The mental health of children in flood-affected areas in Pakistan needs urgent attention

The 2022 floods in Pakistan have affected more than 33 million people.1UNICEFPakistan humanitarian situation report No. 4 (floods): 28 September 2022.https://www.unicef.org/media/128291/file/Pakistan-Floods-SitRep-28-September-2022.pdfDate: 2022Date accessed: October 2, 2022Google Scholar Although this calamity has had devastating impacts on people of all ages, it is children who are the most vulnerable to the consequences of public health emergencies. As of Sept 28, 2022, the flooding has left an estimated 3·4 million children in need of assistance and an estimated 50% of the affected children are showing signs of distress.1UNICEFPakistan humanitarian situation report No. 4 (floods): 28 September 2022.https://www.unicef.org/media/128291/file/Pakistan-Floods-SitRep-28-September-2022.pdfDate: 2022Date accessed: October 2, 2022Google Scholar Natural catastrophes, including floods, have a profound negative impact on children's mental health, and can lead to disturbed sleep patterns, regressive behaviours, depression, hostility, somatisation, and pessimistic thoughts.2Kousky C Impacts of natural disasters on children.Future Child. 2016; 26: 73-92Crossref Scopus (127) Google Scholar Children can be particularly vulnerable to physical, verbal, and sexual abuse after natural catastrophes like floods, due to loss of protection after being separated from their caregivers.3Seddighi H Salmani I Javadi MH Seddighi S Child abuse in natural disasters and conflicts: a systematic review.Trauma Violence Abuse. 2021; 22: 176-185Crossref PubMed Scopus (95) Google Scholar The long-term consequences of these calamities include an increased risk of post-traumatic stress disorder, suicidal thoughts, and substance use, and an increase in child labour.2Kousky C Impacts of natural disasters on children.Future Child. 2016; 26: 73-92Crossref Scopus (127) Google Scholar Several factors, such as homelessness, losing access to education, and the trauma of the deaths of loved ones, are known to affect the psychosocial wellbeing of children during disasters.2Kousky C Impacts of natural disasters on children.Future Child. 2016; 26: 73-92Crossref Scopus (127) Google Scholar The humanitarian response to the floods in Pakistan has allowed for shelters to be arranged, distribution of food, and provision of support for the physical wellbeing of individuals affected by the floods. However, there has been little focus on psychosocial support for flood victims, particularly children. Various guidelines exist to address mental health distress after disasters and prevent abuse in children and adolescents. These include basic principles such as reassuring the children, educating them about the situation in age-appropriate ways, and maintaining structured, consistent, daily routines. UNICEF's child-friendly spaces are helpful for finding comfort in familiar school routines and might facilitate the healing of emotional trauma. Psychological First Aid (PFA) is an effective and cost-effective public health intervention in the context of Pakistan.4Wang L Norman I Xiao T Li Y Leamy M Psychological first aid training: a scoping review of its application, outcomes and implementation.Int J Environ Res Public Health. 2021; 184594Google Scholar All organisations involved in disaster relief work, as well as volunteers in schools, can be trained for the provision of PFA. Play and art therapies help children express their feelings and emotions.5Ahmed SH Siddiqi MN Essay: healing through art therapy in disaster settings.Lancet. 2006; 368: S28-S29Summary Full Text Full Text PDF Scopus (13) Google Scholar In schools, coping skills and resilience-building strategies can improve childrens' wellbeing, hope, and self-worth, along with education on recognising early warning signs of mental illness. Telepsychiatry, the provision of psychiatric evaluations and therapy by means of telecommunication technology such as videoconferencing, can also be used as an effective tool to provide counselling and psychological support to children and adolescents. Thus, the government should focus efforts on developing child mental health policies beyond the immediacy of the flooding, including investing funds in children's education and permanent secure homes, and provision of paediatric mental health services. The lives and wellbeing of displaced children within Pakistan depend upon proactive and collaborative humanitarian response. We would like to thank Nazish Imran (Department of Child and Family Psychiatry, King Edward Medical University, Lahore, Punjab, Pakistan) for her intellectual contribution and guidance in the drafting of this manuscript. We declare no competing interests.