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    Tsunami Aftershock: Grief, Sickness

    Disease, Mental Health Woes Yet to Peak as Tsunami Disaster Continues

    Tsunami Aftershocks: Disease continued...

    This is far more than enough. But it's not all. Long before the tsunami, most of the affected areas suffered from mosquito-borne diseases -- malaria and dengue fever in particular. The waves have receded, but they've left huge pools of stagnant water in their wake.

    "Think of the explosion of mosquito populations and the explosion of malaria and dengue fever," Kozarsky says. "Those are huge items in a population where there may be a tremendous number of homeless people. These numbers may make the mortality seem low. If you say OK, in the tsunami we lost 70,000 people, disease may take a toll as great as that."

    Tsunami Aftershocks: Mental Illness

    Experts are only beginning to appreciate the mental health toll of huge disasters. Intense studies of recent disasters -- including Hurricane Andrew in Florida, the 9/11 attacks, and the 1988 Armenian earthquake -- provide startling numbers. A large proportion of survivors, Marshall says, will suffer major depression or posttraumatic stress disorder. Many more will get stuck in the worst part of the grieving process, a phenomenon known as complicated grief.

    "The mental health consequences of disaster are alarming," Marshall tells WebMD. "For adults with the worst exposure -- those who feared for their lives, or narrowly escaped losing life, or dealt with the most horrific aftermath such as having to bury loved ones -- the PTSD rate could be 30% in adults and 50% in children."

    The scale of this mental health tsunami is difficult to imagine. Marshall's estimates are based largely on studies of industrialized nations. Studies suggest that the mental health consequences of a disaster are even more severe in developing nations. Even in the best of times, these people have scarce resources.

    "What we cannot estimate now is how many survivors witnessed the horrific aftereffects of the tsunami," Marshall says. "It is expected that probably the majority of those people will recover if their social support systems are more or less intact. But when entire communities are affected, social support systems are devastated."

    Tsunami Aftershocks in America

    Those indirectly affected by disasters do not, of course, suffer anything like those in harm's way. But we are affected.

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