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| Journal of the New Zealand Medical Association,
29-June-2012, Vol 125 No 1357
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Mohamud Osman, Andrew Hornblow, Sandy Macleod, Pat
Coope
On 4 September 2010, at 4:35am local New Zealand time, the
city of Christchurch experienced an earthquake of magnitude 7.1 on the Richter
scale. The epicentre of the quake was 40 km west of Christchurch at a depth of
11 km.1 Many residents suffered serious damage
to their property, with thousands of homes temporarily or permanently
uninhabitable, but miraculously no fatalities were reported. After the September
4 earthquake, there were regular ongoing aftershocks which ranged between
magnitudes 2 and 5 on the Richter scale.
On 22 February at 12:51pm the city was devastated by a
second major quake, measured at 6.3 on the Richter scale; the epicentre was
10 km south-east of Christchurch at a depth of just 5
km.1 This resulted in widespread further
destruction to property, including the destruction of much of the central
business district, and a final death-toll of 181, making it the second-deadliest
natural disaster recorded in New Zealand.2
Earthquakes may cause profound emotional and psychological
trauma to thousands of people.3 Livanou et
al4 investigated the level of post-traumatic
stress disorder (PTSD) in 157 Greek survivors of the 1999 Parnitha earthquake in
a 4-year follow-up study. They concluded that there is an association between
exposure to a traumatic event such as an earthquake and the development of PTSD.
Maldonado et al5 conducted
a longitudinal survey in Guadalajara, Mexico, to examine the factors associated
with acute stress reaction. Their results showed that exposure to traumatic
events such as an earthquake increases the risk of developing anxiety-spectrum
disorder.5
Refugee communities are part of the spectrum of Christchurch
residents affected by the quakes. The definition of “refugee”
according to the United Nations Refugee Convention, 1951 is:
“any person who, owing to well-founded fear of
being persecuted for reasons of race, religion, nationality, membership of a
particular social group or political opinion, is outside the country of his
nationality and is unable or, owing to such fear, is unwilling to avail himself
of the protection of that country; or who, not having a nationality and being
outside the country of his former habitual residence as a result of such events,
is unable or, owing to such fear, is unwilling to return to
it.”.6
New Zealand has had a long-established custom of welcoming
refugees from around the world. Refugees can come to New Zealand as
asylum-seekers, through the United Nations High Commissioner for Refugees
(UNHCR) mandated quota programme, humanitarian migrant intake or the family
reunification programme.7 There is an existing
body of research which has consistently documented that refugees are more likely
to experience PTSD due to past traumatic events or political
violence.8 There is also evidence of the
resilience of former refugees.9
The 4 September 2010 and 22 February 2011 Christchurch
earthquakes and subsequent continuing aftershocks have had a significant impact
on the Christchurch population as a whole, but, arguably, particularly on
refugee communities whose location, circumstances or past history have made them
more vulnerable.
In this study we investigated how the refugee communities
responded to and coped with the 4 September and subsequent earthquakes.
MethodA total of 105 former refugees aged over 18 years, who
were living in Christchurch at the time of the 4 September 2010 earthquake, were
systematically selected every 1 in 3 from a list of 317 refugees provided by the
Canterbury Refugee Council. The participants were drawn from five ethnic and
geographic groups of former refugees, representing major and different
communities; Afghanistan, Kurdistan, Ethiopia, Somalia and Bhutan. It may be
noted that earthquakes are very rare in the Horn of Africa, though not
infrequent in Afghanistan, Kurdistan and Bhutan.
Former refugees belonging to any of these groups were
eligible for inclusion in the study provided they were resident in Christchurch
at the time of and following the 4 September 2010 quake. Potential participants
who had been selected for the study were contacted individually and invited to
take part by completing a questionnaire regarding their experience of the
September 4 earthquake and aftershocks, and how they had coped. All those
contacted agreed to participate and so, after obtaining verbal consent,
information sheets and consent forms were posted. Each interview lasted not more
than one hour. All interviews were conducted by the first author, who was
himself from the Somali refugee community, and, for the subjects comfort,
conducted in their home.
Interviews were structured, with a 26-item
questionnaire which included questions on the participant’s experience of
and response to the quakes, their coping processes and level of support, past
experience, and demographic information. The questionnaire used a 5-point Likert
scale (1=‘not at all’ and 5=‘extremely’).
After the 22 February 2011 quake, and part way through
the study, just under one-third (N=33) of the sample evacuated the city and were
lost to the study before being interviewed.
All statistical analyses were done using statistical
(SPSS) software; significance being determined from use of the Chi-squared
(χ2) and Mann Whitney U tests at a 5%
significance level.
Ethical approval for the project was given by the
University of Canterbury Human Ethics Committee.
ResultsAfter the devastating 22 February 2011 earthquake, and part
way through the study, just under one-third (N=33) of the sample evacuated the
city and were lost to the study. Participants lost to the study were mostly from
Kurdistan (N=16) and Afghanistan (N=13); most were male and employed, and all
were in the age range 25–39 years.
This loss of participants may have biased our results in
that it is plausible that those leaving Christchurch may have been more severely
affected than those remaining. However it was reported in the media that about a
third of the residents of the city departed at this time. Most have since
returned. As the circumstances in which the participants fled could not be
controlled the best option we had was to continue interviewing those who wished
to stay and take part in the study.
Seventy-two participants (69%) out of 105 completed
interviews; 40% from Somalia, 19% from Bhutan, 14% from Ethiopia and Kurdistan,
and 13% from Afghanistan. Table 1 shows some demographic characteristics of the
participants broken down by their country of origin.
Table 1. Demographic characteristics of 72
Canterbury former refugees exposed to the 4 September 2010 and 22 February 2011
earthquakes
* Students are classified as being those in schools,
tertiary education or language centres.
Table 2 compares how the former
refugees responded to questions on to their level of worry, fear, coping, damage
experienced, access to information and help received following the Canterbury
earthquakes. More than 85% of Kurdish, Bhutanese, Ethiopian and Somali refugees
were very worried after experiencing constant aftershocks, whereas Afghans were
less worried (33%).
Across the ethnic groups, the only significant differences
related to worry (χ2=16.734, df=4,
p=0.02), feelings of helplessness
(χ2=28.859, df=4, p=0.025), and disturbing
thoughts or images about the earthquakes
(χ2=32.973, df=4, p=0.007). Afghan
participants, predominantly young single males, were less worried and had fewer
feelings of helplessness than other ethnic groups. Participants from Bhutan,
Ethiopia and Somalia had more disturbing thoughts than those from Afghanistan
and Kurdistan.
Analyses by marital status and gender, using a cut-off score
of 3, indicated that married participants with children were more likely to
suffer from high levels of worry and anxiety than participants who were single
(U=392.5, p=0.012), and more women were highly anxious than men (73% and 39%
respectively, U=396, p=0.002).
Worry levels varied with age as the younger participants
aged 18-24 were relatively less worried compared to older participants 40+ (58%
vs 96%, χ2=20.9, p=0.007). Additionally,
in term of occupation and experiencing fear, students reported having a higher
level of fear compared to employed and unemployed participants (88% vs 56% and
54% respectively) though the differences were not statistically significant
(χ2=9.2, p=0.34).
When we assessed the impact of the earthquakes on the
remembering of past traumatic experiences, also how well participants were
prepared, we found that 72% of participants had never been exposed to traumatic
events or natural disasters before, nor had they any emergency supplies for
natural disasters. In addition, the majority of Somali (83%) and Afghani (67%)
participants used spirituality and religious practices as a form of coping
mechanism post earthquake experience, these coping mechanisms also being
important, tho’ to a lesser degree, for Ethiopian (47%), Kurdish (43%) and
Bhutanese (21%) participants.
Twenty-nine participants were interviewed after the second
major earthquake on 22 February 2011 and so we were able to compare their
responses with those of the 43 participants interviewed prior to that earthquake
(Table 3). Differences between the two groups were not statistically
significant, except on the fear question. When participants were asked what has
been their biggest fear 83% feared death and had concerns for their family
safety after experiencing the 4 September 2010 earthquake, 100% after the 22
February earthquake (U=414, p=0.016).
Despite the worry about aftershocks, when participants were
asked to score their level of coping from 1–5 (1=not at all and
5=extremely), over three-quarters of all participants scored 3 or more. Over 80%
of all participants did not receive help or support from the City Council or
Earthquake Commission, and over two-thirds reported difficulty in accessing help
and information.
Table 3. Percentage of responses comparing
former refugees interviewed before and after the 22 February
earthquake
Note: All
percentages are for responses scored 3 or more on the 1–5 scale, except
those marked by an asterisk which indicates yes/no questions.
DiscussionThe 4 September 2010 and 22
February 2011 earthquakes and subsequent aftershocks have had a significant
impact on the Christchurch population as a whole, including on refugee
communities whose location, circumstances and past history has arguably made
them more vulnerable.
The dead and injured in the
22 February earthquake included members of the close-knit refugee communities,
adding to the overwhelming feeling of the earthquakes and aftershocks as a
devastating and ongoing experience generating high levels of worry and anxiety,
challenging personal resilience and coping resources.
The survey was designed for
five former refugee groups in Christchurch, chosen because they represented the
majority of the refugee population in the region. The aim initially was to
investigate how they coped after the 4 September earthquake, assessing the level
of anxiety across the groups, whether their experience of the earthquake and
subsequent aftershocks reminded them of past traumatic experience and how
supportive the local services were.
The Somali, Afghani,
Bhutanese, Kurdish and Ethiopian participants were systematically selected from
the refugee contact list provided by the Canterbury Refugee Council to reduce
the effect of selection bias. Following the 22 February 2011 earthquake 30% of
the participants excluded themselves from the study as they left Christchurch
and could not be traced. However the initial sample size of 105 was adequate,
though the impact on the results of the loss of 33 potential participants is
unknown.
The circumstances in which
the participants fled the city could not be controlled and the best option we
had was to continue interviewing those who wished to stay and take part in the
study.
Distressing and ongoing worry
and anxiety, hyper-vigilance in expectation of further aftershocks, feelings of
helplessness, disturbing earthquake-related thoughts and images, and fear of
further earthquake trauma were the norm across all ethnic groups in the study.
The Afghani participants were
the least anxious compared to the other ethnic groups, perhaps because over
two-thirds were young and single and our results have shown that younger
participants without family responsibilities were less worried than older
married participants. Also, earthquakes occur occasionally in Afghanistan, and
thus this population has prior earthquake knowledge and experience.
Married participants with
children were more anxious than single participants, and females were
significantly more anxious than males. Other studies indicate that females are
more likely to experience anxiety following earthquakes than
males8,10 and a May 2011 Christchurch media
report also indicated males to be less worried than females, 55% compared to
71%11. Other research reports parents as being
more psychologically affected by earthquakes12.
In terms of occupation and
experiencing fear, while our study suggested that students were more likely to
experience fear compared to employed and unemployed participants, these
differences were not statistically significant. Whether or not students
participating in our study were personally affected by the deaths of a group of
students in the 22 February earthquake is unknown.
The possibility that the
Christchurch earthquakes might remind participants of past trauma or distressing
experiences was considered in the development of our survey. It is noteworthy
that 72% of participants in our study reported having no prior experience of a
traumatic event or natural disaster, and responses to open ended questions in
our study indicated that the Christchurch earthquakes did not reactivated
memories of earlier experiences.
Three quarters of
participants reported coping either satisfactorily or well after both the 4
September 2010 and 22 February earthquakes, this being attributed by many of the
participants to their strong cultural beliefs and spiritual practices. Religious
and spiritual beliefs have been identified as an active form of coping which
decreases the level of stress and improves the acceptance of challenging
situations13. Whatever the mechanisms of
psychological and social support, the high level of coping reported is a tribute
to the resilience of the refugee communities.
A limitation of this study
was the lack of a control group which could compare support of refugee and non
refugee communities. Nevertheless, access to appropriate support was a major
issue for participants. The majority of the participants (80%) did not receive
support from local government or the Earthquake Commission, and it took some
time for them to access help, two-thirds having difficulty doing so.
The low support from
mainstream agencies could be an added factor influencing the level of anxiety
among the refugee communities. The language barrier could also be an issue, as
some refugees are not confident enough to call for help, relying on family and
friends for support when difficulties or crises arise.
The issue of barriers to
access to care has been raised in previous New Zealand
research,14,15 and the resourcing of health
sector responsiveness to the needs of refugees resettled in New Zealand has been
highlighted in a recent policy review.16 The
apparent difficulty in accessing information and help which the participants in
our study experienced is cause for concern.
In New Zealand’s
increasingly diverse society, and particularly in circumstances such as the
recent Christchurch earthquakes, more engagement by both national and local
services is needed to build trust and cooperation between the communities of
former refugees, also other ethnic minority groups, which are an increasingly
significant part of our wider community.
Competing interests: None
declared.
Author information: Mohamud Osman, Graduate
Student, Andrew Hornblow, Adjunct Professor; Sandy Macleod, Adjunct Associate
Professor ; Pat Coope, Statistical Advisor; Health Sciences Centre, University
of Canterbury, Christchurch
Acknowledgements: We are particularly
grateful to those former refugees who participated in this study and thank them
sincerely for their patience and responsiveness; we are also grateful for the
support of their communities. Special appreciation is extended to Mr Ahmed Tani,
Chairman of Canterbury Refugee Council, for his initiation of and contribution
to this project. We are grateful also to Partnership Health Canterbury (PHO) for
encouragement and support throughout the study and funding of a summer
studentship for the first author.
Correspondence:
Professor Andrew Hornblow, Health Sciences Centre, University of Canterbury,
Private Bag 4800, Christchurch 8140, New Zealand. Email: andrew.hornblow@canterbury.ac.nz
References:
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