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Collapsed buildings after the Nepal earthquake
'Since the initial earthquake on 25 April, there have been well over 100 quakes registering at a magnitude of 4 or over.' Photograph: Athit Perawongmetha/Reuters
'Since the initial earthquake on 25 April, there have been well over 100 quakes registering at a magnitude of 4 or over.' Photograph: Athit Perawongmetha/Reuters

The Nepal earthquakes have unleashed a mental health disaster

This article is more than 8 years old
There’s a less visible tragedy going on in Nepal: the unravelling trauma of the survivors and aid workers, which will continue long after the media has left

What happens when a disaster zone falls out of the media? What happens when the real impact of a disaster is not easy to see anyway? Last month’s earthquake in Nepal attracted frenzied international media attention. Live rolling coverage allowed us to avidly follow every building that had collapsed or been spared, every survivor or body pulled from the rubble, every comment from an expert or witness. International aid was pledged in increasing amounts, like a sickening parody of a gameshow. The figures clocked up, excruciatingly mirroring the body count. It was shocking. It was gruesome. It was – to use the darkest possible label – exciting.

News, however, by definition, does not stay new for very long. There are only a few different ways that the same devastation can be reported, only a limited number of unique angles before everything has already been said. Tragedy quickly becomes drudgery, and drudgery is not news. The large sections of the world’s population eking out their day-to-day existence in extreme poverty are largely absent from the media. They live and die silently.

On the day of the UK election last week, you would have been hard-pressed to find coverage of what was happening in Nepal. You would be forgiven for thinking that the effects of the earthquake were over, that everything was cleaned up and everyone had gone home. You would perhaps have been forgiven for forgetting that there had been an earthquake at all.

Unfortunately for Nepal, the country was hurtled back into the limelight on Tuesday for the most horrific of reasons. A “second” earthquake had struck the country and caused continued and further devastation. Cue terrifying eyewitness reports, tales of flattened villages, and blood-curdling amateur footage.

Here’s what you don’t know: there have not been two earthquakes in Nepal. Since the initial one on 25 April, there have been well over 100 quakes registering at a magnitude of 4 or over. Those living through it have invented their own coping mechanisms. Words have taken on new and sinister meanings. “Ayo”, which roughly translates as “arrived”, used to be the call of the neighbourhood’s children for when the power came back after an outage. Now, accompanied by panic, it is the ubiquitous signal for people to evacuate buildings during aftershocks.

Despite forcing the people of Nepal to spend their nights under canvas, terrified of collapsing buildings, and robbing them of sleep for nights on end, the continuing disturbances remained largely unreported in the international media, presumably because earthquakes below magnitude 7 are not dramatic enough. Earthquakes that are not worth reporting are invisible unless you are there experiencing them on the ground.

The effects of the continuing instability in Nepal are perhaps more tragic and deeply-scarring than the physical devastation that blights the landscape. “There is already evidence that the quakes are impacting on mental health,” says Dr Sonya Martin, psychiatrist for the Ciwec hospital and travel medicine centre in Kathmandu. “The quakes have incited widespread fear and uncertainty about what the future will bring.”

Research suggests that the long-term emotional consequences of a disaster are related to feelings of powerlessness and lack of control over forces bigger than oneself. The fragile veneer of forced normalcy that had settled on the strange new “post-disaster” Nepal, the world of tents and meal hand-outs, was cracked open after an aftershock as big as the one on Tuesday, and the continuing tremors mean that victims are constantly revisited by their indiscriminate attacker. Rather than subsiding with time, the extreme stress response is being prolonged over days and weeks.

Science also unfortunately holds little comfort for those looking for certainty and rationality. Seismology, being a science of general patterns not rules, cannot provide clear-cut answers. Before the 7.3 magnitude tremor on Tuesday, rumours circulated on social media both that there was over a 99% chance that a magnitude 7 aftershock will not occur any time soon, and contradictorily, that a “twin quake”, coming soon after the first, was a distinct possibility.

The mental and emotional impact of an earthquake is the other invisible disaster. Arguably, issues of mental health are always invisible – always something embarrassedly swept aside in favour of problems easier to acknowledge and talk about. But how does this invisible disaster compare to the billions of dollars of physical damage? In Nepal at least, the psychological damage is far from invisible: it is present and real. Dr Gerda Pohl, trustee of Phase Worldwide, an organisation on the front line of the relief effort, says that she has heard of a number of suicides and attempted suicides in the wake of the disaster.

On top of the obvious trauma caused by destruction and loss, is the burden of survivor guilt. Devaki, from Fulpingkot in Sindhupalchowk in central Nepal, was seriously injured, but struggles to understand why she was spared when her 16-year-old daughter was killed by falling rubble, while still clinging to her. It has also long been recognised that aid workers rushing to help after the disaster are not immune to emotional trauma. In Nepal, the people at the forefront of the relief effort, many who have not a day off or even an undisturbed night’s sleep, are often those whose families and homes are amongst the most badly affected.

The effect of this string of disasters on Nepal will last a long time. Long after the tremors have stopped, long after homes have been rebuilt, long after the stories have moved out of the media spotlight. But how invisible this lasting impact remains is up to us. The support and solidarity for Nepal that we have so generously extended needs to stretch far beyond the initial few days of crisis. Because, arguably, invisibility is the biggest tragedy of them all.

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