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he monsoon of 2022 brought torrential rains across Pakistan. Although the Meteorological Department had warned about possible flooding, sooner than expected it turned into reality. Many areas of the country were under water. Sindh was no exception.
I had just assumed charge as dean of the Faculty of Medicine at my university. The vice chancellor called an emergency meeting to discuss how to contribute to relief efforts for the communities in flood-affected areas. Teams comprising doctors and paramedics were being sent for the provision of first aid, food, medicines and treatment for medical conditions expected to be encountered, such as skin and eye infections.
As a mental health professional, I could foresee that physical healthcare alone would not be enough. Acute panic and deep psychological scars are often part of such disasters. So, after a brief training on psychological first aid, I sent some medical officers, psychiatry trainees and psychology interns to join our medical teams.
This team worked effectively on site but many patients were later referred to hospitals in Hyderabad for ongoing treatment. I had a chance to meet many of these individuals. Among them was an old lean man I will never forget. He was quiet and tears streamed down his blank face. He seemed unable to express the many thoughts that crossed his mind and the emotions he felt. He was struggling to find words. A companion informed me that in the flood he had lost the dowry he had saved for his daughter’s marriage. Without uttering a single word, his grieving face and eyes spoke volumes of his dreams that had been washed away; of his broken spirit.
I also recall a mother who screamed every time she remembered her child drowning; a farmer who lost his cattle, his livelihood. Behind every individual case there was a story of human pain and sheer helplessness. The floods had not only dismantled the houses and damaged the crops, but also swept away the hopes and peace of countless helpless people.
The problem did not end there.
In a few weeks’ time, the people who had brought these patients and had helped them settle down, themselves suffered from anxiety, sleep disturbance and trauma. Thus, during and after that flood, my team and I had an unforgettable experience of managing the various dimensions of grief.
Many survivors experienced shock in the beginning. They felt numb and were unable to grasp what had happened. The ones who had helped others felt an intense fear of losing loved ones, their belongings; of facing hunger, disease and another disaster.
There was overwhelming grief for those who had lost family, relatives, homes and lifelong savings. As people tried to rebuild their lives amidst instability and insecurity, we found some struggling with panic, anxiety and sleeplessness. Some had developed post-traumatic stress disorder, reliving traumatic events through flashbacks and nightmares. Others had suicidal thoughts due to survivor guilt.
Imagine a white-collar worker, once living with dignity, now standing in a queue for food—his pride shattered; his spirit broken.
The children, accompanying the families of psychiatric patients, displayed a withdrawn and fearful demeanor, often reflecting anxiety and confusion about their surroundings; adults expressing irritability, helplessness and emotional numbness. The elderly, already sick and fragile, lost their sense of safety and belonging. Deep psychological scars linger on much long, even after the damage is repaired apparently.
Recognising and treating emotional wounds is as vital as treating physical conditions people encounter in disasters. Recovery, in essence, goes beyond rebuilding homes and providing food and living; it means restoring the resilience, dignity, self-esteem and hope of those who suffered. If psychological wounds are not addressed, healing remains incomplete. If the fear, grief, despair and ego are not taken care of, a person cannot recover completely despite the provision of adequate physical healthcare. This is because emotional scars erode motivation, disturb sleep patterns, and weaken the body’s resilience. This hurts me often as the focus of public attention, and the media, tend to be far more on physical health and infrastructure than on mental well-being.
This flood left us wondering, can we not learn the lesson and train ourselves to practically help those in distress? Rather than merely watching as bystanders, making videos or shouting in panic, we can act with empathy by listening, connecting and comforting those who have suffered, offering them a ray of hope. Can our governments not support these distressed people in a dignified way that protects their self-esteem rather than hurting it so as to enable them to be more resilient and capable of rebuilding their own lives and maybe even helping others in turn?
The writer is the president-elect of the Pakistan Psychiatric Society and a faulty member of Psychiatry College of Physicians and Surgeons, Pakistan. He is a founder member of the Sindh Mental Health Authority; former dean of the Faculty of Medicine at LUMHS; former chairman of the Department of Psychiatry at LUMHS; former director of the Centre for Psychosocial Wellbeing; and an editorial board member of the Asian Journal of Psychiatry.