March 2015


On the morning of 16th December 2014 terrorist attack on Army Public school Peshawar killed 147 innocent lives, leaving the families of martyred and injured in grief and pain. 

 The sheer scope and severity of destruction have prompted extraordinary national and international attention and support for survivors of the families of martyrs and injured on priority basis. The devastation created by the incident was catastrophic, not only for the affected families but also to those who watched TV, reliving the past traumatic events for survival of suicidal bomb blasts of the past. Those who watched the social media or print media as well resulted into an immediate acute stress and mental health sequel. The task facing the national community as it attempts to provide relief was equally extraordinary. The short-term emergency needs were enormous, and the longer-term needs for need assessment and rehabilitation have not ever been quantified. 

Firstly the relief activities confronted the challenges of the disaster as a complex emergency. Secondly, the clinical and psychological profile of this disaster is not similar to that of any incident in the past. The death of children and family members was a blunt trauma, and the injuries among the survivors arise from complications of experiencing the traumatic incident. Thirdly, the short-term public health needs of the surviving population were not familiar. 

There was an urgent need for the need assessment of the people, affected in APS incident, including children, parents and other family members or relatives, identification of the PTSD symptoms, deciding for the required interventions, and initiating a support system. 

These problems did not represent the bread-and-butter work of any relief organization. Fulfilling immediate needs on such a massive scale represents, in large part, a challenge of logistics and coordination. The major public health priorities of ensuring the availability of security, psycho education, social support and reassurance are technically not complex, but accomplishing these goals presents tremendous challenges in terms of coordination (to identify the needs of each and determine who will do what to meet them) and logistic capacity (for transporting and delivering the necessary services). Provincial Health Department formulated practical priorities though its Mental Health Task committee for coordinating and identifying the community mobilization. 

Horizon Welfare Organization, with a team of experienced and trained volunteers, as well as employees including clinical psychologists and doctors, stepped forward to initiate the challenging task of assessment and rehab activity as a tradition. 

There was an effort to quantify and standardize the aid we provide in large-scale to affected population in the form of support and psychological intervention. Initially unstructured interviews were used to collect the qualitative information at preliminary level, using purposive sampling technique. The information was later analyzed to establish the quantifiable assessment methodology to have a core understanding of the affected community. This was possible through the provision of instrument by the Rawalpindi Institute of Psychiatry and WHO collaborating center. 

For this purpose detailed account of the affected persons were collected including addresses and contacts as well, so that the data could be available for future review, validation and replication purpose. As this was late, nonetheless a small effort was made in this respect. 

In addition the professionals, psychiatrists child psychologists, representatives of the media and parent of effected families participated in a brainstorming session to streamline the basic objective. 

The final analyses then resulted in the development of a semi structured need assessment scale - divided in five key areas to be assessed: Shock and denial stage, Recovery stage, Co morbidity scale and Core symptoms scale. This study in disaster management have helped to find out several possible ways to address the needs of the people and analyzing the presence of PTSD symptoms. 

Initially the project included locating the families who are affected. After their informed consent they were visited for initial interviews. The people had queries about psychological problems faced by their children, such as depression, anger irritability, which were not present before the incident. In such situations psycho education and supportive counseling was provided. 

Further a short term strategy was decided for the possible interventions or activities to facilitate the affected community. Counseling centers were started on urgent basis for the children and adults who consulted for the help in Ibadat Hospital Nishterabad, Peshawar. The basic purpose was to provide quick, quality services on priority basis and free of cost. The affected ones were assessed for their required needs and presenting problems, and by professional and expert Psychologists and Doctors. Special activities were designed for younger children to help them express their feelings to their family members.  

The incident evoked a debate in mental health practitioners that how this huge number of affected families, and other people who are severely affected by this incident, could be assessed for their needs. This debate initiated an urgent need for the collection of information from those resources .There was a dire need to develop an objective assessment procedure to evaluate the PTSD symptoms and plan for required intervention. There was no preexisting data to be used as a guide line to deal with a disaster on such scale. This could possibly be done through approaching the effected population and try to find out the way in which they could be professionally helped, without any interference or debriefing their experience. 

The public health model for disaster highlights a cycle of preparedness, mitigation, response, and recovery. It is thus crucial to consider what sorts of preparations may prevent a similar disaster in the future or could possibly be used to help the sufferers. Horizon Welfare Organization has the capacity to provide several hours of early management and support services; as provided sufficient funding and will for this cause, it could be adapted and introduced throughout the country for future reference. The larger issue, however, is the development of rapid assessment, interventions, communication and support systems for such populations. 

Despite the massive scale of this emergency, we need to be better prepared than ever to deal with the immediate psychological and physical health threats created by such traumas. What remains uncertain is the extent to which donors and implementers will be able to support the transition to long-term rehabilitation services. In the past, we have been far less proficient at this second crucial task. Yet we know that the need for long-term success has never been more urgent than it is now. 

Khalid Mufti

WPA Zone Representative for Zone 15 (Central and Western Asia)




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