In Bam, restoring homes and hope

The Iranian mother survived the Bam earthquake, but she needs more than a new house, food, and running water. She also needs to talk and cry, to cope with the extraordinary trauma that has battered families here.

"How can I sleep? I am always thinking of that day, when my brother woke up and my husband didn't," Mariam Ibrahim Ebadi tells a group of a dozen women brought together as part of a novel counseling program spearheaded by Iran's health ministry and UNICEF.

Her voice lowering, Ms. Ebadi tells of clutching her two young children to her as the earthquake roared. "I could hear them scream: 'Daddy is not here!'"

The Dec. 26 quake killed at least 43,000 - a sizable portion of the local population - and turned three-quarters of this ancient city to rubble, including its 2,000-year-old citadel, the largest mud-brick complex in the world.

As survivors begin rebuilding, officials are putting new priority on mental health to generate hope. They aim to touch half the population, but say success ultimately will hinge on government and relief efforts to restore normal life.

"A person who is hopeless and sees everything destroyed, goes to the edge of a precipice," says Abbas Zamiyad, a psychiatrist and codirector of the Health Ministry's mental health project. "We bring them back, talk to them, and give them hope, but if they turn around and see nothing - no home, no job, no future - we are just postponing their death."

Dr. Zamiyad says the government is "not fast enough to respond, and that affects the root of what we are doing." Still, eight weeks after the devastating quake, the government and aid groups are slapping together prefabricated houses, installing latrines and showers in zones around the city, and working to reestablish broken underground irrigation channels to protect Bam's famous date harvest. Twenty-seven temporary schools have been established so far for the 20,000 students expected to return to the classroom. On the streets, trucks carrying fuel and water, as well as rubble, rumble through as motorcycles zoom by.

UN and relief agencies give Iran high marks for moving swiftly, if not entirely efficiently, to ask for outside help and throw its own resources into the crisis.

"There will always be criticism, but if you consider where we started, and where we've got to now, it's gone well," says Pete Sweetnam, head of the US-British relief agency Mercy Corps, and a 20-year veteran of refugee and humanitarian efforts. "This has been fast- moving, and people's expectations have been raised by the government."

Already, 4,000 Bam survivors have taken part in several weekly group sessions directed by a psychiatrist and a therapist. Zamiyad fields 10 two-person teams a day and wants to double that.

Health Ministry figures reported to the UN show that 700 people are receiving one-on-one counseling, and that 210 psychologists and psychiatrists are being trained, along with 45 Education Ministry counselors and 130 teachers. Some 12,000 brochures about post-traumatic stress disorder (PTSD) have been passed out. "[Survivors] are in mourning reaction now, depressed, and feeling hopeless about the future," says Zamiyad. "If we can give them hope we can stop PTSD. But to give hope, we must show them something."

This is the first disaster in which Iran has undertaken a broad mental health effort. It stems from a pilot project during a much smaller earthquake in western Iran in 2002.

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