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Vanuatu and PTSD: What to expect from survivors of Tropical Cyclone Pam

March 16, 2015

The mayhem of Tropical Cyclone Pam, one of the most powerful storms ever to make landfall, is gone, but the misery it left behind in the islands of Vanuatu is just becoming apparent.

Aid workers in the capital of Port Vila described homes and shops flattened, swaths of trees plowed over and residents seeking shelter in schools, churches, or with neighbors.

Communication with many of the 80-plus islands in the archipelago is impossible, so the fear is that the death-toll will climb.

It is unclear how many thousands will be displaced by the massive storm that bore the might of a Category 5 hurricane when it pounded the islands for most of a 24-hour period.

“It’s like a bomb has gone through,” journalist Michael McLennan, who lives in Port Vila, told CNN. “It’s really quite apocalyptic.”

Most buildings were destroyed or damaged, while most roads were blocked by fallen trees or power lines.

Hardly a tree stood straight after Pam bellowed across the South Pacific nation, where some 260,000 people lived in flimsy homes built of thatch.

Sune Gudnitz, regional head for U.N. aid agency OCHA, told CNN from Fiji, that his agency had been notified that much of Efate, the island housing the capital, had been destroyed.

Pam was the equivalent of a Category 5 hurricane. CNN’s weather center reported 155 mph, with gusts up to 200 mph.

“Unfortunately, the more that comes out, the worse it looks,” said Gudnitz. “I should say it’s really a case of the worst-case scenario for the country and for the people.”

Studies on the emotional toll of such natural disasters correlate strongly with the extent of devastation to the environment, since this determines the likelihood of ensuring delivery of basic material necessities.

Natural or man-made disasters (such as civil war or genocide) can cause terrible personal loss, injuries and illness, and loss of vital resources.

While the survivors of such tragedies may recover from their physical injuries, the emotional damage may be permanent.

Dr. Pynoos studied the effect on 231 children from three cities at increasing distances from the devastating earthquake that occurred in Armenia in 1988.

Following 18 months of the event, children suffered frequently from “severe post-traumatic stress reaction” correlating with the proximity to the quake epicenter (The British Journal of Psychiatry (1993): 163).

The authors concluded from their research that after catastrophic natural disaster, PTSD in children may reach epidemic proportions, remain high for a long period, and jeopardize the well-being of large segments of the populations in earthquake affected areas.

In an article published in the Journal International Social Work (Vol. 52, 2009), Taghi Doostern showed that following the 2003 earthquake in the Iranian city of Bam, children’s grief and distress was compounded by the following adverse elements:

  •  Loss of family members, homes and communities
  • Lack of access to information regarding the well-being of family members
  • Uncertainty about the future

There have been several other longitudinal studies investigating the prevalence of PTSD years after other famous natural disasters:

Duggan and Gunn, reporting on adults exposed to an array of different disasters, found the frequency of PTSD of 39% within the first year of the event and falling to 23% after 26 months (British J Psychiatry 1995, 167).

Since reports suggest that PTSD is most intense and enduring in victims exposed to extreme violence, Goenjian and colleagues compared two groups of adults:

One group had been exposed to a severe earthquake and the other to extreme violence.

78 non-treatment-seeking Armenians were assessed 1.5 years and again 4.5 years following the 1988 Spitak earthquake in Armenia and the 1988 pogroms against Armenians in Azerbaijan (Am J Psychiatry June 2000: 157).

The rationale behind the study was that in both genocide and natural disasters, individuals experience loss of loved ones, displacement, medical injuries, and material loss.

Beginning in February 1988, pogroms were perpetrated against the Armenians. In Sumgait, the most terrorized city, survivors had witnessed murder, looting, and destruction of property.

In Gumri, the second largest city in Armenia, 50% of the buildings were destroyed and 90% severely damaged.

7% of the population (280,000 people) died.

Following the initial devastating earthquake, survivors were subject to unremitting stress in the form of impoverished and crowded living conditions, and lack of basic necessities such as food, heat, electricity, clothes and medicine.

The distinction between PTSD symptoms among Gumri residents (exposed to extreme earthquake trauma) or Sumgait residents (exposed to severe violence) was not in the severity of symptoms, but in their unique profile attributed to the specific trauma experienced.

The flashbacks and trauma recollections experienced by the earthquake victims were dominated by the vivid visual imagery they had experienced. During the earthquake they had heard screams of trapped individuals, and had witnessed friends, neighbors, or family members burned or trapped under collapsed buildings.

In terms of trauma triggers, those exposed to the earthquake recalled how destroyed buildings, shoddy homes, and absence of family members served as trauma reminders.

The disturbing outcome of this study was that survivors of extreme trauma, caused either by violence or natural disaster, showed persistence of their PTSD symptoms when revisited three years after the initial study.

Traumatized populations remain vulnerable to persistent PTSD symptoms when they are displaced

There are several possible explanations for traumatogenic effect of displacement:

“Empty situations,” posed by the sense of an absence of personal location, deprive the victim of a safe “holding environment” necessary for the recovery process.

These secondary adversities, caused by displacement, function as a barrier to the effort required in “processing” the trauma of personal loss.

The immediate emphasis of rescue functions following war, terrorism, and natural disasters is to provide survivors with food, shelter, medical treatment, and communication with significant others.

The structural devastation of the earthquake in Haiti may become the most significant long-term post-disaster factor determining psychological well-being.








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