"When the waters rose around my house during recent flooding, it brought back memories of the tsunami, and I felt some of that fear all over again," Nyak Minah, a tsunami survivor in the seaside village of Kubang Gajah, told Catholic News Service.

Minah's mother died during the Dec. 26, 2004, tsunami, which left an estimated 280,000 people dead or missing in Indonesia, Thailand, Sri Lanka, India and several other countries.

Minah said she escaped because she was away from home at the market when the waves struck.

In the months that followed, the Indonesian government tried to force Minah and her neighbors to relocate their village farther inland, but they successfully fought the idea. Catholic Relief Services, the overseas aid agency of the U.S. bishops' conference, built her a new home. She has added on a kitchen and a small store, from which she sells food and household supplies.

In late October, heavy rains led to severe flooding in the community, the worst that Minah, a widow who says she's about 50 years old, can remember. Deforestation to clear the way for expansion of nearby palm oil plantations has exacerbated annual flooding, she said.

A new early warning system in the area means a siren will sound if a tsunami is suspected. Residents are supposed to flee to a nearby palm oil processing plant, which is located on elevated ground. Micah said that tests of the siren bring back uncomfortable feelings.

"When I hear the siren, or I see the floodwaters, I remember that day. It all comes back. I remember the destruction, the fear, and the sadness of looking in vain for our loved ones afterward," she said.

A Catholic priest in Banda Aceh, the city on the northern tip of Indonesia's giant Sumatra Island and ground zero for the destruction, said Minah's experience is common.

"Many of the survivors are still victims, suffering from psychological distress," said Father Hermanus Sahar, pastor of Sacred Heart Catholic Church.

"That stress manifests itself in a variety of ways. Some have lingering physical problems for which there's no other explanation. And some remain afraid of everything. When there's an alarm or a loud noise, some people start screaming, not from pain, but simply because they are afraid," Father Sahar told Catholic News Service.

The tsunami, provoked by the third-strongest earthquake ever recorded, also brought positive changes to the Aceh region. Long afflicted by a separatist insurgency, Aceh's warring parties stopped fighting and signed a 2005 agreement on autonomy for the region.

The capital city of Banda Aceh, much of which was reduced to rubble a decade ago, is today a thriving modern city with fancy stores and traffic jams. Large infrastructure projects, like the Mother and Child Hospital built by Catholic Relief Services, are symbols of the estimated $14 billion in international aid that poured into the region after the disaster.

Father Sahar said the aid helped spur economic progress throughout Aceh.

"There was a lot of international aid that helped the people to recover, and that provided infrastructure we didn't have before. There are now roads, for example, providing good access to many places that were not connected to the economy before. Although there are many tragic stories, the tsunami brought blessings to some of the survivors," Father Sahar said.

Some elements of the aid response didn't go well, however. In several areas, houses built for survivors today stand empty, the result of pressure to build things quickly before local communities could make comprehensive decisions about their future. In some other communities, complaints abound of families that tricked aid agencies into building them more than one house.

Some negative elements of the aid response are not as visible.

Raihal Fajri, executive director of the Katahati Institute, an Aceh-based organization advocating for democracy, said the widespread implementation of "cash for work" programs, where local residents were paid to do reconstruction work, eroded the willingness of many to engage in volunteer work.

"The value of communal work was changed by the United Nations agencies and international NGOs that wanted to give something to motivate people to get involved. But before the tsunami, when the village chief asked the people to work, they did so. And no one paid them for it," she said. "Now people won't do anything unless they get paid. If an NGO wants to have a meeting, people ask what they'll get paid to come to the meeting. Volunteerism has been lost."

According to Fajri, many aid agencies also had difficulty understanding the nuances of gender in Aceh.

"Because Acehnese culture tries to protect women, the family house and the land where it sits is usually given to a daughter, not a son," she said. "If the daughter marries and has children, and then her husband divorces her or dies, the woman has the security of owning the house. That protects her and her children from abuse."

Yet not everyone who came to Aceh after the tsunami understood that principle.

"The United Nations Development Program wanted to issue land titles only in the husbands' names, and we had to push to get them to recognize local customs and issue the titles in the women's names. If there is other property, such as agricultural land, that is usually registered in the name of the man. But the house should be in the woman's name," Fajri said.