Special on Bam six months on

Six months after the earthquake that devastated Bam in southeastern Iran, the city remains strewn with rubble. Rows of small, white, box-like prefabricated shelters fill cleared wasteland in tightly packed neat lines, while tents still dot every road, back alley and clearing.

The damage to the qanats, an ancient complex underground network of water channels, is now evident. Dying date trees, once the lungs that made the oasis city resemble a lush garden, now wilt with thirst.

The unforgiving scorching desert wind whips up the caramel-coloured dust and ensures that a film of it clings to everything and everyone. The smell of death is gone, but reminders of over 20,000 dead are everywhere.

Every day a regular stream of survivors visits the Beheshteh Zahra cemetery where they mourn the loss of their loved ones and contemplate the earthquake that razed their city and irreversibly changed their lives.

But the city is slowly coming to life. Makeshift shops have been set up in tents amid the debris. Stalls selling fruit, food, clothes, bags and even flowers are bursts of colour in the flattened city, sprouting up from the rubble as survivors struggle to attain some sort of normality.

Mohsen Ghalekhanee used to work in his family shop in the centre of town. It is now ruined, but he has set up a grocery stall in a tent. "It's hard, the water and electricity come on and off and we get the bread from Kerman [a three-hour drive from Bam]. We also get people trying to steal the food. And as we can't lock up I have to sleep here too," the 23-year-old told IRIN. "All I want now is a career. Anything will do, as long as I make enough to survive. I just want to lead a normal life."

Ghalekhanee's family sleep in a prefabricated house (prefab) west of Bam. Five family members live cramped into a small room with neither bathroom nor kitchen facilities.

Not far from Ghalekhanee's stall, a line of boys and men sit on red plastic chairs under a large tent as they await a haircut - this is a barber, Bam-style. Ali had his own salon before the disaster, but now his business is under the rubble. When he found out that the hairdresser he employed at the salon was not dead, he asked him to join his new venture. "I managed to find broken pieces of furniture and mirrors," he told IRIN as he combs and cuts a client's hair.

Mohsen Ghalekhanee waits for customers at his makeshift grocery

A group of local women wearing black headscarves is an incongruous sight in the international camp where most international non-governmental organisations (NGOs) are based. They mill busily around a tent. The women are from Baravat, a large rural community southeast of Bam that was badly damaged in the quake, and are part of a volunteer group they set up to help their fellow survivors.

"We do anything that needs to be done - from collecting rubble to helping people out with form filling," Maryam told IRIN. The all-women team started out with over 120 volunteers, but when schools started their number dropped to about 75.

"We're unemployed, with nothing to do but stay at home and think about our predicament - it can drive you mad. So we decided to start this group, to get us out of the house and get us doing something to take our minds off things," she explained.

RECONSTRUCTION

According to the Iranian authorities, 26,000 people were killed in the 26 December quake, which measured 6.9 on the Richter scale and destroyed nearly 90 percent of the city.

But the death toll is a moot point, with many Bamis and NGOs claiming that the figure is more like 40,000. What is certain is that some 30,000 people were injured and up to 75,600 were left homeless.

The relief phase is over and, since the end of April, efforts have concentrated on reconstruction. In February, the International Federation of the Red Cross (IFRC) and the Iranian Red Crescent Society (IRCS) undertook an assessment of rehabilitation and reconstruction needs, while at the same time the Iranian authorities began working on a comprehensive Master Plan for the reconstruction of Bam, which will give birth to an entirely new city.

In the last six months, 11,327 people - about 11 percent of the total population - have moved into prefab accommodation in temporary camps. There are 23 temporary camps in Bam and the government has had trouble filling them. From the start Bamis were reluctant to leave their land, at first feeling a strong emotional bond to the place where their loved ones had been buried alive, then later fearing that they would loose their small patch of land, all that most of the survivors have left. Many grew dates in their gardens and wanted to stay by their plots to resume farming as soon as possible.

It is estimated that about 30 percent of the population is now housed in prefabs in the city and the Iranian authorities have highlighted the need for 25,000 immediate shelters for Bam and surrounding villages, plus 5,000 for eight nearby villages.

Some 16,200 prefabs have been ordered by the government, 800 container houses have been provided by Turkey and 1,000 used prefabs are to be provided by Tehran city.

But the rebuilding of Bam has not yet begun. This is mainly due to the Master Plan, which is currently waiting final approval. "People need a roof - that's the most important thing. They need to rebuild their social life. They need a normal town, with a normal market - the normal structure that helps psychosocial rehabilitation. Living in tents in 50 degrees centigrade doesn't help," Thomas Dehermall, emergency field coordinator for the United Nations Children Fund (UNICEF), told IRIN.

Meanwhile, Azzam sits on dust-encrusted rug on the ground outside a tent, breastfeeding her small baby. The rug was one of the few items she managed to salvage from the ruins of her home. Beside her sits her elderly mother-in-law. They lost scores of relatives in the earthquake.

Azzam sitting outside her tent hopes for milk for her two-month old baby

"We have nothing. I need milk and clothes for the baby and we really need a rug to sit on," she told IRIN, smiling at her suckling two-month old baby. Her mother-in-law finds the heat unbearable. Daytime temperatures can soar above 50 degrees centigrade. Three of them sleep in the small tent given to them by the IRCS. At night it flaps noisily in the wind, while during the day it becomes a furnace.

Azzam, like all survivors, gets a small monthly grant from the government, but she complains that it is not enough. "I get frustrated. We're stuck in the tent, but we don't want to leave our land," she said, explaining her reluctance to be rehoused in a prefab on the outskirts of town. "Most of our neighbours were buried alive, but at least staying here we're near the ones who survived. We can talk to each other."

The government has requested heavy-duty machinery from the international community to speed up the debris-removal process and many NGO workers say that the reconstruction of Bam is no slower than should be expected.

"It's easy to be negative but the task of rebuilding a town is enormous - if you look at Turkey or Japan, it took them four to five years to rebuild after the earthquakes. It really does take a couple of years, so it's not strange, and in the long-term it will pay off - you don't want to do a quick job as you are building something to last generations," Hans Guido Rietkert, project manager for the Swiss-based NGO Medair told IRIN.

But in the villages surrounding Bam it is a different story - the reconstruction effort is instantly visible. Building work has begun and there are eight NGOs now working on the reconstruction of houses in the surrounding villages in conjunction with the Iranian Housing Foundation (Bonyad Maskan).

Medair is assisting the reconstruction of 115 houses in three different villages, starting with a pilot scheme of 35 houses in Sarjangal, about two kilometres west of Bam. The new houses are designed by Bonyad Maskan and feature a steel frame as the houses' supporting skeleton, rather than the traditional brick work that crumbled with such alarming ease when the quake struck. The house is then reinforced using concrete foundations and concrete roof - they are strong, earthquake-proof buildings.

Hans Guido Rietkert, project manager for the Swiss-based NGO Medair

"The villagers are very active in helping us, digging foundations and just trying to assist us with reconstruction. It's very positive," Rietkert told IRIN. "About 90 per cent of the people we are helping are farmers, so they are very practical orientated people. They're very hands on, so I suppose that makes a difference," the aid worker added.

Medair holds village meetings to discuss all projects and the villagers' expectations, with Rietkert explaining that reconstruction was a two-way process.

"We try to involve them in our project and that helps. It's a dialogue," he said, noting the main problem they faced right now was procuring building materials.

"There's a big demand, so you have to order in time. It can take up to three weeks - cement comes from Kerman, steel comes from Tehran [northern Iran], bricks come from Yazd [central Iran]."

CHILDREN AND EDUCATION

All 131 schools in Bam and the surrounding villages were destroyed or damaged beyond use, with officials estimating that 18-20,000 students were in dire need of school facilities and teachers. There are now 8,200 students left in Bam and over 1,000 teachers have registered at more than 50 school sites.

But there is still a long way to go before Bam's youth can start to benefit from a fully functioning education system. Only a third of the registered teachers are deemed fit to teach with the remainder struggling to cope with their own families' immediate needs and their own post-disaster problems, as well as the task of going back to work.

Immediately after the disaster, UNICEF provided more than 400 school-in-a-box kits, each with emergency supplies for up to 80 students. UNICEF is also assisting with supplies for child care activities for young children, 10 recreational centres for school-age children and limited material support for orphanages.

The centres are able to receive up to 80-100 children a day and the UN agency has deployed a child protection officer specialising in tracing family members and reuniting separated and orphaned children. Some 2,000 children were orphaned by the earthquake. Many of them were sent to orphanages around the country, but 1,228 still live in Bam.

UNICEF also launched an intensive study programme based in Kerman for 400 students from Bam in preparation for sitting their university entrance exams, which are extremely competitive in Iran, with 10 students competing for every place.

The course enables students to catch up with work that they missed as a result of the trauma suffered, and gives them a chance at university.

"Taking students away from the disaster situation helps to give these children equal opportunities to other pre-university students in Iran," Afshin Parsi from UNICEF told IRIN.

The government has agreed to allow students from Bam a special quota following the quake, based on the percentage of university entrants who were accepted from Bam last year. The government is even considering extending this quota to two or more years. UNICEF is also training 1,210 teachers in Bam with psychological support, preparing them to go back to school.

Meanwhile, several NGOs are working with children's needs and education in Bam. Dr Judy Hanawalt Slobig, psychosocial programme manager at Mercy Corps, has compiled a manual called "Discovering Resiliency" and is involved in training teachers on how to cope with psychosocial problems. "We've trained 22 teachers in one group, 30 psychologists and psychiatrists and 25 representatives of local NGOs," she told IRIN.

Mercy Corps has also conducted Post Traumatic Stress Disorder (PTSD) reduction training with 22 teachers, who have already completed a pilot study with 150 children.

Local girls learning computer skills in Bam

"It appears that there has been an improvement - the children are less depressed, more engaged and more talkative," Dr Slobig said. "The biggest gap is the need of programming for adolescents that is really not picked up by any NGO in any systematic way."

Mercy Corps is also helping to fund psychosocial programmes with six local NGOs, including the Science and Arts Foundation (SAF). In a long mobile prefabricated shelter, Neda Shirazi, a 30-year-old teacher from Tehran, is surrounded by children on computers. Up to 60 children a day come to learn everything from Microsoft Word to PowerPoint. The classes are open for the children to drop in to everyday - girls in the morning and boys in the afternoon - as well as music and art therapy next door.

Shirazi has noticed a difference in their demeanour. "At first the students were quiet and sad. They didn't participate in class and they'd often just sit looking into the distance. Now they are much more confident and happy," Shirazi told IRIN. "Recently they took me to the graveyard and showed me where their families are buried. I asked them, 'are you sure you want to talk about it?' and they said 'yes, we must. We want to remember.' They didn't even cry."

Mitra Raadmanesh, 20, helps teach the children. She lost nearly all her family in the earthquake. "I feel lonely. I just feel really lonely. I love being here, it keeps my mind off things," she told IRIN.

Mercy Corps is helping SAF get online. "Already 100 countries have sent emails of support for the children, and we want to put the children in touch with other children round the world who have suffered traumatic events such as earthquakes - we want to celebrate their resilience," Slobig noted.

The art therapy is also showing signs of hope - paintings immediately after the disaster were full of dark colours and deathly images. Now the children are using light, bright colours and are painting flowers, tents and houses.

Mercy Corps is also helping the Society for the Protection and Assistance of Socially Disadvantaged Individuals (SPASDI) develop three sports fields, establish a forum for children to talk about their needs and concerns and they are supporting the SPASDI "outreach van" which is a mobile van with books and videos for children. The Society for Protecting the Rights of the Child - for which Nobel Laureate Shireen Ebadi is a board member - is running Friday workshops for teachers and art and music sessions for orphaned and handicapped children.

The Iranian NGO FYB (Fetad Yar-e Bam) is assessing children's psychological progress and is also using music and art therapy and the Association for the Protection of Child Labourers has set up a women's centre with visiting psychologists where women can learn to sew and share their experiences with one another.

WATER AND SANITATION

Water is now a major issue in Bam. Immediately after the quake, it was thought that the drinking water was safe. Most of the underground wells that provided drinking water to the city were so deep that they did not get disturbed.

But recently, the Environmental Health Department (EHD), which monitors the water for bacterial contamination, has reported that drinking pipe water is not safe as the earthquake caused breaks and leaks in the pipe network. Laboratory tests have confirmed this.

"One of the main outstanding issues is water sanitation and contamination - there is a shortage of water facilities," Adrian Ouvry, programme director for Mercy Corps in Bam, told IRIN. "People aren't used to preserving water - they let taps run, which lowers the water pressure in the pipes, so the water is more susceptible to contaminants."

Saviz Gharavi, inter-sectoral recovery manager for the United Nations Development Programme (UNDP), told IRIN that Bam is suffering from a drought - rainfall has been at its lowest for the last 30 years.

A local family in their tent

The rainfall last year for the agricultural year, which runs from September to August, was 100 mm - this year it has been just 62 mm. Compounding the problem further, the distribution of bottled water in the city has been stopped.

Cleaning and rebuilding of irrigation channels have been major priorities for many NGOs. Bursting out of the qanats, the water channels were Bam's arteries, pumping sweet desert water from the depths of the fertile oasis to the date trees, one of the main industries in the city. Survivors still rely on farming dates, so repairing water channels is crucial to the survival of their crop. Medair employed some 40 local Bamis to help repair the seriously damaged water channels with cement lining and is continuing reparations.

Sanitation is an issue that upsets many Bamis, most of whom do not have proper toilet facilities. "I've got four girls, and when they get their periods it is awful. We really need a toilet," Fereshteh told IRIN at the prefabricated home she shares with five other family members.

In an effort to mitigate such problems, UNICEF has provided 2,000 squatting slabs, including plastic sheets, while other NGOs continue to work on providing more permanent facilities.

HEALTH

The health system in Bam was completely disabled. According to the Ministry of Health (MoH) all 95 health houses, 14 rural health centres and 10 urban health centres were destroyed or damaged beyond repair, as well as the general governmental hospitals, which had a total bed capacity of 240 and were providing health care to some 240,000 from Bam and the surrounding area. Reconstruction of an urban health centre has not yet begun, again due to the time it is taking to finalise the Master Plan.

There are now 12 private health clinics in the city, five GPs (general practitioners) and seven specialists. The field hospital of the IFRC and the IRCS run the only hospital in the area that is providing an inpatient service and about 800 patients a day visit the outpatients department.

The IFRC/IRCS also run four outpatient clinics around Bam with a doctor and a midwife in each one. What used to be Bam's main hospital before the earthquake, Imam Khomeini Hospital, is now a day clinic, with an ear, nose and throat specialist and a psychiatrist.

There are more than 250 Volunteer Health Workers (VHWs) in the area who are being trained by the World Health Organization (WHO), the MoH, UNICEF and some NGOs.

A local resident stands in front of her prefab

But environmental health conditions need desperate improvement. Tent populations and most of the survivors in the temporary camps are faced with a shortage of latrines, showers, kitchen facilities, sanitary water and safe drinking water. Irregular waste collection and disposal is also posing a threat to the locals' health safety.

Six months after the earthquake, with continuing poor environmental health, unsafe drinking water, inadequate access to curative care, and insufficient primary health care services, the situation in Bam is still in a state of emergency regarding health issues. The significant increase in the temperatures coupled with unhealthy living conditions has significantly increased the risk of epidemics of communicable diseases.

Sleeping outside in tents has increased the survivors' chances of insect bites. Since the disaster there have been five serious cases of malaria (two Iranian and three Afghan) and 36 cases of cutaneous leishmaniasis (CL), a parasitic disease spread by the bite of infected sand flies, which causes skin sores. There have been 16 cases of TB.

WHO has reported an increase of diarrhoea but says it may be considered normal at this time of year. About 2,000 bed nets and 13,000 educational pamphlets addressing malaria and CL prevention have been distributed. A polio campaign was also launched and the WHO said it stretched the capacity of the health system to the limit. Hypertension is the third most prevalent illness seen by doctors.

About half of the population has been screened by the MoH for mental health problems. About half of those screened - nearly 27,000 people - were found to be in need of psychosocial intervention.

With the emergency phase over, the number of small food providers dropped dramatically which has made monitoring food safety a challenge for local health authorities.

There is a paucity of health workers in Bam and WHO fears it will become a major issue unless appropriate measures are taken by the MoH. Of these, securing special residential facilities for female staff is essential. Adequate salaries and incentives will help healthcare workers to come to Bam.

WFP is distributing food, with IRCS as WFP's implementing partner. Bam is divided into 14 districts and each district has one to three food distribution points. Female-headed households, orphans, elderly and those living in remote areas have great difficulty in reaching these points.

THE FUTURE

Until the Master Plan is finalised, the people of Bam remain in limbo in a post-disaster transitory life that, to many, is beginning to feel frighteningly permanent. The estimated population of Bam and its surrounding villages was 125,000, but since the earthquake, and even with the high death toll, the population has swollen to 200,000.

This is due to relatives who poured in after the disaster to support loved ones and look after vulnerable family members, and also desperate people from poor, neighbouring, drought-ridden towns who came in search of aid.

It is hoped that, with the finalization of the Master Plan, a more permanent society will reveal itself once the support-network feels it can leave.

Opium addiction is a big problem - the strong, rich smell fills every street. With nothing to do and a feeling of uselessness endemic among men, the drug is being used as an escape. The government and NGOs must face this growing crisis before it gets out of control.

The Beheshteh Zahra cemetery spills out into the desert. Gone is the roar of the bulldozers digging long deep trenches in the ground, trying to keep up with the trucks piled high with bodies streaming into the cemetery. Now the only sound is an occasional sob.

A solitary man squats on a mound of dry earth, his head in his hands. He has been sitting in the same position for a long time. In front of him is a mass grave - an entire family wiped out in 10 seconds. The people of Bam want to move on, to create a new life, but the victims will never be forgotten.