Summary
Background
The Aceh Province in Indonesia was the hardest hit territory in the world when the tsunami struck on December 26, 2004. Approximately 170,000 th people lost their lives and 600,000 lost their livelihood.
As the natural disaster unfolded in Aceh, there were about 185 persons of Acehnese origin residing in Norway. The majority had come to this country as UN refugees at different points in time during a seven year period prior to the tsunami. With the exception of one family, all lived in Rogaland county on the Norwegian west coast; in the municipalities of Time, Sandnes and Stavanger.
Objectives
The objectives of this study were to describe the background of the Acehnese living in Norway, to explore how the tsunami affected them, and to evaluate the assistance and support they received during and after the tsunami.
Methods
We carried out a questionnaire survey among Acehnese adults living in Norway in February and March 2006. A total of 82 persons took part, corresponding to 75 per cent of the adult Acehnese population in the country. We also carried out qualitative interviews, both with Acehnese individuals (n=30) and with representatives from municipalities, authorities and NGOs that had been involved in activities and interventions aimed at helping and supporting the Acehnese in the period after the tsunami (n=49).
Life prior to arrival in Norway
The Acehnese had experienced many potentially traumatising events in connection with the conflict in their home country, during their escape from Aceh and/or during their time as illegal immigrants in Malaysia prior to arrival in Norway. Close to 90 per cent reported that they had ever experienced a life-threatening situation. A similar percentage had ever been forced to live apart from their family members. 81 per cent had lived in hiding at one or more points in time, and 73 per cent had experienced war events first hand. Among males, 59 per cent reported having been exposed to physical violence and 38 per cent had experienced systematic torture.
Life in Norway
Life in Norwegian exile had been characterized by the process of adapting to a new country and culture, and worries about family members and friends back in war-torn Aceh. Many had weak social networks in Norway, and only 38 per cent were employed. When asked what they experienced as difficult in Norway, the most frequent answers were: problems finding a job (reported by 96 per cent), separation from family (96 per cent), concern for family and friends in Aceh (95 per cent), the impossibility of returning to Aceh in case of emergency (91 per cent), fear of being repatriated (87 per cent) and difficulty learning Norwegian (85 per cent).
Tsunami experiences
The sudden and unexpected news about the immense natural disaster that had struck Aceh was experienced as shocking and unreal by the Acehnese in Norway. The immediate reactions among people varied. Some cried, some became introverted and some were seemingly less emotionally affected. Many described feeling numb.
For a period of approximately two weeks it was practically impossible to get in contact with Aceh, and almost all of the Achenese in Norway lacked information about what had happened to family members and friends.
As the information gradually became available, it became clear that the number of people lost at home was very large indeed. Our study shows that each Norwegian Acehenese, on average, lost 20 persons: 10.2 family members and 9.8 friends. One third experienced loss of close relatives, i.e. parents, siblings, spouses, children, grandparents and/or grandchildren.
In addition to grieving for the dead, people were very worried for the survivors in Aceh. Their situation was extremely difficult, physically as well as psychologically. The Acehnese in Norway felt an intense desire to help them. Their primary wish was to return to Aceh to assist and be together with their loved ones. If that was not possible, they wanted for some of their affected family members to come to Norway.
The majority of the Acehnese did not succeed contributing in any of these ways. In practice, the possibilities of helping were limited to what they could do from Norway. Many of them saved money to send home, and many participated in local fundraising efforts. However, tension arose between the Achenese and Norwegian aid organizations because the former wanted money raised to be earmarked for relief efforts in Aceh, whereas the latter did not want funds to be restricted in this way.
Assistance and support
In the questionnaire survey, participants were asked who they could get assistance and support from in the period after the tsunami. The largest proportion mentioned the municipality authorities (44 per cent), followed by friends (41 per cent), NGOs (41 per cent) and family members (36 per cent). 13 per cent felt there was none they could get support from.
Only a relatively small percentage sought professional help. Eight per cent contacted their GP in connection with the tsunami disaster, whereas less than four per cent sought help from a psychiatrist or a psychologist.
Local activities and interventions
Activities intended to help and support the Acehnese were initiated in all the municipalities where they lived. Many of the interventions were carried out in collaboration between local authorities and NGOs. Personnel working with refugees on a daily basis were key persons in initiating and carrying them through.
Interventions included meetings and gatherings, personal contact, memorial services, coverage of communication costs, interventions at schools and kindergartens, fundraising, as well as other things. The scope and design of the interventions varied from municipality to municipality:
• In the municipality of Time , contact between local government employees and the affected Acehnese was close and frequent. 24 hours after the first tsunami reports, all Acehnese families had been contacted by telephone. Later, home visits were made to the same families on three different occasions. Also, local authorities and the local chapter of Red Cross collaborated about an ‘open house’ where affected Acehnese could meet and receive counselling and information. The municipality also provided economic support for communication to Aceh via telephone and the internet.
• In Stavanger, the most pronounced intervention was the ‘open house,’ established and operated jointly by local authorities and the Red Cross the day after the tsunami. The refugee section of the municipality contributed with outreach activities and one-on-one counselling. Free phone and internet access was made available. Schools, kindergartens and introduction programmes were focused on the affected persons and families.
• In Sandnes, employees of the introduction programme kept close contact with the Acehnese students both day and evenings. The reception office for refugees played a more modest role. The overall scope of interventions was less in Sandnes than in the other two municipalities.
National authorities
The central authorities had a modest focus on the situation among the Acehnese refugees in Norway in the period after the tsunami. This was rather different from the attention given to Tamil immigrant groups in Oslo during the same time period. The ‘Tamil Resource and Guidance Centre’ (Tamilsk ressurs- og veiledningssenter; TRVS) received direct professional and economic support from the Directorate of Health and Social Affairs, and Tamil representatives were invited to several meetings and discussions at ministry and directorate levels. There were no similar interventions targeting affected individuals of Acehnese origin.
There was, however, one government-funded intervention that also included the Acehnese: a memorial travel assistance program. Up to two persons from any family that had lost close family members (parents, spouse, children and/or siblings) due to the tusnami could apply for financial travel assistance. The intent was to support visits to countries of origin, but for the Acehnese memorial journeys to Malaysia (were many in the group had lived before coming to Norway) were also approved.
Among the Acehnese who participated in the questionnaire survey, 83 per cent indicated that they would have liked to apply for travel aid. However, 51 per cent reported that they did not receive information about the program until it was too late to apply. Another 29 per cent did not meet the criteria for reimbursement. Eventually, of those that wanted to travel, only 19 per cent actually went on a memorial journey.
The majority that received travel aid went to Malaysia. They would have preferred to go to Aceh, but they were not yet Norwegian citizens and therefore did not have passports that allowed them to visit their country of origin.
Four persons did however travel to the Aceh province. They had either been granted citizenship prior to the tsunami or just afterwards. In some cases in the period immediately after the tsunami, citizenships were granted even though the applicants had not met the criterion of seven years of residency in Norway. Several of the interviewed Acehnese said that they were not informed of the possibility of applying for dispensation from the ordinary rules.
The Acehnese evaluation of help efforts
In the questionnaire survey, the Acehnese were asked to evaluate the support and help they had received after the tsunami. More than half (54 per cent) indicated that they were discontented, either “very discontented” (29 per cent) or “a little discontented” (25 per cent). Only 26 per cent were “contented” (15 per cent) or “very contented”. The remaining 20 per cent answered “medium”.
There are, of course, no interventions that can replace or make up for the loss of close friends or family members, and in a situation characterised by loss and crisis it can probably not be reasonably expected that a large proportion of people feel “contented”. The poor assessment must partly be seen in this light.
The criticism was, however, rather strong. It was primarily aimed at the memorial travel assistance programme. The strongest felt need among the Acehnese was to go to Aceh to help provide support to surviving family and friends, and they viewed the travel support arrangement as a very good intervention. Their disappointment was therefore great when they only later found out about it, and that so few had been given the opportunity to benefit from it. The Acehnese found it hard to understand why they had not been better informed about the existence of the program, why one had to have as long as three years residency in Norway to qualify for it, and why support was only given to two persons per family. They felt that the last restriction made it difficult for families with children to benefit from the arrangement.
The majority who undertook a memorial journey assessed it as a positive experience. We found that 67 per cent of these experienced feeling better during and after the trip, than they had felt before.
At the time of this survey, very many of the Acehnese expressed a strong wish for an additional period of travel support.
Mental health after the tsunami
Many Acehnese still experienced strong grief 15 months after the tsunami. This study also shows that the mental health burden was weighty among many. More than ¾ of the participants in the questionnaire survey had symptoms of assumed clinical significance as assessed by GHQ-28. Four out of ten met the criteria for PTSS-12 ‘caseness’, a measure of post-traumatic stress symptoms.
There were statistically significant relationships between traumas earlier in life and symptom load, and between exile-related problems and symptom load. On the other hand, no significant differences were found between those that had lost close family members in the tsunami and those that had not.
Discussion
The relative strengths and weaknesses of the interventions targeting the Acehnese in the period after the tsunami are discussed here.
Relative strengths
• Locally, there was a considerable mobilisation of help. Municipalities as well as local NGOs got involved in the situation and helped create good frameworks for dealing with trauma, provided spaces to be together and talk, and supported efforts to obtain information.
• Cooperation between public and private actors worked well.
• Many individuals made significant personal contributions in the situation, among these were employers and colleagues.
• The central authorities contributed through the establishment of a memorial travel assistance program.
Relative weaknesses
• Although the mobilisation of help was good on the local level, it did not adequately meet the felt needs in the target group. The felt need, and intense wish, among the Acehnese in Norway was to find ways in which they could be of assistance to the affected people in Aceh. The assistance they received, on the other hand, consisted of activities designed to help them, the Acehnese in Norway themselves, get together, talk and obtain information. Many reported that although these interventions were useful, they were still not the help they considered most important. The imbalance between felt needs on the one hand, and the actual help provided on the other, was the main reason why the Acehnese evaluated the interventions as being poor.
• Instead of systematically approaching the entire minority ethnic environment in Norway that might have been affected by the tsunami, the central authorities primarily focused on the Tamils in Oslo. Towards this group, they even got involved on an operational level. The very strong focus the authorities had on the Tamils in Oslo, may in part have been responsible for the weak focus on the situation among the Acehnese in Rogaland.
• The fact that so many of the Acehnese were unaware of the memorial travel assistance program implies that information about the arrangement was insufficient.
• The memorial travel assistance program appears to have been insufficiently funded. The funds ran out even though many Acehnese did not know about the program and never had the opportunity to apply. The budget was also considerably smaller than for a similar program targeting ethnic Norwegians affected by the tsunami. Whereas the total cost of memorial journeys for Norwegians was 11.7 million NOK (approximately 30,000 NOK per person on average), the budget for travel support for ethnic minorities was approximately 1 million NOK (7,000 NOK per person).
Recommendations
1. Renewed period with travel assistance. It is recommended that the authorities consider meeting the request for a new period of travel aid, as expressed by the Acehnese participants in this study. To arrange for new opportunities to travel now could contribute to better coping among affected individuals and families.
2. Medical care. In light of the significant psychosocial symptom load that has been uncovered through this study, the health services in Rogaland need to assess how they can currently assist members of the Acehnese exile community in the best possible way.
3. Evaluation. Based on the experiences from the 2004 tsunami, it is recommended that a process be initiated to evaluate and discuss how the authorities can become better prepared to handle situations where ethnic minority groups in Norway are affected by disasters or crises in their countries of origin. The process should involve civil servants from central, regional and municipal levels and include all relevant sectors and services. Some questions that ought to be discussed as part of such a process are proposed in the report.
The report also contains a detailed summary of lessons learnt.