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High risk of PTSD for survivors of the Nepal Earthquake of April 2015

May 6, 2015

In a tragic echo of the catastrophic events in Haiti in 2010, a powerful earthquake struck one of the poorest nations on Earth on April 26, 2015. The Nepal earthquake (also known as the Gorkha earthquake), killed more than 7,000 people. It was the most powerful disaster to strike Nepal since the 1934 Nepal-Bihar earthquake, and triggered an avalanche on Mount Everest, killing at least 19, making it the deadliest day on the mountain in history.

Hundreds of thousands of people were made homeless with entire villages flattened across many districts of the country, and centuries-old buildings classified by UNESCO as World Heritage Sites in the Kathmandu Valley were destroyed.

The latest estimates from seismologists put the quake magnitude at 7.9, about half the size of the previous major event in 1934, which killed around 10,000 people.

However, the number of dead in Kathmandu could rise to match it.

Geophysicists who have long monitored how fast the Earth’s plates are moving, knew that this disaster was eventually coming, since the entire subcontinent of India is being driven slowly but surely underneath Nepal and Tibet at a speed of around 1.8 inches per year.

Over millions of years, the squeezing has crushed the Himalayas like a concertina, raising mountains to heights of several miles and triggering earthquakes on a regular basis from Pakistan to Burma. It’s the reason Everest exists.

In the 81 years since the 1934 Bihar earthquake, the land mass of India has been pushed about 12 feet into Nepal.

Catastrophic earthquakes of this magnitude occur when the pent-up energy is released over a large area, generating a quake of sufficient intensity that destroys buildings, killing people over a huge the huge area of slippage. The bigger the area that slips, the greater the damage.

Saturday’s slip took place over an area of about 1,000 to 2,000 square miles, a zone spanning the cities of Kathmandu and Pokhara in one direction, and almost the entire Himalaya mountain width in the other. Parts of India slid between 1 and 10 feet in a northward direction under Nepal within a matter of seconds.

In Haiti in 2010, although the earthquake was more than 20 times weaker than Saturday’s, well over 100,000 people were killed by the shaking and its after-effects. Despite some differences, the Nepal and Haiti earthquakes share similarities — both geological events were known to be approaching; both struck areas afflicted by widespread poverty; rapid increases in population resulted in a lack of adherence to improved building codes in building infrastructure.

About 1.45 million people live in Kathmandu, the majority in poorly constructed homes not designed to withstand the kind of shaking generated by the quake. Nepal`s per capita income, (around $1,350 annually), is only a notch above that of Haiti, which is among the lowest in the world.

Studies on the emotional toll of such natural disasters correlate strongly with the extent of devastation to the environment, combined with its far sprung and remote layout, become critical deterrents for the likelihood of ensuring the delivery of basic material necessities.

Natural or man-made disasters 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.

Research into the after-effects of catastrophic natural disasters have shown that 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).

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 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.

One mitigating factor was the unprecedented mobilization of international support.

As an example, the Israel Defense Forces (IDF) sent 260 doctors, nurses and personnel trained in finding disaster victims to Kathmandu following the quake.

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