The number of individuals who have lost their lives to natural disasters such as earthquakes, storms, volcanic eruptions, and heat waves since 2010 is difficult to digest. Approximately 375,000 people have died, with the majority of deaths occurring in the 2010 earthquake in Port-au-Prince, Haiti. The number of individuals affected by natural disasters within this timeframe, however, is dramatically larger: scholars estimate that these events have touched at least 1.65 billion individuals.
Given their scope, power, and destructive capacity, natural disasters clearly pose complex challenges for both professionals and non-professionals in the medical, public health, and political arenas. These include the obstacles surrounding the initial and sustained delivery of medicine, health services, and infrastructure support, especially to those in the hardest-hit areas, and also the intricacies involved in the allocation of governmental funding and assistance. But despite the need for a great deal of support, national governments and public health teams often overlook or are late to appreciate the supportive roles that certain groups can offer, such as religious/spiritual institutions, organizations, and actors.
To complicate the issue further, religion and spirituality are relatively unexplored areas in the context of public health. Consequently, their roles in mediating post-natural disaster societal reconstruction and individual healing remain poorly understood. As a graduate student at Harvard Divinity School with interests in both science and religious studies, I dedicated a large portion of my time to understanding the ways in which religion and spirituality might contribute to and aid in the healing and coping process, and specifically to the mental health of natural disaster survivors.
Dr. Marife Grafin described mental health treatment or care in Tacloban City as only for the wealthy and educated.
In 2014 and 2015, with the support of the Harvard University Asia Center, I traveled to Tacloban City, Philippines, just over a year after Super Typhoon Yolanda/Haiyan ravaged the area. Scholars have characterized Yolanda/Haiyan as the strongest tropical cyclone in recorded history to make landfall. With winds over 180 miles per hour and a flood wave of up to twenty feet, it killed more than 6,000 individuals and left hundreds of thousands throughout the Philippines homeless. I learned first-hand of the disaster by Ms. Clyde Yvonne A. Clima, one of my valuable contacts in the area, and a member of Grace Baptist Church (GBC) in Tacloban City. Clima details the survival stories and testimonies of members of GBC in Strongest Storm, Sovereign God, a book that she recently co-authored and edited.
While in Tacloban City, I conducted several interviews with public health and community leaders. It quickly became apparent that survivors face a wide array of mental health issues, and that they, and especially children, will require some sort of psychosocial intervention. Dr. Marife Grafin, a nurse and program coordinator at Shalom Integrated Health Ministry, a mission of the United Church of Christ in the Philippines, described mental health treatment or care in Tacloban City as only for the wealthy and educated. She also noted: “I think very, very few people in Tacloban City will even recognize, even can recognize, for that matter, that they might be traumatized or depressed, but there are so many that are.”
Dr. Gloria Fabregas, head of City Health Cluster and in charge of psychosocial health services in Tacloban City, likewise recounted the events before and immediately after Yolanda/Haiyan. According to Fabregas, she was the only medical doctor at “ground zero” 48 hours before and 48 hours after the super typhoon unleashed its deadly effects. On the topic of mental health, Fabregas noted: “Yolanda/Haiyan has more than ever made me realize the importance of catering to the mental health of survivors via holistic and spiritual approaches.” When asked how exactly public health officials address the mental health needs of survivors in the context of religious or spiritual approaches Fabregas stated: “Unfortunately, we are just starting to institutionalize our mental health program. What needs to be done first and foremost is to create a multidisciplinary mental health program that is community based and that draws on the expertise of various fields such as religion and spirituality.”
At the institutional level, serving the mental health of survivors in Tacloban City is only in its preliminary stages, most likely due to limited resources and funds. But there are other important factors as well, ones that emphasize the importance of religious groups and institutions. I met with Venus Ecleo, holistic pastor and administrator at the Samaritan’s Purse field office in Tacloban City, to discuss the religious and specifically Christian side of mental health treatment in the area. Ecleo recounted: “After Yolanda/Haiyan, there were a lot of people in tears looking for a leader with whom they might be able to talk to about God. Many were asking whether this was some sort of judgment from God.” I asked Ecleo what approaches she had taken to address her communities’ mental health needs, and she responded that, “as with many cultures, but especially in Tacloban City, seeking out professionals for mental health needs is extremely taboo. The fact that I am from the Philippines and also a survivor allows me to connect with people on a deeper level. Sometimes I just hold their hands and other times do more structured things like stress debriefers or community discussions around Biblical scriptures in regards to disasters.”
Three takeaways stand out regarding my conversations with public health officials and community leaders in Tacloban City: first, public health professionals and institutions need more multidisciplinary community engagements; second, stronger knowledge of specifically religious or spiritual actors and organizations could enable broader and perhaps more effective post-natural disaster response efforts; and third, religion and spirituality’s role in people’s lives, especially when it comes to coping with mental health traumas, highlights the importance of engaging holistic healing approaches systematically. These hold for most countries and communities, though are particularly important for those with few resources and large populations of vulnerable people.
Even more crucial, however, is the willingness of a mental health system to utilize systems of aid, such as those provided by religious organizations, to streamline their health delivery processes.
A mental health system that is systematically willing to tap into the repertoire of skills that different religious communities offer has the potential to unite key resources that might otherwise be isolated or less effective on their own. Identifying the locality of each responder and organization, as well as detailing their roles in (mental) health delivery, is a feasible example of a step that could improve post-natural disaster response efforts in terms of efficiency and effectiveness. Dr. Grafin, for example, developed Touching Lives after the Storm, a program to assist Yolanda/Haiyan survivors medically, but also to train them educationally and spiritually on how to cope with their physical and mental health conditions. The benefit of the program, according to Grafin, is its location at a (Christian-affiliated) hospital where, theoretically, most people would go for their needs anyway. Whether survivors who aren’t Christian, who face differences in culture and traditions, or who struggle with a sense of mental health stigma feel comfortable seeking out those resources, unfortunately, remains unclear.
The training that public health officials and community leaders undergo is another area in which one can integrate strategies attentive to religious groups and practices. This training, for example, should include culturally and religiously diverse approaches, each of which could be further developed into psychosocial and mental health interventions. Even more crucial than this knowledge and training, however, is the willingness of a mental health system to utilize systems of aid, such as those provided by religious and spiritual organizations and actors, to streamline their health delivery processes. For places like Tacloban City, where doctors and resources are scarce, this is especially critical. A multi-faceted and combined system, though difficult, is still practical, and could enrich response efforts and health delivery on a much broader scale.
At the end of our interview, Dr. Fabregas noted: “I want to see a healthy individual, family, and community. But health is not only an absence of disease and mental health is not only an absence of mental illness.” She then followed with what I assumed was a rhetorical question: “When are we going to see a real, authentic answer for the survivors who are so dramatically affected by disasters?”
I now have a response to her question: if disasters mean situations in which people are unable to cope, teaching positive coping mechanisms to survivors is not only important but absolutely necessary. Perhaps religion and spirituality offer keys to unlocking the door to a more effective health system and healthier mental health world.
Bobby Brooke Herrera is a graduate student at Harvard T.H. Chan School of Public Health with research interests in immunology and infectious diseases. He recently graduated from Harvard Divinity School (Masters of Theological Studies, Philosophy of Science and Religion) and in 2008 from New Mexico State University (Bachelors of Science, Biology).
 Jude Mary Cénat and Daniel Derivois, “Assessment of Prevalence and Determinants of Posttraumatic Stress Disorder and Depression Symptoms in Adult Survivors of Earthquake in Haiti after 30 Months,” Journal of Affective Disorders 159 (2014).
 Matthew E. Kahn, “The Death Toll from Natural Disasters: The Role of Income, Geography, and Institutions,” The Review of Economics and Statistics 87, no.2 (May 2005).
 Seiji Yamada and Absalon Galat, “Typhoon Yolanda/Haiyan and Climate Justice,” Disaster Medicine and Public Health Preparedness (October 2014).
Tacloban City Stadium, one of the only structures in the area to withstand Super Typhoon Yolanda/Haiyan, served as a refugee center for thousands. Image courtesy of Amos Yeung