A barren tree stand in front of a building with a collapsed roof

Psychological first aid critical after traumatic earthquakes

More than 50 mental health and psychosocial support specialists—from HI and local partners—are offering care to survivors of the February 6 earthquake. Mehdi Firouzi, who supervises the psychosocial teams in Syria, explains the benefits of psychological first aid after a tragedy of this magnitude.

In psychological terms, people are now in survival mode. We provide them psychological first aid (PFA): these are one-to-one consultations, conversations that the psychosocial workers have with patients, caregivers, relatives of a wounded person—whoever needs it. Such a supportive conversation can take around 30 minutes. The idea is to stabilize the person, to try to calm him or her down.

This is mostly done by very active listening, giving them the room, the safety and the time to talk about what they want to talk about, and giving them back the feeling of being in control. During these conversations, we acknowledge their concerns, and we validate their feelings: distress, anxiety or maybe anger. After such natural disasters, it is not unheard of that some people may express feelings of anger, for example, if the aid response was delayed.

Many people in North West Syria have expressed feeling abandoned. So, there may be a lot of anger. We also keep an eye on any severe symptoms of distress that some may show. Again, the crisis is still very recent, so a lot of people are still in hyper-alertness mode. They're still very anxious. Some of them, for example, are not sleeping these days.

Providing a safe space, basic needs

Many will be concerned about the safety of their children, about their future, if they have lost their homes. There are still aftershocks in the area. This also can be triggering for people who have lived through the earthquake and makes it more difficult for people to feel safe.

We also try to make sure that their basic needs are met like shelter, food, and clothing. If people have basic needs that aren't met, we try to identify them and link them with existing organizations.

We conduct these PFA consultations at a multitude of hospitals, health centers and community centers. We have to deal with a large influx of wounded people, some of whom will be mentally or physically scarred for life.  

When we talk about people who have just been through the earthquake, it's still very hard to tell how many of them will continue to have anxiety symptoms because it's quite a complex situation. It's reasonable to give some time before saying, 'OK, this person is showing very severe symptoms and may be at risk of, for example, developing post-traumatic stress disorder (PTSD) in the long term.' However, we know that if survivors of a traumatic incident, such as the earthquake and its aftermath, are given enough time, safety, basic needs (food, shelter, warm clothing, etc.) and social support (through family, community, peers, etc.) they are able to mentally recover without the need for specialized mental health support. It is therefore important that we facilitate access to these basic needs as best as we can. 

Benefits of PFA

Psychological First Aid (PFA) reduces the risk of psychological complications: People who receive PFA are less likely to remain in a protracted state of anxiety. This can help them recover better from the initial shock.

So PFA is a way to mitigate the risks to a certain extent. It's not a magical tool. It doesn't cure anyone. It doesn't save anyone, but because we focus so much on stabilizing someone and encouraging them to think of solutions for themselves to give them back some control over the situation, that in a way reduces the risk of further complications later on. See it as the psychological equivalent of putting a blanket on someone and giving them a hot cup of tea after a severe incident has occurred.

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