massive earthquake measuring 7.6 on the Richter scale shatteredthe mountain ranges straddling Pakistan and India. Though devastation occurred inIndian Kashmir, the scale of destruction on the Pakistan side was unprecedented. Theearthquake struck twelve districts of Pakistan in the North West Frontier Province(NWFP) and Pakistan-administered Kashmir covering an area of 30,000 squarekilometers. Some 80'000 people lost their lives and many were injured. An estimatedtotal of 3.5 million people have been affected. In many places, the family unit hasdisappeared, leaving infants without mothers, women without husbands, parents withoutchildren, grandparents without children or grandchildren.
Working for women's rights and social justice, Shirkat Gah-Women's Resource Centresees itself as a catalyst for change (through capacity-building and advocacy interventions)and is not a service-delivery organization. Nevertheless, confronted with the tragicsituation wrought by the devastating earthquake, Shirkat Gah (SG) - like many rights-based advocacy groups - immediately responded by sending relief goods such as food,warm clothes, bedding, shelter materials (CGI sheets, tool kits) and stoves. Initially SGchanneled its relief through the Joint Action Committee for Earthquake Relief, a coalitionof rights-based groups, directing relief to groups with field presence in those areas.Subsequently, SG started direct relief to specific areas missed out by relief efforts:Punjgiran in Azad Kashmir and Kohistan in NWFP. Up to now over 4'700 families or over30'000 persons have benefited from SG relief efforts, including corrugated galvanized(CGI) sheets for temporary housings, clothing, stoves, and many other relief goods1.
1. Shirkat Gah Earthquake Relief Report, May 2006.
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In addition to providing direct relief, SG was concerned about ensuring that women'sspecific needs were being met and issues of rights and security addressed. In a first phase,Shirkat Gah invited different experts to share their experiences and conducted a rapidassessment of the camps from the perspective of women. After the initial phase, ShirkatGah started focusing on other major needs of the survivors such as women's need for safespaces to meet, share experiences and learn skills for reconstructing their lives. A linkedbut separate issue are the psychological and social needs of affected people. For this,Shirkat Gah - in collaboration with Open Society Institute, Rozan (Umeed) and OmarAsghar Khan Development Foundation- organized a training workshop in Abbottabad on20-21 March, 2006, under the theme of "Child Psychological & Emotional Health".
The training workshop was conducted by Dr. Anica Kos2 a highly experiencedprofessional child psychiatrist assisted by Katja Cibej Fras and directed towards helpersoften working with children and adults who are distressed and traumatized due to thetragic events of the earthquake.
The workshop "Child Psychological & Emotional Health" underscored the vital importanceof maintaining the emotional well-being of the survivors of a disaster. In the first instanceresponse to any disaster must, of course, ensure the essentials for physical survival: medicalassistance, food, stoves, clothing, beddings and shelters. But nearly as important as ensuringthese basic needs, is the need for the survivors to receive psychological help to cope withand overcome the psychological impact of a traumatic experience. What they areexperiencing (due to the earthquake or other disaster) will be of an almost unbearablemagnitude; the loss of family members, injuries and destroyed houses. Emotional recoveryis critical to enable these people to move on and reconstruct their lives.
Whenever a disaster occurs, there are only a limited number of professional psychologistsavailable to take care of people's emotional well-being. But, it is not only professionalpsychologists or psychiatrists who can help people overcome their emotional stress. Otherstoo, even survivors themselves, can help those affected to overcome their trauma.
Based on the workshop conducted by Dr. Kos and her assistant in Abbottabad, theexperiences shared by participants of the workshop held in Abbottabad, as well as on theinsights Shirkat Gah gained in working in the quake affected areas, this training manualprovides some basic guidelines and some approaches for helping people in a post-disaster situation.
2. Dr. Anica Kos is the program director of the Slovenian "Together Foundation". She started runningprograms for refugee children from Bosnia and Herzegovina in 1992 and is presently working in other areasaffected by armed conflicts such as the Balkans, Iraq and North Ossetia.
9
Design and methodology
The two day workshop on psychological and emotional health was designed to providelocal trainers, volunteers and all kind of helpers with practical tools to facilitate theirdaily work with traumatized people in the earthquake hit area. It also provided anopportunity for relief workers (for many the first one) to exchange their concerns and toshare the knowledge gained. While based on the specific circumstances and experiencesof the October 2005 earthquake, this training manual nevertheless applies to any otherpost-disaster situation.
The teaching-learning method of the workshop was participatory, using variousparticipatory methodology tools. The major part of the learning consisted of sharingexperiences between the participating helpers. Additionally, participants undertookvarious group work interspersed by many group and plenary discussions conductedthroughout the workshop.
10
Main idea of the manual
The aim of this manual is to provide relief workers (volunteers, teachers etc.) with someuseful and practical approaches for addressing the countless problems confrontingsurvivors. The manual should help facilitate their work with traumatized people due to adisaster, be it man-made or of natural cause.
A second purpose of this manual is to make helpers aware of the so-called "burnoutsyndrome"3 that comes with the stress of difficult and depressing work. It offerssuggestions how to avoid having a burnout.
Finally, the manual suggests ways in which relief workers can mobilize the communityto participate in their own personal recovery and in the recovery of their communities.Especially young volunteers can make a difference through their involvement in thework since youth is often very motivated to undertake activities with the community.
3. Burnout refers to a person being in a state of extreme fatigue/ exhaustion. This may occur as a result of toomuch and stressful work or work in a depressing and sad environment, e.g. after a disaster. It leads toinefficiency or even an inability to continue working.
11
Reactions and perceptions ofsurvivors of the earthquake
Survivors of any disaster have different reactions and perceptions as to whathappened and why. This is equally true for the survivors' response to the enormousdisaster of October 2005. Some of the post-disaster reactions and perceptions can besummarized as follows:
Perceptions why the earthquake occurred:
n The earthquake is a punishment for some sins
Many people were and remain convinced that the earthquake hit them as a punishmentfor some sins. They merely cannot think of any alternative explanation why theearthquake occurred.
n God punished them because of the sins of women
This interpretation of the disaster was promoted by certain vested interest groups usingthe general perception of the earthquake being a punishment from God. Indeed, somereligious preachers or maulvis claimed that the earthquake happened "because of allthese naked women"4. These accusations further victimize the already very vulnerablegroup of disaster-hit women. In some camps women gave relief workers a message totake out: "Please, we are not asking you to send us relief goods, we need nothing. But we
SECTION ONE
4. Omar Asghar Khan Development Foundation Earthquake Response 2005. Progress Report on WeeksThree & Four: 22 October — 4 November 2005, page 4.
12
beg you; tell the world we are not sinful women."5
n The ox holding up the earth tilted its head
An ox stands on a stone, balancing the earth on its horns. From time to time, its neckbegins to ache, and it tosses the globe from one horn to the other to relieve the ache. Thismovement provokes the earthquake. This is an old tale which people in the area say theirgrandparents used to tell them.
n Scientific explanation of an earthquake
Earthquakes happen because of the movement of the earth's tectonic plates hitting eachother. This is a new explanation given to people by relief workers. For many people inthe area who have never been taught earth sciences, the existence of tectonic plates seemsas implausible as the ox story.
Relief worker's approach towards interpretations:
Explain to the people who experience a natural disaster, the possible reasons for such anatural catastrophe (earthquake, tsunami). Involve survivors and leaders (includingwhere appropriate religious leaders) in a discussion about causes of earthquakes or othernatural disasters. Make sure that discussions are held with different community members(such as women or different ethnic or religious groups). Give examples of other naturalcatastrophes. Reassure the people and especially affected women that they didn't doanything bad that provoked the disaster.
Guilt
Many people find it impossible to feel happy that they survived the quake. Their sadnessabout others who have lost their lives is too great. Furthermore, many people feel a hugeguilt at not being able to prevent the deaths of family members and friends; for not beingable to help them when they most needed help. A mother was crying: "Why didn't my childsurvive and I lose my life?" There was the permanent question on many survivors mind:"Why did I escape the catastrophe? Why did my sister, brother, mother, father, teacher die?"6
5. Woman in a camp, interviewed for the Rapid Needs Assessment for Women Survivors by SG and five otherinstitutions December 2005.
6. "Child Psychological & Emotional Health", Abbottabad 2006; plenary discussion during the Workshop.
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Relief worker's approach:
As a relief worker you need to reassure the survivors that in a situation of a naturaldisaster nobody is able to help others; that everything gets out of control within seconds.
Tell survivors that they are not responsible for the death of others. There was nothingthey could have done to help, or that they did whatever they could to help. Engaging inany kind of spirituality (such as offering prayers) will be a help for many survivors in thissad situation.
Emotional and physical problems
In addition to suffering from severe injuries and illnesses, children and adults alikecomplained about other problems such as sleeping disturbances, eating disorders,headache, tummy ache, difficulty to breathe and actual symptoms of shock likeshivering. Others fell into a depression or had the feeling that they were losing theirmind. Children especially, had difficulty concentrating in school. There was also severeanxiety among the people: would there be another earthquake? And most of all, survivorsfelt sadness and hopelessness.
Relief worker's approach:
Some of the post-disaster symptoms need medical health intervention. But manydisturbances are purely of an emotional nature resulting from the shock and stress ofexperiencing such a catastrophe. Even if you do not have any training in psycho-socialcounseling you can help people by asking about their problems: how they feel, what hashappened to their families, if they lost loved ones.
A relief worker who participated in the Abbottabad workshop said: "In the beginning thepeople didn't want to talk about what had happened to them or talk about their feelings,but after some time they opened up and only to speak helped them a lot."
For children it is especially essential to distract them from the sadness by engaging themin games, story-telling, singing songs, and making drawings. If they complain that theycannot fall asleep or don't feel like eating, make them run around and play football orsome other game that makes them hungry and sleepy.
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Fear
The earthquake created immense insecurity among people. Regular aftershocks madethem fearful of another earthquake. What would happen to them? What would the futurehold for them? Young survivors worried if they would be able to complete theireducation, find a job and get married. People who had to move to the tent camps werescared of living in an unknown area, surrounded by strangers. Women in particular werevery afraid of strangers. A woman who had moved to a camp said:
"We do not fear harsh weather or wild animals but [we dofear] men who loiter around as if looking for an opportunityto pounce [on us] like wild beasts."7
Relief worker's approach:
Talk to the people about their worries. Take adequate security measures together with thecommunity to address the concerns and sources of fear and worry. How are the tents andthe sanitation facilities set up and in the camp? If the camps are not set up in a mannersuitable for those living there or certain groups such as women, discuss a better and saferway to set up or run the camp and involve the community in reorganizing the temporarysettlement.
YOU help us, we can't do it ourselves
While bringing aid to the devastated areas, relief workers often confronted the problemof people sitting around and not participating in any relief work. Of course, this reactionwas mainly due to their state of shock, despair and grief. In the wake of a devastation thatmade their future uncertain, it is common for survivors to try and obtain as much reliefgoods as possible from aid-workers for themselves (and their families or dependents).This can become problematic if this greed and selfishness continues and becomes apattern, depriving others of relief goods
7. Woman in a camp, interviewed for the Rapid Needs Assessment for Women Survivors by SG and five otherinstitutions, December 2005.
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Relief worker's approach:
Talk to the communities; try to have group discussions about the lack of cooperationfrom the local people and why cooperation is needed. Show them how they cancontribute to improve the situation they live in and the benefits they will derive fromcollaborating with the relief teams. For example, if they get involved in the rebuildingprocess, they can decide how they want things to be done.
As a relief worker you should also discuss the topic with organizations delivering therelief goods. The relief work must be well-coordinated. Establish the degree of needamongst different members of the community. Of course most people are affected in adisaster but some people will be worse off than others. For example some people willhave lost family-members, others not; some will have lost all their possessions, othersmay be able to salvage some goods; some will be older and more infirm and thereforeless able to cope than others. When distributing relief goods this differentiation needs tobe kept in mind. Communicate the criteria of the distribution of relief to the communityand maintain a clear record of who received which relief goods.
Shirkat Gah had the following criteria for the distribution of relief goods:
1. Persons with completely destroyed homes (people with partially destroyed housescan retrieve something)
2. Widows
3. Families that lost the only bread earner
4. Elderly people and families with young children
Both the tendency to sit around "helpless" and to gather a maximum of relief goods werereactions noticed by field workers. Although it must be mentioned that despite the tragicevents of the earthquake, many affected people remained optimistic, cooperated in anexcellent manner with the relief workers and organizations and gave hope to thecommunity and even to the helpers who were also struggling at times.
16 A relief worker who participated in the Abbottabad Workshopsaid that the distribution of relief goods created conflicts andtensions among the people. In one village people werecomplaining that they were not receiving any relief goods. Inthis situation the helpers selected a group of representatives ofthis village and discussed the problems with them. It showedthat the people who live in the higher mountain areas were atgreater risk of heavy snow fall and should be given priority inthe distribution of goods. Due to the better relationshipbetween the relief workers and the community many of thevillagers started helping as volunteers.
Basic approach to typical post-disasterreactions
As a relief worker (field worker, teacher, volunteer) you must beaware of the possible reactions people will have to a disaster. Try tomake an assessment of the particular problems existing in theenvironment you work in. Encourage the community members todiscuss their problems and develop possible solutions. Giving peoplethe opportunity to talk can itself be helpful in overcoming a problembut it is also important to exchange views and experiences to benefitfrom knowledge other people have acquired.
17
Different nature ofperson - different reaction
A person's reaction to a disaster will of course depend on what happened to a survivor andhis or her family. Did the person lose a child, a parent or a sibling? Another importantfactor in coping will certainly be the character of each individual. Some people are veryresilient while others may be less strong and therefore more vulnerable. So as a helper youneed to identify the kind of nature and character of each survivor you are trying to help.
Teachers and parents should pay attention to the nature and character of a child. Somechildren will have less difficulty in coping with the tragic situation; they will talk or evenlaugh again quite quickly. Others will need a lot of support; some may be almost unableto recover even a little bit.
In a village where an entire school collapsed, the survivingschool children reacted in very different manners, dependingon their kind of nature. Some children could cope better withthe tragedy and others could not concentrate anymore inschool. Some children were so traumatized they could noteven go back to school for a long time.8
Which school children are the types of steel, plastic or glassdoll? Which are the strong children who can help a teachercheer up the other ones and give a good atmosphere in class?
SECTION TWO
8. "Child Psychological & Emotional Health", Abbottabad 2006; plenary discussion during the Workshop.
18
Model of the type of doll a person can be compared to.
It may help to think of people as different types of dolls:
Does every sad person have to see a professionalpsychologist?
n Glass doll
A very sensitive person, who will be completely devastated dueto the catastrophe that happened.
n Steel doll
A very strong person who will not be too traumatized althoughhe or she went through very difficult experiences.
n Plastic doll
A person who is in between the very sensitive and the verystrong person. This type of person will find it difficult to carryon and be sad but will more or less be able to cope with thesituation.
n No, not everybody who is sad has to seek professional help. Upto a certain extent, reactions like sadness, grief, hopelessness,flash backs, sleeping and eating problems, should be consideredas "normal" reactions to a disaster.
n If these symptoms do not at least decrease after about onemonth the traumatized person should seek professionalpsychological help.
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Sources of Support for Peoplein grief and despair
Who can help others after a disaster has occurred to overcome sadness and despair?
In a post-disaster situation, entire communities will be in grief with many peopletraumatized as a result of their disaster experiences. It is important to use all kinds ofemotional sources of support to console and comfort sad people. A broad social supportnet is important for an emotional recovery.
The following sources of support can give emotional assistance to survivors:
SECTION THREE
n Family membersn Friendsn The communityn School and Teachersn Institutionsn Relief workersn Volunteersn Psychologistsn Psychiatrists
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The Family is an important source of support
Parents can console children, a sister can help her brother, and children can give hope toparents. But the support might only be possible up to a certain extent.
If a disaster affects an entire family unit and environment, then family members will nothave enough strength to support one another, like they can under normal circumstancesif only one family member is going through a difficult time.
A parent who has lost her/his child might not have the energy to take care of the family,to reassure and console the other children. That is why it is vital to activate all sourcesof support.
Relief workers of Shirkat Gah observed that the people of AJKand NWFP have very strong family ties. These families cangive a lot of emotional help to other family members (mother,father, uncle, aunt etc.). Helpers encourage people who lostfamily members to be strong and take care of the survivingchildren, aunts, uncles etc. Helpers also told the people theyplay a very important role for the support and recovery ofother family members.
Activate and use sources of support from outside the family
After a catastrophe people need the support of their family members and also help fromoutside the family to overcome their sorrow.
Schools and institutions
Schools and institutions are a particularly important place of support. They can quicklycreate a kind of normal environment when everything around them is destroyed andchaotic. But keep in mind that teachers and helpers might also need somepsychological support to deal with the situation. There will be many children attendingclass who are traumatized by the disaster that struck them and their families.
Relief workers of Shirkat Gah observed that many children did notreturn to school after the earthquake. Parents as well as children were
21
afraid of joining classes as many schools had collapsed during theearthquake. Relief workers and teachers tried to get the children backto school by distributing sweets among the children to get theirattention and encourage them to come back to school. In some placesthis strategy was helpful.
A teacher told Shirkat Gah relief workers that she had lost her familymembers in the earthquake. After the disaster, she went into adepression and did not want to teach anymore. But later, when she sawchildren running around her and smiling she gained the strength to goback to school and teach again. At that time she felt she could helpothers who had survived the earthquake like she had.
Relief workers
Relief workers can provide emotional assistance to people in grief. They can do thisby listening and talking to the concerned people about the tragedy. They also assistby their very presence in the affected area which shows solidarity and gives hope.Relief workers can initiate activities with the people to distract them from the painor to help express their feelings (e.g. through art work).
Professional help
Regarding professional psychological help for traumatized people, relief workersshould be aware that only very few affected people will have the opportunity to gettheir professional help. This is the reason why helpers and especially teachers playa very big role in helping children and adults overcome their trauma.
The particular importance of schools as a source ofsupport after a disaster occurredThe earthquake turned the whole life of the affected people upside down. In such achaotic and desolate situation the emotional recovery of children can be improved byschools. The contribution of schools to the well-being of the children will also improvethe general situation of the community.
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How does school help the children recover?
n If the atmosphere at home is tense and sad, children can benefitfrom a more cheerful atmosphere in class.
n School keeps children occupied (instead of children roamingaround not knowing what to do).
n They can exchange stories with other children of the same age.
n School is a place where children can play together.
n Schools with a good atmosphere, where children feelcomfortable, can contribute to the improvement of their well-being.
n The school gives the children a feeling of security and makesthem more confident again.
n Teachers must adapt the usual timetable in class to:
q Integrate activities such as games, singing songs, lettingchildren make drawings or paintings or any other kind ofart work, as these activities are a very helpful way forchildren to express their feelings.
q Plan 2 hours daily for activities other than mathematicsand writing exercises.
n The teachers should hold discussions with school-children inwhich the children can talk about what happened to them andsay what is bothering them.
n Teachers can help parents become aware of their children'sproblems:
q Teachers can observe children in class and see if there is aproblem. They can tell parents how to reassure children athome (telling stories, taking interest in the child'sactivities etc.)
Teachers helping the process of recovery
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n Relief workers and volunteers can organize special activities forchildren as well as adults to distract them from the events of thedisaster:
q Make the people do art work; give them paper and colorpencils to draw, organize a singing contest or games.
n Run existing schools and set up new schools in camps as fast aspossible (see above "How does school help the children torecover?")
n Create special areas for children, e.g. a "fun tent" or even a "funspace" demarcated on the ground.
n Draw a tree of hope and wishes to help survivors focus on thefuture (see image page 25).
Relief workers and volunteers helping the process ofrecovery
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Psychologist or Psychiatrist: What is the difference andwho can help survivors with emotional problems?Psychologists as well as psychiatrists can support traumatized people:
n Psychologists can use their special knowledge and tools (Whatcan help traumatized people? How can children and adultsrecover emotionally? How can you lead a fruitful discussionwith survivors?).
n Psychiatrists can use special knowledge as well as medication(tranquilizers, antidepressants etc.).
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Coping strategies to recoveremotionally from a disaster
After a disaster the pain of those affected about their losses is indescribable.Nevertheless, after a certain period of time, people have to try to recover as well aspossible and cope with the new realities of their lives.
Psychologists as well as psychiatrists can support traumatized people. The majorproblem is always the limited number of experts available after a disaster has occurred.Another problem will be that some people will not be willing to talk to professionalseven if in great emotional trauma.
As a relief worker you should try to show coping strategies to survivors. Guide them withhelpful ideas of how to recover from emotional stress.
SECTION FOUR
26
Coping strategies for children and adults
n Relief workers should make people talk to each other abouttheir concerns:
q Relief workers can sit with people in their tents, homes ora centre and start a discussion about the disaster, aboutpeople's losses and their concerns. Create a goodatmosphere of confidence. Encourage people to share theirimpressions and experiences with each other.
E.g. one mother will say that her child doesn't sleep wellat night and another mother might have had the sameproblem but is now telling her child a story at night so thechild can fall asleep much better.
n Tell people that many reactions they are experiencing areabsolutely normal, e.g. to have flashbacks, bad dreams.Reassure them and tell them they are not going mad.
n Encourage survivors to get back to a daily routine:
q Children have to get up in the morning and attend schoolclasses, do home work.
q Remind parents of the responsibility for their children andthe duty to look after the household.
n Try to distribute relief work and rebuilding tasks. Assignspecific tasks to the community.
Relief workers from Shirkat Gah observed that vulnerablepeople (widows, elderly people) struggled a lot to build shelterswith wood and the tools distributed. Since the relief workerswere not enough to help all the people, they encouraged someyounger people to help the more vulnerable people.
n Make sure that people are not unoccupied.
n Actively encourage people to move on, think about the future.Make them draw their future plans in the mud or on a sheet ofpaper. The fact of drawing a future house, for example, makes itseem more possible to actually rebuild one. Initiate a discussion
27
with survivors about their wishes and hopes for the future.
n Remind the survivors of spirituality and religion. It can helpthem recover and gain hope through prayers and faith.
n Encourage women to act as the head of the family if they havelost their husbands.
n Give decision making power to women. E.g. the women shoulddiscuss which kinds of relief goods are most important. Howshould the tents or temporary shelters be arranged?
n Set up community centers. Provide a space for people to gather,exchange ideas, and improve their skills (stitching, embroidery,how to produce handicrafts). Workers should be present in thesecenters for counseling or to provide any other kind of neededhelp.
n Remind the community of their duties to one another. Everyhuman being should try to help others, console others.
School
Job
StudiesMarriage
Happiness House
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Parents have a great responsibility to improve thewell-being of the familyRelief workers must encourage parents to take care of the well-being of their childreneven if they mourn the loss of other family members. Tell parents to:
Relief workers must involve the community in their actions
To do fruitful relief work it is useful to involve the local community in your activities.As a relief worker, try to build up a good rapport with the locals. Show them solidarityand genuine interest. Involving the community is also very important to unburden a reliefworker of his/her countless tasks.
Involve the youth and older school children. They usually like to participate in the reliefwork and to act as volunteers.
n Comfort and reassure the children.
n Take interest in their activities, in school, ask how their daywent.
n Put the children to bed and tell them stories, sing a song withthem, pray with them, hold their hands.
n Make a cup of tea and sit with the children.
n Losing family members should not result in neglect of thesurviving family members.
29
When involving the community the following areuseful tools:
n Conduct a rapid assessment of the situation, the needs, and themajor problems.
n Find out about the specific issues of women.
n As an outsider and unfamiliar with the locals, try to getinformation about the community, find out about their needs.
n Involve the community. Do not impose anything on them.
n Approach the elders and talk to them:
q Find and approach the community leaders. Facilitatediscussions with survivors about their feelings and concerns.
q Listen to people and show them that you are taking theirconcerns serious.
q Encourage communities to take action and improve theirpresent situation.
q Find occupations for the people. Involing people in thework will make people feel needed and important.
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Difficulties helpers can encounter whileworking in a post-disaster environment
Too many tasks are waiting for you as a field worker -Distribute your workWhen arriving in an area hit by an earthquake or any other kind of disaster, theamount of tasks to be done and organized will be huge.
Medical care has to be provided as fast as possible, food has to be distributed, andshelters set up in addition to a rapid assessment of the required help and relief goods. Toomany people will need the help of relief workers. Helpers should involve the communityand distribute the work. For this, they must first decide which tasks can be given to thelocal community and which must be fulfilled by them.
How to manage your tasks as a field worker:
As a relief worker you must set priorities for your work. Which criteria will you apply tomanage your tasks? What kind of help can actually be provided?
SECTION FIVE
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The burn-out syndrome9
Relief workers usually have to carry out their tasks in physically rough conditions andwork in an environment of devastation and sadness. Their tasks therefore become bothphysically as well as emotionally exhausting. The result is that helpers themselves canget traumatized. They may feel the same symptoms as the survivors of the catastrophe(e.g. flashbacks, depression, guilt, sadness, sleeping disorders). Often the helpers cannotcontinue to help the survivors and suffer from a "burn-out syndrome".
The personal commitment and the energy that helpers put into their work are pivotal forimproving the post-disaster situation. But this will also be the most exhausting part ofyour work.
n Find out what kind of help and relief goods are most required.
n Decide what tasks you can distribute among the locals.
n Involve the community in the work
n Find out who the natural leaders of the community are. Theycan help approach the community and make people participatein the relief work. The stronger ones have to help the vulnerablepersons (infants, elderly, widows.)
9. See footnote 3, page 8; Main idea of the manual.
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Activities to prevent and/or overcome a burn-out
n Take regular breaks from work. Change your environment,take a vacation for a few days.
n Change your daily routine. Which helper of the team doeswhat exact work? Can you switch your responsibilities with acolleague?
n This will help you reload your batteries and feel better:
q Go for walks
q Listen to music
q Do joyful activities (without guilt)
q Sleep enough
q Pray, meditate
n Do not try to handle everything on your own
q Distribute your tasks
q Encourage other people to act as volunteers
q Involve the community in your work
n Co-workers must support each other
q Share your feelings with co-workers. Individually youmay only see the sad and negative things. The group canhelp correct your perception of the things.
q Organize group discussions for helpers to prevent possibleburn-outs.
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When the camps close & people moveback to their places of origin
Due to the earthquake of October 2005 in Pakistan some 200,000 people were forcedto live in tent camps and temporary shelters10. Most of these persons were veryreluctant to leave their homes but the circumstances did not leave them with a choice.These internally displaced persons (IDPs)11 were settled in various camps throughoutthe North West Frontier Province (NWFP) and Azad Jammu & Kashmir (AJK).
In the present phase, relief workers must help internally displaced people anticipate theirreturn to their places of origin. Talk to the people in camps; find out about their situation.Conduct a survey among the persons in the camps: Where are they from? Where can theygo and live once the temporary shelters close? Keep a list of persons who are particularlyvulnerable, like disabled persons such as the elderly, orphans, women who lost malefamily members.
Many people who remained in the affected villages will warmly welcome returningfriends and family members. However, there will be some people who are likely toaccuse the returnees of having abandoned their villages and chosen the easy way out.
Another problem that may arise in post-disaster situations is that returnees tend to expecttoo much from the community who remained behind or from the government. They think
SECTION SIX
10. RISEPAK: Relief Information System Earthquake - Pakistan, A case study on Internally Displaced Persons.
11. Internally displaced persons (IDPs): persons who have been forced or obliged to leave their homes asresult of armed conflict, violence, human rights violations, natural or human-made disasters and have notcrossed the country's border.
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that the government should provide for water, electricity, support the families financiallyand many other things. But many will be disappointed about the slow, the insufficient ornon-existent assistance available. For people who left it is not easy to settle back home.
The people who stayed in the affected area can often cope better with the situation; theyadjusted to the new situation immediately after the disaster struck them, and this makesthem more independent.
Relief workers should help anticipate and organize thereturn of IDPs
n Help organize the return of IDPs.
n Who came from where? Who is able to return to the originalvillage?
n Set up crisis centers that people can approach if they cannotorganize their return themselves (persons who have no place togo back to, no house, no land, widows, elderly, disabled, injuredpersons).
n Who has no land, no house, no money? How can you help thesesurvivors?
n Are there women in the camps who lost their husbands? Howcan you arrange their situation of living?
n Set up transitional camps for the vulnerable.
n Form groups of volunteers who will be responsible for returnproceedings in their communities.
n Prepare the people for their return. Inform them of what kind ofhelp they can expect and what situation they might encounterwhen they arrive back home?
n Prepare the community that stayed behind for the return ofneighbors, family members, and friends. Discuss concerns,feelings with the community who remained in the devastatedplaces.
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Relief workers must be aware of thefollowing post-disaster issues
In a post-disaster situation everything gets out of control. For relief workers andcommunities it is certainly not possible to handle every problem immediately. Yet,all those who work in a post-disaster environment should be aware of the followingconsistently arising problems that have been indicated by relief workers andorganizations who have worked in previous disaster situations.
Problems of IDPs in camps:
Women's privacy, hygiene & health
SECTION SEVEN
n There is no privacy in tent camps. This is especially disturbingfor women and young girls.
n There are often not enough toilets and/or washing facilities.
n In some camps women's toilets are further away and womenhave to cross the men's washrooms to reach them.
n Sanitation/ shortage of water. Not enough water to meethygiene and household needs.
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Women's security
n Women's hygiene is an issue of concern but local norms do notallow an open discussion of these problems.
n Insufficient hygiene augments the risk for diseases.
n Lack of sanitary pads for girls and women. Ensure that sanitarypads are considered relief goods and distributed to women! It ispreferable for women relief workers to distribute hygiene kitsfor women. If there are no female relief workers available,designate women who live in the camps.
n Inadequate and insufficient food for pregnant women
n Fear, insecurity: Women often feel insecure in camps; theyexperience a constant fear of men following and harassingthem.
n Women fear using toilets because they tend to be further away,men can follow them and toilets do not have proper doors,increasing the risk of harassment.
n Tents are open and anyone can enter at any time.
n Verbal harassment.
n Sexual harassment and rape.
n Domestic violence.
n Men frustrated due to lack of employment or activities unjustlydirect their anger towards the women.
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Help does not reach the entitled persons
Social problems
n Men of one community do not respect the women from othercommunities.
n Patriarchal views clash with women taking action. Why arethese women stepping out of their homes and speaking up?
n Dependency on external help.
n Child beggars.
n There can be tensions among internally displaced people.People from different communities live closely together intemporary shelters. They have different views, customs,religions and belong to different clans.
n Participants of the workshop said, that corruption was a verybig problem. Affected people believed government officialsfavored their own people; rations meant for many people wereonly distributed to a small number of persons. Inequitabledistribution of goods.
n Existing relief schemes are poorly communicated. People whoare entitled to obtain money or certain goods due to theirpersonal situation come to know too late about the availablehelp. By the time they apply for the granted help, they are toldit is no longer available.
n Insufficient communication and clarity of organization andaction among government, organizations, relief workers,survivors.
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A disaster should be an opportunity to improveexisting realities. Women's issues can be raisedand the situation of children can be improvedby sending them to school (free of cost) orproviding them with medical care.
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Seizing the moment - Let somethingpositive arise from a disaster
Positive changes for women
Shirkat Gah field workers witnessed positive changes for women in their respectivecommunities. When Shirkat Gah field workers first arrived in Punjgiran (AzadKashmir) with relief goods, no women came to receive food or clothing. This waspartly because their families did not allow women to leave the house even before theearthquake. But once a relationship was established between helpers and survivors,women started stepping out of their shelters and/or homes and the men acceptedthis change.
Women in Punjgiran reported another positive change after the disaster. They said thattheir husbands were kinder than before and appreciated them more because they hadrealized they could have lost their wives in the earthquake.
After the earthquake women's mobility increased as they became actively involved in therelief work. The organizations and helpers in the quake hit area depended on the localwomen's contribution to the relief work and their knowledge about customs and theinformation about the required help for their families. This interaction between reliefworkers and the local women had a positive impact on women's confidence.
SECTION EIGHT
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Education
Before the earthquake many girls, especially from NWFP were not sent to school by theirparents. After the disaster many schools were set up in camps and villages and girlsstarted attending the classes too.12
Health
When Shirkat Gah relief workers went to the quake affected areas they were approachedby many men and women who asked them for contraceptives. Birth control will have apositive impact on women's health and hopefully reduce child and maternal mortality.
Environment
As people witnessed the earthquake and following landslides they got aware of theimportance of trees. Before the disaster, they cut a lot of wood which they used forcooking and heating.
Some villages did not have electricity even before the earthquake. Due to reconstructingof devastated areas, electricity was installed in some of these villages.13
Respect for other religions and cultures
Help for quake survivors came from all over the world, from governments, organizationsand a lot was donated by private people. The relief workers too came from all over theworld to help. Experiencing such a huge support from people of different nationalities,religions and cultures, the ones who had prejudices against foreigners before theearthquake, changed their mind and became more respectful towards others.14
12. Observed by Shirkat Gah relief workers.
13. See above-mentioned footnote.
14. See footnote 12.
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Opportunity for improvement
A disaster should be an opportunity to improve existing realities. The rebuilding ofdestroyed areas that were very poor before the catastrophe happened can bring a betterinfrastructure for the people (water, sanitation, electricity, roads). In a post-disastersituation women's issues can be raised and discussed with the communities (health,mobility etc.). Furthermore, it can be an opportunity to improve the situation of childrenby sending them to school (free of cost) or providing them with medical care andvaccinations.
