They number in the thousands, but have been denied help in the wake of Asia's tsunami tragedy as the more urgent short-term business of burying the dead, treating the seriously wounded and cleaning up to prevent disease takes place. Now, thanks to a Hong Kong-based initiative, those left with physical or mental impairments and in need of long-term therapy to resume a productive life will soon receive attention. 'It is hard to imagine the fear, confusion and desperation of survivors, who have seen enormous waves wash away their worlds and their dreams,' said Kit Sinclair, who lectures in occupational therapy at the Department of Rehabilitation Sciences at Hong Kong Polytechnic University. The professor emphasised that those who suffered debilitating injuries or were left suffering from mental trauma would need help and assistance over a long period. The World Health Organisation estimates that 5 to 7 per cent of tsunami victims living in camps or temporary shelters are afflicted with some sort of a disability. In addition to those who were disabled before the tsunami struck, many more are now handicapped as a result of their injuries. The WTO estimates the overall figure may have risen by 20 per cent. And so even as the world's biggest relief operation moved into action, another long-term plan to provide victims with this kind of specialist help was beginning to take shape. 'Many of those who experienced the tsunami will never fully come to terms with their memories during their entire lives,' Professor Sinclair said. 'The key to helping is to understand that it is not just the physical damage that is outwardly seen, but what lies behind the tragedy pent up in people's minds and memories.' Last Friday, Professor Sinclair, who is also president of the World Federation of Occupational Therapists (WFOT), and Kerry Thomas, an executive member of the WFOT's management team, left Hong Kong on a mission to visit affected countries and offer advice and assistance related to occupational therapy. 'I believe the time is right to make the visit,' Professor Sinclair said. 'The initial disaster relief operations are well established, and locally people are developing a better idea of what is needed for long-term rehabilitation and care, especially for those with disabilities.' She said children and adults who had existing physical, social, emotional or learning problems may experience particular difficulties over the coming months and years. 'The tsunami is not a disaster whereby people are expected to 'click back' to good physical or physiological health on their own, or where human suffering can be turned off like a tap,' she said. Professor Sinclair said many of the items and facilities that disabled or traumatised people needed were no different than the needs of other people, but just with some specific attention. For example, those with physical impairments might find it difficult to keep warm or stay dry, and so may need additional clothing. She said that in any crisis, disabled people were likely to feel the negative impact of the situation more intensely than able-bodied people. 'Their ability to cope and survive may be completely dependent on others and the capacity of any family to support its disabled members is severely tested when they are victims of a catastrophe.' Professor Sinclair said the disaster would have serious long-term effects on the countries hit by the killer waves, and the role of occupational therapists would be particularly important as they worked with the thousands of victims to help them recover from immense physical and emotional trauma. She and Ms Thomas will hold meetings in Sri Lanka, Thailand and Indonesia with national occupational therapy associations, local therapists and representatives from NGOs and international aid agencies working in the region. The meetings have been arranged to build a better picture of the tsunami-affected areas and to form a strategic WFOT response to the disaster, both at a local and international level. The WFOT's executive management team has established a taskforce and drafted a project plan to help develop and implement long-term assistance programmes. These strategies include collaboration with the WHO and other international NGOs, developing resources and training materials, and setting up communication networks for liaison and collaboration. Funding has already been provided by WFOT country members, including $150,000 for a dedicated website to co-ordinate the operation. With a membership of more than 130,000 in 60 countries, large numbers of occupational therapists have volunteered to travel to areas that need help. Findings from the visit will also lay the foundations for worldwide occupational therapy responses to future disasters. 'There are many areas where occupational therapists can provide knowledge and advice that will have a significant impact on the wellbeing of disabled people in the future,' Professor Sinclair said. For example, planners of reconstruction often missed opportunities to improve access by failing to adapt the designs of buildings. Depending on the type of building, the added cost of providing accessibility for people with disabilities can be as low as 0.5 per cent of the total project. In addition to rehabilitation, Professor Sinclair said the emphasis should be placed on co-ordinating programmes to get people back to work. She said the WFOT effort would address the need to restore confidence in victims so they could earn an income and restore their sense of purpose, another helpful step towards recovery. Professor Sinclair said it was no surprise that a significant part of this initiative should be co-ordinated from Hong Kong, as the SAR had one of the most developed occupational therapy programmes in the world. The concept of occupational therapy was born in the 1960s, when Hong Kong was a manufacturing colossus, churning out cheap plastic toys and garments from cramped factories. Workplace safety was little more than an afterthought and injuries were frequent and horrific. Hong Kong's first programme to train professional occupational therapists was launched in 1970 by the Polytechnic, which at that time was still a technical college. Today, Hong Kong has more than 800 fully trained professional occupational therapists. Many more have taken their skills overseas. Professor Sinclair said countries affected by the tsunami were democratic, functioning nations, some of which had significantly developed response agencies of their own. For these reasons, any suggestions and offers made by the WFOT to provide assistance must be channelled through appropriate government bodies and agencies. 'Our job is to support them. We need to make sure we are sensitive to the fact that these people are capable of making rational decisions and we are not going there to take anything over - we are simply helping them,' she said. As governments, local authorities and international aid agencies dealt with the aftermath of the tsunami, Professor Sinclair said one of their goals must be to empower local communities by incorporating long-term occupational therapy initiatives into recovery efforts. In Sri Lanka and India, this process has already begun, with the government of Sri Lanka calling for doctors, psychologists and paediatricians to counsel the large numbers of children left without parents. However, successful counselling is easier said than done. The WHO estimates that for a total population of 19 million, Sri Lanka has 38 psychiatrists, 17 occupational therapists and 410 psychiatric nurses. It also has the highest suicide rate in the world, at 49 per 100,000 people. Professor Sinclair said tsunami survivors and refugees were at high risk of developing clinical syndromes such as post-traumatic stress disorder and depression, which could cause a range of social and emotional difficulties. 'Even those who appear to recover could face further painful experiences if they are involved in further accidents or even witness minor floods,' she said.