As the crowd gathered in the hall of a Buddhist monastery to receive their free lunch, Hnin Mya sat listlessly, oblivious to the smell of warm curry, the sounds of clinking utensils and the chatter of her compatriots.
Unlike most survivors of Cyclone Nargis whose lives have begun to return to normal, Hnin Mya has withdrawn into silence since the storm swept away her husband and two young children two months ago.
She tried to recount her loss, but words failed her. She started sobbing quietly, her body shaking.
"She sits and stares at the river the whole day. But she frantically searches for a place to hide whenever she hears strong wind or heavy rain," said U Kaitila, a monk at the monastery, which has provided shelter for Hnin Mya and 16 families made homeless by the storm.
The dead have been buried or cremated, the hungry fed and a massive effort to provide shelter has been launched since the May 2-3 cyclone. But the mental trauma affecting survivors like Hnin Mya may not be so easy to deal with, and it appears to be widespread.
"You can have the supplies, you can deal with a lot of practical problems ... but in the end people also need support to reconstruct their lives and make it worth living," said Kaz de Jong, a mental health specialist from the humanitarian group Medecins Sans Frontieres who traveled to some of the hardest hit areas in the country's Irrawaddy delta.
He recalled a woman telling him: "You know you are all worried about rice, and enough rice, that's important, but do you also worry that people must also have motivation to eat it? At this moment my life is not worth living. ... I've lost all my family members."
Some 80,000 people were killed in the storm, with another 50,000 unaccounted for, and hundreds of thousands of families had homes battered or destroyed.
Preliminary findings of a survey undertaken by the government, UN agencies and the Association of Southeast Asian Nations found that 22 percent of storm-affected households reported psychological stress. Common symptoms among survivors include the inability to sleep, recurrent nightmares and flashbacks, apathy, absentmindedness and concentration problems.
Some victims also experience headaches, body pains and palpitations.
"Some people start avoiding places, people and conversations which remind them of the event," said de Jong. Others "become hyperactive, working nonstop to avoid their mind wandering off to what happened and what is lost."
"People report that they have (the) impression that everything takes a lot of effort and they've lost energy, in many cases also their motivation, to rebuild," he said.
Short-term psycho-social trauma is common after terrifying and life-threatening events, but some victims will suffer mental problems for months or years, said Surachet Satitniramai, director of Thailand's National Medical Emergency Services Institute, who headed a team of about 30 Thai health specialists who worked in the devastated area.
Even after concerns about displacement, separation from loved ones, poverty and livelihood are addressed, "some may never fully recover," he said.
Burmese government medical teams sent to the delta include mental health experts, but since the country has never before experienced a tragedy on this scale, they may not be as well-qualified as outsiders who have dealt with similar disasters, such as the 2004 Indian Ocean tsunami.
However, "it makes more sense for local doctors to deal with mental health issues since they understand the culture and how people react," said Surachet.
"Outside experts can help but there is a language barrier which makes diagnosis and treatment difficult," he said. "Myanmar [Burmese] people are very reserved and resilient and they may smile when they see a stranger, so it may be more difficult to detect cases of mental trauma."
Many of the same Buddhist monks who provided food and shelter in the storm's wake are able to offer spiritual comfort as well.
"It is our duty to give them courage to move on and rebuild their lives," said U Pinyatale, a 45-year-old abbot who provided shelter for some 100 villagers living along the Pyapon river.
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