Mental Health of Children in Conflict and Natural Disaster Situations: Its Implication to Scaling up of Health Services Maria Teresa Sharon C. Linog Research Institute for Mindanao Culture Xavier University, Philippines Dealing with Disasters International Conference November 2010, Northumbria University, UK

The Study Methodology To present the profile of children survivors in natural and man-made disaster episode. To probe the extent and manifestation of mental and emotional disturbance. To describe the gravity of disaster impact on the mental and emotional well-being. Dealing with Disasters International Conference November 2010, Northumbria University, UK

The Study Methodology Qualitative/formative Methods of Data Collection case study Focus Group Discussion (FGD) in-depth interview (IDI) Dealing with Disasters International Conference November 2010, Northumbria University, UK

The Study Methodology Guinsaugon, St. Bernard, a community in Southern Leyte 3 communities in Lanao del Norte (Southern Philippines) − Kauswagan − Maigo Poblacion − Matampay, Munai Dealing with Disasters International Conference November 2010, Northumbria University, UK

Respondents/Participants 8 survivors of landslide that covered an entire community 16 children (key informants in conflict episode) 21 participants of FGDs Dealing with Disasters International Conference November 2010, Northumbria University, UK

Instruments Used picture association sentence completion Qualitative Measures Used case study protocol/guide questions FGD and IDI guide questions Dealing with Disasters International Conference November 2010, Northumbria University, UK

The Observance of Research Ethics screening process − determining the respondents and key informants seeking approval from local government offices, representatives from DSWD and parents of children obtaining informed consent of both parents and children consent for voluntary participation Dealing with Disasters International Conference November 2010, Northumbria University, UK

Natural disaster (n= 8) Armed Conflict (n= 37) Age EducationHigh school Primary or elementary Average number of siblings Average HH size Occupation of parentsfarming 1. Socio-demographic Profile (at the time of disaster episode) Findings of the Study Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 2. Experiences during the disaster Natural disasterArmed Conflict landslide which killed the great majority of the population more than 2,000 died 19 residents survivors, whole community was wiped out firefight between military troops and Muslim rebels explosions and bombing families and children held hostage setting-up of roadblocks and seizing of the town hall and school by Muslim rebels Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 2. Experiences during the disaster Natural disasterArmed Conflict civilians were pursued and fired at residents fled to shoreline, forest, and to other safe places Evacuation of residents to government temporary shelters Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 3. Injuries and death during the disaster episode Natural disasterArmed Conflict all 8 respondents either had a parent or a sibling or both who died one-half are sole survivors with both parents and all siblings perished in the disaster no death among the immediate family members sustained serious injuries during the evacuation rush considerable number of deaths among relatives and friends Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 4. Reactions during disaster episode Natural disasterArmed Conflict stunned shocked running around looking for family members pray and hope for a miracle incessant crying fear, trauma due to witnessing firefight and exposure to series of explosions panic, chaos “we are running to and fro Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 5. Damages Natural disasterArmed Conflict stunned shocked running around looking for family members pray and hope for a miracle incessant crying fear, trauma due to witnessing firefight and exposure to series of explosions panic, chaos “we are running to and fro Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 6. Manifestation of emotional and mental disturbance Natural disasterConflict/armed cannot sleep, had nightmares cannot focus on studies/lost the desire to study always crying constant fear/tremors, shakiness loss of weight sleep disturbance, nightmares Enuresis (bedwetting) reduced interest to participate in school activities helplessness Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 6. Manifestation of emotional and mental disturbance Natural disasterArmed Conflict no appetite nurture hope for six months that lost family members were somehow alive pray to God; ask for Divine help Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 7. Gravity of Impacts: Physical, Psychological/Emotional Natural disaster Physical Impact Armed Conflict Physical Impact shakiness and tremors loss of appetite incessant crying for weeks shortness of breath light-headedness and headache weight loss loss of appetite shakiness and tremors feeling of fatigue/ exhaustion non-specific pain prone to crying Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 7. Gravity of Impacts: Physical, Psychological/Emotional Natural disaster Psychological/ Emotional Impact Armed Conflict Psychological/ Emotional Impact cannot sleep fear of rain and earthquake intense feeling of being alone/grave sadness depression for the loss of parents and siblings aggression fear of strangers fear of going to school sleeplessness dislike of war toys Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 7. Gravity of Impacts: Physical, Psychological/Emotional Natural disaster Psychological/ Emotional Impact Armed Conflict Psychological/ Emotional Impact emotional pain and fear of the future loss of identity blank and unfocused look withdrawn/easily provoked feeling of insecurity, worry where to live, where to get food, etc. Dealing with Disasters International Conference November 2010, Northumbria University, UK

Findings of the study 7. Gravity of Impacts: Physical, Psychological/Emotional Natural disaster Cognitive/ Mental Impact Armed Conflict Cognitive/ Mental Impact short attention span learning difficulties poor academic performance inability to recall events no desire to attend classes poor academic performance don't want to talk Dealing with Disasters International Conference November 2010, Northumbria University, UK

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Nawad-an ug paglaum, mingawon sa pamilya, Nanay, Tatay ug igsoon sa panahon sa pagkaon.” (I lost hope and I terribly miss my family; mother, father, and siblings especially during mealtimes.) Nica, 15 years old whose parents and 3 siblings all died

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Dili makatulog, magsige ug hunahuna nga tingali buhi pa sila--hangtud six months ang pag-hope. Magdamgo nila kanunay.” (I cannot sleep and always thought that they might still be alive. I kept on hoping for six months. I always dream of them.) Salie, 16 years old landslide survivor; both parents and all sibling died

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Nakita ko ang paghagba. Dili ko makatuo nga Guinsaugon ang natabunan. Pulos lapok ug dagkong bato ang makit-an. Dili namo makit-an among mama, papa, ug mga igsoon. Naka-ingon jud ko nga ako na lang nabuhi.” (I saw the mountain slide. I cannot believed that Guinsaugon was buried. Instead of our homes, only mud and boulders can be seen. We cannot find my mother, father and siblings. I realized that I was the only one who survived.) Armando, 11 years old, lost 3 siblings and both parents

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Akong manghud hapit mahulog kay gi-itsa sa barko para makasakay paingon sa Iligan.” (My younger sister almost fell into the water because she was thrown into the boat bound to Iligan City.) -11 year old, female, Christian

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Nangadto mi sa baybay unya nakit-an man mi sa MILF mao nga gi-hostage mi. Tulo mi, kauban nako ang igsoon ug ig-agaw. Naa pud akong uncle…gidala mi sa auditorium.” (We went to the shore to escape but was caught by the MILF and taken hostage. There were three of us; me, my sister and cousin. My uncle was there too and together we were brought to the auditorium.) -12 year old, male, Christian

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Nitawag man sila ug duha ka pumpboat aron masakyan apan wala naka-abot. Unya naay nagsumbong sa MILF nga naa ra mi didto, gi-apas mi ug nadakpan mi. Gi-hostage mi ug duha ka oras. Nangabot man dayon ang mga marines. Nagubatay na dayon sa kilid sa auditorium.” (They called up two pumpboats to take us but it did not arrive. Then someone informed the MILF where to find us. They caught us and we were held hostage for 2 hours. The marines came and a firefight ensued in the auditorium year old female, Christian

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Nagkurog ko sa kahadlok sa buto-buto. Ang mga kuya nagkurog sab ug nanagan mi. Ako nagsige ug hilak.” (I trembled in fear because of the gunfire. My older brothers were trembling too and we all run for cover. I was crying all the time.) - 10 year old male, Muslim

Snippets of pain remembered Dealing with Disasters International Conference November 2010, Northumbria University, UK “Ang dili nako malimtan kay kadtong buto-buto. Mahadlok ko hangtud karon kun makabati ko ug buto-buto. ” (I cannot forget the sound of gunfire. Even up to now I feel nervous and afraid when I heard loud explosions.) - 10 year old male, Muslim

Recommendations Dealing with Disasters International Conference November 2010, Northumbria University, UK For Researchers/Social Scientists A more thorough investigation is warranted to examine closely the magnitude of the problem as well as its impact on the lives of these children. Wider coverage and a bigger sample.

Recommendations Dealing with Disasters International Conference November 2010, Northumbria University, UK For Health Service Providers and Related Stakeholders Strengthen psychological/psychiatric assessment and intervention extended to children in emergency situations.

Recommendations Dealing with Disasters International Conference November 2010, Northumbria University, UK For Educators/Guidance Counselors Guidance counselors in affected areas shall be trained pertaining to health assessment of children victims of emergency crises. They should be tapped to identify children suffering from severe stress and other signs of mental disturbances for referral to experts. Psychosocial interventions for the affected children during conflict should involve a holistic approach with the active participation of family network/ members who also experienced similar crisis.

Recommendations Dealing with Disasters International Conference November 2010, Northumbria University, UK For Policy-Makers and Local Government Units Comprehensive review of the disaster risk management policies and programs particularly at the local community level. Line agencies tasked to respond to emergency situations need to take cognizance of the children’s special needs and provide appropriate services.

Thank you for your attention! Dealing with Disasters International Conference November 2010, Northumbria University, UK