Cyclone Fani-struck Odisha is rebuilding itself brick by brick. Affected communities in temporary shelters are trying to move on, a month after the extremely severe cyclone hit the state. But for many, it is difficult to even fall asleep at night. The cyclone has taken a heavy toll on their mental health.

The fear of the raging storm and anxiety for their future is keeping the beleaguered population in affected areas, wide awake.

Extremely severe cyclonic storm Fani (Bangla for “snake’s hood”) battered the pilgrim district of Puri where it made landfall on May 3, killing at least 60 people. Thirteen other districts were also shaken up by the cyclone that packed wind speeds of more than 200 km per hour.

The aftermath of Cyclone Fani in Khordha district in Odisha on May 3, 2019. Credit: R Narendra/Reuters

Puri district’s Satapada, a town at the mouth of the Chilika lagoon, is in need of immediate mental health intervention, according to a team of mental health experts sent out by the state department of health and family welfare.

“It is becoming very difficult to come to terms with our loss,” said Pooja Naik, a young mother huddled together in a Satapada shelter with her family of nine. “We have surveyed the damage in our village after the cyclone died down and there is nothing left. I am not sure when we will go back.”

Naik, cradling her five-month-old, shuddered at the thought of another cyclone. She vividly recalled the whooshing wind, thrashing waves and swaying trees.

“We were brought here from our village on May 2 and since then we have been here,” Naik told Mongabay-India in a fly- and mosquito-infested room, her current home. “I have not had such a terrifying experience earlier. I feel like crying every time I think of the cyclone.”

In the adjacent room, septuagenarian Moili Naik was relatively calm. Displaced three times in recent years, Moili exclaimed she would have been dead if she had not moved out from her mud-and-thatch house. “This time around, the experience was really scary,” she said.

Director of Cuttack-based Mental Health Institute, Sarada Prasanna Swain, mobilised a team to map the mental health conditions of survivors. Swain observed that people are still on edge and in the absence of timely interventions, mental health issues may follow long after the disaster.

For example, a year after the 1999 Odisha super cyclone, the prevalence of post-traumatic stress disorder was reported to be 26% among affected adolescent girls. The persistence of PTSD was attributed to hopelessness and lack of adequate post-disaster psychological support.

A mother and child inside a relief camp. Credit: Sahana Ghosh/Mongabay.

“Our initial observations for Fani have shown that those who have lost properties, livestock and their business are in duress,” Swain told Mongabay-India, referring to the report he submitted to the government. “They are displaying symptoms of adjustment disorder, post-traumatic stress disorder and some are displaying signs of acute stress disorder. They are having sleepless nights, difficulty in maintaining a daily routine and social cohesion. They are depressed after observing destruction around them. Presence of mosquitoes has further added to their sleep deprivation.”

Swain and colleagues have drawn up intervention plans based on the level of psychological trauma the cyclone has caused in different pockets of affected districts.

The climate-health link

Studies have shown that in the aftermath of severe storms, survivors demonstrate a 25% increase in the onset of depression, according to Australia’s Climate Council’s fact sheet.

The fact sheet, which discussed the 2017 Cyclone Debbie that caused widespread damage in Queensland, notes that emotional stress can undermine the resilience of individuals and communities, placing further physical, emotional and financial burdens onto recovery efforts.

In 2005, the World Health Organisation emphasised how the December 2004 tsunami, that affected at least five million people in India, Indonesia, Maldives, Myanmar, Thailand, Seychelles and Sri Lanka, wreaked mental health havoc on communities.

Environmental stressors (hotter temperatures, long-term warming, more severe tropical cyclones) exacerbated by climate change have related to worsened mental health in the United States, recent research by scientists from the Massachusetts Institute of Technology found.

In Odisha, groups such as children, pregnant mothers, the disabled and those with pre-existing mental illness have been severely impacted in terms of mental health, explained Swain, adding that the impacts were more pronounced in areas that witnessed more damage from the cyclone.

Residents of Puri district, for example, seem more frightened than counterparts in other affected areas of the state such as Ganjam because, for Puri, Fani was a unique event, said disaster management expert Jayant Routray.

“Puri residents have not seen such ferocity earlier,” said Routray, who is an emeritus professor at Asian Institute of Technology in Bangkok. “They have limited experience in comparison to residents of districts such as Kendrapada who have seen such disasters since 1967.”

Odisha, home to 46 million people, has been struck by 128 recorded tropical cyclones in 200 years (1804 to 1999), including the supercyclone of October 28 to October 30, 1999, which killed approximately 10,000 people and had a 7.5-metre storm surge.

Livelihood loss

It’s a two-punch situation for the communities that compound their stress.

Displaced communities have to tackle both immediate problems such as access to water and toilets in cyclone shelters, and plan returning and rebuilding back home, Routray said.

Pooja Naik’s family, for instance, has lost all nine of their fishing boats to the cyclone. Initial government estimates peg the number of traditional marine fishing boats lost to the cyclone at 6,389 while three fishing harbours, six fish landing centres and five fish farms have also been lost in the storm.

Ratnakar Bhoi, a community leader boarding in the Satapada relief camp operating inside a government college, said that agriculture can longer be considered a livelihood option. “The soil is salt-encrusted now because of the storm surge so at least for five years we can’t bank on full-scale farming,” Bhoi said.

Saline water ingress has rendered the soil lifeless for now. Credit: Sahana Ghosh/Mongabay

According to the Intergovernmental Panel on Climate Change, the next century will see fewer tropical cyclones but an increase in theglobal proportion of tropical cyclones that reach very intense (Category 4 and 5) levels due to gradual anthropogenic (pollution caused due to human activity) warming.

Routray, who has extensively studied disaster preparedness and management practices in South and South East Asia, underscored Bangladesh’s experience.

“They are self-aware of the situation that will follow post-disaster,” he said. “People’s indigenous coping strategies have helped them reduce their vulnerability significantly from repeated floods. Even though the early warning system and forecast was robust for Fani, people were not well-prepared to adjust to the reality of the situation.”

The impending monsoons may make matters worse, said Routray.

Swain contends that a sense of stability can only be met with the restoration of their properties and by going back to daily life. “Quality and quantity of health service and relief work will tremendously influence psychosocial well-being in days to come,” he said.

Mental health in policy

Psychosocial support and mental health services are embedded in India’s disaster management framework. The National Guidelines on Psychosocial Support and Mental Health Services in reponse to disasters was released in December 2009 so as to provide overall guidance for efficient and effective qualitative service provision to survivors.

This document defined psycho-social support in the context of disasters as comprehensive interventions aimed at addressing a wide range of psychosocial and mental health problems arising in the aftermath of disasters.

Standed passengers wait for train services to resume on May 3. Credit: Rupak De Chaudhuri/Reuters

Routray batted for capacity development of community workers so that pop-up mental health clinics can be set up to address immediate needs.

“We have the knowledge and the policy instrument but transfer of knowledge and outreach is still weak,” Routray said.

Looking forward, Odisha has started building the capacity of local community workers such as Accredited Social Health Activists and other health workers to conduct interventions such as active listening, counselling and identifying symptoms of mental stress in the wake of a disaster.

“These activities will be integrated with relief work and co-ordinated with nearest hospitals for referral,” said Swain.

This article first appeared in Mongabay-India.