The Taal volcano eruption could leave victims with anxiety and depression for years to come

Aid groups and NGOs should be prepared to screen for signs of trauma and other mental health concerns, which can have long-term effects on physical health as well

An erupting volcano, like the one currently blanketing parts of the Philippines in ash, is dramatic and frequently deadly. But it’s a public health hazard that can goes beyond physical harm. The aftermath can have devastating effects on victims’ mental health.

The immediate danger now though is the massive ash fall which Filipinos are breathing from the Taal volcano, located about 44 miles from Manila, the Philippines’ capital. Breathing in that ash can cause or exacerbate respiratory, skin, and eye issues. For people who are already vulnerable – young children, the elderly, anyone who’s already sick – it’s especially dangerous.

While some organisations are working to obtain protective N95 masks designed to filter out harmful particles, they’re still in short supply. I spoke to Rebecca Galvez Tan, a program director at Filipino aid organisation Health Futures Foundation, who told me that people were hoarding the masks in Manila and that has kept them from going where they’re most needed. Tens of thousands of people – many of whom badly need masks – are crowded into schools, basketball courts, and other temporary evacuation centres.

Lourdes Damazo, executive director of the aid group IPI Foundation, told me she’d received word that approximately 40,000 people were sheltering in 189 evacuation centres. Aside from urgently needed masks and goggles, most of the concerns at the evacuation centres are meeting the basic needs, including water, food, and soap. Some people were forced to flee without the medicines needed to manage chronic conditions like heart disease and high blood pressure.

Galvez Tan is planning to set up a medical tent, staffed by volunteer doctors, near the evacuation centres. She expects to see plenty of respiratory and eye ailments, along with chronic diseases that have flared out of control.

But importantly her organisation needs to be prepared to offer mental health services. “It’s a displacement, it’s a loss of almost everything they own, it’s a loss of livelihood. So it’s something really quite traumatic,” she explained to me.

Depression, anxiety and post-traumatic stress are likely to linger long after breathing problems and diabetes flare-ups subside. Doctors in disaster-impacted communities report seeing mental health issues even years after people have returned to their homes. Some even report seeing increases in drug and alcohol use.

Aid groups and NGOs should therefore be prepared to screen for signs of trauma, anxiety, and other mental health concerns, which can have long-term effects on physical health as well. People with mental illnesses die 20 years earlier on average than the general population, often as a result of chronic disease. They also need to be aware that the communities they're working with may understand mental health differently and be wary of seeking and receiving treatment.

It’s hard to tell how serious Taal’s eruption will be. The volcano once spewed ash, fire, and projectiles into the air episodically for seven months – that would be one of the worst case scenarios. A three-day eruption in 1911 killed an estimated 1,300 people. The volcano experts monitoring Taal maintain that a hazardous eruption may – or may not – happen within days or hours.

But it doesn’t take a violent eruption to have a profound impact on people’s health. Smoke and steam began emerging from Cotopaxi, an infamous volcano in Ecuador, in April of 2015, and continued for months. Although it never became a violent eruption, the stress took its toll, and people in the risk zone began to display symptoms of depression and anxiety.

For the most part, medical aid is still being mobilised. Government agencies, the Philippine Red Cross, local organisations and some private citizens are already helping on the ground. Direct Relief is supplying N95 masks, requested by the Philippine Red Cross, and financial assistance for medical outreach. The organisation also staged a large cache of emergency response materials in ASEAN's Coordinating Center for Humanitarian Assistance on Disaster Management (AHA) in Manila earlier this year for situations precisely like the current eruption.

Galvez Tan is expecting longer-term health issues to also emerge and knows she’ll need a lot of medicine – a lesson she learned responding to Typhoon Haiyan in 2013. But if there are 1,000 people who could be affected, then you need to be ready to service 1,000 people. Meanwhile, all Filipinos can do now is wait and hope the worst is over.

Talya Meyers is a humanitarian and health journalist for the NGO Direct Relief, which is distributing N95 masks and other aid to groups in the Philippines