Psychosocial Response to the Haiti Earthquake: the Experiences of IOM Intervention 2010,Volume 8, Number 2, Page 158 - 164

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Psychosocial response to the Haiti earthquake: the experiences of IOM Intervention 2010,Volume 8, Number 2, Page 158 - 164

Psychosocial response to the Haiti earthquake: the experiences of International Organization for Migration

Guglielmo Schinina' , Mazen Aboul Hosn, Amal Ataya, Kety Dieuveut & Marie-Ade' le Salem

This article brie£y describes the International au Prince is damaged, and many towns on Organization for Migration’s (IOM) immediate the city’s outskirts have been almost entirely psychosocial response to the January 2010 earth- destroyed (O⁄ce for the Coordination of quake in Haiti, and aims to substantiate some Humanitarian A¡airs (OCHA),2010). of its underlying principles.The interconnectedness A massive international relief e¡ort was of activities at the national and inter-agency coordi- rapidly put into place, but was severely nation, direct intervention and capacity building hampered by logistical and coordination levels are illustrated, with particular regard to the challenges. One month after the cata- speci¢cities of the Haitian culture, and of the pace strophe, the humanitarian situation was still of the overall humanitarian intervention. dramatic: more than 80% of camps lacked a managing agency, more than half of Keywords: earthquake, Haiti, Inter-Agency the displaced population lacked suitable Standing Committee, International Organi- shelter, reports of very occasional distri- zation for Migration, mental health, psycho- bution of food in many independent settle- social support ments, water and sanitation facilities not up to standards and numerically insu⁄cient in most sites, and a vague resettlement plan, Earthquake consequences: a while the rainy season was approaching background and the ¢rst storms were showering the The earthquake that struck Haiti in camps (NewYorkTimes, 2010). January 2010 greatly damaged the country. Displacement due to natural disasters The government estimates that more than requires major adaptations, as people need 300 000 people were killed, and some to rede¢ne personal, interpersonal, socio- 300 000 wounded. The exact number of economic, cultural, and geographic bound- casualties will probably never be known. aries. This implies a rede¢nition of indi- More than 105 000 houses were destroyed vidual, familiar, group, and collective and over 208 000 were damaged. Three identities, roles and value systems, and may million people have been a¡ected, of whom, represent an upheaval and a source of stress according to the government, more than for the individual, the family and the com- two million are living in 1300 improvised munities involved. This causes considerable settlements. Over 20% of the capital Port psychosocial distress that needs, primarily,

to be considered normal consequences in Direct interventions (support to the population) abnormal situations. Providing psychosocial In the ¢rst 10 weeks this included: assistance in educational, cultural, community, religious, and primary health a) The establishment of psychosocial settings aims to reduce psychosocial vulner- mobile teams, providing community abilities, and prevent their endemisation. mobilisation, psychological ¢rst aid, This may, in turn, result in long term mental group and individual counselling, problems, and social pathologies (Inter- creative problem solving workshops, national Organization for Migration, 2009). support groups and educational and recreational activities in camps with International Organization for Migration earthquake survivors.The teams consist psychosocial intervention in Haiti of a psychologist, a social worker, an The International Organization of Migra- animator-artist, an educator and a team tion (IOM) initiated an ‘Emergency Psycho- leader. Until April 2010, these served social Assistance’ project with activities on all 30000 direct bene¢ciaries. The team four levels of the intervention pyramid as members receive supervision and train- described by the IASC Guidelines on Mental ing from IOM sta¡ and sta¡ of the Health and Psychosocial Support in Emergency Departments of Psychology of the Uni- Settings (Inter-Agency Standing Committee, versity of Haiti; 2007). This encompasses activities that aim b) Facilitation of Haitian creative and ani- at direct intervention for survivors, as well mation groups to organise events and as activities aimed at capacity building and creative problem solving workshops. coordination (Table 1). This included forum theatre sessions,

Table 1. Mental health and psychosocial support interventions by IOM in Haiti

159 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Psychosocial response to the Haiti earthquake: the experiences of IOM Intervention 2010,Volume 8, Number 2, Page 158 - 164

during which problems such as domestic a) Co-chairing and providing secretarial violence increase after the earthquake,and assistance to the IASC Mental Health con£icts generated from food distribution and Psychosocial Support (MHPSS) were presented to the population of the working group in Haiti, which involved camps, and solutions are found in an 90 psychosocial actors. The working interactive way; group promotedthe relevant IASC guide- c) Family tents were distributed to the lines and developed matrix mapping of inpatient residential psychiatric hospi- service providers, materials for com- tal Beudet, which had been severely munity messages, workshops for com- damaged during the earthquake. One munity leaders and inductions of of the teams visits the hospital on weekly psychosocial agencies. Meetings and basis to provide missing psychological workshops were conducted with reli- and recreational activities for the gious leaders, in order to devise psycho- remaining patients.The hospital cannot social consistent spiritual messaging; provide referral for cases identi¢ed in b) Providing MHPSS guidance and refer- camps, due to logistical and professional ral for agencies in the Camp Coordina- gaps. Nevertheless, protection of its tion and Camp Management (CCCM) residents was considered a priority. cluster. This included introductions on psychosocially aware provision of Capacity building activities humanitarian assistance (do no harm) These included: for camp managers, humanitarian workers, military, and community a) Training for psychosocial teams in psy- activists. chosocial approaches, principles and guidelines onpsychosocial interventions Re£ections on mental health in emergency displacement, psycho- and psychosocial needs in post logical ¢rst aid, community mobi- earthquake Haiti lisation, arts-based interventions, early A ¢rst evaluation was conducted by detection of possible severe psycho- IOM, through brainstorming, based on logical reactions and pre-existing con- Papadopoulos’ systemic trauma grid ditions. (Papadopoulos, 2002) with 200 community b) Training for psychology students of the activists, academics, professionals and stu- University of Port Au Prince; dents, many of which are living or operating c) Training in art therapy as a response to in the camps. The trauma grid systematises disasters for animators and educators of self-reports from the respondents, highlight- ‘Place Timun’, a psychosocial initiative ing their psychosocial needs, the resilience for children living in camps; factors to be respected and supported and d) Training on psychosocial responses to the developments activated by the adversity disaster and arts based interventions on which to build the psychosocial responses for local sta¡ of faith based nongovern- on the individual, family, group, and com- mental organisations (NGOs). munity levels. No comprehensive data are available on the Support to national coordination prevalence of severe disaster-induced dis- This included, among other things: tress and/or disorders. In the ¢rst six weeks

of activity, our colleagues from the Inter- 2010). Urbanised communities tend to recre- national Medical Corps identi¢ed less than ate it in the urban suburbs, and the same 50 severely distressed cases in need of happens among university students moving specialised psychiatric services. Our own to the capital. During our brainstorming IOM teams have, so far, identi¢ed and sessions, the revitalisation of the lakou referred16 such cases in 30 000 assisted indi- system after the earthquake was identi¢ed viduals. as one of the main resilience factors. IOM therefore advocates considering using lakou Socio-cultural strati¢cations in the planning of new settlements, both in Haiti is often associated with the culture of the selection of the population to be reallo- vodou. However, the Haitian socio-cultural cated in the same camps, and in the physical system encompasses several subcultures. A organisation of spaces in courtyards. Such westernisedculture, withthe upper and most organisation could indeed provide protec- educated classes cohabiting with strongly tion and support to orphaned and unaccom- religious (catholic and protestant) middle panied minors, female headed households, class values, and a cosmologic, vodou and vulnerable elderly populations. The informed lower class majority (McGill Uni- new settlements were designed accordingly. versity, 2010; Caribbean Country Manage- From a therapeutic point of view, the cen- ment Unit (CCMU), 2006). Faith based trality of the family called for systemic and organisations, and certain academic family counselling, rather than an indivi- environments are often very critical towards dual one, even though individual counsel- the vodou value system. With most of the ling was still o¡ered. camps hosting lower class populations, the mobilisation of professionals and civil Religion and identity society in providing assistance may also Religion plays a crucial role in the de¢nition mobilise sub cultural clashes with the beliefs of individual and collective identities in of most bene¢ciaries. Therefore, the IOM Haiti, and it is therefore a strong resilience psychosocial programme encompasses the and response factor. Eighty percent of the active participation of the camp inhabitants population are Catholics and 20% protes- in the design of the intervention, the creation tants, but people from lower classes are likely of forums between academics, professionals to adhere exclusively, or in combination with and traditional practitioners, and religious other religions, to vodou. Identity within leaders. vodou is characterised by a ‘cosmocentric’ rather than ‘anthropocentric’ vision of the self. Family Wellbeing is the result of the harmony that In the past, families were organised around an individual is able to create within his/ the lakou, which de¢nes both the courtyard her context and the natural world. This around which the members of an extended encompasses a universe of spirits, ances- family live, and the extended family itself tors, and materialisations of the so-called (Nicolas, Schwartz, Pierre & Donnelly, ‘invisible’. A strong collective and spiritual 2009). The system has been challenged by component is embedded in the concept of urbanisation, migration, and loss of social individual identity, which is de¢ned by connectedness, but lakou is still a fundament ‘belonging to’, more than by the uniqueness of of Haitian society (McGill University, the self. The IOM programme therefore

161 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Psychosocial response to the Haiti earthquake: the experiences of IOM Intervention 2010,Volume 8, Number 2, Page 158 - 164

gives particular attention to spiritual mat- Creativity ters, avoiding the use of westernised body/ Art is very popular among all layers of mind identity paradigms, and using more society in Haiti, particularly dance, music collective than individual settings, modal- and movement. In vodou, music and dance ities and objectives. play an important role. Di¡erent ritual While religious beliefs can help in accept- drums, dances and rhythms are associated ing natural disasters, they also support the to di¡erent lwas, and characterise the dedi- idea that these can be caused by the rage of cated ceremonies (Gray, 2004). Drum music family ancestors (lwas), or the revenge of and dance involve individual bodies, and as God towards certain individual and collec- such facilitate the body/mind connections tive behaviours. Sadly, many religious lea- and relaxation and expression. Additionally, ders used this concept to call for a stricter they usually happen in a group circular set- adherence to religious principles by believ- ting, therefore reinforcing the group ties, ers.This has provoked a strong sense of guilt and through their codi¢ed forms connect in the faithful. The development of alter- the individual and the group to the cosmolo- native public messaging, and the engage- gical forces and the ‘invisible’ sphere, giving ment of religious leaders in providing containment to the sense of loss. Hence supportive spiritual messages have been at dance, animation, arts and drama based the centre of our work as co-chair of the interventions were included by IOM among IASC group. the community mobilisation and stress relief activities. Death For many Haitians, the world of spirits, Determinants ofaccess to mental health ancestors and the deceased and the world Half of the Haitians do not have access to of the living, are closely linked. The spirits formal healthcare (CCMU,2006).The rural of the African and family ancestors directly population accesses primary health care in£uence the emotional wellness of families thanks to faith based NGOs, and mainly and individuals. The vodou practitioners refer to traditional healers. Among all can establish communication between the classes, emotional matters, and psychiatric living and the dead, and practices of black uneasiness are dealt with within the family, magic include the revivifying of the zonbi or religious context. Lower class Haitians (soul) of dead persons to possess other indi- will generally seek help from houngan viduals. Such a close a¡ective relation (traditional spiritual leaders) and only turn between the two worlds leads the people to to mental health professionals if behaviour give high importance to funeral ceremonies, is already unacceptable within their context. and the care of the graves. Many families, Upper class Haitians are more likely to refer who could not celebrate proper burial to a combination of herbalist care and rituals, feel guilty and distressed by possible prayers (McGill University, 2010). possessions and retaliation from those who More serious forms of depression among the did not receive proper burial. In response, lower classes are likely to be associated with the IOM, together with religious leaders, spells or possession. In these cases, vodou developed guidelines for the organisation of practitioners are involved, and community rituals in the absence of corpses, and teams ceremonies are celebrated to heal those were trained to train families in this matter. possessed. If the person is freed by the

spirit, he/she can be initiated into the vodou counselling. The response should also priesthood.Therefore, possession may bring include capacity building, coordination and someone a higher level in society and the advocacy. In the volatile context of the post discrimination between the person and the disaster situation, we have to facilitate e¡ec- possessing spirit attributes the ‘problem’ to tive and non violent coping mechanisms of the entity, and not to the individual, thereby the survivors themselves, and to promote avoiding stigmatisation. participation of the survivors through the As for posttraumatic disorders, the country use of creative problem solving tools. speci¢c literature is poor, and mainly relates to family violence and individual, References not mass, trauma. However, some of the stu- Allen, I. (1996).PTSD among African Americans. dies found that ‘the e¡ects of trauma are seen, In: A. J. Marsella, M. J. Friedman, E. T. not only in local variants of disorders of anxiety, Gerrity & R. Scur¢eld (Eds) Ethnocultural depression, and PTSD’ (McGill University, aspects of post-traumatic stress disorders: Issues, 2010). There is professional consensus not research, and clinical application.Washington, to popularise professional terms such as DC: American Psychological Association. trauma and depression (IASC Reference Group on MHPSS, 2010). On the contrary, Caribbean Country Management Unit (2006). those terms among the Haitians are used Socialresilienceand statefragility in Haiti. Acountry without medical connotations, to de¢ne social analysis. Port Au Prince:World Bank. respectively the general state of vulner- ability faced by individuals after disaster, Gray, A. E. L. (2004). Dancing in our blood. and the normal sadness due to events. Dance/movement therapy with street children and victims of organized violence in Haiti, in The humanitarian crisis induced distress N. Jackson, T. Shapiro Prim (Eds.) Dance, Haiti has a long history of natural disasters, human rights and social justice. Lanham: but the capacity of the country to respond Scarecrow Press. is very limited. The earthquake found the international agencies highly unprepared. IOM (2009), Mental health and psychosocial response Many of the indicators of stress in the camps, in emergencies, the IOMapproach. Geneva: IOM. including powerlessness and anger, may be associated with the so-called response Inter-Agency Standing Committee Working trauma (Allen, 1996). This is connected to Group on Mental Health and Psychosocial the lack of adequate support from inter- Response in Emergency Settings (2007). Guide- national and governmental agencies, which lines on mental health and psychosocial response in can be as distressing as the traumatic emergency settings. Geneva: IASC. experience itself. Inter-Agency Standing Committee Working Conclusion Group on Mental Health and Psychosocial In responding to the psychosocial and Response in Emergency Settings (2010), Note mental health needs of the population in de Directive pour le support a' la sante¤mentale post earthquake Haiti, it is important to et psychosociale. Re¤ponse urgence concernant le take a broad approach that includes more tremblement deterreen Haiti-Janvier 2010. Geneva: than just providing direct services, such as IASC.

163 Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited. Psychosocial response to the Haiti earthquake: the experiences of IOM Intervention 2010,Volume 8, Number 2, Page 158 - 164

McGill University, Division of Social and Trans- The New York Times (2010), Haiti Earthquake culturalPsychiatry (2010).MentalhealthinHaiti. of 2010 http://topics.nytimes.com/top/news/ A literature review. Geneva:WHO. international/countriesandterritories/haiti/ index.html?8qa&scp=1-spot&sq=&st=nyt Nicolas, G., Schwartz, B., Pierre, E., & Donnelly, S. (2009).Weathering the storms like bamboo: the strengths of Haitians in coping with natural disasters. In D. Eugene, A. Kalayjian Guglielmo Schinina'is IOM global coordinator &G.Reyes(Eds.)Cross-cultural handbook of for Mental Health, Psychosocial Response and emotional healing: rituals and practices for resilience Cultural Integration. after trauma, 2 volumes.Westport, CT: Praeger email: [email protected] Publishers. Mazen Aboul Hosn is IOM psychosocial o⁄cer and co chair of the IASC MHPSS group O⁄ce for the Coordination of Humanitarian in Haiti. A¡airs (2010). Report on humanitarian assistance Amal Ataya, is project manager of the IOM in Haiti. NewYork: OCHA. Emergency Psychosocial Response in Haiti. Kety Dieuveut, is IOM psychosocial program Papadopoulos, R. (ed.) (2002). No place like home: assistant in Haiti. therapeutic care for refugees.London-NewYork: Marie-Ade'le Salem is IOM psychosocial expert Karnac. in Haiti.