After Cyclone Aila struck in 2009, children were seen burying dolls in clay mounds. The children would also carefully place twigs in the mud, so they looked like small trees -- before blowing loudly like strong winds and dramatically crushing them.
Similarly, in Koira -- a village in coastal Bangladesh -- 15 days after the cyclone, a father and son were found sitting quietly on barren land that used to be their home, staring out into the sea.
When the relief worker who found them asked what they were doing, they did not reply, they did not even acknowledge the relief worker was there.
The officer later found out the man had lost his wife and two daughters during the cyclone. The father had found the body of one his daughters, but the other two women in his life remained lost.
Mental health and climate change are two issues almost nobody talks about in Bangladesh. This is partly because mental health itself is still a taboo topic in the country. People are often labelled crazy (pagol in Bengali) and left to their own devices.
Of all the psychiatrists in the country, only 0.4% are mental health professionals.
Yet when it comes to climate change, mental health is a topic that is going to have to be addressed.
Climate change is not only about the physical destruction of lives and livelihoods, but the traumatic impacts as well.
Dr M Tasdik Hasan, a researcher at the International Centre for Diarrhoeal Disease, Research, Bangladesh, is one of the few people in the country studying these issues.
In his yet-to-be published paper, conducted at the Institute of Disaster Management and Vulnerability Studies in University of Dhaka, he argues it is crucial for the country to include mental health issues in its disaster risk reduction plans.
“Trauma not only arises from the cyclone incidents themselves,” he explains. “Women face a lot of anxiety just having to stay in the cyclone shelters. Often they will wait until night to relieve themselves at a time when they cannot be seen.”
Dr.Tasdik has encountered many people who feel that mental health is too much of an issue for disaster risk reduction community to address. He reports one high official saying: “What will I do with the crazy people after the disaster? When people cannot get food, and have lost their houses, cattle, and other belongings -- you people are talking about mental health!”
Although many may share this sentiment, for people to become resilient against the shocks of climate change, they are going to have to be in a relatively healthy state of mind.
When it comes to climate change, mental health is a topic that is going to have to be addressed. Climate change is not only about the physical destruction of lives and livelihoods, but the traumatic impacts as well.
What is the point of trying to adapt to worsening changing climate conditions, when you are depressed, anxious, and have lost the will to live?
Dr Helen Louise Berry, professor of psychiatric epidemiology and associate dean research at the University of Canberra, has been studying the mental health impacts of climate change in rural Australia.
Her findings reveal climate change related trauma, in her case longer droughts in Australia, not only affects individuals but community well-being.
As she wrote for The Conversation in 2012: “Damage to land and buildings can create economic pressures that force people of their farms out of their businesses. When this happens, communities’ social infrastructure is at risk.
It is this last link in the chain -- a loss of social capital and connectedness -- that hits mental health hardest.”
Similar patterns may apply to Bangladesh as well. Dr Hasan believes more research is needed to learn about the impacts of slow onset climate change such as rising temperatures and increased river erosion on mental health.
As people lose their ancestral homes and are forced to migrate, he asks, how will they mentally cope with their newfound rootlessness.
In the meantime, he has a few suggestions to support trauma patients in the aftermath of cyclones.
First, one-stop crisis centers should be established in each sub-district or upzilla with in-house counseling services.
Disaster respondents should learn about mental health first aid kits. Similar to a medical first aid kit, this tool was developed in the UK to help healthcare workers use basic questions to screen for mental health issues and provide short term mental health relief.
Thirdly, he believes there should be a Psychosocial and Mental Health committee within the Health Ministry in Bangladesh government as well as separate national mental health policy plan that takes into account climate change.
Bangladesh has had tremendous success in its disaster risk management over the last 40 years.
The numbers of lives lost from cyclones has dramatically decreased as early warning systems have improved and number of cyclone shelters has increased.
Now it is time for the country to build on that success and address an issue people are still hesitant to talk about.
Mental health may not be the most obvious climate change issue, but it is an important one not to forget.
Meraz Mostafa works at the International Centre for Climate Change and Development at the Independent University, Bangladesh.