Quake trauma could haunt children forever

Thousands of children who survived the October 2005 earthquake in northern Pakistan and Pakistani-administered Kashmir may suffer from trauma for the rest of their lives, specialists say.

Shaheen Mir’s son is one of tens of thousands of children still recovering after a 7.6-magnitude earthquake ravaged the area on 8 October 2005, killing more than 80,000 people and leaving millions of others maimed, injured, or homeless.

Mir, a school teacher in her 30s, watches her four-year-old son, who is unusually quiet for his age, in front of her tented shelter in Muzaffarabad, the capital of Pakistani-administered Kashmir.

“He wouldn’t speak for months. He has only become somewhat normal now, after almost a year and a half. I have six children and all of them were traumatised when the earthquake took my husband’s life, as well as our house,” she said, wiping her eyes.

The United Nations Children's Fund (UNICEF) estimates that more than 18,000 schoolchildren were killed in their classrooms. Many of those who survived have had to contend with the psychological effects, including witnessing the deaths of close relatives, seeing amputations or being orphaned.

According to Zahida Manzoor, a UNICEF child protection officer in Muzaffarabad, in the initial phase, up to 60 percent of children in the area that UNICEF saw were found to be suffering from stress and trauma caused by the quake.

But putting exact figures on the scope of the problem more than 16 months after Pakistan’s worst natural disaster is difficult.

“Although we were unable to carry out a dedicated survey focusing completely on children following the quake, we have provided psycho-social support to more than 20,000 children since the earthquake,” Violet Warneri, the focal point for child protection in UNICEF Islamabad, said.

“A study is being carried out by consultants hired by Save the Children (UK) through UNICEF funding that will give us a more definite idea of how many children are still suffering from trauma,” Warneri added.

Muzaffarabad earthquake

Earthquake damage in Balakot - close to the epicentre 100 km north of the Pakistani capital, Islamabad

On 8 October 2005, a 7.6 magnitude earthquake devastated much of Pakistani-administered Kashmir and the North West Frontier Province. More than 80,000 people were killed and more than 3 million rendered homeless by Pakistan's worst disaster to date. Some 18,000 school students and 850 teachers were killed in the earthquake, which struck just as Saturday morning classes got under way. Tens of thousands of survivors were left traumitised by the quake, many of them children. Post-Traumatic Stress Disease (PSTD) can affect children all their lives. More than 16 months after the disaster there has yet to be a conclusive survey as to the actual number of children suffering from trauma.

Also, doctors from the department of psychiatric medicine at Robert Gordon University at Aberdeen in the UK will, in collaboration with the World Health Organization (WHO), conduct studies focussing on local communities in the Muzaffarabad area, including adjoining districts.

The studies are expected to provide a clearer picture of the mental health situation in the area, Dr Sardar Mahmood Khan, the District Health Officer in Muzaffarabad, said.

Trauma can linger on in people’s consciousness all their lives, doctors say.

Post-traumatic stress disorder

“People here, especially children, were found to be suffering from what is known as Post-Traumatic Stress Disorder [PSTD],” Dr Mohammed Arif, an official with the health NGO Merlin International, said in Muzaffarabad.

PTSD occurs when a person is exposed to an extremely stressful situation - such as the earthquake - in which people have a near-death experience or witness or hear about serious injuries or deaths of family or close friends.

A child with PTSD may be afraid to be alone; become withdrawn; some may display unusual irritability or may be easily angered, while some may easily burst into tears, according to psychiatrists.

Psychologists can help most affected individuals, but “patients, especially children, who fall in the severe category of having witnessed a loved one’s death or [suffer a] disability require dedicated counselling to help offset the problem,” Arif said.

“PTSD can continue to afflict everyone – children, adults alike – for all their lives,” he added.

In an effort to tackle the issue, immediately after the quake UNICEF established child-friendly areas in camps for internally displaced people (IDPs) in the affected area. Children could play or indulge in interactive activities with other children in those places, so that their minds could be taken off the pain or trauma.

“We offered a lot of psycho-social support to children, mostly in IDP camps. Because of that support, we have since seen the mental health of some children improve a little, but not much,” UNICEF’s Manzoor said.

But dealing with mental disorders is a daunting task in the quake-ravaged area, where much of the health infrastructure was destroyed by the quake.

With an estimated population of 165 million, Pakistan is the world's sixth most populous nation, but has only 250 psychiatrists, according to a recent paper published in the online 'Journal of Medical and Biological Sciences'.

According to WHO, Pakistan's total health expenditure per capita was US $48 in 2003. Of that amount, less than $0.20 was allocated for mental health budget per capita.

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