A total of 882 (449 female, 433 male) adults; 138 adolescents aged 12 to 18 (74 female, 64 male); and, 333 children (3-11 years old) displaced by the Marawi siege and Typhoon Vinta were provided with Mental Health and Psychosocial Support Services (MHPSS).
More than 300,000 people have been displaced since the Marawi siege. These IDPs have sought shelter in evacuation centers or with relatives in several municipalities in Lanao del Sur (LDS) and Lanao del Norte (LDN).
After more than 5 months of armed clashes that were initially thought to last only three days, the government has finally declared Marawi liberated from the militant group.
Approximately one third of the city is in complete ruins due to the almost daily aerial bombings, and the rest in various degrees of damage. Stories abound of looting of houses and commercial establishments in areas that were not significantly affected by the war.
The need to psychologically prepare returning populations for shocks they may experience upon seeing their homes and properties has been recognized by government and partners alike. Likewise, the need to have in place respondents who can provide culturally-sensitive MHPSS for returning IDPs has also been stressed.
Municipalities in Lanao del Sur aside from Saguiaran have also hosted populations displaced by the conflict. The unstable security situation has adversely affected their economy and delivery of basic services.
As one of the earlier responders of the Marawi siege which provided health, nutrition and MHPSS support to the displaced families, The Moropreneur Inc responded to the call for application and selected by the WHO to augment the health services specifically on MHPSS and provide the necessary medicines and supply in the rural health units. The contract period for this project is from 15 November to 15 December
2017. However, due to extent of the damage brought by Typhoon Vinta, TMI and WHO agreed to extend the operation until 31 January 2018. The Project was funded by the Central Emergency Response Fund (CERF) (Fonds central d’intervention d’urgence, in French).
CERF is a humanitarian fund established by the United Nations General Assembly on December 15, 2005 and launched in March 2006. With CERF’s objectives to 1) promote early action and response to reduce loss of life; 2) enhance response to time-critical requirements; and 3) strengthen core elements of humanitarian response in underfunded crises, CERF seeks to enable more timely and reliable humanitarian assistance to those affected by natural disasters and armed conflicts.
The Project was able to provide displaced populations in the municipalities of Bacolod-Kalawi, Balindong, Tugaya, Marantao and Marawi City in Lanao del Sur; Tubod, Lala, Salvador and Munai in Lanao del Norte with access to mental health and psychosocial support.
Psychosocial Support Services
Conflict, emergencies and calamities are often sites of intense adversity and stress. Wars, natural disasters, forced displacement, as well as the chronic stress of trying to make ends meet all take their toll on the mind, body and spirit. As the impacts of such stressful experiences accumulate, they hinder an individual’s ability to engage in economic and social life.
On the collective level, chronic stress makes it hard for people, families, and communities to trust one another and come together to realize common goals.Survivor of the Marawi siege reported suffering from psychological distress. Many complaint of deep fear, sleeplessness and/or nightmares, generalized anxiety and unexplained somatic symptoms, such as body pain, stomachache and headache especially among children and teenagers.Following a gender and age-appropriate approaches, TMI divided the population in each of the 15 barangays reached into general adults, women, adolescents and children. The result of which is as follows:
PSS Among Women
Whether disasters or conflicts, the impacts are much higher for women than for men (ADPC 2010). The impacts of disasters increase the magnitude of pre-existing development issues and are not just dependent on the natural hazards that are part of the environment. Different socio-political factors exist within society before a disaster and cause serious vulnerability among women. Disasters expose this vulnerability. Women’s vulnerability is connected to their generally lower socioeconomic status.
The PSS for Women was given to make sure that the displaced women are protected. In all the sessions in all barangays, the participants were divided in three groups. Each group has an activity to present.
A total of 449 Adult Women (above 18 years old) were reached by the project in the 9 towns of LDS and LDN.
At the onset, the Roundtable Drawing is being provided. This activity aims to strengthen the sense of unity and support system within the community or certain group. In processing, participants realized that every individual has different needs and coping mechanisms. Even twins have own personality thus everyone is unique. As one of the participants said, “Ibat iba ang hugis ng ating kamay dahil magkakaiba tayo ng personalidad o pangangailanagan sa buhay ngunit iisa ang mithiin natin na makamit ang kapayapaan, tahimik, maayos at masaganang buhay. (We have different sizes of hands and fingers because we have different personality and needs in life. But all of us dreamt of same thing – peace, tranquility, order and progressive life)”
Another activity is the Caring for Women which aims to instill appreciation of the contribution of women in the community by identifying their roles. One participant in Salvador, LDN, shared her story as a mother regarding her daily routines, coping mechanisms, skills, strengths and the way she cares herself. She said that “ matagal na ako hiwalay sa asawa ko dahil may iba na siyang babae. May dalawa ako babaeng anak na tumutulong sa akin sa paglilinis ng bahay o kaya sa paglalaba. Sila ang nagsisilbing lakas at inspirasyon ko sa buhay. Mahilig ako magtanim at nag-aalaga ako ng manok. Nung masalanta kami ng Typhoon Vinta at nadisplaced, tinatagan ko ang sarili ko. Ang coping mechanism ko ay unang una ay prayer, nagdadasal ako at dinidiligan ko ang mga halaman ko pag ako ay stress.” Gradually, in the process, the TMI team heard increasing voices from the women who were now more open to share their stories. Some of them shed tears, while others laugh and make things lighter. Over-all, the sessions were always heartwarming. Some of the take-away learning to all activities conducted are as follows:
- Everyone – male and female have rights. What’s important is that people understand their selves better.
- The activities were regarded to be “useful” and can be used in the Family Development session of 4Ps”.
- The women have showed interest in forming self-help group.
PSS among Adolescents
At the evacuation centers, it’s observable that there is huge number of adolescents. This is true to the various areas affected by the siege and the typhoon Vinta. Given this, psychosocial support services specific for adolescents (13- 17 years) is therefore needed.
The 1987 Philippine Constitution has enshrined the principle of the State recognizing the role of the youth in nation-building and that it shall promote and protect their physical, moral, spiritual, intellectual and social well-being. And yet the youth seems to be a neglected and underestimated sector especially in the conflict-affected areas of the Autonomous Region in Muslim Mindanao.
Adolescents and young people (aged 10-24) make up approximately 20 per cent of the population in the ARMM region of Mindanao with over 45 per cent of the population are aged 0-18 years. However, compared to other population groups, young people receive relatively little programming and policy attention and have limited civic engagement roles and value within society.
This reflects, in part, the lack of recognition of young people’s rights, value and potential contributions but also the absence of a comprehensive youth program that provides them opportunities to realize and hone their potentials.
In response, series of adolescent sessions such as listening, creative and interactive games, and talk therapy were employed to provide awareness on mental health as well as help the youth understand better how they can manage the various stressors in their lives.
Over-all, 138 teens were reached by the project. There are 74 females and 64 males.
The Activities provided to the Teens were the provision of safe spaces which offered a protective environment for the adolescent to have productive discussions and life-changing activities that may help boost their confidence, self-respect, and practice while they are being displaced.
The participatory mechanisms provide young people focus on engagement at the level of personal identity and worldviews, translating internal transformation into patterns of behavior conducive to peace and unity.
PSS among Children
The experience of an emergency can significantly impact the psychosocial wellbeing and development of a child. Exposure to violence, accumulation of stress, loss of, or separation from family members and friends, deterioration in living conditions, inability to provide for one’s self and family, increased militarization and divisions in societies, and lack of access to services can all have immediate, as well as long-term consequences for children, families and communities.
Restoring normalcy in the lives of children includes providing boys and girls with culturally and age appropriate activities, such as sports, play and perceptual, memory and creative games that are structured, safe and stimulating. Such activities develop children’s life skills and coping mechanisms, as well as promoting children’s participation in daily family and community life through cultural or media activities or community service. Structured group activities in a calm and safe environment enable boys and girls to help and support one another.
Over-all, 330 children (151 girls, 179 boys) were provided with PSS activity. Feedback from the parents revealed that some children who remained silent and passive during the siege have become active again. Others are delighted that their children have started to become open and expressive again.
Provision of Medicines and Supplies to the RHUs
Essential medicines play a crucial role in the prevention and control of diseases especially in a conflict situation. The types of medicines and supply provided to the RHUs are based on the assessment of the needs. The team, at the onset, conducted KII with the municipal health officers to determine the common diseases and the needed medicines. The WHO has also provided a list of standard medicines. These lists have been combined to determine the type of medicines and supply to be procured and delivered to the intended RHUs.
For this project, 85 types of medicines and supply were provided to the RHUs of Bacolod-Kalawi, Balindong, Tugaya, Marantao and City Health Office of Marawi. The medicines were received on 22 – 23 December 2017 which is two days before typhoon vinta. Coincidentally, the recipient RHUs were the ones hardly hit by Typhoon Vinta. And because the medicines were prepositioned earlier, it was able to help the RHUs in providing health care to the survivors of the siege as well as the typhoon.
Conclusion and Recommendation
Delivering psychosocial services in a humanitarian setting is essential. Due to delays in reconstruction, people continue to live under difficult conditions exposing them to higher risk of mental health consequences. Mental health, one of the health issues ignored during disaster response and recovery, has drawn increased and unprecedented attention of planners and policymakers. It is important to utilize this momentum to ensure a responsive health system capable of ensuring essential mental health services during the aftermath of disasters, as well as normal.
The MHPSS Project in other areas of Lanao del Sur and Lanao del Norte was essentially beneficial to the lives of the survivors. The result is greatly encouraging that many of the survivors have responded positively, participated well in all sessions, and have made remarks as to how good the activities were in helping them cope up and move on.
Some of these practices that helped achieve the objectives of the project are as follows:
- Active participation and support of IPHO and RHUs. TMI was able to establish good relationship with the health facilities in Lanao del Sur and Norte which paved for the smooth and successful implementation of the project;
- Strong and good relationship between WHO and the implementing partners were able to address difficulties with ease and provide flexible terms to achieve the objectives of the project.
- Flexible Planning and Scheduling allows to take sudden changes due to several reasons that are beyond the control of the team, i.e. delays caused by martial law’s system/procedures, sporadic fighting, security issues, etc.
- Hiring of Local Staff from the affected communities was vital in the success of the project. These local staff are familiar with the terrain and dynamics of the areas making it valuable in the planning and actual implementation of the project.
- Shared mental models, common assumptions and expectations, and coordinated decision making strategies among various actors are important to ensure inter-agency cooperation that leads to improved resilience.
It’s also significant to note that in building resilience, it’s essentially helpful for the MHPSS provider to include the following strategies:
- It’s important to provide knowledge of common reactions to trauma. This will help both the health workers and the survivors become aware of the signs and symptoms of mental health disorders and act accordingly.l
- It was also helpful to have a standardized and common knowledge on methods to be taught to the population. In this case, the Task Force Bangon Marawi and the MHPSS subcluster have developed a Meranaw version PSS material which were helpful in implementing the project and ensure conflict and gender sensitivity of the materials used.
- Tracking the environment of the population also provided better understanding on what approach could work.
These strategies can be made into standard procedures that can be disseminated and learned by both public and professionals to help affected populations. It is alsoo good to integrate these strategies into the health care system to help people build capacity and resilience to trauma.
Generally, the Project recommends to extend the duration of the project and do the following activities or approaches:
- Baseline Study. Systematic review of intervention after disasters highlighting aspects of resilience such as strength of evidence, information on reactions after disaster, resilience strategies, unpredictability of disasters and the challenge of studying people’s reactions after the disaster.
- Sensitizing women on self-help psychosocial counseling at community level through women groups for resilience capacity building.
- A public awareness campaing for psychosocial response capacity by addressing the population through media, reaching out to those with clinical needs, using adequate methods and establishing proactive response capacity. To build community resilience through community leadership, caring neighborhoods, using community organizations, good public health care, and support from the society at large.
- The need to improve knowledge on: individual, family and societal coping mechanisms; how psychosocial follow-up efforts can be tailored to the type of disaster and the affected population; and, how to move from basic to more effective interventions.
- It is necessary to work more on educating the donors to address the funding challenges.
- Raise awareness on the effects of conflict and climate change on children; adopt climate change adaptation strategies for children affected by disasters may include child friendly responses.
- Explore the role of faith-based organizations in providing MHPSS.