Bam survivors continue to deal with psychological trauma

Earthquake survivors in Bam continue to suffer psychological trauma from their ordeal in December, with health officials noting that rehabilitation may take quite some time. The quake hit the southeastern Iranian city in the province of Kerman, on 26 December, killing at least 40,000 people and leaving more than 100,000 homeless and destitute. Four-year-old Hossein, is one of many children in the city that was deeply affected by the quake. His grandmother, looking after him and his two sisters as his parents were dead, told IRIN that his behaviour had totally changed after the incident. "He wakes up at night and cries out for his mother," the 63-year-old said. The United Nations said in a recent report on the stricken city that the disaster had created 2,000 orphans, with another 5,000 children believed to have lost one parent. Amina, 32, is currently living with her relatives in the government's Bureau for Aliens and Foreign Immigrants Affairs (BAFIA) camp, one of the largest emergency settlements in the city, after losing her entire family, including her husband and four children. Understandably, she's depressed and detached, questioning why she is alive, while her relatives perished. "Why do I live? Life doesn't have any meaning for me," she told IRIN. According to provincial mental health authorities, one in two of the people that survived the quake were at risk of developing severe depression. "Anxiety disorders have significantly increased in the population, especially among children and women, while we see more aggressive behaviour and disorders in men," Mohammad Farajpour, a health official responsible for Bam's mental health programmes, told IRIN. Before the disaster, local people were not keen on seeing psychiatrists about the behavioural problems of their children, primarily for cultural reasons. But according to Farajpour, many parents were now coming to doctors with their offspring. "Children at the age of four or five are highly dependent on their mothers because of anxiety problems. We think that rates for anxiety among children have significantly increased," the health official explained. Amanda Melville, a UNICEF officer in Bam responsible for child protection issues, told IRIN that one of the major issues on the ground was a psycho-social one. "It's really hard for them to start rebuilding their lives from a psychological point of view," she observed. Some 12,500 children were estimated to be deeply psychologically affected by the deadly quake with some of them traumatised and some of them seriously depressed. Moreover, some of them were now prone to start relying on drugs and displaying anti-social behaviour, the UNICEF official explained. As for men, Farajpour noted an increase in smoking cigarettes and use of narcotics since the quake. "I have seen a lot of my patients that quit smoking cigarettes or even opium, restart," he said. Even before the disaster the prevalence of psycho-social problems in southeastern Iran was higher than average, due to widespread poverty. "The prevalence rate of mental health disorders in the country has been estimated to be 25 percent," Farajpour said. But according to a survey that had been done in Baft, a city in the southeast near Bam, the prevalence rate was more than 40 percent before the quake, he said, adding: "given the similarity of the social, economic and cultural characteristics of the two cities, we expect that the rate had been the same in Bam before the incident." Health authorities are trying to address this. They have a plan that had been developed from previous earthquakes, like the one in the northern Qazvin province. "This is a six-month plan to cover the needs of some 25,000 people, focused on children, adolescents and adults," Farajpour said, adding that the programme could be extended to one year if need be. There were different interventions for children and adults with psychologists, psychiatrists and counsellors involved in the programme, he added. Also, the Iranian health ministry is focusing on outreach programmes, including tent-by-tent visits in the camps and streets, group counselling and individual psychological and psychiatric treatment with referrals to other services. Meanwhile, health authorities are cooperating with UNICEF and international NGOs. "What we are trying to do in psycho-social interventions is to try and help them [children] to deal with what happened and also to try and help them rebuild their lives and return to normality gradually," Melville of UNICEF said, adding, that it would be a huge task.