I - Introduction
a - General Overview
It is estimated that 200,000 people are currently housed in approximately 130 tented camps and prefab cities in all affected areas. As of 30 November 1999, a total of 10,960 prefab houses had been built and 4,283 handed over to families for their resettlement (20,000 people). As the manufacture of prefab houses is ongoing, people are continuously being transferred from tented camps to prefab cities. The Ministry of Housing plans to resettle all affected families in prefab cities by the end of the year.
For the above-mentioned provinces,
the following map indicates the locations of the main affected urban areas,
namely Bolu, Duzce, Kaynasli, Izmit, Golcuk, Adapazari and Yalova. A total
of 708,300 persons were registered in 1997 in these 7 cities.
On 25 November the first
heavy snowfall of the year was reported in Bolu Province. Freezing temperatures,
snow and heavy rains are considerably worsening the living conditions of
the homeless in affected areas. With temperatures dropping to minus 8 Centigrade,
the Turkish authorities still report a critical need for winterised tents.
c - UNICEF’s response and framework of activities
In consultation with the Government of Turkey (GoT), UNICEF developed a Recovery Plan for Turkish Children (RPTC) to immediately answer in an integrated manner the needs of children and women affected by the earthquakes. Valued at US$ 14.2 million, the RPTC includes relief and rehabilitation interventions in the health, nutrition, education, water, sanitation, and psychosocial sectors.
Activities are implemented through an integrated multi-sectoral approach, which aims at providing a friendly environment for children and their mothers in tented camps and prefab cities, using the concept of “Child Friendly Environment” as a model. The concept provides an integrated set of services to meet the basic needs of children and their mothers in various sectors, namely health, nutrition, education, water, sanitation, and psychosocial. In addition to relief interventions, UNICEF focuses on rehabilitation efforts and is actively advocating with government counterparts and humanitarian partners to ensure that all basic services are available for the affected populations. The following graph indicates the sectoral allocations of funds under the Recovery Plan:
The RPTC has been designed for a period of 6 months and is being implemented in all affected areas. To date, the international community through 13 UNICEF National Committees and 9 Governments answered generously to UNICEF Recovery Plan, and US$ 13.4 million have been pledged or received. UNICEF established a strong field presence, with over 16 staff deployed in the affected earthquake areas.
II - UNICEF activities
a - Relief activities in Kaynalsi
On 29 November 1999, the daily Turkish newspaper Sabah referred to UNICEF’s tent cities as “an exemplary place to live”. The camp in Kaynasli is serving 742 people and offers water, sanitation, education and health facilities, in addition to a Child Friendly Space where children and mothers are provided with psychosocial support. UNICEF also provided generators, blankets, stoves, plastic sheeting, sleeping bags, and wooden pallets to benefit most families of the camp. UNICEF is cooperating with the Ministry of Health and National Education, the Department of Social Welfare and Child Protection (SHCEK), the French Red Cross, the Turkish Psychological Association (TPA) and Caritas in providing services in Kaynasli.
b - Water and Sanitation
Valued at US$5 million, UNICEF interventions in this sector aim at providing safe drinking water and sanitation facilities in tented camps and prefab cities. To date, 15 water tankers, 6 of which on 24 hours double shifts, are operating in Adapazari Province and continue providing safe drinking water to over 100,000 people daily. UNICEF also supplied 2.8 million water purification tablets in all affected provinces. In addition, UNICEF installed 12 water and sanitation clusters to benefit 7,200 people in 12 tented camps in Bolu, Kocaeli, Sakarya, and Yalova provinces. Valued at US$ 35,000 each, a cluster benefits 600 people and offers 12 latrines, 10 hot water showers, 2 water tanks, and 2 septic tanks. Additional 36 clusters have been ordered and are under manufacturing for further installation in tented camps, prefab cities and schools.
As of 1st December
1999, US$ 2.56 million worth of equipment and materials have been distributed
in Bolu, Kocaeli, Sakarya, and Yalova provinces to support water and sanitation
interventions.
Valued at US$2.7 million,
interventions in this sector focus on the following areas: Expanded Programme
of Immunization (EPI), Nutritional Surveillance and Intervention Programme,
and Revitalization of Health Centres.
A child being vaccinated against measles in a tented camp in GolcukNutritional Surveillance and Intervention Programme:
Within the framework of the Recovery Plan for Turkish Children, UNICEF and its partners are addressing the nutrition problems through a combination of psychosocial interventions and more traditional nutrition interventions. The former aims at decreasing the psychological negative after-effects of the earthquakes on children, adolescents, parents and teachers to contribute, inter alia, to a renewal of appetite among affected population. The latter consists in the distribution of supplementary food to benefit 150,000 children and pregnant/lactating mothers, interventions for growth monitoring and promotion, breastfeeding, nutrition education, nutrition surveys, and control of daily diet and food hygiene in tent cities.
On 29 November 1999, the first consignment of 40 metric tons of high protein biscuits out of an order of 900 tons, was delivered in Izmit. Distribution through 79 schools for 37,800 students and health infrastructures for 8,600 pregnant and lactating mothers started the following day in Yalova and Kocaeli provinces. A distribution plan for Bolu and Sakarya provinces is currently being developed together with the Ministry of National Education (MoNE) and MoH.
In the following weeks, the food supplement programme will extend to 150,000 children and pregnant/lactating mothers in all affected areas for a period of 5 months. The supplementary feeding programme is implemented together with MoH and covers approximately 33% of the daily need of children and pregnant/lactating mothers in terms of proteins, vitamins and minerals.
A survey conducted together with Hacettepe University and MOH regarding the nutrient contents of daily menus in the camp’s soup kitchens found out that calcium, vitamin A, riboflavin and vitamin C are below the daily-recommended dietary allowances. It also indicated the need to observe proper sanitary practices in the kitchens. To address the findings of the survey, UNICEF advocates for the establishment of Nutrition Units in tented camps and prefab cities. Nutrition Units are used to ensure proper hygiene and better diet in the camps’ soup kitchen, and to provide hygiene education and growth monitoring and promotion services. These units also serve as storage and distribution points for supplementary food. UNICEF already established 36 Nutrition Units in various camps in Golcuk.
A total of 525 emergency health kits have been distributed in the affected provinces. In terms of essential drugs, the kits provided cover the needs of 550,000 persons for three months. In addition, refresher training seminars for Primary health Centres staff in the mental health referral system and Immunization and Nutrition after Disasters were organized in Yalova, Golcuk, Izmit, and Sakarya and benefited 1,350 health workers.
The recent earthquakes in Turkey have left considerable numbers of children and adults at risk for developing post-traumatic stress disorder and other stress-related problems caused by the exposure to traumatic events and the losses experienced during the earthquakes.
UNICEF, with the support of the Centre for Crisis Psychology in Norway carried out a pilot study to assess the psychological impact among 150 primary school age children affected by the first earthquake. The results of the study indicates that approximately 30% of the children reported posttraumatic stress reactions in the severe and very severe range. Another 33% reported levels of posttraumatic stress reactions in the moderate range. Finally, approximately 40% of the children reported levels of depressive reactions in the moderate and severe range.
There are numerous factors that can lead to the lack of intake of adequate nutrition in children, some of the most obvious being the lack of access to food or lack of ability to prepare the available food. However, it can also be assumed that psychological factors contribute to inadequate nutrition among children. Following are listed several typical psychological factors experienced in a large-scale disasters like the recent ones in Turkey:
The two large earthquakes in Turkey in August and November 1999 have resulted in a very complex situation among the populations directly affected by the disaster. The situation must be assumed to be especially alarming among the part of the affected populations who still live in the disaster areas, mostly under poor or very poor conditions in temporary shelters (tent cities).
d - Education
Valued at US$ 3.9 million, interventions are essentially aimed at providing and replenishing affected schools with educational and recreational materials, and distributing supplementary food through schools. Over the past fortnight, activities mainly concentrated on the identification of teachers and pupils’ needs and the establishment of a distribution plan for educational, recreational and nutritional supplies in all affected provinces.
In Yalova province, all primary schools will be repaired by the end of the year. Although the Ministry of Public Works has planned pre-fabricated schools in the area, MoNE is reluctant to use them due to the near completion of the rehabilitated buildings. The number of students in Yalova primary schools before the earthquake was 23,329. With the exception of kindergartens for children aged 3 to 6 years, most students of the province are back in schools.
In Kocaeli province, there is still a tremendous shortage of school buildings, especially in Golcuk areas. All schools are operating on a shift system. Less than half of the 198,942 students registered prior to the earthquakes are currently attending schools. Pre-school classes are operating in some of the districts with significantly reduced numbers of children. 24 prefabricated schools of 12 classrooms each have been completed and will accommodate 8,640 children. Teachers and students are both fearful to enter school buildings. A group of students interviewed explained that they do not attend schools when their lessons are on the third floor of the building.
In Adapazari Province, schools initially reopened on 11 October 1999, but close again following the 12 November earthquake. Nearly a third of the school buildings reported some damage after the first earthquake. Assessments of damaged school buildings are now redone, and schools remain officially closed.
In Bolu province, MoNE is in the process of finalizing plan for the reopening of schools for 7 December 1999. Although only 1 primary school was damaged in Bolu town, the psychological damage is immense. In Kaynasli 3 of the 7 primary schools were destroyed, and in Duzce 15 schools are unusable with an additional 6 that need major repair work. A total of 16 pre-fabricated schools to accommodate 5,760 students are already planned. The number of teachers in the area is still unclear. Several headmasters and teachers have expressed their dilemma of wanting to move away from the area for the sake of their families, but on the other hand they feel obligated to stay.
UNICEF is preparing to distribute 1,700 educational, recreational and pre-school kits to benefit 76,000 students in Bolu, Kocaeli, Sakarya, and Yalova provinces. Distribution to schools will start mid-December 1999. Distribution plans for Kocaeli and Yalova provinces have already been developed together with MoNE, and will benefit 26,019 students in 66 schools. Distribution plans for Bolu and Sakarya provinces are still under preparation. To date, 19 basic educational kits were distributed in tented camps in affected areas.
UNICEF has begun discussions with MoNE Provincial levels as to the material needs within the prefabricated schools. School supplies, furniture and heaters have been identified as essential. The needs assessment will be finalized once the numbers of prefabricated schools is known.
UNICEF is supporting teachers in Bolu province, channelling aid through the teachers’ crisis management centre in Duzce. To date, UNICEF supplied 800 blankets, 150 heaters, 12 tents with heaters, 30 sleeping bags, and 4 generators.
e - Psychosocial
This project consists of three phases and is being implemented by UNICEF and MoNE. The first phase consisted in the training of 65 experts, psychologists, psychiatrists, and school counsellors on debriefing techniques. During the second phase, 289 school counsellors in the affected areas were debriefed and trained on debriefing techniques. In turn, the trained school counsellors debriefed 6,689 teachers. The debriefing of teachers is crucial, as it is believed that a teacher who himself is deeply traumatised and left on his own to recover, will not function at his optimal as a teacher – simply because he is too busy to cope with his own trauma.
The project already entered its third phase with the training of 188 professionals and academicians on classroom interventions, which took place in Ankara and Istanbul from 17 to 25 November. Among trainees, 42 were Ankara-based professionals, 28 school principals, 85 guidance counsellors, and 33 psychologists from the TPA. An expert from the Boston Trauma Centre conducted the training. The third phase aims at accelerating normal recovery in 240,000 children who have survived the earthquakes, and who are having normal traumatic stress reactions to an abnormally stressful event. This phase will be based on classrooms interventions in selected schools in affected areas (refer to Panel 3 for details of the project).
On 25 November, UNICEF and the Department of Social Services and Child Protection (SHCEK) signed an agreement, which aims to train 400 social workers to handle psychosocial interventions in the tent cities. Already 87 social workers were debriefed and trained to handle child recreational plays in emergency situations. This 4-month project is expected to promote the Child Friendly Environment concept for children in Turkey.
Meanwhile, MoNE announced that it would integrate psychosocial debriefing activities as part of the school curriculum to reach affected students nationwide on a more sustained basis. UNICEF and MoNE are studying the design for the execution of this plan.
What is a psychological debriefing?
A psychological debriefing is a group meeting organised for people to review in detail facts, thoughts, impressions and reactions following a traumatic situation. The goals of such meetings are to prevent unnecessary after-effects, hopefully accelerate normal recovery, stimulate group cohesion, and support and maintain group cohesion and motivation for life. Another important function of such meetings is to hear others describe reactions similar to one self, thus having one’s own reactions normalised. Meetings promote gaining a cognitive ”grip” on the situation as well as stimulate emotional ventilation.
Besides giving participants a chance to talk about experiences related to a more or less life-threatening or traumatic event, debriefing also allow for expression of thoughts and reactions related to important losses that the participants have suffered.
These meetings are not a form of psychotherapy but helps in the initial organisation of the traumatic event or loss. They also provide group leaders with a chance to identify people who will need more extensive follow-up.
Debriefing meetings can be used for survivors of life-threatening events (i.e. non-injured survivors following transportation disasters), survivors of massacres, bereaved colleagues following a sudden death in the workplace, and for helpers following their involvement in situations that had a strong impact on them. These are only examples of some of the events where debriefing meetings can be used. The structure of these meetings makes them easy to adjust to a variety of situations.
Children will typically change their behaviours after a traumatic event, because the deepest beliefs about whom they are, and what to expect from the world is shattered throughout the trauma. Children often will return to earlier stage of development/earlier behaviour – but this is a way for them to regain control and trust. This, adults – mother, fathers and teachers- need to fully understand to be able to help the child to recover.
The program will be offered to the whole class. In this way two things will be achieved at once: speed up the recovery process for the assumed majority of the children and at the same time identify children who are the more at risk. These two results are intertwined, and the one can not happen without the other. Hence the program will have to take this into consideration and to offer necessary support to those children most at risk to be able to speed up the recovery process for the majority of the children
After any trauma, children will see the world through the lens of trauma. Any intervention will seek to help so that once again the child can see the world through non-traumatic eyes. Any intervention will also help the traumatized child to tell their own story – so that ”one can put his arms around that bad story.” And because all traumas have the common loss of control, safety and trust as the main psychological component, all interventions will be designed so that a sense of safety, trust and control will be re-established.
The classroom interventions will be built on these principles. The interventions will take place after the counsellors have been in-depth trained. The classroom interventions will be carried out at least for one year, and it is the expressed intentions of MoNE to make this a nationwide program.
III - Level of
funding
As of 1st December 1999, contributions to UNICEF Recovery Plan for Turkish Children amounted to US$ 13,447,408. Only 4.5%, or US$ 632,674, of the required total amount has not been covered yet. US$ 6,312,622 has been received/pledged from UNICEF National Committees, and US$ 7,134,786 from Governments. The following table provides a breakdown of the funds received/pledged:
|
|
|
| Sweden | 5,000,000 |
| UK | 699,183 |
| Australia | 632,910 |
| Ireland | 295,130 |
| Germany | 225,000 |
| Luxembourg | 131,129 |
| Canada | 101,434 |
| Netherlands | 25,000 |
| South Africa | 25,000 |
| Sub Total | 7,134,786 |
|
|
|
| Netherlands | 3,868,237 |
| Japan | 486,352 |
| Spain | 369,959 |
| Germany | 353,675 |
| Hong Kong | 321,336 |
| UK | 278,418 |
| Belgium | 249,470 |
| Italy | 162,068 |
| Greece | 120,000 |
| Ireland | 50,000 |
| Finland | 35,186 |
| Canada | 16,556 |
| Austria | 1,365 |
| Sub-Total | 6,134,786 |
| Grand Total | 13,447,408 |