The last few days I have spent scouring the tsunami-devastated coastline of Japan's north-east. From Ishinomaki to Onagawa, Shichigahama to Kesennuma, the landscape has been drastically altered as Japan presses on with the world's costliest disaster recovery till date.
Town after town affected by the tsunami has been razed to the ground. Houses, schools and busy markets have all disappeared. Almost everything that was damaged has been flattened and cleared. The horizon is now marked with towering stockpiles of scrapped cars, recovered metal and millions of tonnes of cleared debris. Some colossal industrial units will take longer to dismantle. The great fortresses of Japan's economic power- they stand like grim mausoleums, annihilated by the brute force of tsunami waves that tore through their steel ramparts as if they were made of paper.
Much like their nation, Japan's tsunami survivors have also put on a brave front to their immense loss and suffering. As the world watched the news of 11 March with disbelief, the survivors were making an orderly queue to receive emergency relief. There was shock and great tragedy, but no public display of emotion.
One year later, the tsunami survivors are still mourning their dead. Many are waiting to hear about their missing relatives. Over 340,000 people are still in temporary accommodation, most living among strangers, unsure when they will return to their homes. The tsunami not only destroyed their towns, but also broke their communities.
Despite all this the survivors rarely speak out and least of all complain about their circumstances. For them, to be seen needing help is a dent in self respect and seeking one is akin to betrayal of those who need it more.
Even with such overarching altruism and valiant attempts to live up to the embodied values of stoicism, tsunami survivors, especially children, need help. For thousands of tsunami-affected people, life has not moved further since March 11 as they come to terms with their loss. Earthquake, tsunami and the fear of nuclear radiation has put a significant population under stress.
Japan's decision to spend 13 trillion yen ($167 billion) over five years for recovery is a robust response. The urgency to getting back to business is evident and core priorities have been set around economic revival and economic benefits. Missing, however, from the discussion is the pressing human needs of survivors. Regardless of a nation's advancement and resources, disasters affect everyone. The emotional impact of tsunami on its survivors cannot be addressed by Japan's rapid reconstruction and physical recovery alone.
Mental health professionals in Japan readily furnish data to show how years after the 1995 Kobe earthquake that killed over 6,000 people, the number of psychological cases continued to rise. The 2011 tsunami dwarfs Kobe disaster in its casualties, magnitude and the geographical spread. The experts fear if emotional needs of affected people are not addressed immediately, it could have long term ramifications on general psychological well being of those at risk, especially children.
Under such compelling circumstances global child rights organisation Plan decided to make an exception and reach out to children in a developed country. The organisation, which runs its entire programmes in developing countries, began responding to the overwhelming emotional needs of tsunami affected children and their care givers such as parents and teachers in the worst affected areas of Miyagi prefecture within days of the disaster.
Plan Japan's experience of reaching thousands of tsunami survivors in the last one year confirms the assessment of psychologists and mental health experts. The organisation has come across deeply disturbing stories of children playing tsunami games and being scared to flush toilets as the sound of flowing water reminds them of tsunami waves. Psychologists working with Plan have reported cases of grown-up children showing anxiety, aggression and wetting beds; and adults going through depression and some even developing alcohol and gambling addictions.
The accepted social norm to be resilient and common confusion of psychosocial care with mental illness in Japan means those in real need may never seek any help. Plan Japan staff had to adapt and evolve ways to reach their own, very private people. Tea parties were used as an excuse to bring people together so they can talk and share their feelings. Psychosocial care had to be rebranded as child support.
The results are evident as you visit schools and temporary housing complexes where Plan has run various activities for children and adults allowing them to experience camaraderie as they live through their private suffering. Plan Japan emergency response unit in Sendai regularly receives beautifully hand bound message books sent by school children and their teachers. In their own writing they mention how much they enjoyed activities like playing African drums together. A girl describes one such emotional support session as the first time when she laughed and enjoyed herself since the tsunami.
Emotional support or psychosocial care is often neglected in disaster response, yet it is among the most basic needs of disaster survivors. It is vital for affected people to be able to relate to and deal with their circumstances. Simple things such as group activities, games or getting people to talk to each other can play a significant role in the healing process. Best still, expressing emotions and sharing feelings can prevent high risk people from advancing into stages where they require specialised mental health care involving psychiatrists and clinical psychologists.
The events of 11 March, however, have exposed a worrying neglect of emotional well-being in Japanese society, a sentiment echoed by mental health experts who fear that things could get worse.
For prided stoicism and economic realities, the pressure is intense on Japan and its tsunami survivors to return to business as usual. As the world's third largest economy races for rapid rebuilding and reconstruction it must not lose sight of survivors' emotional well being. It is a challenge and a humanitarian need that must be met.
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