Real Risk

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N THE MORNING

of 26 December 2004, a large earthquake

occurred under the sea northwest of the island of Sumatra.

It caused an enormous rift 1.2 kilometres long in the earth’s

crust and a tsunami of massive proportions. The tsunami was devas-

tating, especially on the coasts of Sumatra, Thailand, Sri Lanka and

India: about 300,000 people were killed or went missing. Other

people were injured and entire communities were destroyed.

Community-based interventions

For those who survived, the consequences of the disaster were

severe. Many of them lost relatives, friends or acquaintances and

most experienced the local events as very shocking, often with far-

reaching psychological consequences.

Many victims continue to complain about ongoing (or even

worsening) psychological and physical problems long after a disas-

ter. This can partly be explained as the normal course of personal

problems related to disasters in general: after the initial and imme-

diate stage of a disaster, a second stage called the ‘honeymoon’

stage will follow, usually creating a strong bond between victims

and non-victims – existing hierarchical structures make way for a

sense of being among fellow sufferers, and for massive aid. As a

result, victims feel unconditionally supported by the community –

a feeling fuelled by the media and the authorities, who in most

cases promise to take all necessary measures.

But after a few weeks, a third stage of the disaster will inevitably

follow, the ‘disillusionment’ stage: as people return to ‘business as

usual,’ those victims who still appeal for help or understanding run

the risk of being considered complainers by the people around them,

as if they were out to profit from the situation instead of repairing

the damage and coping with events emotionally. Proper care must

be focused especially on minimizing negative effects on the victims’

ability to recover. Psychosocial aid focused on strengthening the

supporting communal bonds can play an essential role here.

People affected by major disasters typically suffer a whole range

of losses, while at the same time natural social networks and other

support mechanisms are wiped out. As existential needs are met

by the provision of food, water and shelter, and as safety is ensured,

psychological defences may drop, and awe of the reality may be

so overwhelming that individuals become numb and feel power-

less. At this point, leadership in providing social care is essential.

The key objective is the re-establishment of meaningful patterns

of interaction in the community which, after massive trauma, is the

vehicle for reconstructing a sense of life purpose. The extent to

which people get support from others (family, neighbours, author-

ities, aid organizations) is crucial for their empowerment,

mastering the hardship and overcoming post-traumatic symptoms.

This is because one of the main healing functions of a commu-

nity is to contain and support both family systems and individual

members.

Psychosocial aftercare in the Netherlands

The consequences for Dutch survivors of the tsunami disaster were

also severe. Psychological consequences for the survivors came to

light very soon after the disaster. Victims became tense, jumpy and

easily irritated. They suffered from insomnia or nightmares or felt

intensely sad. They had trouble shaking themselves free from

memories of the tsunami and were not able to take up their daily

responsibilities. There was therefore a requirement for help in the

Netherlands too.

The objective of Impact, the Dutch Knowledge and Advice Centre

for post-disaster psychosocial care, is the advancement of high

The healing community: the importance of

community-based interventions

Magda Rooze, Ariëlle de Ruyter, Dean Ajdukovic, Nienke Fundter and Jorn Hövels,

Stichting Impact, Dutch Knowledge and Advice Centre for post-disaster psychosocial care

Community-based interventions can involve every level of the community

Photo: www.anp-photo.nl / Barbara Walton