Report of Inter

Report of Inter-Governmental Meeting of Experts

to Formulate Psychosocial Programme

for Rehabilitation of Tsunami Survivors

Jakarta, 4-5 April 2005

1. The Government of the Republic of Indonesia, in this regard the Ministry of Foreign Affairs of the Republic of Indonesia as the organizing committee, in cooperation with the Non-Aligned Movement Centre for South-south Technical Cooperation (NAM CSSTC) hosted the Inter-Governmental meeting of experts to formulate psychosocial programmes for rehabilitation of tsunami survivors in Jakarta on 4-5 April 2005. The meeting was triggered by the massive tsunami earthquake that occurred in Indian Ocean in late December 2004, which devastated many countries and claimed hundreds of thousands of lives and losses.

2. The objectives of the meeting are to: (a) get common understanding of the psychosocial support in complex emergency; (b) identify existing mental health systems and problems and share country experiences in dealing with mental health problems in the aftermath of tsunami; (c) identify issues to be addressed in improving inter-sectoral collaboration among major stakeholders in the provision of psychosocial support; and (d) recommend the affected countries to undertake specific measures and assistance for tsunami survivors.

3. The organizing committee, represented by Ms. Linggawaty Hakim, Director for Non-UN Economic, Financial and Development Cooperation, Ministry of Foreign Affairs, and Director of Non-Aligned Movement Centre for South-South Technical Cooperation, welcomed all delegations to the meeting. She thanked all parties involved in supporting the implementation of the meeting as a forum of exchange of views, perspectives, knowledge, and concrete experiences among experts from different countries and institutions on psychosocial problems faced by tsunami affected countries. The text of her welcoming remarks is attached as Annex I.

4. The Secretary General of the Ministry of Foreign Affairs of the Republic of Indonesia, Mr. Sudjadnan Parnohadiningrat, delivered the keynote address and formally opened the meeting. He highlighted the importance of addressing psychosocial and mental health problems of the Tsunami survivors, and the need to formulate related programmes particularly in the field of health, education, social support and temporary shelters. The initiative of conducting the expert meeting reflects the commitment of the Government of Indonesia in providing appropriate assistance for Tsunami survivors, and as a contribution to South-South cooperation. The text of his keynote address is attached as Annex II.

5. The meeting was chaired by Dr. G. Pandu Setiawan, Director for Community Mental Health, Ministry of Health of Indonesia and Dr. Stephanus Indradjaya, from the World Health Organization country office in Indonesia, as co-chair. It was attended by experts on mental health and psychosocial support from Tsunami affected countries (Indonesia, India, Malaysia, Sri Lanka, Thailand), and experts from experienced countries (Australia, Iran, Japan, Turkey and United States), as well as from international organizations and institutions (WHO, UNICEF, UNESCO, AUSAID, USAID, International Organization for Migration/IOM, Australia-Indonesia Partnership for Reconstruction and Development, Kanto Medical Center of Japan, General Hospital of Batticaloa, Turkish Red Crescent, and from academic institutions such as University of Queensland, Idaho State University and University of Indonesia. The list of participants is attached as Annex III.

6. The meeting was preceded by the presentation of WHO and UNICEF experts on general overview on psychosocial and mental health problems in countries affected by Tsunami, and followed by country report presentations from Indonesia, India, Malaysia, Sri Lanka, and Thailand. Experts from experienced countries and other international organizations and institutions also presented their reports and information on programmes of assistance provided for Tsunami survivors. Reports of the affected countries are attached as Annex IV.

7. All presentations stressed that there is an urgent need to cope with the psychosocial and mental health problems as an impact of tsunami. It is recognized that the problems of mental disorder is likely to be increasing in the affected Tsunami areas. The conduct of the expert meeting was considered timely to address these crucial problems as a follow up action of the global commitment to provide comprehensive post-disaster assistance for Tsunami survivors. Experts from different countries and international institutions were expected to formulate appropriate and workable programmes for those in needs, taking into account that most international assistance and aids are focused on rebuilding physical infrastructures rather than assisting psychosocial interventions.

8. It was also emphasized that public awareness on the existing problems is still lacking, particularly on the need to have psychological aid. Furthermore, there is also lack of synchronized and coordinated efforts by Governments, NGOs and private sectors, and limited capacity of human resources in health facilities.

9. In the deliberation, it was agreed that three Working Groups were set up to discuss three major topics comprehensively for implementation in the rehabilitation phase. These topics are (a) Coordination and partnership among stakeholders in psychosocial programmes; (b) strengthening the levels of mental health care; and (c) programme development in education, culture, as well as social and economic welfare, that provide leverage in addressing psychosocial problems.

10. The result of the discussion in the Working Groups contain suggested follow up actions and programmes, as well as recommendations to the Governments of the affected countries and to the international community to provide necessary psychosocial support and assistance for tsunami survivors.

11. Discussion in Working Group 1 focused on the topic of Coordination and partnerships among stakeholders in psychosocial programme. In the acute emergency phase, many agencies provided psychosocial assistance to the tsunami survivors. Experience showed that not all interventions conducted were based on strong evidence. In addition, the chaotic situation during the acute phase usually hampers the establishment of coordination mechanism within sectors and inter-sectors. It was also recognized that government is unable to sufficiently address the huge burden alone. Therefore, government should create an environment that is conducive for national and international institutions, as well as NGOs and civil society to work together, under the appropriate procedures. This means that government should take a strong leadership in coordinating all the stakeholders involved in providing assistance to tsunami survivors. The existence of a strong national coordinating body is required to develop national disaster management policy, as well as to increase the preparedness of the community and mitigation of the disaster impact. This effort should be supported by international agencies as appropriate. The report of the Working Group 1 is attached as Annex V.

12. Discussion in Working Group 2 focused on Strengthening Mental Health Care. The magnitude of the psychosocial problem resulting from this major disaster has increased the awareness of governments on the importance of mental health. This trend provides a golden opportunity to reform mental health system in the respective country to ensure access for basic care for people with mental problems whether they have mild distress or severe preexisting mental disorder. This system should be integrated as appropriate into the existing health and/or social services system. It is conceived that a model of mental health service can be divided into four strata, namely: (a) self help at family level; (b) formal and informal community care outside the health sector; (c) primary care; and (d) community mental health services. Definite roles and minimum functions at each strata was clearly defined. Community mental health/NGO/civil society organization may work across the strata. The report of the Working Group 2 is attached as Annex VI.

13. Discussion in Working Group 3 focused on programme development in education, culture, as well as social and economic welfare, that provide leverage in addressing psychosocial problems. It is well recognized that in order to have a strong and effective psychosocial support, all sectors and local community should be involved. Deliberation in the Working Group focused on education, culture, social development and community empowerment to build community resilience. The experts recommended that special programmes should be developed both in formal and non-formal education in order to build community resilience. However, to achieve optimum result of psychosocial interventions, there should be a coherent direction of economic development in the affected area. It is further emphasized that the interventions should be culturally and socially appropriate. The report of the Working Group 3 is attached as Annex VII.

14. The meeting was closed by Mr. Mangasi Sihombing, Director General of Information, Public Diplomacy and International Treaties, of the Ministry of Foreign Affairs of the Republic of Indonesia, who is also the Chairman of the Ministry’s Working Group for Tsunami Assistance. In his closing remarks, he expressed gratitude and appreciation to all parties involved in successfully conducting the meeting, and to the experts who have been working so hard during the last two days in finalizing the work to formulate important programmes and recommendations through productive sharing process. It was hoped that the tsunami-affected countries will be able to further adopt and adapt the recommendation derived from the expert meeting, and undertake necessary actions to provide appropriate assistance to tsunami survivors. He recognized the challenges faced by the affected countries in implementing the recommendations, therefore triangular partnerships with countries of the North and international donor institutions should be further encouraged. The text of his closing remarks is attached as Annex VIII.