With an official death toll expected to be in excess of 20,000 and devastation and personal loss having struck nearly every family in the earthquake region, one of the crucial aspects of the MSF intervention in Bhuj and the surrounding area is the development of mental health programmes to assist the local population come to terms with the consequences of the recent earthquake.

The emotional toll on the families there is, and shall be, enormous. In addition to the dead, hundreds of thousands have been made homeless and have lost all their posessions to the disaster.

In order to provide care to as many people as possible, MSF is training local professionals (nurses, teachers and social workers) who will remain in the earthquake region for the long-term. Their counselling skills are being developed; in particular, how to interact cope deal with trauma victims, and the mental effects severe trauma can create.

A total of 19 volunteers were in the first development group on Feb 3, 4 and they will be supervised throughout their work by MSF. Half of the group are survivors of the earthquake, and three of them were caught in the debris. After training the counsellors will start working in villages throughout the region.

In traumatic situations such as earthquakes, affected people often go through three phases.The first is the survival phase, where there is a lot of torment, grief and anxiety related to oneself and family members. Among elderly people, feelings of guilt are common, often due to surviving the disaster when so many young people did not.

Normally, the first phase is over in about a week. Aftershocks have prolonged this first phase, as a lot of people are still afraid the next tremor might kill them.

Then there is the later phase, the reality phase, when the reality of the disaster has sunk in. There will still be depressions, floods of intense emotions, stronger anger and fights, followed by the recovery phase, in which people have come to terms with what happened, accepted the facts and are going back to a normal life.