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The emotional impact in survivors of the tsunami that hit South Asia on December 26, 2004, is hard to describe, not only because of the many lost in the disaster, but also because thousands of people who were hurt by the tsunami left the area to return to their home countries.

Collective efforts of numerous countries, and worldwide organizations, industries, agencies, local groups and individuals was unforeseen. Numerous initiatives were undertaken to enable survivors to tell their stories, try to locate loved ones and seek emotional support. And never before was the Internet used so widely for this purpose. Prior experience with Web-based surveys after major catastrophes and disasters has illustrated that the Internet is an asset for victims, fostering resilience by providing information and enabling contact among affected persons—it also is a valuable resource for research.

The first week after the tsunami, a group of clinicians, researchers and Internet specialists in the Netherlands, prompted by a group of Dutch repatriated patients from Phuket, started a worldwide Web-based service for victims—the Tsunami International Survey on Emotional Impact (www.tisei.org). The initiative was analogous to the initiative after 9/11 (Butler, et al.) and the Pan Am 103 crash (www.geocities.com), using the Internet as a medium for help. The service enables victims to express experiences and seek contact in their own language. In addition, it provides the tools to perform longitudinal multiple time point research in victims of the tsunami worldwide.

The initiative’s services include:

  1. A survey consisting of trauma-related questions in 11 sections. It begins with questions about a person’s situation when the tsunami struck (e.g., country, purpose of trip); questions about where the person was at the time and details of his or her experience (Did you perceive that the sea withdrew? How long were you in danger? Were you wounded? Did you lose family members or friends?); and followed by a series of structured questions on trauma, dissociation, depression, emotional responses, sleep and grief.
  2. Consultation services from professional mental health workers, in which victims can receive personal advice about the necessity of treatment; referral to local mental health workers can be provided.
  3. A forum for victims, support groups, helpers and others to share their concerns and express their feelings.
  4. A news portal that provides relevant information about developments in mental health issues for victims worldwide; it also can provide information online (e.g., files, readers, etc., for parents and teachers).

Personal information entered in the Web survey is anonymous (through a procedure called pseudinomisation) and meets criteria of European law. As evaluated from the 9/11 initiative, the assessment itself can help victims evaluate their emotional well-being. Participants can print their survey and take it to a professional when they need help.

At the other end, it enables the administrator to collect information on a group scale. Because several thousand tourists from a variety of countries were visiting the region hit by the tsunami, it was essential to reach out to all of the countries in which victims lived and to offer the Web survey in many languages.

The survey is translated in 15 languages: Czech, Danish, Dutch, English, Finn, French, German, Indonesian, Italian, Russian, Swedish, Spanish, Turkish, Korean and Thai. More portals are planned.

Individual countries, using their own language, are represented through the portals. Each portal can have its own user group that can be modified and shaped to a preferred style, with local information and services—as long as the Web surveys remain similar. Each user group can build a database of Web surveys of its own. Several portals are open now and, by building a team of consultants, can offer local user groups in different countries the opportunity to provide regional psychological support through the electronic consultation service.

Collected data can be shared or used for reports in victims’ respective countries. By combining the surveys from different countries, a unique database on the emotional impact of the tsunami worldwide can be established. The database then provides valuable information for planning emergency help and mental health interventions in future disasters.

The long-term needs of victims of the tsunami should not be forgotten. Disasters’ long-term impact frequently has been demonstrated through chronic psychological and psychiatric complaints (Norris). Participants can be invited on a low level at discrete time points to return to the survey. At the same time, the participant can express needs that otherwise may be overlooked or collected only in local timely surveys .

To promote our initiative, we contacted international news media and ISTSS, WHO, World Psychiatric Association and the United Nations. ISTSS is the first partner that offered a liaison for this initiative; we are in process of a similar request with the United Nations. ISTSS will offer the TISEI link on its home page for a limited period of time.

The initial service of TISEI has been realized with the help from companies such as Microsoft, Hewlett Packard and Intel. The first weeks presented a unique collective atmosphere in which many doors were opened. The situation has changed now, and this project is seeking funding to utilize the potential, maintain stability and provide service to local users groups. The awareness the project has created so far is overwhelming, and there is a desperate need for financial support to guarantee its future. We are convinced that this project serves as a preventive service to reduce mental disease with victims.


Butler, L.D., Seagraves, D.A., Desjardins, J.C., Azarow, J., Hastings, T.A., Garlan, R.W., DiMiceli, S., Winzelberg, A., and Spiegel, D. (2002). How to launch a national Internet-based panel study fast—Lessons from studying how Americans are coping with the September 11, 2001, tragedy. CNS Spectrums, 7(5), 597-603. http://www.geocities.com/CapitolHill/5260/latest.html.

Norris F.H. Psychosocial Consequences of disasters. PTSD Research Quarterly 13, 2, 1-3

Eric Vermetten, MD, PhD, and Cobie Groenendijk, MD, are with the University Medical Center and the Central Military Hospital, Utrecht, The Netherlands, and Luc Taal, PhD, is with the Emergency Hospital in Utrecht, The Netherlands.