Bangalore, India, 26th Feb 2001

"Community – wise rehabilitation and People's participation should be the focus in rehabilitation."

"Community-wise rehabilitation and people's participation should find central places in the long-term rehabilitation programme", says Oxfam India in its rapid need assessment report and long-term intervention plan for the earthquake affected areas. Oxfam India is a leading disaster relief, humanitarian and development agency that pressed its services in limited pockets of Gujarat that was shattered by a killer earthquake on January 26th. The report titled - "Gujarat earthquake: Healing the wounds"- calls for a people-centric long-term rehabilitation plan for the area.

"Physiotherapy based intervention to respond to the needs of the physically disabled (especially the paraplegics and those with multiple injuries of spine and limbs); Psycho-social support for the traumatised communities; Access to appropriate information to build earthquake resistant houses with the active involvement of the survivors/ community and campaigns to achieve basic rights of the disaster affected will be the key challenges for those involved in long term rehabilitation", notes the report. Oxfam India, in association with the survivors, leading professional organisations, voluntary agencies and others has developed a long-term intervention plan for select pockets in Gujarat.

A multidisciplinary team that comprised of a leading physiotherapist, a gender and rights activist, a medical doctor, a social scientist and others conducted Oxfam India's need-assessment mission. The report was released today, exactly a month since the disaster shattered the lives and livelihoods of thousands of people across the western Indian state of Gujarat. "With summer about to step in, the already drought hit areas in the earthquake affected areas will have to bear the shortage of water. This must be dealt with extreme urgency", cautions the report.

There are over 90 paraplegics in the Civil Hospital Ahmedabad alone. This is not a case in isolation. With pelvic and spine fractures dominating the caseload in certain villages, the situation calls for their long-term rehabilitation. "Without physiotherapy intervention, the future of many survivors will end up in wheel chairs. In Marathwada, there are paraplegics awaiting rehabilitation even after 8 years since the killer 1993 earthquake. We need to act fast," cautions the report. Physical disability is not a visible agenda in the rehabilitation package. Many in villages will need physiotherapy assistance at their doorstep to get their normal movements back. "The situation calls for a community based rehabilitation", states the report.

"There has been an increased incidence of premature deliveries in some of the pockets. Anxiety levels are high amongst people". Quoting the case of Nancy Takkar, a 12 year young girl who was the lone survivor when the killer earthquake killed over 300 of her school mates, the report says that the community was initially passing through the "heroic-phase". Now they are in a "phase of hope and optimism", a short lived phenomenon. People can break up with small provocations sooner or later. Flash back memories of the tragic incident can lead to emotional breakdown.

The survivors need assistance to overcome trauma and subsequent psychosocial problems they face. Past experience shows that long -term impacts of psychosocial problems are many-fold. If not handled adequately by cultural, societal and family support, it could lead to long-term emotional problems. "In Marathwada, even after 8 years, at least 30 per cent of the affected survivors require continued mental healthcare. Independent studies point out that in Marathwada, there is a sharp increase in the incidence of alcoholism, up to five times than that of the pre-earthquake situation", the report quotes experts who had worked on this issue. According to sources, the government plans to make a short-term intervention lasting 6 to 12 weeks. "Past experience and our (Oxfam India's) assessment shows that the situation calls for a long-term psycho-social intervention, lasting at least for 12 to 36 months," says the report. Meanwhile, experts from National Institute of Mental Health and Neuro Sciences, Bangalore (NIMHANS) also calls for a long-term intervention.

Report also highlights the increased incidence of women's health problems and incidence of chicken pox, measles, respiratory complications and water-borne diseases amongst children. "With no gynaecologists and women doctors in the relief teams and no visible signs to correct the situation, meeting the health needs of the women will be a challenge. This calls for urgent attention", notes the report.

"A people-to-people exchange programme between community groups based in other earthquake affected areas of India (like Marathwada) and Gujarat will help to facilitate a people-centric rehabilitation. The planners and policy makers need to be innovative", notes the report. To call the attention of planners and to request them to be more sensitive to local realities and sensitivities, the report narrates the case of temporary tents that have come up in certain pockets. "The temporary tents that have come up in Adhoi spells disaster. It is a fire risk, lacks sanitation facility and was built without people's involvement. This top down approach must be stopped", suggests the report.

The report calls for the need to press-in the services of more veterinary doctors. It requests the media to be more alert when the rehabilitation phase begins. Efforts may have to be put to encourage the media to visit the other earthquake-affected places in India such as Marathwada, Uttarkashi and Jabalpur to report about the plight of the survivors even after so many years. This kind of reportage will help to put the issues in a broader perspective.

The report notes that many of the international humanitarian agencies are in Gujarat with a short-term agenda. It adds that the short-term interventions that most of these agencies make don't relate to field level realities. The situation calls for a long-term commitment. "Oxfam India feels that such agencies need to rethink and redefine their operational mandate to suite the local level realities. While we understand and caution the limited role of external aid agencies, we welcome a synergy between local community-based organisations and International agencies", adds the report.

The multidisciplinary need-assessment team conducted extensive field visits, especially to some of the less-publicised villages and focussed on some of the issues those are yet to attain importance. The team held extensive discussions with the survivors, NGOs and government officials, international relief agencies, health and other sector specialists and hospital authorities.

Oxfam India has formulated a long-term intervention strategy. The work plan for Gujarat have special focus on (a) Community Based Rehabilitation of physically disabled; (b) Psycho-social care; (c) information dissemination campaign on earthquake resistant houses, people-to-people exchange programme and construction of (to demonstrate) earthquake resistant community centres and (d) campaign for basic rights and a disaster management policy. These programmes are designed and will be implemented in partnership with the affected communities, professionals from the Indian Association of Physiotherapists, mental health experts, voluntary agencies, educational institutions; others like the St. Xavier's Social Service Society, Ahmedabad and collaborating agencies of Bangalore Response for Gujarat Earthquake. Oxfam India has approached ordinary people and select corporate houses for financial assistance to implement the programme. It also appeals for volunteers to work on this issue for the next one year.

"When the situation moves from relief to rehabilitation, the key challenge for humanitarian agencies is to shift gears from charity mode to advocacy and political action to attain basic rights", adds Oxfam India's report.