Psychosocial and Ethical Response to Disasters: A SWOT Analysis of Post-Tsunami Disaster Management in Sri Lanka

Background Disasters take place around the globe on a regular basis, creating challenges for various stakeholders responsible for managing the aftermath. Large-scale disasters bring about many challenges regarding human rights, research, ethics and social policies.

In this context, the authors aim to share the experience gained in the aftermath of 2004 tsunami tragedy in Sri Lanka, which engulfed several nations in the Asian region. This is especially relevant due to the paucity of evidence emerging from developing world on managing disaster aftermath.

Although the authors of this article were explicitly engaged in the field of mental health, the overall strategic approach described here went beyond mental health and involved academics, policymakers and practitioners. The approach was further aimed at incorporating seemingly diverse fields of work and experiences by the authors into a coherent focal point of mental health. These diverse fields such as dead body identification, ethics and medically unexplained symptoms had a direct relevance to mental health and disasters. These experiences can be equally relevant in the management of internally displaced people in post-conflict areas of Sri Lanka.

A vast number of organisations conducted valuable work in Sri Lanka after the tsunami. The work described here was conducted by the authors and their affiliated organisation in Sri Lanka; the Institute for Research and Development (IRD — www.ird.lk) with the partnership of Institute of Psychiatry (IoP), King’s College London (KCL). IRD is a non-profit academic institution and a network of local and expatriate Sri Lankan academics working to achieve an overarching multi-disciplinary research culture in Sri Lanka.

On 26 December 2004, an earthquake with a magnitude of 9.3 on the Richter scale resulted in a catastrophic tsunami which affected 12 countries. The human impact of the tsunami was enormous in terms of the families affected, displaced or dead. More than 175,000 people were killed. Almost two million people lost their homes. Indonesia, Sri Lanka, India and Thailand were the worst affected countries. There were around 40,000 deaths in Sri Lanka and thousands were displaced. Whole swathes of the coastal belt were destroyed, causing devastating damage to the economy and society. Mental health was recognised as one of the 17 main components in primary healthcare as far back as 1980, but by 2004 Sri Lanka had a limited number of psychiatrists (around 40) for a population of around 20 million. Mental health services are more or less based on institutional care and lack public health approach. At the time of the tsunami, common with most affected countries in the region, Sri Lanka did not have a mental health policy or a disaster management plan.

These contradictions within Sri Lanka do not allow for generalisation of the Sri Lankan experience, although it can be safely said that there are important lessons to be learnt for other nations within the region and globally.

The immediate overall concerns among the team comprising the authors included provision of basic needs and alleviation of the immediate impact of human and material loss on the directly affected survivors, needs of children with or without surviving parents, basic need of dignified burial for the perished, sensationalised and traumatising nature of the media coverage and cultural intrusion and inappropriate “aid” rushing in. Also, pathologising immediate psychological reactions along with placing undue emphasis on PTSD at the expense of other long-term mental health consequences were another concern. Exploitation of vulnerable survivors for easy and cheap research along with potential tendency to neglect the psychological component of the health status of survivors in providing care was among other particular concerns.

The authors were involved in various activities providing psychosocial services to the affected population, and had the chance to carry out assessments and observations on the immediate prevailing situation. A Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis was subsequently carried out by the team of authors, utilising this information.