Aid after disasters

Editor—The editorial by van Ommeren et al on aid after disasters is right on the mark.¹ The psychosocial component in emergency relief action has increased recently. Donors clearly feel morally bound to provide funding for psychosocial relief, although many aid providers are not necessarily qualified for these services, in the process discrediting those who are.

From an epidemiological perspective, the evidence for these services needs strengthening. Moreover, the effectiveness of psychosocial interventions in post-disaster relief is unknown, raising questions on opportunity costs of this aid.

On a recent mission to Aceh after the tsunami, we analysed patients' records from a large Red Cross hospital between 11 and 31 January 2005 and interviewed several medical non-governmental organisations providing relief.

Out of 1174 consultations, 9.6% (113 patients) had a psychiatric disease as the main diagnosis. Diagnoses ranged from anxiety, insomnia, and depression to psychosomatic disorders. No severe psychiatric illness was observed except for one patient with schizophrenia. Most patients were adults, and only eight (7%) were aged 12 or younger. Better understanding of age related vulnerability would improve targeting psychosocial services.

We are convinced that psychological shock is an important and neglected issue after devastating events such as the tsunami. Losing family, home, and livelihood will traumatise a normal person in any culture, but time and natural resilience help most victims in their recovery. Nevertheless, some will require professional help, and severely ill patients from the period before the disaster will need continued care in the aftermath.

We were encouraged in Aceh by a few humanitarian agencies that were using pragmatic approaches to deal with victims of grief and hopelessness. They engaged victims in physical activities such as building their own homes and their lives. The victims themselves reported to us simply that they were able to sleep again after a day's work.