On 8 October 2005 the mountains moved in northern Pakistan and Kashmir, to cause human tragedy unparalleled in the history of a country ill-equipped to face such devastation. An estimated 73 000 lives were lost, 4 million made homeless and an entire generation of 8- to 14-year-olds wiped out as they attended school when the earthquake struck. I witnessed the devastation ten days after the event and listened to heartrending stories of loss and grief from those whose villages and towns were completely destroyed.
Unaiza Niaz, one of the few women psychiatrists in Pakistan and a prolific writer, has contributed a timely and detailed account of this tragedy. In a comprehensive manner she has brought together experts in the field of trauma to review the early response efforts, societal effects and both known and innovative intervention methods of a population having witnessed such devastating human loss.
The book reports how the experts of the country cooperated to set up and implement a national plan of action for mental health and psychosocial relief for earthquake survivors within days of the earthquake and started operating highly effective mental health relief units, while the capacity of local professionals to work with trauma victims was enhanced by training efforts spread across the country. A chapter on the role of non-governmental organisations noted that 55 agencies from other countries rushed to set up services and coordinated themselves, perhaps by the sheer pressure of the task facing them.
The book is divided into two sections with international and Pakistani perspectives. It was refreshing to read that Niaz and her colleagues formed an ‘institute in psycho-trauma’ and reviewed the importance of usually marginalised women in disaster settings in the patriarchal Pakistani society. Although some chapters of the book were repetitive and difficult to read, those on the role of the media in seeking assistance and the practical approaches to treating trauma in children came across as true experiential accounts. The contributors report the remarkable spread of post-traumatic stress disorder (PTSD) in the survivors, from 29 to 94%, and major depression, to 81%, as well as the sensitive issue of sexual harassment in these settings. However, the surveys would need the scrutiny of peer-review to assess their significance. Nevertheless, it shows an ambitious team gathering data, imparting training and working directly with survivors.
The chapters based on the Turkish experience with earthquakes gives a detailed review of the subject of stress following trauma and innovative new approaches to treating PTSD, such as single-session therapy, modified behaviour therapy and effectiveness of earthquake simulators as therapeutic tools. Hembree and colleagues, from Philadelphia, have contributed a useful chapter on prolonged exposure therapy, and Klien, from Aberdeen, has tackled the challenges to effective research in disaster settings.
The book is a welcome contribution to the literature and a timely reminder of the need for preparedness to work in disaster settings. I found it a difficult read but interesting as I had directly worked in the camps after the Pakistani earthquake. It makes a good reference book, but perhaps not an essential read.
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