Those that war does not kill, it traumatizes. Like the children of Marawi, who along with their families have been displaced by the nearly month-long fighting in southern Philippines.

Thousands of families have fled their homes. Many sought refuge with relatives and friends in other places. But thousands remain in cramped evacuation centers where life is just slightly bearable.

Yes, they evaded gunfire and bombs. But the greater challenge now is how to survive a future that remains uncertain.

A humanitarian organization has already warned that prolonged displacement and the onset of the rainy season increased the risk of disease, especially among children and the elderly.

But equally critical as hypertension, diarrhoea, and respiratory conditions, is the trauma faced by very young victims, and health officials are working double time to train psychosocial teams to help children cope with their harrowing experience.

Other than providing for the very basic necessities such as food, water, and shelter, evacuees have an overwhelming need to be heard as they relate their stories.

Dealing with trauma

Listening to what they have been through is a crucial step in their recovery, Health Secretary Paulyn Ubial told the media. It has been observed that some evacuees, especially children, are becoming withdrawn and this makes them prone to breaking down.

“We need to listen, and hear their feelings and experiences,” the Health chief said at a press conference.

Displaced Marawi residents will be evaluated and categorized - depending on the degree of their needs (mild, moderate, severe) - by psychiatrists and psychologists who have been deployed to evacuation centres.

Cases classified as mild are usually subjected to games and activities, but those under the moderate and severe categories will need more extensive one-on-one counseling.

Time is of the essence, Secretary Ubial emphasized, because if the children’s mental needs are left unattended, these could lead to introversion where the young victims will be unable to participate in school activities or play with other children. Even worse is that it could lead to break-down episodes.

The Department of Social Welfare and Development (DSWD) has reported 4,317 families (20,754 individuals) staying in 64 evacuation centres, while 42,672 families (207,622) are staying with relatives or friends.

The Department of Education (DepEd) has likewise confirmed many children are experiencing trauma.

Language barrier

The bigger obstacle in addressing trauma among evacuees is not lack of qualified personnel but the language barrier. Several psychosocial teams have arrived to assist in debriefing, but their skills are of little use because they do not speak the native languag, Maranao.

Maranao is a Malayo-Polynesian language spoken largely in Lanao Del Sur, Lanao Del Norte in the Philippines, and in Sabah, Malaysia.

“We need to overcome the language problem, so what we are doing is training local health workers - speakers of the Maranao language - so that they will administer the debriefing themselves,” said the Secretary.

About a thousand Maranao-speaking health workers from Region 11, 12 and Marawi City have been tapped to assist, including personnel of the Amai Pakpak Medical Center (APMC), which is not yet fully operational despite receiving the Philippine Army’s “go signal” to resume operations.

Psychosocial First Aid

According to the World Health Organization (WHO), Psychosocial First Aid (PFA) involves a humane, supportive response to a fellow human being who is suffering and in need of support.

PFA includes providing practical care and support but does not intrude; listening but not pressuring to talk; addressing basic needs; providing comfort and calm, helping people connect to information, services and social supports, and protecting them from further harm.

However, WHO notes that PFA is not “something only professionals can do” and that it does not necessarily involve a detailed discussion of what occurred that caused the stress. Neither is about “pressuring people” to talk about their feelings.

PFA primarily focuses on factors that help long-term recovery such as feeling safe, having access to social, physical and emotional support.

Families displaced by the fighting in Marawi languish in cramped evacuation centres Photo courtesy of
Families displaced by the fighting in Marawi languish in cramped evacuation centres Photo courtesy of

Other health concerns

Apart from the psychosocial needs, the DOH is likewise focused on other health concerns such as basic health needs, the physical state of the evacuation centres and logistics.

Health concerns involve hypertension, respiratory tract infections, skin diseases, and acute gastroenteritis.

The department has readied vaccinations for distribution and profiled women of reproductive age for possible provisions of family planning services, while pregnant women and lactating women are ensured of health services such as prenatal check-ups, multivitamin supplies and breastfeeding counselling.

Medicines and drugs are also on standby in case the need arises. Tents, water disinfectant solutions and hygiene kits are also distributed.

A total of Php 37.8 million worth of logistics and financial assistance have alreay been given to the displaced residents. MIMS

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