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Psychosocial aid to children after the Dec. 26 Tsunami

By Kathleen Kostelny and Michael Wessells
Republished with permission from The Lancet

The Dec 26, 2004, tsunami had profound effects on children, who have unique vulnerabilities, needs, and strengths. The tsunami ravaged children's sense of safety and predictability, and increased their vulnerability. Many of the children involved feared for their lives or narrowly escaped death, and many suffered the loss of parents, siblings, friends, and neighbours. The tsunami destroyed children's social supports by devastating homes, schools, and communities, and overwhelming the adults caring for them. Adding to children's risks were ongoing threats to their protection, such as separation from parents, sexual exploitation, trafficking, recruitment into armed groups, and dangerous labour.

Previous research and our observations indicate that most children experiencing disasters, conflict, and other traumatic events have mild to moderate levels of distress but remain functional. (1,2) Typically, less than 15% of a disaster-affected population express mental disorders that require intensive mental-health care. (3) What most children need is not therapy but community-based activities that help to restore their sense of safety, connection to caring adults, and hope for the future. (1,2)

To support children, Christian Children's Fund, working with local partners, established 240 child-centred spaces in tsunami-affected areas of Sri Lanka, India, and Indonesia, involving more than 38000 children from birth to 18 years of age. In open areas or in new or existing structures, these spaces provide rapid psychosocial support by engaging children in activities that aim to restore a sense of safety and predictability, enable emotional expression, address health risks, and foster social integration. (4) The staff are local community volunteers, including teachers and youth workers, who are trained and supported by specialists in child protection. Previously, child-centred spaces have been started by the Christian Children's Fund in conflict and postconflict situations in Afghanistan, Angola, Sierra Leone, Kosovo, and East Timor, where the scale and nature of the devastation have affected children. (5)

Activities in the children's centres aim to help to restore young children's sense of safety by providing a safe place where they can play surrounded by caring adults whom they trust. The centres try to restore children's sense of normalcy and predictability through structured activities such as singing and dancing, activities that are part of the local culture. Informal education, provided when schools have been destroyed or disrupted, is an important part of the normalising process, and fosters psychosocial health by providing a routine, and social interactions with peers. (4) The centres try to promote children's health through education about hygiene, physical hazards, and disease diagnosis, prevention, and treatment; and by providing nutrition monitoring and therapeutic feeding for infants and toddlers. Through art, story-telling, and drama, children express emotions and have space to cope with distressing events.

The children's centres also aim to benefit older children, who develop life skills and leadership abilities through participation in sports, youth clubs, community activities such as clean-up campaigns, and mentoring younger children. Children's caretakers also receive psychosocial help through participation in support groups, child development and health education, and workshops on parenting skills that enable them to attend to children's physical, emotional, and social needs. Trained staff refer severely affected children to mental-health specialists, traditional healers, or other professionals.

In the small fishing village of Vallandalmomi in Tamil Nadu, the whole community participated in the opening ceremony of their child-centred space: parents cradling babies, children linked arm in arm, youths in small groups, and elders watching and nodding. A community committee had earlier cleared the open space of debris, and the young people wove decorative strings of birds out of palm leaves and carefully placed them throughout the centre. Throughout the afternoon the children sang traditional songs, played group games, and lined up for a turn on the newly installed slide. They performed local dances and elders passed out sweets. An elder declared: "The children are happy again. Now we can be hopeful for all our futures."

These centres are not a stand-alone intervention but are supplemented by wider child-protection efforts. Community members participate in child well-being committees that stimulate community action to reduce risks and improve vulnerable children's psychosocial well-being. Made up of children and adults, the committees work to identify, monitor, and reduce physical, social, and emotional risks to children. They also educate parents and communities about children's rights and psychosocial needs. By intermixing urgent assistance with prevention, this holistic approach aims to create hope for the child survivors of the tsunami and their caregivers.

KK is a psychosocial consultant with Christian Children's Fund. MW is senior child-protection specialist for Christian Children's Fund. We have been active in the development of child-centred spaces and child-protection activities in Afganistan, Sierra Leone, East Timor, Sri Lanka, and India.


1. Agger I. Reducing trauma during ethno-political conflict: a personal account of psycho-social work under war conditions in Bosnia In: Christie D, Wagner RV, Winter D, eds. Peace, conflict, and violence: peace psychology for the 21st century. Upper Saddle River, New Jersey: Prentice-Hall, 2001: 240-250.

2. Hubbard J, Pearson N. Sierra Leonean refugees in Guinea: addressing the mental health effects of massive community violence In: Miller K, Rasco L, eds. From clinic to community: ecological approaches to refugee mental health. Upper Saddle River, New Jersey: Erlbaum, 2004: 95-132.

3. WHO. Mental health assistance to the populations affected by the Tsunami in Asia
(accessed June 13, 2005).

4. Nicolai S, Triplehorn C. The role of education in protecting children in conflict. London: Humanitarian Practice Network, March, 2005:.

5. Wessells M. Child protection and well-being in emergency situations: CCF's strategy for assisting war-affected children. Richmond, Virginia: Christian Children's Fund International, 2003:.