Adequate survival behaviour is a crucial “gift of nature.” Humans have been fairly successful in reducing the threat to life. Nevertheless, crossing a street or driving a car requires increased alertness in order to survive. Natural disasters such as the recent tsunami and man-made disasters such as war, terrorist attacks, killing, robbing, sexual and physical abuse, and plane crashes show how vulnerable we are. After surviving such an event, people need basics—food, shelter, medical care, and consolation.

The ethnic war in Sri Lanka has brought psychosocial problems for individuals and families. In addition, it has had a devastating effect on Sri Lankan society; we can speak of a collective trauma. It has caused regression of all development, destroying social capital, structures and institutions. It has also resultedin changes, for the worse, offundamental social processes like socialization, social norms and social networks.

ONE YEAR later, reports related to the psychological and physiological effects of the terrorist attacks perpetrated on September 11, 2001, continue to emerge. These reports and what little is known about the long-term health effects of terrorism suggest that many people will present to their physicians with medically unexplained symptoms. These symptoms may be mistaken for organic medical diseases, but are likely to be physiological manifestations of psychological distress.

Comment on Psychological sequelae of the September 11 terrorist attacks in New York City. [N Engl J Med. 2002]