Soon after 9 am on the 26th of December2004, the district of Batticaloa on the easterncoast of Sri Lanka was struck by tidal wavesproduced by an earthquake off the coast ofSumatra. The tsunami directly affected over250,000 people in the Batticaloa district,resulting in the displacement of over 70,000people, the confirmed deaths of 2,846 people,1,027 people missing and a further 2,375injured1. As with so many other coastal areasbordering the Indian Ocean, apart from thetragic loss of individuals and the direct threatto life because of the tsunami, there was alsoterrible material and social devastation of thecommunities affected. Homes, livelihoods,community infrastructure, and social net-works have all been disrupted, or destroyedaltogether. These impacts, together with theadditional ongoing difficulties and vulnerabil-ities produced by conditions of displacementand loss, present a considerable assault on thepsychosocial well being of persons affected bythe tsunami. This brief field report will outlinesome of the challenges in the ongoing effortsto develop coordinated (and appropriate) psy-chosocial services in the Batticaloa district.

The Imperative for PsychosocialInterventionFor the first two weeks after the tsunamistruck, the concerns of humanitarian agen-

cies, the Sri Lanka government, the militantLiberation Tigers of Tamil Eelam (LTTE),local and international emergency responseteams, and the public in Batticaloa seemed tocentre primarily on delivering material relief(food, clothing and shelter) and curative med-ical services to people displaced or otherwiseaffected by the tidal wave. At this time, con-cerns about psychosocial needs were explicit-ly articulated by the numerous visitingreporters from North America and WesternEurope who interviewed local mental healthworkers about the need to address the ‘trau-ma’ of adults and children who had sufferedterrifying experiences and tremendous personalloss. It was only by the end of the second weekthat a discussion of the psychosocial needs ofaffected persons had gained prominenceamongst the groups and organisations involvedin emergency work within the Batticaloa dis-trict, or indeed elsewhere in Sri Lanka.Psychosocial intervention swiftly attained thestatus of a priority area for emergency response,alongside the provision of shelter, and securingof adequate water and sanitation facilities fordisplaced persons. While it was not clear fromwhere this drive for psychosocial interventionoriginated, it soon became apparent that inter-national and local media, government, non-gov-ernment agencies (NGOs), international organ-isations and individuals, and groups of mental

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health professionals in Sri Lanka and otherareas of the world had developed a broad con-sensus about the need for psychosocial inter-vention. Resources to provide this interventionwere swiftly mobilised.

The Emergency PsychosocialResponseThere were, of course, significantly differentperspectives about what were the mostappropriate psychosocial interventions in theaftermath of the tsunami, and activities con-ducted in the Batticaloa district reflected this.The dominant impulse amongst local NGOs(primarily those with little prior involvementin psychosocial programming) and con-cerned groups from other areas of the islandwas to provide ‘counselling’ for survivors ofthe tsunami. Aside from the few counsellorsalready working locally, these services wereprovided by volunteers trained for a fewdays, or by teams from elsewhere on theisland. There was a widely held assumptionthat speaking about their experiences andfeelings with ‘counsellors’ would be emotion-ally beneficial for people who had faced theloss of their families, houses, livelihoods andwho were living in temporary camps. Thisview resulted in small teams of ‘counsellors’being deployed to visit camps to speak withdisplaced persons. Given the unstable condi-tions in camps (i.e. fluid populations, poormanagement and delivery of relief supplies,threats of closure) and the large numbers ofresidents, such ‘counsellors’ often reportedthat their working sessions were usually withlarge chaotic groups anxious to tell their sto-ries. The sessions also presented few opportu-nities for in-depth support to individuals or forfollow-up. These experiences often left ‘coun-sellors’ feeling overwhelmed and frustrated.At the same time, there was an apparentlycontradictory approach advocated by someorganisations and individuals. These groups

had implemented psychosocial interventionswithin the district in the context of the armedconflict that existed for many years before thetsunami. This perspective prioritised address-ing the social and material needs of affectedpersons as the primary form of support pro-vision in the acute phase following the disas-ter. Attempts to ‘counsel’ survivors wereactively discouraged as an initial interven-tion, although supportive listening and‘befriending’ of survivors was encouraged ifthey initiated conversations about theirexperiences or difficulties. This view wasinformed by prior experiences of service pro-vision in the district, as well as by guidelinesand perspectives put forth by other agenciesnationally (tsunamihelpsrilanka.blogspot-com; Ministry of Health, 2005) and interna-tionally (van Ommeren, Saxena & Saraceno,2005; WHO, 2003). The implementation ofthis approach was characterised by its lack ofconspicuously ‘therapeutic’ activities. Forexample, agencies working with separatedchildren would make efforts to reunite chil-dren with family members, or familiar care-givers. Some would respond to women’s con-cerns about sexual harassment in camps byarranging safe spaces for women to sleep orbathe within camp premises. Yet others pres-sured government officials to issue clear writ-ten information related to mechanisms forreceiving relief, compensation, shelter andother issues that caused displaced persons agreat deal of worry and uncertainty. Mostinterventions with children have been orientedtowards providing structure to their daily livesthrough assisting them materially to restartschool, or by offering facilitated play activities.

The Need for CoordinationOn the 12th of January 2005, a large groupof organisations implementing (or planning)psychosocial activities within the Batticaloadistrict participated in an open meeting to

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reflect on the task of responding to the psy-chosocial needs of people affected by thetsunami. The need for coordination betweenthe numerous service providers was identi-fied as crucial, in order to ensure equitableaccess to consistent services for affected peo-ple. The establishment of such a mechanismover the following week was extremely time-ly as the psychosocial sector of the Batticaloasuddenly expanded exponentially.Organisations and groups already providingpsychosocial services in the district prior tothe tsunami began to expand their activitiesin response to the large numbers of displacedpersons. There was also increased pressurefrom donor organisations to ‘scale-up’ activi-ties to meet perceived needs. Other organisa-tions that had not been traditionally involvedin psychosocial work within the district alsobegan developing and implementing inter-ventions. There were soon minor conflictsand disagreements emerging as variousimplementing organisations began to tripover each other in their desire to work withparticular populations, or because of disrup-tive practices in the field. For example,attempts to conduct play activities with child-ren in a camp where another organisationhad already initiated a similar process. Inaddition, the frequent short-term (usuallybetween 2 - 5 days) visits from teams of train-ers, or support workers from the capitalColombo, or other (mostly Western) coun-tries without adequate accurate informationabout local conditions, capacities, or require-ments has continued to raise concernsamongst psychosocial personnel resident andworking in Batticaloa. The numerous visitsby donors, needs assessment, and proposalwriting teams for international agencies bothfamiliar with and entirely new to the districtin the past weeks also seem to indicate thatfurther ‘crowding’ of the field is likely to takeplace. This could result in the service users or

‘targeted beneficiaries’ being caught in themiddle of inter-organisational dynamicsunless measures to coordinate are successful.Over the past four weeks, a coordinating col-lective established by the large constituency ofnon-government, international and state agen-cies implementing psychosocial activities (seethemangrove.blogspot.com for further details)has been providing the services of mapping,mediating and guiding the development of thepsychosocial sector in Batticaloa.

The Need for an IntegratedApproach to PsychosocialInterventionThe variety of theoretical and practicalapproaches to psychosocial work both glob-ally and in Sri Lanka (see Galappatti, 2003)presents a challenge for the development ofan integrated psychosocial sector inBatticaloa. The polemical nature of thedebates in the field, both locally and globally,has made the accommodation of diverse per-spectives and methodologies within a singleframework difficult. Within the Batticaloadistrict, however, it appears that the develop-ing such an approach is essential if the broadcoalition of psychosocial actors is to bestrengthened, rather than be allowed to frag-ment. At present, the conceptual frameworkput forward by the Psychosocial WorkingGroup (Strang & Ager, 2003; PsychosocialWorking Group, 2003a, 2003b) is being usedas a basis for developing a pluralistic concep-tualisation of impacts, and legitimate inter-ventions. In particular, efforts are being takento avoid emphasising a dichotomy betweencommunity-development and mental healthapproaches to service provision – as has oftenbeen the tendency both locally and globally(Galappatti, 2003; van Ommeren et al.,2005). In the context of inadequate localresources, particularly for referral of individ-uals in extreme distress or crisis, there is a

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practical necessity to mobilise and strengthenall available services – with the hope thatgreater engagement between various serviceproviders would produce a movementtowards common ground. At present, exam-ples of psychosocial interventions availablewithin the district would include the elicitingof experience narratives by volunteers, theprovision of Eye Movement Desensitizationand Reprocessing (EMDR) treatment, practi-cal information provision and home visits tofamilies of the missing. As well as placementof separated children in temporary foster-carearrangements with kin of their choice, regularplay activities for children displaced to campsand the improvement of consultation ofwomen and children in the placement ofwater and sanitation facilities to alleviate therisks and fears of sexual harassment or vio-lence. There has also been a great deal oftraining (usually related to trauma manage-ment, counselling, or play work with childrenfor 1-4 days) offered to teachers, health work-ers, community-based workers, volunteers,and respondents to newspaper advertisements.Given the reality of an externally driven supplyof psychosocial services that is only subject toself-regulation, there seems to be little alterna-tive but to engage constructively with thosebeginning to work within the district. Of course, critiques put forth by authors likeSummerfield (2005) and Bracken (1998)remind us that the diverse professional andtraditional approaches to healing and wellbe-ing often have incompatible theoretical con-structs or epistemologies underpinning them.Therefore, there are ought to be serious con-cerns about linking together approaches thatespouse wholly different values and frame-works for work. While the tension betweenan imperative for professional interventionand a commitment to folk/indigenous per-spectives has, in the case of this tsunami dis-aster, been resolved yet again in the favour of

the former. However, there is some smallcomfort to be had in the fact that sufferershave the capacity to shape the sense that theymake of the activities and information pro-fessional or traditional healers offer them.Many would admit that interventions oftenhave unplanned benefits (and deficits) thatare less to do with professional and tradition-al healers’ theoretical ideas about the efficacyof a particular healing activity and more todo with the meaning that individuals andgroups of ‘beneficiaries’ give to them. This is,of course, not to deny the power that human-itarian agencies and others have to deliverunsolicited and potentially inappropriateinterventions to vulnerable populations.

Relevance of Lessons from Pre-Tsunami Conflict-RelatedProgrammingIn the rush to respond to the recent disaster,there has been insufficient attention paid tothe experiences of over 15 years of imple-menting conflict-related psychosocial pro-grammes within the Batticaloa district prior tothe tsunami. Indeed, the hard-learned lessonsfrom around Sri Lanka about the challengesof establishing and maintaining quality psy-chosocial services, as well as good examplesof sustainable and socio-culturally-relevantinterventions, seem to have found little placein the current planning. The pressures offunding processes, key personnel having littleprior knowledge of psychosocial program-ming in Sri Lanka, the lack of documentationor institutional memory in local organisations,and the lack of elaborate and widely-usedguidelines on setting up cross-cultural psy-chosocial services all seem to have con-tributed to this situation. However, it may alsobe the extraordinary nature of the tsunamidisaster that has inhibited a realisation thatmany of the difficulties faced by affected pop-ulations (mass bereavement, repeated dis-

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placement, loss of livelihoods, disruption ofsocial roles, or separation of children) are sim-ilar to the losses and trials experienced duringthe extended years of conflict. Perhaps some-thing useful could be gleaned from examiningthe effectiveness of programmatic responsesand folk measures for dealing with the latter.Despite the passage of nearly seven weekssince the tsunami, it seems that the sense ofurgency of the initial emergency response hasnot yet faded. In the area of psychosocial inter-vention, it also appears that the pitch of activi-ty has heightened in recent weeks. The axiomof ‘more haste, less speed’ may prove to be alltoo relevant in the case of providing appropri-ate and quality services that tsunami affectedpopulations should be afforded access to. It iscrucial that this commitment of agencies andprivate groups to intervene swiftly on behalf ofpersons affected by the tsunami is temperedand guided by an awareness of the need to planand coordinate with one another in the inter-ests of providing consistent and coherent inter-ventions to persons who may need support. 14 February 2005

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1 Situation Report 18 January 2005, 9.30 am,Tsunami Disaster Information Unit DistrictSecretariat Batticaloa.

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Ananda Galappatti is editor of Intervention andpsychosocial advisor-coordinator of TheMangrove, psychosocial support and coordinationunit, Batticaloa, Sri Lanka. E-mail:agalaps@eureka.nl; http://themangrove.blog-spot.com/

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