School of Public Health Resilience and Women in the Maldives post-disaster: A case study Mariyam Athifa 0000-0002-3059-1396 This thesis is presented for the Degree of Doctor of Philosophy of Curtin University May 2020 Declaration To the best of my knowledge and belief this thesis contains no material previously published by any other person except where due acknowledgment has been made. This thesis contains no material which has been accepted for the award of any other degree or diploma in any university. The research presented and reported in this thesis was conducted in accordance with the National and Medical Research Council National Statement on Ethical Conduct in Human Research (2007), updated March 2014. The proposed research study received human research ethics approval from Curtin University Human Research Ethics Committee (EC00262), Approval Number # HR 22/2008. Signature: Date: 20/5/2020 Acknowledgments Thank you and my sincere gratitude to all those who have supported me in completing this doctoral journey. ❖ To the participants of this study, especially the women who welcomed me warmly into their communities and took time to share their painful experience and stories. ❖ To my supervisor, Professor Jaya AR Dantas, for her unswerving support, patience and particularly her guidance and advice. Thank you for the constant encouragement, keeping me focused on the end, and being a great supervisor. ❖ To my co-supervisor Dr Janice Lewis for your generous availability and guidance in conceptualisation and design of the study. You have been a valuable source of information by generously sharing your knowledge. Thank you for the support and always making time to assist me. I could not have done this without your supportive assistance. ❖ To my co-supervisors Dr Maryanne Doherty and Dr Aishath Shiham for their clarity and assistance in the early stages, especially in the fieldwork phase. ❖ To my friends and colleagues here in Australia and Maldives who stayed by my side and cheered me along and held me up whenever I reached a milestone. ❖ To Mum and Dad: although not here today, they will be beaming with joy and pride in seeing me reach this goal. ❖ My deepest thankfulness goes to my loving daughter Jano, who stood by me in every step of this journey. You are my hero. I acknowledge the financial funding of the 2013 Academic Support Grant awarded by the Nursing and Midwifery Office, Department of Health, Government of Western Australia. ii Abstract Natural disasters are responsible for millions of deaths and increased health risks persist in surviving populations. An affected population faces severe public consequences, with displaced people bearing additional effects such as malnutrition and communicable diseases. Women are more adversely affected in disasters. Their vulnerability increases because of societal roles. Surviving women often take up additional roles to care for the sick and look after the families of deceased relatives. This significant change in the care-giver role, putting family needs before their own, results in a decline in their emotional wellbeing, and contributes to deteriorating health outcomes for women. The December 2004 tsunami was one of the worst natural disasters recorded in history to reveal the difference in impact on genders in all countries: for every male death there were three female deaths. Maldives is one of the countries greatly affected by the tsunami disaster. One third of its population was affected with 7% displaced for varying periods of time. The cost of the damage was estimated at 62% of the annual GDP. The study used qualitative methods in a discipline-configurative case study design to understand the factors that contributed to women’s experiences following a disaster. The concept of resilience was selected as the conceptual framework for the study. This research attempted to identify the factors that enabled the women to achieve a sense of personal control. It also investigated the influences on the women’s sense of personal coherence and the strategies the women used to achieve a sense of personal connectedness. The research has provided important new data from these perspectives and has also explored the attitude and behaviour of others towards the women and the perceptions of changes of their role. The setting for the study was four islands selected because the population had been externally displaced to another island. The principle sample group were the women from these islands who were accessed by snowball sampling. Others who helped these women in rebuilding their lives were categorized into groups and accessed through purposeful sampling. The groups are Family, Volunteers, Army, Health Professionals and the Disaster Management Centre. Data was gathered from multiple data sources of interviews, focus groups, documents and archival records. Participants who were thought to be best able to inform the research were invited to participate in the study. The 103 interviews were conducted by the iii researcher in English or Dhivehi (Maldivian local language) as preferred by the interviewee. In addition, 531 newspaper clippings were collected and analysed as documentary evidence. A deductive approach was used to analyse data related to the pre-set objectives of the study. Data management was facilitated with the use of NVivo 12 software (QSR International Pty Ltd; Doncaster, Victoria, Australia). Data gathered in Dhivehi was translated into English before transcription. As the transcribed interviews generated a large amount of unstructured text, data analysis was conducted in sequences. Sequence 1 was the open coding of the women’s interviews. Sequence 2 was the framework analysis of the women’s interviews, which found that their experience of the disaster was understood in periods of four distinct timelines. Sequence 3 was the content analysis of the interviews of the other groups who assisted the women. The Sequence 4 analysis was of the 531newspaper clippings, which were coded according to timelines then content analysed. The final Sequence 5 analysis was pattern matching all sequences of analysis to build the case study. All key characteristics of data from all phases of the analysis were pulled together, mapped and interpreted as a whole. The process allowed a multi-dimensional analysis and created typologies where two or more dimensions in the tables were linked at different points. The typologies and associations explained the experiences of the Maldivian women following the December 2004 tsunami. This study is among the first of its kind by a female researcher to understand the experiences and resilience of women in disasters within their own cultural context in small island nation communities. According to Reich (2006) principles of control and coherence are a fundamental element of attaining connectedness in disaster contexts. The study findings showed that the provision of help for immediate needs continued with the provision of basic needs of food and shelter, which was assumed as a means for the women to regain their personal control; in fact this undermined their personal control as it created a state of dependency. This study highlighted the lack of enhanced meaning, direction and understanding by others as weakening a response to the women’s call for explanations and their search for coherence. The lack of adequate information to meet the women’s drive for cognitive clarity, coupled with a lack of support from social relationships, hindered the strategies that could help the women iv achieve a sense of personal connectedness. Along with these observations, the study revealed a difference between the women’s reflections on the attitudes and behaviours of those who assisted them, and the views of the people who provided that assistance. This research concluded that the women were unable to achieve a sense of personal control nor attain coherence, resulting in them not being able to achieve a sense of connectedness with others. The study findings accentuated social capital as an important factor to maintain women’s connections with others in post disaster rebuilding. The findings contributed to the proposal of a context specific model for resilient communities and elucidated recommendations for community organisations and governments in policy and practice. It is hoped the model will be incorporated in changes to policy for disaster management plans. v Table of Contents Declaration .................................................................................................................... i Acknowledgments ........................................................................................................ ii Abstract ....................................................................................................................... iii Table of Contents ........................................................................................................ vi List of Figures ............................................................................................................. xi List of Tables............................................................................................................... xi List of Abbreviations.................................................................................................. xii Glossary of Terms ..................................................................................................... xiii Chapter One: Introduction...........................................................................................