Post Trauma Stress Disorder in Flood Affected areas of Pakistan

A disaster is an event that is severely damaging and disruptive for a significant number of individuals. An important fact to remember is, disasters do not just effect those directly involved, this means that there is a wide range of people that may be considered ‘victims’ of a disaster. This includes those who nearly escape death, those injured and those who witnessed a traumatic event. However with increasing media and news footage of natural disasters family and friends of those deceased or affected by the event may also go on to suffer some degree of psychological stress as a direct result.

Disasters whether natural cataclysms, like earthquakes, cyclones, snow storms, floods, hurricanes etc or man-made disasters affecting large populations in different parts of the world like wars, bomb blasts, ethnic or political violence and terrorism always result in tremendous number of deaths & destruction among the affected populations. Traumatic events & the coping strategies of people in such circumstances have a vital role in development of Post-Traumatic Stress Disorder (PTSD) and other psychiatric disorders like: major depressive disorders, (MDD) generalized anxiety disorders (GAD), & dissociative disorders.

Post traumatic stress disorder (PTSD) is a common disorder among victims of various disasters such as road traffic accidents, violent crimes, hurricanes, earthquakes and floods. PTSD is also a severe and complex disorder precipitated by exposure to psychologically distressing events. It is characterized by persistent intrusive memories about the traumatic event, persistent avoidance of stimuli associated with the trauma and persistent symptoms of increased arousal.

Flood is one of the most common and severe forms of natural disasters. It can result in direct economic and property losses, physical injuries, deaths, and psychological injuries.

Floods occur frequently in Pakistan. A severe flood that struck Pakistan in 2010 left hundreds of thousands of residents homeless and destroyed many infrastructural and agricultural projects.

The devastating flood in Pakistan which broke all previous records of havoc caused by natural disasters in the country has not only imposed huge losses on life and property, but also left unforgettable horrifying imprints on the minds of people resulting in psychological disorders among the affectees. Majority of the flood affectees, especially women and children, are suffering from psychological disorder after witnessing destruction of their belongings due to furious torrents.

It is of great importance to find ways of readily identifying flood victims who are likely to develop PTSD to enable the government take timely measures to protect the health of such victims.

In July 2010 heavy monsoon rains started in Pakistan resulting in great floods in the Khyber Pakhtunkhwa, Sindh, Punjab and Balochistan regions. The Indus River basin was badly affected. It was blamed on unexampled monsoon rain.

It was estimated that at one point, approximately one-fifth of Pakistan's total land area was underwater. According to Pakistani government data the floods directly affected about 20 million people with 2,000 people dead. There was huge destruction of property, livelihood and infrastructure. The number of individuals affected by the flood exceeds the combined total of individuals affected by the 2004 Indian Ocean tsunami, the 2005 Kashmir earthquake and the 2010 Haiti earthquake, as been told by Maurizio Giuliano, a spokesman for the UN Office for the Coordination of Humanitarian Affairs (OCHA).

The Pakistani economy has been harmed by extensive damage to infrastructure and crops. Structural damages have been estimated to exceed 4 billion USD and wheat crop damages have been estimated to be over 500 million.

Floods of the Indus River in 1973 and 1976 were considered the most severe after which Pakistani government created the Federal Flood Commission (FFC) in 1977. The FFC operates under Pakistan's Ministry of Water and Power. It is appointed with carrying out flood control projects and protecting lives and property of Pakistanis from the impact of floods.

The 2010 Monsoon rains broke all the previous records of rain in the last 80 years in Pakistan and were forecasted to continue into early August. The Pakistan Meteorological Department reported that over 200 mm (7.88 inches) of rain fell over a 24-hour period in a number of places in Khyber Pakhtunkhwa and Punjab. A record-breaking 274 mm (10.7 inches) of rain fell in Peshawar during 24 hours. Reports of UN stated that 36 districts were involved and 20 million people were affected.

A report of ICRC international committee of the Red Cross said, The ongoing devastating floods in Pakistan will have a severe impact on an already vulnerable population. In addition to all the other damages the floods have caused, flood water have destroyed much of the health care infrastructure in the worst-affected areas, leaving inhabitants especially vulnerable to water-borne disease.

Post Traumatic Stress Disorder (PTSD) is a psychiatric condition that may develop following any catastrophic life experience. There are a variety of different factors that may determine an individual’s specific predisposition for developing PTSD.

The recent interest in PTSD started with the Vietnam Veterans in USA. Since the recognition of PTSD as a diagnostic entity in early 1980, significant advances have been made in its recognition, measurement and management. Much of the earlier work was done on combat veterans and relatively less attention was paid on civilian populations. It has been known that pathological stress response syndromes can follow war, sexual assault and other types of trauma.

Professionals from the health department started considering PTSD as a major problem after this event. The soldiers returning from the conflict war zone developed many disturbing psychological symptoms, depression and loss of functioning. The ex-servicemen displayed a characteristic array of symptoms, which needed a definite diagnosis. This led to the impact for the development of PTSD. Since that time, there is increasing recognition that adults and children can develop severe and debilitating reactions to traumatic events.

Epidemiological data is usually available from USA & Australia. The developing countries usually lack authentic data and research work. This is the reason that developing countries do not pay attention to PTSD and assume that PTSD does not exist .4 But after the last two decades of natural disasters like earthquakes, floods & tsunami havocs in South Asia have led the researchers to think seriously to a series of research work on PTSD. The Asian researchers started working on psychiatric research topics after earthquake in Pakistan & Kashmir on October 8th, 2005. In the last few years the concept of psycho-trauma in development of psychiatric disorders has been latest in the field of psychiatry.

However, even now in a world so interested in learning about psychological disorders, when faces a disaster, much of the work is done in areas like giving relief and aid to the victims and providing other medical services. Less attention is given to the psychological problems faced by the affectees. As a result of this a majority of individuals around the world facing PTSD are left unattended.

This is an abstract from the research "Post Trauma Stress Disorder in Flood affected areas of Pakistan" by Dr. Sana Shakeel.