20 Years After Tsunami, South Andaman Survivors Still Battle Fear, Poor Sleep: Study

Two decades after the 2004 Indian Ocean tsunami devastated parts of the Andaman and Nicobar Islands, the disaster may be long gone from the headlines, but its psychological impact has not disappeared for many survivors.

Persistent anxiety, intrusive memories, disturbed sleep, disrupted education and gaps in long-term healthcare continue to shape the lives of people who lived through the catastrophe, a new qualitative study has found.

The study, titled “Long-term Psychological Impact and Post-tsunami Resilience Factors among the Residents of South Andaman, India: A Qualitative Study”, was conducted among 22 adult survivors in South Andaman. The researchers — Dr Samar Hossain, Dr Aanchal Anand, Dr Ajay R Sethuraman and Sabaa Begum and Shahin Kassim of Department of Community Medicine, Andaman and Nicobar Islands Institute of Medical Sciences, Sri Vijaya Puram and Irena Mandal from Department of Community Medicine, Maulana Azad Medical College, New Delhi interviewed survivors nearly 20 years after the tsunami to understand not just the scars left by the disaster, but also what helped communities recover.

The study, published after interviews conducted between March and August 2024, found that psychological trauma often outlasted the physical destruction. Participants recalled intense fear, helplessness and anxiety during the disaster, with some continuing to experience flashbacks years later.

Nine of the 22 participants reported ongoing or episodic flashbacks, while all participants described major disturbances in sleep. For some, fear of another disaster continued to affect their ability to rest.

“Even today… I find myself overwhelmed with fear,” one 56-year-old male survivor told researchers.

The findings underline an often-overlooked aspect of disaster recovery: rebuilding homes and infrastructure may happen within years, but rebuilding a sense of safety can take much longer.

The tsunami had struck the Indian Ocean region on December 26, 2004, killing hundreds of thousands of people across several countries. South Andaman was among the affected regions, with communities facing deaths, displacement, destruction of homes and disruption of livelihoods.

Interestingly, most participants in the study—20 of 22—did not suffer major physical injuries. Yet the psychological consequences remained profound. One 72-year-old survivor who was badly injured recalled, "I was severely injured; my feet were cut."

The study also found that healthcare and rehabilitation systems struggled to meet survivors’ needs in the aftermath. Damaged health infrastructure, shortages of essential resources and limited rehabilitation services particularly affected vulnerable groups, including children, elderly people and pregnant women.

“Rehabilitation programmes were practically non-existent. I had to rely on friends and family,” an 84-year-old participant said.

Government assistance in the form of food, shelter and financial support was acknowledged by survivors as crucial to immediate recovery. However, researchers found considerable dissatisfaction over bureaucratic delays and complicated documentation requirements. Those who had lost identification documents, homes and other assets often found it difficult to navigate relief processes.

More significantly, the study found a gap in long-term recovery planning, particularly in mental healthcare and rehabilitation.

For survivors, the end of emergency relief did not necessarily mean the end of the crisis.

The disruption extended to education too. Schools were converted into relief camps, study materials were destroyed and children’s academic schedules were interrupted. For some, the tsunami struck at critical stages of their education, adding another layer of stress and uncertainty.

The researchers said such disruption can have consequences far beyond missed classes. Educational continuity provides children with routine, stability and social support after a disaster — all of which can help protect mental health.

The study also found that women may face a particularly high psychological burden following disasters. Its findings are consistent with earlier research showing greater vulnerability to post-traumatic stress disorder among female tsunami survivors.

Previous studies cited by the researchers have reported high rates of PTSD among tsunami-affected populations in India, with psychological distress associated with factors such as perceived stress, injury, loss of homes and livelihoods.

But the South Andaman study also offers a more hopeful message: communities themselves can become a powerful source of recovery.

Family members, neighbours and community networks emerged as important sources of emotional and practical support. Local governance institutions and NGOs also helped bridge gaps when formal systems were unable to respond adequately.

For some survivors, the intensity of fear gradually declined. “Over time. The fear has lessened,” a 29-year-old female participant said.

The researchers argue that this community resilience should be incorporated into disaster preparedness rather than treated as an informal or secondary response.

The study recommends integrating mental health into disaster preparedness and response systems, rather than treating psychological care as an afterthought. Routine screening for PTSD, anxiety, sleep disorders and functional difficulties should continue beyond the immediate relief phase, particularly among vulnerable groups.

It also calls for trauma-informed care through primary healthcare systems, greater involvement of community health workers and stronger collaboration with schools and local institutions.

The key lesson from South Andaman, researchers say, is that disaster recovery cannot end when the relief camps close or damaged buildings are reconstructed.

The psychological aftermath can persist for decades.

The study argues that future disaster planning must therefore combine early-warning systems and resilient infrastructure with community-based psychological preparedness, educational continuity, accessible healthcare and long-term psychosocial support.