Wednesday, September 18, 2019

Psychosocial care for riot affected people: Challenges for the caregiver[1]

Joseph O. Prewitt Diaz, PhD
American Red Cross
Disaster Mental Health Consultant


The 2002 Gujarat riotswere a three-day period of intercommunal violence in the western Indian state of Gujarat. Following the initial incident, there were further outbreaks of violence in Ahmedabad for three months; The burning of a train in Godhra on February 27, 2002, which caused the deaths of 58 Hindu pilgrims returning from Ayodhya, is cited as having instigated the violence.

According to official figures, the riots ended with 1,044 dead, 223 missing, and 2,500 injured. Of the dead, 790 were Muslim and 254 were Hindu. The Concerned Citizens Tribunal Reportestimated that as many as 1,926 may have been killed.  Many brutal killings and rapes were reported, as well as widespread looting and destruction of property. 

In the aftermath of the violence, it became clear that many attacks had been focused not only on Muslim men, but also on Muslim women and children. The Psychosocial Support (PSP) project provided assistance to two refugee camps, Morjari Chowk and Charodia Chowk. Most of the clients were women and children. The women reported having been raped, and having observed violence against children. According to some refugees, children were killed by being burned alive, and those who dug the mass graves described the interred bodies as "burned and butchered beyond recognition.” The women survivors in the two camps reported that violence against women “consisted of forced nudity, mass rapes, gang-rapes, mutilation, insertion of objects into their bodies, cutting of breasts, slitting the stomach and reproductive organs, and carving Hindu religious symbols on women's body parts.he results of the project to date consist of psychosocial orientation to Red Cross fieldworkers. 

Indian Red Cross volunteers were trained in techniques of psychosocial first aid and self-care. The delegation provided staff care through everyday meetings in the morning and evenings. All the volunteers were asked to talk, paint or write, and to act out their fears and frustrations in a controlled two-hour session every third day. 

A cadre of twenty-two IRCS psychosocial support trained workers served in a community support role. Meetings were also held with workers from other agencies operating in Ahmadabad to share information about psychosocial worker orientation and worker self-care. Following the departure of the psychosocial delegation in April 2002, the project was put on hold until a permanent PSP delegation could be appointed.


This is an attempt to report some of the experiences of caregivers working among the riot affected people, predominantly women and children. This delegate had direct interaction with the PSP volunteers during daily meetings and training activities. In addition, I accompanied them to the two refugee camps on three occasions where I interacted with the affected people. 

People living under the shadow of communal conflict experience stress and consequent behavioral changes. The stress is caused by a series of situations. The violence inflicted upon people in a situation of conflict prevails in different forms over a long time. The loss of family members and friends, and damage to property are just two aspects of the bitter experience. Fears of continued violence by other community members and solid segregation in the public domain are some of the reasons for anxiety and stress.  The following sections examine the situation and stressors uncovered by the volunteers while interacting with the affected community.

The anxiety of being hounded

The violence inflicted on the survivors keeps reminding them of their traumatic experiences; they cannot forget those instances. Every discussion in the social sphere brings more depressing news. The communal hatred and prejudices are so deep-rooted that the affected people of both communities are not ready to accept each other. A sense of anger and hatred is expressed by one community member to the other community as a whole. The faith and trust toward the community to which the perpetrators of violence belonged have been shaken and replaced by animosity and distrust.

Being a secondary citizen and refugee in one’s own place

In a communal conflict situation, taking shelter in a relief camp makes people feel as if they have been designated as “refugees.” The difficult living conditions, such as cramped space, lack of privacy, and improper hygiene, further deepen the feeling of loss of citizen status in one’s own village, city, and state. The policies, including enrollment in the camp, daily dependence, and uncertainty of aid to run the camps, often irritate the inmates.

The constant fear of further reprisals at the hand of the state leads to continual insecurity and anger among the affected community. Many who have actually faced such hostility from the state’s arms, such as police and neighbors, feel acutely pained that they are not looked upon as citizens of the state. 

The affected community is often driven out of their homes and villages, and yet many have bravely stayed on. However, they do fear for their lives and safety.

Disturbed life routine

For the people who come to stay in the relief camps, life changes drastically. Their daily routines and lifestyles are completely disrupted. People find difficulty in performing even the simple everyday routines that they were an integral part of their lives. This offends and hurts the people deeply.

The constant intrusion into their privacy is a source of tension for the people. This lack of privacy has different implications for different people. For the women it is a shock because many had previously observed “purdah”, a cultural and religious practice that involves the seclusion of women. Some women in mourning are not emotionally ready to meet others. Living in the open in a camp distressed and offended them greatly. For men the continuous stay in camps meant an increase in sexual frustrations. The adolescent boys were now at a stage of sexual awareness and the camps gave them plenty of proximity to girls of their age, something they were not accustomed to in their earlier lifestyles. 

Women have great difficulty maintaining their personal hygiene, especially when they have their menstrual cycles. Several women experience disturbances in their monthly cycle, which is the effect of the traumatic experience. Pregnant women and women with newly born babies are especially at risk to infections and do not receive the required pre- and postnatal care. Overcrowding and the vagaries of the weather may worsen matters.

Children have little space to play. They are no longer able to attend their old schools or appear for their exams, causing them to lose those precious academic years of study. The relief camps do not provide an appropriate environment for studying. There are constant worries, especially among the older children, about their education. Several children had been witnesses to the horrific rapes and killings of family members and friends. Some had even fought the mobs alongside other family members. Nightmares and sleeplessness were common occurrences. They would cry at the very mention of those who were near and dear to them. Others were unable to comprehend the tragedy that had struck them and were numb and silent.

As the children were displaced from their old localities and schools, they missed their old life and were not happy with their current circumstances. The sudden displacement from their homes perplexed many younger children initially. Their parents had quickly taken them away to relief camps, leaving behind their homes and all their possessions. The terrifying experience of witnessing violent crimes devastated the children emotionally, as they had not yet developed the emotional maturity to deal with their feelings. This was manifested in behavior such as constant weeping or clinging to their mothers and other family elders. Some had become silent and were terrified to be alone or in the company of strangers. Many developed feelings of vengeance toward the other community and the perpetrators of violence. Certain incidents might trigger off hidden fears and expressions of violent behavior.

The days are usually spent sitting idly. This free time has no value attached to it. The people have no work to occupy them; instead they brood over their conditions, which in turn, only cause them greater distress. 

Displacement into relief camps is usually sudden and forceful. People fleeing for their lives have no time to save their homes or their assets. Therefore, when they resettle into new lives they have to start from scratch. Often they are unable to pick up pieces of their old lives, and the effort to do so only exhausts them emotionally. For instance, most displaced people had a sufficiently stocked home. Due to loss or lowering of incomes, they must now manage with much less than they once had. A woman must now manage with just one pot and a couple of plates for a family of six. These day-to-day difficulties create tensions within the families. The affected people may also become irritated by their new houses, which are often inferior to their original homes.

Uncertain future

The affected people want to resettle in ghettos, as this brings a sense of psychological safety. Some shift to their old places or begin looking for newer localities, which are perceived as “safe.” Many now live with friends and relatives or stay in rented houses while their new houses are being built. 

The shift to new localities snaps old social and economic ties of affected people. Their old friends from the other community are no longer perceived as friends. As families are displaced, they lose contact with their extended family or get distanced from them. In several instances, wedding engagements are broken due to deaths or lack of finances to arrange the ceremonies. This can cause immense anxiety among the parents.

With the typically employed members of the family out of work, it is difficult to make both ends meet. The avenues of employment have become greatly reduced. They slowly lose hope of finding regular employment. Those who were gainfully employed before the violence now sit idly. At times men and youth who have been unemployed for a long period of time may display unusual anger and aggression toward family, friends and the wider society.

A feeling of helplessness exists among the people as they feel that they are unable to control their lives and their futures. They may continue to live in the city or the state due to certain factors; however, the fear of persecution still persists. From a broader perspective, they worry for their safety in public life.

Seeking justice

The affected community feels immensely angry, hurt, and betrayed by the participation or support of the violence by their friends and neighbors of the other community as well as by the apathy of the wider section of the other community to their suffering. They are skeptical of the process of justice as they see the perpetrators go free while the people from the affected community are continually harassed by the police.

Those affected often fear state reprisals. The police are effectively used to harass and terrorize displaced people. They feel severe anxiety for family members who are continually harassed by the police. Young boys and men are losing out on educational opportunities and work as they wait without hope in jails. Innocent victims have been incarcerated on false charges. The process of legal compensation and justice has been slow. In fact, the victims are not spared from constant police harassment. For instance the victims of gunshot wounds are rounded up by the police on charges of creating trouble and rioting and then further jailed or harassed. As the police also instigate and abet the violence, they are looked upon as more of a foe than a friend. The fear of police harassment has forced people to shift residences or stay away from work and colleges, thus exacerbating the tensions in their lives.

The delay or denial of justice and constant harassment increases mutual suspicions between the affected community and the other community.

Continual fear and insecurity

As discussed previously, the affected community does not feel safe and comfortable in their present situation. Their constant fears and insecurities are a hindrance to normalization. The emotional ties between communities have become severed and they are fearful of one another. This reinforces mutual prejudices and distrust. 

Therefore, the caregiver should strive to bring about community interaction and not confine oneself to looking at individuals. Individual counseling would have serious limitations in the present situation of fear and insecurity.

Degree of vulnerability of members of the affected community 

The violence was brutal and it has left its marks on all, the survivors as well as the witnesses to the tragedy. The effects of the violence differ depending upon the degree of vulnerability. The children, single women, women who lost their husbands and are now the sole bread winners of their family, women subjected to sexual violence, older women and men, especially those who have no one left to care for them, and those disabled in the violence all have reacted differently depending upon the age and the type of violence and suffering inflicted on them. Several individuals were predisposed to emotional instability and they have suffered further.

For women who now must shoulder all economic responsibilities, the trauma is very severe. They have had to cope with the loss of their husbands and other earning members of their family and also make efforts to keep themselves strong to maintain their family. Therefore, while on the outside they perform their new roles, inside they remain emotionally fragile. They have developed symptoms such as loss of appetite and disturbed sleeping patterns. 

Psychosomatic symptoms, such as pain or loss of movement in limbs, paralysis, blurring of vision, etc. have been noticed more in older women and men.

The older men are filled with a very high anger and often lose their tempers without provocation. They feel helpless to control their lives and have a high sense of hopelessness. Many have lost interest in life. Those who were inclined to praying and fasting feel a great sense of injustice and betrayal. Many feel suicidal. 

The significant point to note is that as for most of the people, the attacks of such a violent nature were a first-time experience; therefore, they had to develop new coping mechanisms. They did not know how to cope with the anger and fear generated by this experience. 

Complexity of the issue 

Man-made disasters create extremely complicated situations; therefore, the caregiver has to be extraordinarily sensitive especially to the affected community’s customs and symbols. The atmosphere of mutual suspicion and distrust makes it difficult for the affected community to accept support from the other community. If the caregiver belongs to the other community, there would be some degree of resistance from the affected community. The community’s perception of the caregiver is an important factor in their relationship. The way that a caregiver relates to the people assumes significance here.  


We were able during this assignment to ascertain the emotional needs of the survivors in two refugee camps.  The population with whom we interacted was traumatized by factors briefly explained in this report. Assistance and direct involvement in the aftermath to this man-made event is beyond the scope of the current American Red Cross. The Seville Agreement clearly specifies the roles of the Red Cross partners during disasters and internal conflicts. 

It is recommended that the American Red Cross (1) continue to meet with local partners, movement partners, WHO, and the National Institute of Mental Health and Neurological Sciences; (2) develop a training center for the Indian Red Cross Society volunteers that includes training in psychological first aid and community support techniques, develop simple tools in conjunction with the affected people that will facilitate the material dissemination, and train personnel (initially the First Aid volunteers from IFRC currently deployed in the earthquake affected area; and (3) collaborate in the empowerment of survivors by providing technical and financial assistance as needed to promote livelihood activities among the survivors. 

[1]Dr. Prewitt Diaz is a Disaster Mental Health Delegate for the American Red Cross. He serves as a technical advisor for the Indian Red Cross Society. He is the only ex-patriate personnel working on the Ahmedabad Riots Recovery Program. He was posted at the Red Cross in Ahmedabad, Gujarat from March 1, 2002 to April 3, 2002.  

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