© Sebastian Bolesch Click for full view

In Meulaboh on the west coast of Aceh, the destruction caused by the tsunami is still there for all to see almost nine months after it struck. Where the town once stood there are now just ruins stretching down to the sea. Most survivors now have a roof over their heads, albeit a makeshift one, and there is food, clean water and access to medical care.

But many people's inner life is as damaged as the town they lived in until December 26. That is why Médecins Sans Frontières (MSF) is extending its mental health care for traumatised survivors.

We spoke to the Psychiatrist Renato Souza, who designs the programmes.

© Sebastian Bolesch Click for large view

What situation are these people in?

"For many people, the extent of the catastrophe quite simply remains unbearable. Take the example of a mother from Meulaboh, for instance. She lived in a modest house near the coast with her husband, their four children and her mother-in-law. Then one perfectly normal day in December, she lost everything she had in a matter of minutes.

"She was the only one to escape alive; the house and everything around it was destroyed. As the water surrounded her time and time again, she feared for her life. She tried to hold one of her children tight in a rescue bid, but to no avail. Now she lives in cramped conditions in a temporary camp with no privacy and no way to earn a living, making her completely dependent on the help of others.

"A woman like her may well be uninjured and quite healthy on the face of it, but even a robust psyche has little chance of surviving such a build-up of stress factors without sustaining some damage. And the situation I have just described is far from being a tragic exception. Thousands of people here escaped with nothing but their lives and have lost everything else they had."

© Sebastian Bolesch Click for large view

How does this psychological strain take its toll?

"Some survivors have lost control over their everyday lives following their traumatic experiences. Even tiny things such as the sound of an engine or a gust of wind can bring memories of the tsunami flooding back, causing their hearts to race or prompting panic attacks. Seismic shocks, which are still part of everyday life, cause widespread panic.

"In one of the temporary camps, I met people who still wake up in the middle of the night and leave their tents for what they consider a safe building on higher ground for fear of another tsunami. Sooner or later, people who live with this kind of tension for months on end and are basically ready to run for their lives at any time reach a point of total exhaustion - physically and psychologically.

"The men go out fishing again and the women see to their household duties like they used to, but people say: 'We aren't like we used to be - we're very tired and we're still weak at the knees.'"

Is there any information about how many survivors are suffering from psychological problems as a result of the tsunami?

"MSF is concentrating on those groups of people we believe to have been hardest hit by the consequences of the tsunami. Above all, that means the people in the displaced camps. Many of them live in these shelters because they have lost all their possessions, while others are simply too scared to return to their coastal villages for fear of another tsunami.

"A study in some of these camps revealed that eight out of ten residents here have serious symptoms of stress, with younger people generally being more affected.

"In addition to the tsunami, there may also be other reasons for that, such as the decade-long civil war which had a major effect on the region in which we carried out the study. But regardless of the reasons, one thing is for sure: there is a huge need for treatment."

© Sebastian Bolesch Click for large view

How exactly is MSF helping?

"Our teams are concentrating on combatting symptoms such as anxiety, nightmares, eating disorders, insomnia, palpitations and headaches. Weekly group sessions offer participants a chance to share their experiences and find out how such complaints are connected with trauma.

"Psychologists and psychosocial counsellors help the participants to question their fears and regain control over them. Some parents, for example, won't send their children to school on stormy days for fear of a new tsunami, so we ask them to think back to December 26, 2004, because there was no storm that day. At the same time, we teach them why a tsunami happens and offer rational suggestions for how to deal with fear and panic.

"We encourage those who wake up in the night drenched in sweat, scared a new tsunami is coming, to look around outside or wake up their neighbour to check that everything is alright. This is accompanied by breathing and relaxation exercises which help people to control their stress symptoms better."

What successes have there been?

"In my personal opinion, mental health programmes should focus on empowering people to cope with their symptoms of stress. Some people have experienced such horrific things that they might never be able to return to normality. But we can help many others to develop strategies to overcome their trauma, making it easier for them to find their way back into a more normal life.

"First preliminary evidence shows that 45 percent of our clients have substantially improved and lots of clients are still receiving our interventions. So, our programmes are working although for many patients it is still a long way to go."