IRIN
PAKISTAN: Quake trauma could haunt children forever
28 February 2007


MUZAFFARABAD, 28 February 2007 (IRIN) - 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 
(US) through UNICEF funding that will give us a more definite idea of 
how many children are still suffering from trauma," Warneri added.

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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