The Department of Health Response to the Maguindanao Massacre in the Philippines

Ronald Law

The Department of Health response to the Maguindanao massacre in the Philippines

Ronald Law

In the aftermath of election related violence in an In the country, there was concern that the area ofarmed con£ict in the Philippines, the Philip- shocking images of the recovered victims pine Department of Health deployed a psychosocial and body parts, and the manner in which team to the area to carry out psychosocial interven- they had been killed could lead to psycho- tions.The main intervention was an activity called social and mental health problems among Psychosocial Processing (PSP) that is brie£y family, relatives, friends and colleagues of described and discussed in this ¢eld report. the victims. The Philippine Department of Health, as the lead agency in the provision Keywords: emergencies, Maguindanao of mental health and psychosocial support massacre, Philippines, psychological ¢rst (MHPSS) services after disasters and aid, psychosocial processing, psychosocial emergencies, organised a quick response. response The intervention was inspired by the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (IASC, 2007) that were introduced in the Introduction Philippines in 2007. Given the psychosocial In November 2009, the town of Ampatuan in implications of the ongoing armed con£ict Maguindanao province on the island of in Mindanao, the Health Emergency Man- Mindanao in the Philippines was the scene agement Sta¡ (HEMS) had already organ- of a violent attack upon a convoy of a local ised basic training courses for MHPSS politician who wanted to challenge the pro- service providers, and training of trainers vincial governor in the upcoming elections. courses, to build capacities of government Passengers were abducted and killed; female health personnel, promote integration of victims were raped, shot in the genitals and mental health and psychosocial support into beheaded. In total, 57 people were killed regular programmes, and to improve the (of whom 34 were journalists). The attack psychosocial response during emergencies was probably organised by the incumbent and disasters. This report will give a brief governor who was later arrested, and now description of the interventions undertaken awaits trial. In Mindanao, cultural and by the Philippine Department of Health in religious divides are deep and armed con£ict the aftermath of Maguindanao massacre. and violence have been pervasive as exem- pli¢ed by many bombings. This particular event was, however, also an o¡shoot of grow- The response ing tension in the political scene that was In the ¢rst week, planning the deployment of due to the forthcoming national elections. psychosocial teams to help the survivors

263 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. The department of health response to the Maguindanao massacre in the Philippines Intervention 2010,Volume 8, Number 3, Page 263 - 267

and their families began after an informal sition was heterogeneous. Facilitators were request. However, because of high security familiarised with the core principles of men- risks, the planned missions could not take tal health and psychosocial support, facili- o¡ in the early aftermath of the emergency. tation skills, grief processing and the steps Two weeks after the incident, regional of psychosocial processing. MHPSS teams were formed, consisting of The objective of the activity itself was to help professionals who have been trained earlier, clients with their grieving process. The to assist the families of the victims. Security Department of Social Welfare and Develop- was a major concern in the planning. Other ment assisted in identifying and inviting challenges in organising the psychosocial participants to an activity which was adver- teams were the limited number of sta¡ tised as a ‘social gathering cum healing process’. trained in MHPSS and that the complexity The whole day activity had a communal of the incident may have been more di⁄cult opening and a closing, in order to make it a to handle than other violent events. Thus, social event as well, and to lessen tension more skilled and experienced facilitators among clients. The day ended with a prayer were needed. Trained teams from the o¡ering, a form of ritual to mark community immediate area were also included.The cen- and family support. The core interventions tral Health Emergency Management Sta¡ were the processing sessions that were led in Manila formed a team led by the author by two facilitators, one of whom was more and which included experts from the experienced.The groups of participants con- National Centre for Disease Prevention sisted of six to 10 people, with separate and Control, and the National Centre for groups for adults and children. Roving sta¡ Mental Health. The team had the following were also assigned to look after the needs of objectives: 1) to organise MHPSS regional the teams during sessions. The clients teams; 2) to conduct assessment of, and appreciated the presence of people from gov- perform appropriate psychosocial interven- ernmental agencies, especially those from tions to, clients; 3) to formulate recommen- Manila. Facilitators elicited stories from cli- dations for long term psychosocial care of ents, probed for facts, feelings and reactions a¡ected families and relatives of victims; towards the event, and discussed coping and 4) to evaluate regional MHPSS capa- mechanisms. The processing sessions were cities and identify gaps for action. emotionally heavy with reactions and issues from participants. They reported a great Organising activities sense of relief after the experience. A total The key intervention consisted of Psycho- of 153 people (87 adults and 66 children) social Processing or PSP.This is a modi¢ed were seen by a total of 35 facilitators. therapeutic session consisting of a series of steps completed with clients to elucidate Psychosocial issues their stress reactions, responses, and action The incident was unique for the Philippines, plans related to their experiences. The inter- because of the level of violence that was ventionteam held an organisational meeting used and the pro¢le of the victims, mostly for planning purposes, and for generating media people and women. The incident a common understanding of skills, experi- sparked concerns in the population about a ence and expectations among facilitators. perceived culture of impunity. Many people This was important, as the team compo- in Maguindanao and neighbouring areas

believedthat the journalists killed, and other apprised of the latest related news. A support victims, were martyrs who helped uncover group was formed to strengthen advocacy a long-time dominance and injustice created for justice (organisation of victims’ families). by a local political clan in power.The people The families of the slain victims are vigi- who participated in the psychosocial proces- lantly in search of justice and are on the look- sing sessions reported a variety of reactions out for any move by the government in to the incident: response to the massacre.

1) Emotional reactions: anger, hatred, fear, Psychosocial interventions feeling intimidated, crying, loneliness, These one-day programmes are part of a lar- longing for the loved one who died, grief; ger set of interventions, following the inter- 2) Physical reactions: di⁄culty sleeping, vention pyramid of the IASC guidelines. headache, dizziness; Basic services and securityThe government had 3) Behavioural reactions: cursing while given ¢nancial aid amounting to Php remembering the event, vigilance, rest- 100,000 (2,200 USD) to each of the victims’ lessness, withdrawal; families. The imposition of Martial Law in 4) Cognitive reactions: such as dissociative Maguindanao after the declaration of a state experiences ( parang panaginip lang: it of emergency may have been generally per- was just like a dream), intrusive mem- ceived by some as a threat to the country, ories (Bumabalik sa alaala ang nangyari at but in Maguindanao and neighbouring ang nakitang kalagayan ng pagkamatay ng areas it was apparently welcomed because kamag-anak: memories of the incident it provided a sense of security. that come back especially while imagin- Community and family support The families and ing the manner of death of victim/ relatives of victims started a support group relatives), suspicion (that the perpetra- to push for the delivery of justice. Social tors areafterthem; beingtrapped intraf- gatherings were organised in the guise of a ¢c gives them the thought of being in a get together with meals.This coincided with convoy and that they may be harmed/ the Christmas season, making it a meaning- killed too), and ful occasion (for predominantly Catholic 5) Existential reactions: hesitancy to pursue Filipinos) and one that conveys warm family one’s vocation (law, mass communi- ties and the spirit of togetherness. cation), religious beliefs (Bahala na ang Focused non specialised supportThe psychosocial Diyossa mga nagkasala: God will deal with processing session was organised to explore the perpetrators; Nagdadasalnamakamtan thoughts and feelings of those a¡ected, ang hustisya: praying to seek justice), and which is assumed to help them go through hope. One participant said, after she the grieving process, empower them to take o¡ered a song for her mother during action to promote and protect their psycho- the meeting: Sana tahimik na ang Nanay ko social wellbeing and help them prevent, or ngayon:‘I hope my mother is calm now’. treat, any resulting mental disorders as required. Coping reactions included faith or belief in A specialised service, in the form of psychia- God, the resolve to go back to work or tric assessment or consultation or referral business, or continue schooling. Almost all to facilities, was made available. A referral vowed to watch out for justice by being system, from the social welfare department

265 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. The department of health response to the Maguindanao massacre in the Philippines Intervention 2010,Volume 8, Number 3, Page 263 - 267

to the health department to the designated interventions to be smooth and e¡ective. psychiatrists, was formulated and commu- However, there are special instances in nicated to the participants, who were which this was not prudent, as in the case advised of symptoms to watch out for and of workers who may have been a¡ected the normal course and duration of possible by disaster or emergency, and therefore illnesses that may arise from the experienced may become an additional burden to trauma. the team. Sessions for the facilitators themselves were important because the Re£ections on the intervention event may have a¡ected them as well. A Looking back on the intervention, the buddy system should be established to authors can identify several challenges and support them. Caring for caregivers is lessons learnt: important since most of the providers based in the area are also a¡ected on 1. There was an apparent lack of trained varying levels ^ knowing a victim, or MHPSS providers in the region, which knowing someone who was connected was understandable considering that to a victim. training had only started recently. The 5. Follow-up sessions for potential high-risk skills of some providers who had been cases and vulnerable populations like trained were still not su⁄cient to deal children and women should occur. Long with the issues that arose from the term accessto mental health services and Maguindanao massacre.Therefore, sup- psychosocial supports for some of the port and supervision from more special- population has to be ensured. For this, a ised sta¡ from the central level was follow-up sessionwascontemplatedthree essential. months after the interventions and a 2. The planned psychosocial interventions referral system was established. Regular were intended for the families, relatives visits of social workers to clients, especi- and colleagues of the victims. Although ally those identi¢ed as having ongoing the team considered doing separate ses- problems, were also made. However, sions for adults and children, the actual clients did not report anything that processingforchildrenwasfarfromsatis- might be a cause for psychosocial or factorybecause allthose under18yearsof mental health concern. age were automatically classi¢ed as children, with a wide age gap existing The team is well cognizant of the fact that between those falling at the extremes single-session debrie¢ng sessions are expli- of ages. citly discouraged by the IASC guidelines 3. Most of the participants requested that on MHPSS because they may do more harm no documentation of the actual psycho- than good: ‘‘Do not provide one-o¡ single-session social sessions would be made, through psychological debrie¢ng for people in the general either photos or note taking. This was population as an early intervention after exposure respectedbytheteam, but was,neverthe- to con£ict or natural disaster’’ (IASC, 2007, less, perceived as a barrier in document- page 15). The IASC guidelines further state ing the experience. that while ‘‘natural opportunities should be 4. Tapping into local capacities to make up provided for sharing among survivors, they should the MHPSS team was important for the not be pushed to describe events in detail nor should

they be pushed to share or listen to details of other perspective though, more evidence, prefer- survivors’ experiences’’ (IASC, 2007: page 91). ably through a randomised control, is The Psychosocial Processing (PSP) session needed to validate the e¡ectiveness of the that we have provided has a semblance of intervention. this single-session activity in its orientation; however, it was not done in the acute phase and more distinctly, the steps incorporate Reference the use of psychological ¢rst aid in which Inter-Agency Standing Committee (IASC), basic needs and concerns of survivors are (2007). IASC Guidelines on Mental Health being addressed, coping methods are dis- and Psychosocial Support in Emergency Settings. cussed, and individual action plans to aid Geneva: IASC. recovery are made. Our experience with PSP made us realise Ronald P. Law, MD, MPH, is O⁄cer-in- that it is a simple, non-o¡ensive, acceptable Charge and Program O⁄cer of the Preparedness intervention that Filipinos can relate to and Division Health Emergency Management Sta¡ ¢ndcomfort in. Most importantly we believe of the Department of Health in Sta. Cruz, that the process is helpful in elaborating psy- Manila, Philippines chosocial issues and concerns of survivors email: [email protected] to guide their recovery. From a scienti¢c