Beruflich Dokumente
Kultur Dokumente
PSYCHOSOCIAL CARE
by
COMMUNITY LEVEL HELPERS
for
SURVIVORS
1
2
INFORMATION MANUAL 2
RIOTS
PSYCHOSOCIAL CARE
by
COMMUNITY LEVEL HELPERS
for
SURVIVORS
3
4
INFORMATION MANUAL 2
RIOTS
PSYCHOSOCIAL CARE
by
COMMUNITY LEVEL HELPERS
for
SURVIVORS
Prepared by:
Dr K Sekar – M A, PhD*
Senior Consultant
Ms Antara Sen Dave – M S W, M.Ed*
Consultant
Mr Subhashis Bhadra – M S W, M Phil.,**
Psycho Social Programme Co-ordinator
Mr G P Rajashekar – M A**
Social Worker
Dr K V Kishore Kumar – DPM***
Senior Psychiatrist
Dr R Srinivasa Murthy – M D***
Professor of Psychiatry
5
INFORMATION MANUAL 2
RIOTS
PSYCHOSOCIAL CARE by COMMUNITY LEVEL
HELPERS for SURVIVORS
Published by
BOOKS for CHANGE
(A Unit of ActionAid Karnataka Projects)
139, Richmond Road
Bangalore – 560 025
Ph: 080-5586682
e-mail: bfc@actionaidindia.org
www.actionaidindia.org
www.oxfamindia.org
www.indiadisaster.com
This document may be freely reviewed, abstracted, reproduced or translated, in part or in whole, purely on a non-profit
basis. We welcome receiving information of its adaptation or use. The opinions, analysis and recommendations expressed in
this document are solely the responsibility of the authors.
6
CONTENTS
Preface vii
Acknowledgements viii
Events in Gujarat 1
Psychosocial Support 8
Psychosocial Interventions 27
Principles
Individual
Family
Community
Special Groups 41
Referral 48
Self Care 52
7
Dedicated to
the Survivors of the 2002
Gujarat Riots
8
PREFACE
PREFA
Riots pose a monumental challenge to the total community. Everyone who is exposed
to the riots experience disruption of their life to varying degrees. Among the survivors,
the most affected are people whose lives are disrupted more severely by the disaster.
This includes those who have lost their home, experienced violence, lost their family
members and community.
For too long, psychosocial consequences have been neglected as a part of relief,
rehabilitation and reconstruction. In India, starting with the Bhopal disaster in 1984,
there has been a gradual acceptance of the need for psychosocial care. Long-term
studies of psychological problems of disaster were studied in the Bhopal population
as well as the survivors of Marathwarda earthquake. Both of them demonstrated
that there is higher emotional illnesses even years after the disaster.
For the first time, following the Orissa Super cyclone a programme of psychosocial
care with community level workers (Snehakarmis) was implemented. This intervention
demonstrated the nature of the needs of the vulnerable groups, the possibility of
community level workers to provide care and the effectiveness of such care. In a way,
the Orissa experience established a new approach to psychosocial care.
Every disaster is similar and different in a number of ways. The riots of Gujarat and
what it means for the survivors and the approach to psychosocial care is the scope of
the current manual. This manual differs from earlier efforts. It outlines the anger,
anguish and betrayal felt by the survivors and normalisation of their emotions. The
approaches outlined are totally based on extensive field work, the initial experiences
of the Aman Pathiks in providing care and the observations of the mental health
professionals to provide support and supervision.
The rebuilding of people, reconstruction of not only of shelters and livelihood but of
the Human Spirit is the challenge. This Manual works towards that goal.
We sincerely appreciate the contributions of all of the authors. The Aman Pathiks,
the People of Gujarat who shared their personal lives and the Aman Samuday team
in Gujarat.
9 vii
ACKNOWLEDGEMENT
CKNOWLEDGEMENT
We would like to take this opportunity to thank all the people who helped to enrich this manual in
varied ways. While it may not be possible to acknowledge them all here, we would like to start by
extending our gratitude to the Aman Pathiks (their names have been listed in p. 56) without whom
none of this would have been possible. They have been with us constantly through the entire process,
right from the start during training to adding valuable insights from the field. They continue to be
our learnings.
We gratefully acknowledge the people and the organisations associated with the Citizens Initiative
without whom the peace movement would not have been possible. Our special thanks to Aman
Samudaya supporters, Fr Victor Moses r. j. of St Xavier’s Social Service Society, Mira Maleek of
Centre for Development, Mishra of Kamdhar Swasthya Seva Mandal, Rajendar of SAATH who
braved the riotous situation and brought in the volunteers to be shaped up as Aman Pathiks.
A warm rememberance on the sensitivities of Brinda Nanavati of Shantikumar Trust and Sushma J
Pucadyil of INTACH. Sonal of Eklavya Foundation and Wilfred of INSAF.
Specific mention is to Amar Jyoti Naik and Supriya of ActionAid India and M G Sriramappa and
Dr P V Unnikrishnan of Oxfam India for all their commitment to actualise psychosocial care
component in the normalization process of the riot victims.
There have been others who have given their time through discussions and review of our material
and we would like to thank them too: Fr. Jimmy Dabhi, Prasad and Persie Ginwille of Behavioural
Science Centre, Kiran Patel, Consultant/Trainer from Oakland, C. Balaji Singh of CARE, Binoy
Acharya of Unnati, Swaroopaben of St. Xavier’s College, Dr Darshan Trivedi, Dr Chandraguptsanan
and Prof. Vankar of Department of Psychiatry, Civil Hospital, Ahmedabad. We also place on record
the service support provided by Dr Ajay Chauhan, Medical Superintendent, Institute of Mental
Health and his team.
We would like to acknowledge the support and guidance of our colleagues at Action Aid India,
Gujarat Regional Office - Javeed, Mahesh, Hiren Gandhi, Bina Srinivasan, Beena Jadhav and Raju.
From Action Aid India Country Office, Delhi - Sandeep Chachra, Damodaram Kuppuswami,
Jeroninio Almedia, Anurag, Sunil Sharma and Shabir Ali from Action Aid, Bangalore office.
Mr Bhurelal is specially remembered for his logistical support. Christy Abraham, Sunitha Singh,
Sujatha and Seetharam of Bangalore Regional Office for facilitating the requirements.
Special thanks are also due to all the volunteers from Andhra Pradesh, Rajasthan, Patna region
who actively gave feedback about the psychosocial needs in various camps and the Aman Pathiks.
Sriram and Somnath, the volunteers in action.
The diligent and meticulous work of Shoba Ramachandran, Rajeev, Gokul, Shailaja of the Books
for Change deserve special mention for the effort and time devoted to this work. We would like to
thank Suresh for the excellent illustrations.
viii 10
EVENTS IN
GUJARAT
11 1
The media reports: ‘Trauma haunts children’, ‘crying need for the healing touch’,
‘practising meditation to come out of their mental depression’, ‘share the
responsibility to assuage, heal and rebuild’, ‘social organisations bound together to
heal’. These statements very clearly indicate that the impact of the recent riots in
Gujarat on the affected people is not only a reality but also widely recognised.
C HALLENGES AHEAD
It is against this grim scenario that any strategy for relief, rehabilitation and
reconciliation in Gujarat needs to be positively considered. Following are the main
challenges that confront the government and indeed the entire nation:
● Ensuring that people living in the relief camps have access to
◆ Regular food supplies, especially for infants and children
◆ Additional sets of clothes and allowance for daily expenses
◆ Sanitation, drainage, toilets and clean drinking water, all vital to protect public
health, are especially endangered during the monsoons
◆ Public health interventions like immunisation, preventive health care in terms
of monitoring expectant mothers and people suffering from tuberculosis
◆ Heat and rainproof shelters
◆ Child care and education facilities and support.
2 12
● Ensuring legal rights and social justice to the riot survivors, including filing of
FIRs, investigation and contesting cases in the court.
◆ Legal aid is essential for the riot victims because in many cases FIRs have not
been registered. Also in several cases, entire families have been wiped out and
no one or sometimes no responsible person is left to file the claims. All these
make the riot victims feel very vulnerable and demoralised. They need a lot of
moral support and confidence building. For them to even be able to think of
taking legal action against the perpetrators is a big step.
● Providing psychosocial counselling and support for dealing with loss, betrayal
and anger.
◆ In the post-riot phase the victims are unable to come to terms with their loss,
feelings of betrayal and anger. The fact is that whoever witnesses/experiences
a riot is traumatised to various degrees. Also responses vary from one another
and manifestations change with time. However, if any of these are unattended,
it can lead to serious mental health problems. Thus preventive measures such
as psychosocial support is needed. Psychosocial support to individuals, children
and women in particular and communities in general enable them to relieve
the trauma. It also helps and guides them to locate the various support systems
available, along with rebuilding their hopes and self-esteem.
● Community based care/rehabilitation for widows, orphans and those who are
physically disabled by burns
The specific population at risk subsequent to the riots is the women who were
raped, persons with burn injuries, widows, orphans, physically handicapped and
the uncared aged. Long-term community based care/rehabilitation activity needs
to be initiated for these groups.
13 3
IMPACT
ON
THE PEOPLE
Any human-made disaster leaves people with a great sense of betrayal, ripping apart
the social fabric that is essential for any person’s sense of well-being. The deep hurt
and anguish caused by the loss of human life, as well as the disruption of daily
living are far more difficult to overcome than when in a natural disaster.
In riot affected areas, as in other major disasters, emotional reactions like anger,
betrayal, irritability and revenge are common among the people living in camps or
the people who are indirectly affected or living under threat. Along with relief,
rehabilitation and care of physical health and injuries, emotional needs have to be
given priority. This in the long run ensures rebuilding of confidence and peace. While
rebuilding the affected areas will take a period of time and require sustained effort,
what should be prioritised is essentially providing long-term wholistic care for the
affected population.
In order to take care of the emotional needs of the riot-affected people, five major
challenges need to be considered:
● Severe stress and trauma due to
the riots.
● Sudden forced displacement.
● Difficulties of living in the camps.
● Uncertainty about the future and
continuation of threat.
● Process of rebuilding personal,
family and community life.
The socio-economic impact, like the
lack of employment, homelessness,
environmental destruction and disorganisation emerges as a consequence
following the devastation. Disaster-affected people show various kinds of
reactions. Emotional reactions immediately follow the event. The following page
illustrates some of the responses of affected persons.
4 14
Physical impact
Stomach-aches, Diarrohea, Headaches, Body aches, Burns
(heat, acid), Physical impairments (limbs, sight, voice, hearing),
Injuries (bullet, sharp objects and others), Fever, Cough and
Cold, Miscarriage, Physical Assault.
Emotional reactions
Anger, Betrayal, Irritability, Revenge-seeking, Fear, Anxiety, Depression,
Withdrawal, Grief, Addiction to pan masala, cigarette, beedi, Drug abuse.
Socio-economic impact
Loss of trust between communities, Lack of privacy, Single parent families, Widows,
Orphan state with loss of both parents, Discontinuity in educational plans.
Loss of employment
Homelessness
Loss of handcart
Disorganisation Migration
of life routines
15 5
It is important to note that all these reactions are inter-linked to one another. For
example, due to loss of livelihood opportunities an individual may get depressed
and feel helpless, or a physical injury may prevent him/her from work, thereby
resulting in the loss of his/her source of income. Hence, an impact on the socio-
economic front causes emotional reactions in the first case, whereas in the second
case, an impact on the physical aspect influences the socio-economic front. This clearly
indicates that all the three areas are inter-linked.
For appropriate and effective interventions it is very important to have a clear
understanding of the emotional reactions to disasters. It is now clear that these reactions:
● Are normal responses to an abnormal situation.
● Are common and universal.
● Are experienced by anyone who witnesses a disaster.
● Manifest differently at different periods of time after the disaster.
● Require rehabilitation and rebuilding over a long-term process.
After a disaster, the emotional reactions among members of a community vary and
usually also undergo change over time. Therefore, post-disaster psychological
interventions should be flexible and based on an ongoing assessment of needs. The
emotional reactions should be understood based on the manifestation of various
stress reactions, level of individual effort invested by the people for their own
reconstruction, the pattern and degree of disability as a result of these psychological
stress, etc. Some factors that could influence the reactions among people are:
● Nature and severity of the disaster.
● Amount of exposure to the disaster.
● Availability of adequate social support.
● Age.
● Gender.
● Status of the person (single/widowed/married).
● Separation/displacement from locality.
● Separation from family/primary support group.
● Personal losses of the survivor (loss of kith and kin, property, source of livelihood,
personal injury).
● Poor pre-disaster mental adjustment.
These factors would influence the coping abilities of individuals who experience a
sense of loss that is unique to them, for example:
● a lady widowed 6 months after marriage.
● an elderly couple losing all their life’s savings.
6 16
● a youngster losing all his/her family members.
● a family whose sole earning member is disabled.
P OINTS TO REMEMBER
➢ Need to consider and care for the emotional needs of the population.
➢ Impact of the physical, emotional and socio-economic aspects on
the individual.
➢ Emotional reactions need to be recognised.
→
depresssion anxiety
→
→
looking ahead reaching out/networking
17 7
PSYCHOSOCIAL
SUPPORT
8 18
Usually people who come from outside the community are doctors, lawyers, NGOs
volunteers and such individuals, who in their own capacity contribute/donate food/
other basic essentials/money, and offer time and their skills and expertise. Along
with them a group of volunteers, Community Level Helpers (CLHs), mostly from
within the community come together and work towards rebuilding and rehabilitation
in a comprehensive manner.
Local Community Level Helpers (CLHs) have been seen to be more effective in
providing psychosocial care and support to the affected people. Aman Samudaya is
an example where the community level support system has been effective. The Aman
Pathiks (CLHs) are part of a larger network of 30 NGOs, who have come together
under the banner of ‘Aman Samudaya’ to work in the current situation.
In the early stages following a disaster, most survivors are open and willing to talk
about their experiences. As time goes by and with no help forthcoming, the survivors
start withdrawing into a defensive, non-cooperative attitude. Therefore, it is of utmost
importance that survivors are encouraged to seek help, share and talk about their
emotional problems as early as possible, to prevent problems and development of
further complications.
In general, people do not readily/directly talk about
their emotional problems. Even during visits to the
health centres, they generally report physical
problems. Emotional problems may be indirectly
manifested as unidentifiable aches, pains, headaches,
tiredness, etc. When given an opportunity, people
do talk about themselves.
It is important that the aid agencies be sensitive
to the emotional needs of the affected population
and provide them opportunities to talk and share
their feelings. Rebuilding and Rehabilitation can
take place with such sensitivity.
19 9
It is important to realise that rebuilding of an individual’s life
and reconstruction of the entire community following the
disaster depend upon the survivor’s ability to accept the losses
as early as possible. It will help him/her understand and
emotionally accept the current reality and thereby work
towards reconstruction of life both at the individual, family
and community levels.
An example: Let us take an analogy of a person with an injury. An injury to any part
of the body will heal over a period of time because the body has the ability to repair
the damage. The natural repair process takes some time.
However, if the person gets immediate first aid
for his injury (e.g., cleaning the wound with
uncontaminated water and covering it with a sterile
or clean cloth), the healing will be hastened, thereby
gradually reducing the pain and discomfort. But on
the other hand, imagine if the wound is unattended.
The wound is likely to get infected and healing will
be delayed, leaving a bad scar. This might even cause
some limitation in the normal functioning of that part
of the body.
It is important to note that in both instances the scar remains.However, in the former,
the scar is light and does not produce a limitation. In the latter, the scar is dense and
produces a limitation for a long time.
Similarly, any emotional reaction like anger, betrayal and pain
due to loss and death requires help to facilitate ventilation or
reliving. This works like the sterile cloth preventing infection,
and allowing the body to work and heal. Non-availability of
such help to release or share these emotions leaves a scar in
the mind. Therefore, it is very important for people to share
the pain, feelings and thoughts about personal losses.
P OINTS TO REMEMBER
➢ Proactive support and care is required to cope with loss.
➢ In a disaster, aid agencies need to play a supportive role in facilitating
recovery among people.
➢ Psychosocial care is an important aspect of the rehabilitation process.
➢ Early recognition and intervention lead to better outcomes.
10 20
UNDERSTANDING
PSYCHOSOCIAL
NEEDS
The need for community level helpers to take on the role of giving emotional support
during such times becomes critical to help people in the recovery process. This section
focuses on enabling the CLHs to understand the psychosocial needs of the people
they would be working with in order to be able to give them emotional support.
21 11
natural buffers in the community, mental health interventions, such as outreach,
support groups and community organisations which seek to re-establish linkages
between individuals and groups, become extremely essential.
12 22
other’s recovery. For those who are orphaned or widowed or lone survivors,
support from other groups are extremely important.
● Behavioural Symptoms
Traumatic experiences cause a lot of stress, which is often beyond the coping
capacity of an individual. The inability to cope effectively leads to symptoms in a
person, some of which are manifested in his/her behaviour, such as:
◆ Loss of interest in life
Why should I be living anymore? What is the use of my life without
my grandson and granddaughter? They should have killed
me too.
◆ Reduced activity, no energy
There is nothing much to do here – just eat and then sit around.
Now we are just living by name.
It feels as if we have been reborn; the whole world has changed for us.
My days just pass by. I do not know what to do.
Earlier I used to do a lot of work. Now without doing much I feel very tired, my body
aches, I cannot concentrate/focus on anything (‘mera maan nahin lagta’).
◆ Overactivity and inability to rest (restlessness)
I am not able to lie down for a minute. I need to do something or the other. My body is
stiff. I am not able to sit or stand for a single minute.
23 13
◆ Difficulty in concentration
Sitting in front of the kerosene stove reminds me of the fire. I am worried and preoccupied
all the time. I keep making mistakes while cooking. I forget to put salt or chilly or other
ingredients in the food.
◆ Sleep disturbances and problem
An aged man talks about his inability to have a restful sleep:
If I start thinking about something, the whole night I lie awake.
◆ Feel as though I cannot breathe
The moment I enter my burnt house, I feel choking in the throat. I am not able to
breathe at all inside my house.
◆ Flashbacks
A young boy saw his family members being killed and burnt alive in front of
his eyes. Only his father was saved. At night he wakes up disturbed and crying
and remembers the horrendous moment when he saw his mother trying to
protect his brother from being killed and finally both of them were killed:
I get up at night suddenly with the image of my mother throwing herself on my brother
to save him, before they cut her up in two.
◆ Taking intoxicants or drugs
There is no work or any activity in the camp. Let me atleast keep munching paan
masala. My child has also developed a liking for it.
● Physical Symptoms
Often people complain of bodily aches and pains, for which they visit a doctor.
These symptoms do not have a physical cause. They are related to the emotional
stress a person is undergoing. For instance, a headache can be due to both physical
as well as emotional reasons. It is important to recognise and understand the kind
of bodily symptoms that an individual experiences while under stress.
◆ Headache
My head aches all the time.
◆ Tiredness
I feel like just lying down.
◆ Tense muscles
My daughter is young and she got so scared that her whole body became stiff.
14 24
◆ Palpitation/irregular heartbeat
Even now, if I hear some noise I get so alarmed as to what is happening. My heart starts
racing (‘Mera dil tez dhadakta hai’).
● Emotional Symptoms
A person who experiences stress will exhibit a lot of behavioural symptoms in
his/her emotions. Emotional reactions are very apparent as they bring a distinct
change in the survivor’s behaviour. It is important for us to identify and understand
these manifestations as reactions to stress:
◆ Anger
We are not interested in your talk.
You are the people who burnt our homes and now have come to soothe us.
You are filling up forms; do you want us to get killed again?
Why are you talking about peace to us? You need to talk to the people who committed these acts.
Why do you come and what do you want to know?
They could have killed all of us together rather than saying that they are taking us to a
safe place and then hand us over to the killing mob.
Next time this happens, either I will be in jail for having killed or I will be dead.
◆ Irritability
A mother beats her child for playing and running around:
Why can’t you sit in one place, always running from here to there.
A husband talks about his wife’s changed irritable behaviour:
For small matters my wife gets very angry with the children.
25 15
◆ Revenge
A teenage girl expresses her frustration and talks about revenge:
You either get those policemen and I will take care of them or get me my mother back.
A young boy talks of revenge:
They killed my father; I will kill theirs.
A woman expresses her thoughts about the situation:
What do you think these children who have seen so much of killing will become when
they grow up? Isn’t it natural that they will become terrorists.
16 26
A middle-aged lady talks about how helpless she felt when she came to
the camp:
Coming here I felt like a beggar, having to wait in line for tea, for food, etc. We often did
not feel like eating. We were all here like orphans (lawaris), wearing whatever clothes
we had worn at that time.
A woman expresses her loss and feeling of helplessness:
I lost my home; one son had got married and both homes have been looted. Now we have
no support, only the camp people are there.
A woman who witnessed other women being molested, raped and harassed
but could not help, expresses her sadness and guilt:
When the rioters (tola) came I was hiding with other women. They started cutting up
people, burning homes and doing ugly things to women. We were watching but could
not do anything. I really think about that time and feel bad.
An old man expresses his guilt and helplessness about the situation:
The girls in my colony used to call me ‘chacha’ uncle. I saw the same children being
raped, they called out to me for help but I just hid and sat there, I could not do anything.
◆ Repeated thoughts about the same thing
A woman talks about what she witnessed during the riots:
I saw the mob who tortured and harassed the women by stripping them naked, physically
abusing them and then burning them alive. I do not know, I just feel very tired. I keep
getting the same thought in my head again and again. Even now I remember those
events (‘Abhi bhi yaad aata hai’).
◆ Moods that keep changing frequently: Poor
concentration, Forgetfulness and Suicidal thoughts
All my family is gone; W hat do I have to live for?At times I
feel I should go and hang myself.
● Relational Changes
When a person experiences stress, certain emotional
reactions appear, as observed in the earlier examples. These reactions lower the
quality of interpersonal relationships and interactions with others, and result in:
◆ Disagreement and argument, unpleasantness
My husband was ill and I used to repeatedly ask people around in my room to stop
talking or lower their tone just for a few days while he needed rest. But they would not
stop; they talked ceaselessly.
I was in the toilet and a lady said, ‘Are you sleeping there?’ I had just gone in and when
I came out I retorted, ‘Is this some place one would like to sleep?’
27 17
Sometimes you are sitting down to have tea and someone will come and tell you rudely,
‘Get up, go and sit there’, you feel like just throwing things around and going away.
◆ Lack of emotion
Initially when Ms X came she was in a very bad condition; like a dead body. She used to
just lie in one corner silently.
That lady just sits in one corner, she lost her young son.
A father talks about his loss in a very detached manner as if he has no pain or
emotions associated with the event.
I had two daughters, both were killed in these riots. They were raped and then burnt. I have
not been able to get the postmortem report till now. I have not got my compensation money.
18 28
NORMAL REACTION ABNORMAL REACTION
OUTCRY OVERWHELMED
(Fear, sadness and rage) (Swept away by the immediate
emotional reactions)
DENIAL
PANIC/EXHAUSTION
(Refusing to face the memory
(From the escalated emotions)
of the disaster)
EXTREME AVOIDANCE
INTRUSION (Drugs etc., to deny the pain)
(Unbidden thoughts of the events)
FLOODED STATES
(Disturbing images and thoughts
WORKING THROUGH about the event)
(Facing the reality of what
has happened) PSYCHOSOMATIC RESPONSES
(Bodily complaints)
For a few days I did not even understand what happened. (‘Thode din to smaje mein
bhi nahi aaya ki huya kya hai’).
My daughter was so scared that she seemed a little lost for sometime (‘Yeh, ladki itna
dar gai the ki iske hosh khoye hua se the’).
◆ Relief, elation, euphoria among the survivors
Some would feel a sense of joy to have escaped unharmed and
have their family members safe.
◆ Anger
This reaction usually occurs when an individual feels helpless and powerless.
It may result from feeling abandoned. Feelings of resentment may occur due to
the injustice of this loss. Some survivors may ask questions, “What did we
do?” “Why us?” “How could they do it?” Then slowly anger towards the people
who have brought them to this state will emerge. It can be a mild feeling or a
raging irrational emotion. People will talk of revenge.
A woman while relating her experiences became very angry and
started shouting: Tell me what would your situation be if you were in
my position; what wrong did we do?
◆ Survivor guilt
Few survivors experience feelings of guilt and regret. “I should
have done more”, “If only I had known”, are thoughts that haunt
29 19
many people. The fact that they are alive may cause distress and discomfort.
I could not do anything to save them (‘Mein kuch nahin kar paya unko bachane
ke liye’).
A woman talking about her daughter-in-law who had gone home for her
delivery and got killed along with her entire family during the riots:
I should have got her back to my home; at least she would have been alive.
◆ Depression
Experiencing a sense of great loss, mood fluctuations and feeling of wanting to
be alone, may follow. Sleep and appetite disturbances, lack of energy and
concentration, and crying spells are some of the typical symptoms. Feelings of
loneliness, emptiness, isolation, and self-pity can also surface during this phase.
After shock and denial have passed and anger has been exhausted, sadness
and even hopelessness may set in. A person may have no energy even to do
the simplest daily chores. Crying episodes may be experienced often. However,
men do not cry often even though they are depressed.
I remember how it was earlier (‘Sab yaad aata hai phele jaisa tha’).
I have lost everything that I had saved (‘Mera to saab kuch lut gaya, sab joe
banaya tha’).
Restlessness, confusion, sleeplessness, repeated experiences of the events,
nightmares, and arousal symptoms may come up.
● As the days pass by (within 1 to 6 months) new reactions appear, these are
seen in about 40–50%of the population in the form of
◆ Grief
◆ Apathy
◆ Lack of response to others
◆ Inhibition of outward activity
◆ Physical symptoms of anxiety
Grief
Grief occurs in response to the loss of someone or something. The
loss may involve a loved one, a job, or some material possession.
Grief is a normal and natural response to loss. There are a variety
of ways the individuals respond to loss. Some are healthy coping
mechanisms and some may hinder the grieving process. It is
20 30
important to realise that acknowledging grief promotes the healing process. Spending
quality time and giving support facilitate the individual’s grieving process, providing
an opportunity to appropriately mourn the loss.
Bereavement is a painful process and at times seems unbearable. It is a combination
of many emotions that come and go, sometimes without warning. Grieving is the
period during which the individual actively experiences these emotions. The duration
and intensity of the grieving period vary from each individual. The length of time
people grieve can be weeks, months, and even years but it gradually becomes less
and less painful.
Because it is so painful, some people try to ‘get over’ a loss by denying pain. When
people do not deal with emotions of grief, the pain does not go away. Understanding
the emotions of grief and its accompanying feelings and symptoms are important
steps to heal and to help others who may be grieving. Some manifestations of this are:
◆ Sadness
◆ Distress
◆ Depression
◆ Yearning for what has been lost
◆ Anger
◆ Guilt
◆ Sleeplessness
◆ Loss of appetite.
◆ Severe irritability
◆ Suicidal tendencies
◆ Being acutely upset and disturbed by anything, which reminds them of the loss.
A person can be helped to come out of his/her grief. What is absolutely essential is
to help him/her share the feelings of loneliness, anger, and sadness openly and
honestly. Next is to help them to understand that such feelings and reactions are
absolutely normal in anyone coping with a personal loss. Practising relaxation,
deep breathing exercises, listening to music and getting involved in other life
activities will help in handling the symptoms of grief. Encouraging them to adopt
a healthy routine, like good nutritious food, regular exercise, adequate sleep, etc.,
will help them cope with their reactions.
31 21
◆ Avoidance of all activities and situations reminiscent of the traumatic event.
◆ Numbness, emotional blunting, and detachment from other people.
◆ Hypervigilance (i.e., inability to relax, being always tense), jumping at the
slightest noise, fearfulness, palpitation.
◆ Inability to enjoy anything.
◆ Panic reactions.
◆ Acute outbursts of violence may also be present.
These symptoms develop because the person always seems to be in a state of arousal.
For example
14-year-old S belongs to a low socio-economic status family. She was witness to her
mother being killed during the riots (Dhanga). She vividly recalls how the mob was
rushing into the small by-lane where they lived and her family was running to safety.
While trying to escape, the group caught up with her mother and slashed her throat. S
was able to reunite with her father and brother at one of the camps. The father describes
that most of the nights S gets up from her sleep and shouts, ‘The mob is coming’ (tola
agaya) and subsequently her whole body shivers and she gasps for breath on some
occasions. S reports that she is repeatedly haunted by the gory incident. She is unable to
remove the scenes or the images from her mind. She very often re-experiences these
memories. Returning from the camp to their house, she is scared of going near the
theatre where the event occurred. She practically avoids going that side and even looking
that side reminds her of the gory day and the events. Even a small cycle tyre burst in the
road and she starts running away screaming, and is then found to be irritable for the
next one or two hours. This sort of behaviour and response are increasing day by day.
As can be seen from this vignette, PTSD is not a single symptom but a cluster of
symptoms like re-experiencing, avoidance, hypervigilance, numbness and irritability
in a person.
A person can recover from PTSD on his or her own over a period of time through
the combined actions of education, support, anxiety-management and lifestyle
modification which can hasten the process of recovery:
◆ Education, the first step, involves helping the person understand his/her
condition and reassuring that the reactions are a result of the stress due to the
traumatic event.
◆ Support from family, friends and anyone working with the person by letting
the person know that he/she is not alone and is not responsible for the event,
etc., helps in the recovery process.
22 32
◆ Teaching anxiety management strategies like relaxation, breathing techniques
and diverting the individual’s mind through involvement in activities.
◆ Changes in their lifestyle is very important. This means following a healthy
diet, avoiding stimulants or intoxicants, regular exercise and adequate sleep.
In certain cases use of medication maybe recommended. All these help in the
recovery process.
P OINTS TO REMEMBER
➢ Use the principles for giving emotional support in your work.
➢ Identify different emotional reactions in people.
➢ Recognise the stage the person is going through on the basis of the
symptoms.
33 23
ROLE OF
A COMMUNITY
LEVEL HELPER
As mentioned earlier, the CLHs play a critical role in the rebuilding efforts after any
community has experienced a disaster. In the Orissa cyclone disaster it was the
Snehakarmis and in the Gujarat earthquake it was the Viklang Bandhus who provided
psychosocial care. During the Gujarat riots, it has been the Aman Pathiks who are
providing this care.
The CLHs are a vital link between the affected population and the helping agencies
(Individuals, Non-Governmental Organisations and Governmental Organisations)
who come from outside the community. The CLHs, most often belong to the
community, and are likely to know the area well and have close ties with several
people in the locality. They will also be able to work in a more intense and sustained
manner with the community.
Emotional interventions can be provided to the family by daily visits. During such
visits, time should be spent to talk about the survivor’s feelings and experiences,
imparting health education, discussion of health problems, engaging in paralegal
work, motivating individuals to hold group meetings, organising educational
activities and maintaining a routine despite loss.
The most important step in the psychosocial care and recovery process is to
recognise that such care is essential for the entire population exposed to the
catastrophic event. People differ only in terms of the degree of support needed.
In other words, the care is wholistic rather than being limited to relief and support.
Psychosocial care means not only emotional support but practical help, suggestions,
guidance, information, education and so on.
Under the spectrum of psychosocial care, seven basic issues will be addressed
by the CLH (see box). The focus will be, identification of needs and attention to
specific problems. Referrals would be made as and when required and there would
be a commitment for long-term work. They would be working not only with the
people who have been affected but also the larger society and others in the Aman
Samudaya team.
24 34
Spectrum of care would cover issues related to
Paralegal Psychosocial
INDIVIDUAL
Housing and Self Help
Livelihood
Role of a CLH
The foremost task of a CLH would be to meet and interact with many families at the
camps. He/she should initiate interactions among the families using culturally
appropriate greetings and gestures like, ‘salaam valikum’, ‘namasthe’, ‘aadhab’. In
subsequent interactions, the CLH would help them with:
● Understanding the changes that they experience in their body and mind.
When people face any traumatic event, they experience both emotional and
physical reactions. Helping them to understand that it is absolutely normal
to feel this way is very important. It will make them feel more comfortable to
deal with what they are experiencing. Knowing what they are experiencing
currently is just a temporary phase and that
over time they will be able to get back to their
normal life, will benefit them.
35 25
● Support and rebuild their shattered lives in the areas of housing, work, health
and community.
After establishing rapport, facilitating reliving and grief resolution, the CLH would
go on to observe or enquire about any specific help a
person may need. This could be in the form of
◆ Guidance to get compensation, assistance in paralegal
work, house damage assessment.
◆ Practical help like getting forms/accompanying
survivors to the offices or helping the individual open
a bank account, etc.
◆ Medical help if need be, specially going to the hospitals.
◆ Mobilising help from neighbours/relatives to support an
orphan or an elderly survivor.
◆ Getting livelihood reorganised.
◆ Networking and coordinating with other agencies are also
important for sourcing various other kinds of support.
The wholistic approach is more substantial not only in terms
of meeting varied needs of an individual but also gives the
CLH more entry points for intervention.
Once the CLH has been able to establish rapport and built relationships with
people, he/she would need to identify groups that need special attention and
work closely with them. These groups are:
◆ Widows
◆ Orphaned children.
◆ Single parent families.
◆ Families being run by older siblings.
◆ Aged people.
◆ People with disability.
◆ People who are economically devastated.
P OINTS TO REMEMBER
➢ CLHs are the appropriate people to work with the affected people, they
are an important link.
➢ CLHs have critical roles to play.
➢ CLHs need to identify and give special attention to people who are
vulnerable.
26 36
PSYCHOSOCIAL
INTERVENTIONS
Under normal circumstances, most people can take care of their problems. The
riots being an abnormal situation, the people’s equilibrium is temporarily upset
because of the emotional reactions they experience. Till the time they can develop
successful coping strategies and handle their lives independently, they require
emotional support.
It is like extending help to a person who has fallen on the ground. Extend your hand
to help the person sit, then slowly make him/her stand. Then walk a few paces with
him/her and gradually he/she will walk independently. The following diagram
would help understand at a glance the three areas of focus for psychosocial
interventions:
37 27
P RINCIPLES
There are 7 principles that can be applied to give psychosocial support to any person
in a post-disaster situation.
Ventilation
A person (i.e., in this case survivors of the riot) who
has experienced trauma will have strong emotions
which will very often be suppressed. The danger
is that if there is no space or appropriate stimulus
for release of these emotions, then the pressure will
keep on building until one day the person can break
down. Hence it is extremely important for the CLH
to meet the people, interact with them and help
them talk about (ventilate) what they have
experienced and share their feelings and emotions.
For example
For instance, in a pressure cooker the safety valve is very important. It systematically
and periodically takes the extra pressure out slowly and helps in getting the food cooked.
The safety valve helps the extra pressure to be released or else the cooker could burst.
Similarly, the CLH will have to work like the safety valve by getting the people he/
she is working with to slowly but constantly release their tensions, pain, anger or
other emotions that they have supressed within them. This is an extremely important
part of the role of a CLH.
This process involves release of emotions and feelings. It is a very important
intervention and should be used as soon as possible. People under stress find it
difficult to relax and may have other symptoms. Even in crowded camps, people
can be very lonely.
For example
Mr A whose daughters were raped and killed in front of him says, “I had two daughters
both were killed in these riots. They were raped and then burnt. I have not been able to
get the postmortem report till now. I have not got my compensation money.”
When you talk with him, his conversation revolves around more practical issues
like compensation, etc. He is not in touch with his feelings that relate to the loss of
his children and the trauma he has experienced. He has managed to suppress those
feelings; but they are simmering inside. If not given timely help, one day the pressure
of those emotions can cause a break down in him.
28 38
Empathy
Often when we look at others we do not see their distress and everything appears
very fine. But to understand another person’s feelings of loss and pain is very difficult.
However, if we attempt to perceive things from the other person’s perspective it will
give us a clearer picture of what that person is going through. This same goes for the
CLH. The idea of being able to feel and experience the pain as your own by trying
to be in the other person’s situation is the main idea of being able to empathise.
While the person is sharing his/her thoughts and feeling, we have to be there, listening
attentively as if his/her pain were our own. Then he/she will truly feel understood.
In Hindi, the words, Mehsoos and Ehsaas express how we should be able to feel and
experience the pain of the survivors while working with them. This will give them a
great sense of relief of having been truly understood. As one Aman Pathik said
Listening to her story and the way she was crying, even I had tears in my eyes.
Active listening
In a camp situation there will be lack of privacy when we are talking with people.
There will be a lot of noise and distraction. But good listening is an important skill to
provide emotional support and all the more in the camp situation. Practising some
of the guidelines given below can help you work better:
◆ Look into the eyes of the person while he/she is talking: This indicates being
interested in what is being said.
◆ Respond occasionally while listening: The person speaking feels convinced
that you understand and take him/her seriously Sometimes it helps to
paraphrase what has been said, often giving the speaker another viewpoint.
◆ Avoid interruptions: Let the other person finish his/her thoughts. Do not
interrupt unless there is confusion and the details are jumbled.
◆ Be accepting: Do not prejudge, moralise, condemn, or interpret how the other
person should feel.
◆ Empathise: Share the experiences of the other person as if they are your own.
You have to be sensitive and have the ability to recognise when the other person
is going through certain feelings or emotional experiences.
Social support
Everyone feels very comfortable with a certain level of emotional support that
comes from others around. Social support networks are extremely important
for feeling comfortable and secure. In a disaster situation these support systems
get disrupted.
39 29
For example
If we go to a new town for the first time and have to work or study there, we would feel,
insecure, lonely, scared, and at times fearful. If we meet some people from our background
(language, religion, region, etc.) then we would immediately feel a sense of happiness, and
want to be with them, try to meet them and generally feel relieved.
So it is essential in efforts like ours to provide some level of support through a bonding
in terms of almost being like a family member. The losses during such riots are not
only personal in terms of family members, belongings, etc., but also the loss of larger
support systems like friends, neighbours, community, and so on, who/which
otherwise could have been of help. The involvement of external agencies and CLHs
specifically can play a great role in extending emotional support.
Externalisation of interests
The women at camps are engaging in community kitchens. They have something
meaningful to do during some part of the day. Similarly, older children are seen
transporting firewood from the truck to the storage area. All these, though small
activities, give people a sense of being productive and help in enhancing their recovery
process. The people are engaged in activities and their minds are meaningfully
occupied. Also, any physical activity energises people and makes them feel better.
For example
One woman mentioned to the Aman Pathik that she would like to work with the children
in the Bal Muskaan programme being run in the camp. It is important for this woman
not only to be given an opportunity to work because she feels she has the skills, but also
because it will help her personally to divert her thoughts from the traumatic experience
she has experienced, to something which makes her regain her self-esteem and self-respect.
30 40
to horrific stories and negative messages. With the introduction of the Bal Muskaan
programme, having their day filled with activities became a reality. The children now
have something to divert their mind from the painful memories and emotions. This
has made them feel releived. This helps in a healthy channelisation of their energy.
Taking part in the Bal Muskaan programme as a facilitator or even taking part as an
Aman Pathik has been healing for many. One lady said, My mind has become ‘fresh’ after
I started working here (Aman Samudaya). Now I work with everyone and today the situation
is such that I feel this camp is my home. This is a clear indication that if survivors are able
to divert their mind and get interested in other activities, they feel better.
41 31
Spirituality
In our country, religious beliefs or belief in a higher power greater than human
beings is an integral part of our being and gives us great relief and support during
testing times.
We may question this power at times to ask why
we are suffering and why we have to go
through the pain, but at the same time we will
again lean on the same power to get through
any crisis we are facing. So it is important to
reinforce this spirituality in anyone we are
working with, because it has tremendous power to heal the pain and suffering.
All the principles mentioned above can be used to work with people at three
levels, i.e., The individual, the family and the community. The example which
follows illustrates all these principles.
Example
S, a 14-year-old girl lived with her family of two brothers and her parents in Ahemadabad.
During the recent riots her mother was killed in the police firing. Actually her mother
was not someone who went out of the house but unfortunately this time on hearing
something is happening in the next lane she became curious and went out to see. While
running back she was killed in the police firing. Subsequently the family members were
reacting to the incident of loss as all others did. The daughter who was very attached to
the mother was very angry and disturbed. Anyone who went to provide her with help
had to face a volley of questions like, “Can you bring back my mother? Or get the four
policemen who killed her?”
In their culture, when someone passes away, the members from the extended
family invite the bereaved family members to stay with them. In S’s case, the
extended family did not invite them over. So S and her brothers had to manage
on their own. In addition, S’s family as such did not have very good relations
with their immediate neighbours.
In this case, the normal social support systems (family and friends) that usually
help people recover from traumatic events were missing. Also, the loss took
place in an unnatural manner and not as a natural death; so the level of pain
and anger is very high.
The Amanpathik of that area visited the home. What follows is the process of
helping S to cope with her loss.
The Amanpathik came to know about this family in the camp and on enquiry
he found that the family had moved to their house in the neighbourhood. After
identifying the family he visited them for the first time.
32 42
First visit
The Amanpathik, P who went to meet the family was greeted with hostility by
the entire family. He was told that they had not done anything to the Hindu
neighbours in the area. Although the other family members were angry, they
talked to P but then S told him to leave saying, “You get back my mother or get
the policemen who killed her and I will take care of them.” She refused to talk
and left the room. She pulled the other family members into the house and
closed the door.
What is happening?
As can be seen, the level of anger and resentment is immense. S has not even come to
terms with her actual loss. She is at the stage of outrage right now. The family as an
institution had been fostering her faulty coping methods rather than helping her
normalise her reactions.
What needs to be done?
It was decided that a four-pronged approach would be taken to normalise the families
reaction to the loss. Firstly, the local Clergy would approach the father. Secondly, a
foster mother would be brought in to help S ventilate or share her feelings about the
mother. Thirdly, work would be done through the elder brother by talking to his friends.
Fourthly, an intra- referral to the support team working for children would be made. It
was also decided that an Amanpathik, subsequent to the initial entry being achieved,
would maintain a regular visit. It was also decided that a female Amanpathik would
take charge of S since she may be identifying P with the policemen and her anger could
be enhanced with his presence. Also, a female Amanpathik would be able to establish
better rapport with S.
Second visit
G, the female Amanpathik who was put in touch with this family went over to
the neighbourhood and was able to identify the opposite house lady who was
willing to help the girl after long persuasion. This lady was requested to find
out three basic answers from S: ‘What was the good thing in your mother?’
‘Which was the best food you liked prepared by your mother?’ ‘Whom do you
resemble – your mother or your father?’ These were questions which would
help S open up and release the pent up emotions about her mother.
What is happening?
The process of creation of a neighborhood support system was initiated. Even though S
made no attempts even to acknowledge this, the neighbour was motivated to continue
to go over regularly and try and talk to S. This interaction is very critical because the
neighbour is providing an empathetic bond, which will enable S to cope with her pain.
As can be seen, it was a time-consuming process and a gradual one. However, these
regular visits of the neighbour helped to establish trust and somewhere S was able to
sense that the neighbour lady was genuinely concerned about her.
43 33
Third visit
The male Amanpathik met one of his elderly Muslim friends in the area and
requested him to help to talk to the father of S. With some reluctance the old
man agreed but the father did not heed his request.
His friends, at the request of the Amanpathik, approached the elder brother of
the girl. After severe argument about his sister’s welfare, the brother relented
to the peer pressure but was unsure of how to help his own sister.
What is happening?
One can see that any situation of trying to support a family must have a multifaceted
approach and at times you will meet with failures but one of the interventions will
have the desired effect. Also in any situation the entire family needs to be worked
with and not just one person.
Fourth visit
The coordinator of the children’s support team monitored the developments.
She visited the house along with the brother and gained entry after sorting out
the brother’s needs in terms of employment. The brother was very facilitative.
The brother by now had understood the need for his sister to release her pent
up feelings. During this visit he shared his concerns with his sister saying he
would like her to start carrying on with her life. He talked to her saying he too
missed their mother. While sharing some memories, S started to cry silently.
The neighbour who had been reinforcing the same messages put her arm around
S, comforting her as she cried. S expressed that she felt totally lost without her
mother and now had no one to talk to. She felt totally frustrated that nothing
had happened to punish those responsible for her mother’s death and she was
very angry with the policemen. She felt that her mother had not deserved death.
Everyone listened to her as she talked about her feelings about the event, her
fears and worries.
What is happening?
This joint meeting was really beneficial in helping S feel comfortable to talk about her
feelings and fears for the first time. It is the start of a process but demonstrates an
acceptance as well as the importance of external support networks to come forward
and help a family cope with its loss.
The neighbour is continuing her work with S and ensures that she maintains
her rapport and offers space for S to share her feelings and emotions. The
Amanpathik, through regular visits, supports her. As of now, S is much
better and is excited about her cousin’s marriage and is getting ready for
the occasion mentally.
34 44
Learning Points
◆ Initial entry was difficult – work to be done by a group than by individual
Amanpathiks.
◆ Establish local support systems to provide guidance and assistance.
◆ Empathetic relations are critical and essential to the helping process.
◆ The entire family needs to be worked with rather than just one individual.
◆ It is a gradual process and ventilation is the key to opening of the channels
for recovery to take place.
◆ Taking part in ceremonies/rituals is one example of how externalisation of
interest helps in normalisation of the life for the survivor.
45 35
◆ Make them understand they are not to blame for the tragedy and need not
feel guilty
◆ Tell them you will return the next day or in a couple of days
◆ Tell them you are not upset or angry because he/she did not talk. Meanwhile
ask him/her to think about whatever has been told. “Memories of good days
you spent with each one must be alive in your memory and coming to your
mind again and again. You must be tense inside! Try and let the steam out, that
will make you feel better.”
Take the example of a father who was unwilling to talk after he lost his son. The
CLH working with him was able to reach out to him and help him ventilate his
pain and deal with his loss.
For example
In Orissa, during the cyclone, a father lost his children. For quite some time he was
unable to accept the death of his youngest child and went into silence. If you talked
about this child he would get very angry. The youngest child, a boy, had been very good
looking with big round eyes and a mole on his face.
Often at night, when everyone was asleep, the father would walk down to the place
where the dead bodies had been burnt. This was noticed by the CLH (Sneh Karmi). One
day the CLH followed him to the place.
Standing behind the father, the CLH said, “Look there is the skull of your youngest
child.” The father shouted very angrily and told him to go away, but the CLH continued
telling him, “Look closely, the eyes are round just like your son’s; the face would have
had a mole there.” The father stood for some time in silence and then suddenly broke
down sobbing and crying. All the feelings he had been suppressing, suddenly came out
in the form of tears.
In this situation the CLH was able to use a ‘skull’ to help the father ventilate and
bring out the feelings and emotions he had been suppressing within him. It helped
the father accept his loss in entirety. This release was very healthy for the father
and a very critical part of the recovery process.
Once the person talks about the loss and personal grief, he/she feels better. It becomes
easier to take stock of his/her life and understand the feeling of a vacuum, an
emptiness created by the loss. This facilitates in rebuilding his/her life. Hence, the
more he/she releases the pent up feelings, the lighter they will feel.
● Once the person starts talking, maintain a conversation using the following
queries:
◆ How are you and how are your other family members?
36 46
◆ Give details of all the losses experienced by you and your family.
◆ How do you feel about the loss? – What is the personal meaning of loss to you?
◆ What is the support you received after the event from relatives, friends, relief
workers, etc.?
◆ How have you been recovering? – How are you handling this situation?
◆ What are the effects of the event on health, like physical problems or problems
like aches/pains, decreased sleep, decreased appetite, fear, and loss of interest?
◆ How do you visualise the future?
◆ What other help do you require?
Caution: Guide individuals to adopt healthy behaviours.
47 37
◆ Try and do things together as a unit and
support one another.
◆ Be together as family members. Do not send
women, children and the aged to far off
places for the sake of safety; separation in
this case can cause a lot of anxiety to them
and to you.
◆ Restart activities that are special to your
family, like having meals together, praying,
playing games, etc.
◆ Keep touching and comforting your parents,
children, spouse and the aged in your family.
This will not only make you feel good but
also make the other person feel the same.
◆ Keep in constant touch in case of a member of the family having to be shifted to
a far off hospital or residence. Update him/her about yourself as well as find
out about him/herself. This gives a feeling of being cared for.
Group mourning
Grief resolution should occur at the personal, family and the community levels.
Group mourning is a process of mass grieving. It expresses solidarity of the
grief-stricken community and facilitates unity and collective action. Such activities
should be initially organised on a weekly basis, gradually on a monthly basis, and
later, annually. In Maharashtra there is a process wherein traditional coloured pastes
(Haldi Kumkum) are applied to a widow before
breaking her bangles. This process helps her to
accept her loss and relate to her feelings.
In Gujarat there is a traditional process ‘Iddath’ among
the community, wherein the widow stays away from the
rest of the people for some time before getting back to
regular societal routines.
Similarly in other communities, mass prayers with lighting of candles are done. All
of these are traditional methods for people to come to terms with their loss and start
their grieving process, which in turn helps them move ahead in their life.
38 48
Group meetings
Group meetings are important activities where the community as a whole participates.
This stimulates the people to think, and brainstorm about various measures/initiatives
for rebuilding the community. It not only helps the community to come to terms
with the reality of loss and emptiness but also helps them to initiate collective action
and rebuild their lives.
An ‘Aman Bhojan’ (community meal) was organised
where people from both the communities along with
few prominent leaders came and ate together. This
helped in establishing some faith and a feeling of
normalcy among the people. It also showed people
that others were with them. Coming together on
occasions has taken place, like in the preparations for mass marriages.
Cultural aspects
There are things very specific to cultures that help in the recovery process. For instance,
singing of folk songs helps people gather in a common place and share their grief.
There is a sense of commonality in grief that increases the cohesiveness of the
community. It was observed that putting Mehndi was an essential part of the pre-disaster
life among this community and has returned even without a wedding taking place. Many are
engaging in decorating their hands with mehndi. Such activities lead to faster recovery
and normalisation of lives of the affected population.
Rally
Organise a rally to sensitise the administration regarding delays in implementation
of action for restoration, rebuilding, relocation, compensation, etc. Rallies are also a
powerful expression of solidarity. ‘All for one, one for all’, demonstrate strength
and determination to fight for a just cause. Such rallies can also be used to sensitise
groups, for instance to create awareness among students about issues around them
and bring about a feeling of confidence and normalisation among them.
49 39
A rally was taken out involving key members of the
government and this was done in an area where there
was great insecurity earlier. The rally helped in rebuilding
the faith of the people in the government agency. It also
helped sensitise the government officials about the reality
of the situation.
Sensitisation process
Involve religious leaders and opinion leaders, in all community activities. Talk about
re-education of the larger community, especially on ways to handle rumours. Also
group discussions would help in expressing their feelings and extending support to
each other and together being able to think about a future course of action. The cultural
wing of the Aman Samudaya is holding street plays both within and outside the camps, and
these are very popular among the survivors.
P OINTS TO REMEMBER
➢ There are seven basic aspects that a CLH can use as psychosocial
interventions to work with people who have been affected.
➢ Rebuilding of life occurs at the level of individuals, the family and the
community.
40 50
SPECIAL
GROUPS
‘No one who witnesses a disaster is untouched by it’. Although we understand this,
it is also important to recognise that due to various factors (mentioned in the chapter
on Impact of People, pp. 4-7), there are groups of people who are more vulnerable
and need greater attention. We need to identify and work with such groups.
For example
There may be a child who has become an orphan. This child has not only been through
the traumatic event but also lost the primary support unit and hence would require
additional care to deal with both experiences.
51 41
When working with a person who has been raped:
◆ Respect the woman and maintain a high level of confidentiality with her, even
regarding her name, etc.
◆ Do not be judgemental. Give her the confidence that she is not to blame for
what has happened.
◆ Help her to overcome the feelings of being unclean and make her understand
that she is not responsible for what happened.
◆ Help the woman ventilate painful experiences and feelings related to it. Through
all this be attentive, sensitive and give all support to her.
◆ If initially she appears withdrawn do not force her to talk to you. Once she has
confidence in you, she will share her feelings and thoughts.
◆ Convince her that her disturbing thoughts and the pain she undergoes are
natural and a result of this kind of a horrific incident.
◆ Let her express her anger towards the people who tortured her, as it helps in
releasing pent up tensions.
◆ Encourage her to recognise the trauma as a small scar compared to several
positive qualities and experiences she has.
◆ Help her regain the support of the family and community if she has lost it.
Work with the family and help them give support to the her and reduce the
stigma.
◆ Identify ways to end her social isolation and if there are support groups working
on this issue make sure that she participates in them.
◆ Look at other support that she might require like livelihood, or medical care
for physical problems, etc. to enable her get back on to the recovery process
◆ If necessary referral may be required, arrange for that meeting.
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◆ Irritable over small things and frequent mood changes.
◆ Feel afraid or nervous.
◆ Feel guilty for not having done enough for others.
◆ Feel humiliated and weak.
◆ A growing feeling of revenge.
A GED PEOPLE
Very old people are often not totally in control of the situation. They may take a
longer time to recover from the disaster. The kind of disaster they witness and also
the death of many young people before their eyes might make them:
◆ Withdraw and weep.
◆ Suffer from sleeplessness and refuse to eat.
◆ Be agitated, feel lonely and hopeless and have
suicidal tendencies.
◆ Susceptible to falling ill as a result of being
disturbed emotionally.
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You can help by:
◆ Keeping them with their near and dear ones.
◆ Visiting them regularly and spending time with them.
◆ Touching them and allowing them to cry.
◆ Re-establishing their daily routines.
◆ Making them feel responsible by giving them some work to carry out which is
not too difficult.
◆ Getting them involved in relief work by requesting for their suggestions and
advice, etc.
◆ Keeping them informed of positive news.
◆ Attending to their medical ailments by helping out with Doctor’s visits and
consultations, etc.
◆ Organising small group prayer meetings.
D ISABLED PEOPLE
People with disabilities may face some hindrance in the recovery process.
Their recovery may get prolonged or they might regress to a lower level of
functioning.
W OMEN
Women tend to feel more vulnerable. There may be many affected groups like young
widows, single people, orphans, the disabled people, those who have lost children,
single parents, aged, etc. Their emotional reactions will be far more visible and their
response is different from men:
◆ They might weep and later become depressed.
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◆ Experience vague body aches and pains and feel weak.
◆ Show more resilience in taking care of younger children, the elderly and disabled
people.
C HILDREN
Children are always disturbed by change. They are often treated as young and hence
not to be informed of what exactly is happening. Thus,
they cannot comprehend what has happened around
them and to them. They seek the comfort of adults as
they feel the need to discuss and sort out their fears
with an adult. They are not very sure of the options to
get out of problem situations. They are dependent on
adults physically and emotionally. Events like loud
noises, shouting, running and panic and anxiety,
separation from loved ones, loss of the comfortable
environment, deprivation of food and drink, impact a
child much more than an adult.
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◆ Experiencing disturbed sleep.
◆ Wetting their bed at night.
◆ Developing health problems.
◆ Regressive behaviour, for instance, he/she may want to be
carried around now even though he/she have been walking
earlier, or may start talking like a baby.
46 56
◆ Encouraging them to play – invariably they will play/act out what happened.
Allow them do it, then discuss what happened and how the people were feeling.
◆ Giving them opportunities for painting and drawing where they can express
their emotions. This is very healing.
◆ Organise story telling sessions, singing songs and games involving physical
movement.
◆ Paying attention to and praising a child’s coping behaviour, like when he/she
follows a routine, makes an attempt to reduce his/her anger, agitation, etc.
◆ Working with other caregivers in the
environment to help the child recover,
like getting him/her to work with the Bal
Muskaan facilitator.
◆ Providing referral to Mental Health Centre
if required.
◆ Paying more attention and spending time on
their studies once they return to school.
P OINTS TO REMEMBER
➢ Although everyone needs care and support, there are groups among the
affected people who need special attention, as they are more vulnerable
due to their age or other factors.
➢ We need to work with these groups.
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REFERRAL
The referral process should be done using the spectrum of care framework discussed
in the chapter on Role of the Community Level Helper (p. 25). We are looking at a
wholistic model of care rather than one focusing purely on the emotional aspect of the
rehabilitation work. There are seven basic areas to consider for each family that we are
working with. It is important to be able to identify the needs in any of these categories
and know whom to contact for further assistance. Also CLHs need to tap sources from
within the larger social network that go beyond the Aman Samudaya network.
48 58
Examples
◆ A man had a business of cars like Maruthi, Ford, etc. He had a house plus newly
married sons. Within a week of the riots he lost everything. When his
compensation packet came with only Rs1250 at that time, he had a paralytic
attack and went into a state of shock. For him, having lost so much, he could not
believe that he would not get his full reimbursement. Now he does not talk
properly and does not respond. If you ask him questions, all he does is smile,
lies down on his side and slowly tears well up in his eyes. No expression is
visible on his face.
◆ A 20-year-old girl behaves in an abnormal way. She hits boys from the front,
irritates them, tears clothes when she sees boys.
◆ A 35-year-old woman just keeps running and does not listen to anyone. She
talks and suddenly gets angry and looks as if she is going to do something. To
calm her down, water is given and to distract her, she is made to involve in
some activity. She cannot concentrate for too long.
The first referral centre would be the Primary
Health Care Centre (PHC) or the doctor attending
your camp. The doctor at this centre would be
able to provide appropriate care. Contact the
visiting Psychiatrist and then follow up at the
hospital if required.
There are four areas which you can consider while deciding whether you can
help or if you need to refer the person:
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Behaviour
Speech
50 60
Emotions
In the Aman Samudaya programme, both intra- as well as inter-referral processes need to
be continued. For instance, when the Aman Pathik identifies a woman who has been raped
and finds it difficult to work, he/she could always refer the case to the women support team,
who would then make specific interventions. Similarly, problems with children and paralegal
issues could be directed to the respective support teams. Links need to be made with the
local government agencies like the Welfare, Hospitals and Police, who provide specialist
care to the community.
P OINTS TO REMEMBER
➢ There may be some people who need guidance for specific issues and you
need to refer them to the right person.
➢ For emotional support and care at times specialist help may be required and
it is important to identify those needs and refer the person.
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SELF CARE
It is important for the CLH to understand that he/she is involved in work that is
going to make demands on his/her physical as well as emotional life. The daily
stress can cause internal tension within the CLH group. It is important for each CLH
to understand this aspect and take some preventive actions to enable themselves to
cope with this stress.
An analogy of a tree is useful to understand this. Unless the tree has strong roots to
support it the tree will not be able to withstand strong winds or give shade to others.
This is applicable to the CLH too. There must also be some source of sustenance and
nourishment in each CLH’s life to enable him/her to be strong and positive. Only
then will they have the energy to support others.
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S EEK HELP IF
◆ You find it difficult to leave your work even for a short period.
◆ Your sleep, appetite is disturbed.
◆ You are unable to enjoy things.
◆ You want to avoid going to work.
◆ You are easily irritable.
◆ You cry easily.
P OINTS TO REMEMBER
➢ The work is going to be taxing on the mind and the body.
➢ It is important to build support systems to take care of one’s personal
well-being.
63 53
RIOTS AND THE
COMMUNITY
54 64
● Volunteer your time to be part of the larger efforts to bring normalcy to the society
at the individual, family and community levels.
● Seek professional help if you are experiencing difficulties of coming to terms with
any aspect of the riots. These could be changes in your body function (sleep,
appetite), or emotional function (irritability, anger, fear)
● At home, at work, or in the neighbourhood help people with the above mentioned
problems to seek professional help to hasten recovery.
● Mastery of the riot situation is a slow and positive process and will occur over
time and not overnight.
At the family level
● Make time to bring together family members to openly discuss their ideas, feelings
and reactions which will help in better understanding and mutual support.
● If you in a group situation, periodically open up the subject to facilitate sharing
and supporting each other.
● You can do many things to protect and promote your mental health and that of
your family and the larger community.
At the community level
● Irrespective of the meaning given to the riots (Why? Who? What? How?), it is to
be recognised as a source of stress that will demand adjustment to the altered
situation in the relationships of the communities.
● It is important to be involved in the developments of the local area (read
newspapers, listen to the radio, watch television, attend group meetings) and
participate in the relief, rehabilitation and reconstruction activities.
● The community can resume its normal functioning only with the returning of
normalcy to all the affected population.
● Reaching out to assist the severely affected population by sharing time with them,
listening to them, giving assistance in whatever manner possible and communicating
the fellow feelings to the distressed population are mutually helpful.
● Rumours must be actively resisted. Prejudices must be acknowledged and dealt with.
● Sense of normalcy and safety can come only from everyone feeling safe and not
with one group feeling superior or more powerful than the other.
● The free supply of food in riot areas under curfew deals with some of the worst
insecurities
● Early establishement of relief camps by governments with leaders of all community
helps rebuilding trust.
● Community efforts like peace committees, meetings and peace marches can be
very healing.
● Involving inter-faith groups of youth,women etc., for relief is a valuable step ahead.
65 55
Aman Pathiks
Ahmed Hussain Mansuri,
Ajmeri Jubedha Bhen, Alaudin Syed
Hussain, Ansari Abdul Hakim, Ansari Anwar
Hussain, Ansari Jameela, Ansari Makbul Ahmed, Ansari Md
Sultan T, Ansari Mohammed Faraz, Ansari Mustaq Ahmed, Ansari
Noorjahan A, Ansari Rashida, Ansari Saleem M, Ansari Shamsu Dhuha,
Ansari Shehanaaz Banu, Anwar Ali Sheikh, Anwar Khan, Arifkhan Pathan,
Asif Bai Sheikh, Ayub Bhai S Bhai, Babu Bhai Rathod, Baluram, Bharvad Bhavan
Bhai, Bilkish T, Chauhan Kishor, Chowdary Satish, Christian Rupal J, Damthedi
Ramand Bhai, Dave Hardik Kanaiyalal, Desai Natwar T, Desai Sikander M, Desai Teja
Bai, Devika Bhen, Dinesh Goswami, Dipak Vegada, Diwan Noorjahan H, Dubhi Goutam
Kumar, Feroz Khan N, Ganchi Irfan M, Gayathri S Pandey, Gevam Bhai, Goswami Durga,
Goswami Harshad V, Gulshan Banu, I R Pathan, Imran Iqbal Khan, Imran Khan Pattan, Imtiaz
Bhai Kureshi, Irshad Banu Shriyad, Jaswant K Rathod, Johara Bibi, Kailash J Damthadi, Kalpana
K Parmar, Kasim Khan, Kazi Mo Mobeen, Khabetha Nasim Ansari, Khan Mamnoon, Khania
Laxmanbhai, Macwone Palvin M, Madhupurawala I A, Mahesh R Vaghela, Makwana Jayesh,
Malek Akthar, Mamesha G Vegalha, Manish Bai Solanki, Mansuri Md Zakir Y, Mansuri Nasim Bhen
Hasan Bai, Mansuri Shaukat Md. Bhai, Mansuri Zakir Hussain Usmaan, Maqsood Bhai, Mazhar
Khan A Khan Warsi, Md. Razak J Bhai Mansuri, Meena Bhen, Mehrunissa Sheikh, Memon Dilavar,
Mohammed Javed, Mustaq Hussain, Nasir Bhai Phattan, Nayak Ashok Bhai, Nazma Banu, Neelam
P Parmar, Nirmala K Dhuri, Noorani Mohammed Abbas, Noorjahan Aziz Khan, Padhiyar
Himanshu, Panchal Malthi Bhen, Paramarak Dinesh, Parmar Rakesh, Parmar Vijay L, Parvathi
Mohanlal, Patadiya Mukesh, Pateriya Jignesh B, Pathan Abdul Latif, Pathan Abdul Wafa A, Pathan
Imran Khan A, Pathan Mahar Angag, Pathan Nazima, Pathan Shah Nawaz H, Pazi Seemab,
Praful Jacob Khambalia, Pravin R Sharma, Premsagar Mahender J, Priyakant Pandey, Qazi
Subahut, Rajesh Bhai D Rathod, Rajesh Kumar, Rajesh Kumar Mishra, Ramesh N Bagade,
Rashida Pathan, Rekha, Sailesh Kumar N, Saiyad Mohsin Y, Saiyed Gulzal Fatma, Saiyed
Nikhat Parveen, Saiyez Zulfikar, Sajid Bai Mallick, Sajid Bai Qureshi, Saleem Bhai K
Mansuri, Salim Bai Mansoori, Salmania Bardat, Sanda Sameer S, Sarif Bhai Babu
Bhai, Saroj Jaunbhai, Satish Bai Chowdry, Savabhai, Savitha Bhen, Savitri B
Dubey, Shah Gulam Hussain, Shaik Mohammed Rashid, Shaikh Amin,
Shaikh Amjed Ali, Shaikh Arshad, Shaikh Ezaz, Shaikh Imran H,
Shaikh Mayudhin, Shaikh Md Saleem Md H, Shaikh Md. Rafi
Mehaboob, Shaikh Md. Saleem, Shaikh Mohammed Rafi,
Shaikh Naseem Bano, Shaikh Siraj K, Sharda Bhen,
Sharifa Banu, Shariff Bhai, Sheik Abdul
Kasim, Sheik Feroz
Ahmed, Sheik Idris Ranjanbhai, Sheik Nasim Banu, Sheik
Sarfaraz Ahmed, Sheikh Afsar Hussain, Sheikh Anish, Sheikh
Anjuman Ara, Sheikh Anjuman Banu, Sheikh Ashia, Sheikh Azim Bhai,
Sheikh Jahunisa, Sheikh Mehrunissa, Sheikh Nilofar, Sheikh Shabnam, Sheikh
Shafikudhin, Sheikh Shamim Akthar, Sheikh Zuber, Shilpa M Chirstian, Shrimali
Banubhai, Shubash Sukhdev Vasanik, Siraj Ud Din, Solanki Chethan C, Solanki Dinesh,
Solanki Girish, Solanki Shilpa Bhen, Sufiya Bano, Suhana J Mansuri, Surekha B Guptha, Syed
Nasir Ali, Trupthi Bhai Solanki, Ujay Pathan Noorjahan, Ujjaini Hozefa M, Umar Farook Md S, Vagela
Chimanlal, Vagela Shantha Bhen, Varsha Bai Qureshi, Varsha Bhen, Vipur Patel Chand,
Yousuf Bai Mansoori, Zakir S Kazi
56 66
WHAT WE KNOW...
◆ Intense emotional reactions in the face of these events are expected and normal.
◆ There is a trajectory of responses over time most often starting early and subsiding
within weeks and months. But for some people, the onset of responses may be delayed.
In others, the reactions may become long-term leading to considerable disability.
◆ Responses will be highly individual in nature, often quite intense and sometimes
conflictual. The vast majority of reactions are in the normal range and the intensity
will diminish for most people over time without the need for professional help. Support
from family and friends is critical. For some, however, the degree of exposure may
lead to more serious and prolonged reactions.
◆ The range of feelings experienced may be quite broad. People may describe intense
feelings of sadness followed by anger. Others may experience fearfulness and
hypervigilance to the environment among numerous other reactions.
◆ There may be temporary disruptions in normal coping mechanisms for many people
and some may go on to develop problems with sleep, nightmares, concentration,
intrusive thoughts and a preoccupation with reliving the events. These reactions are
generally short lived but if they persist, professional consultation should be sought.
Overwhelming feelings are to be expected and can stress individuals, communities and
nations. There are many actions that can be taken at the level of governments, international
NGOs and local groups to appropriately and effectively support victims of such a
catastrophe.
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INFORMATION MANUAL 2
RIOTS
PSYCHOSOCIAL CARE
by
COMMUNITY LEVEL HELPERS
for
SURVIVORS