It has been three weeks since Tugce Seren Gul's aunt and grandmother were killed in Antakya, when a devastating earthquake struck Turkiye's south-east. And, yet every night, she waits until 4.17 am in the morning, the exact time that the disaster hit, to try to go to sleep, Reuters reports.
"I keep thinking another disaster will strike at that time and just wait for it to pass," said Gul, 28, who managed to run out of her family house with her mother, moments before the walls of her house collapsed during the tremors.
After reaching the street barefoot, Gul saw the dead bodies of neighbours killed by falling concrete. She remembers the screams of people trapped in collapsed buildings.
Gul said the horror had put a heavy toll on the mental health of survivors who "lost everything" in the city of Antakya, which was devastated by the quake. She wants to, one day, seek professional help to address the trauma but, for now, establishing a new life for herself and her family is the only priority.
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The 7.8 earthquake magnitude earthquake, the most deadly in modern Turkiye's history, will have a deep psychological impact, experts and officials say. More than 44,300 people died in the country and over 1.5 million were left homeless, in freezing conditions. Millions have lost family members, jobs, life savings and their hopes for the future.
Children at risk
Experts fear children will be hardest hit. The United Nations International Children's Emergency Fund (UNICEF) said many of the more than 5.4 million children who live across the quake zone were at risk of developing anxiety, depression and post-traumatic stress disorder.
"We know how important learning and routine is for children and their recovery," UNICEF Regional Director for Europe and Central Asia, Afshan Khan said, after a visit to Turkiye.
"They need to be able to resume their education, and they urgently need psychosocial support to help deal with the trauma they have experienced."
At a large camp for displaced people next to Hatay Stadium on the outskirts of Antakya, psychosocial support teams have set up small play areas and pitched tents filled with toys. Children sat on multicoloured chairs in front of a large portable screen that played cartoons. Some children played hopscotch.
Mehmet Sari, a government psychosocial support worker, said he and others in his team have picked up signs of trauma in kids. "We see that some children can't sleep, others can't eat, others have flashbacks and wet their beds," he told Reuters.
They need long-term support to recover from trauma, he said.
Turkiye's Ministry of Family and Social Services said it has dispatched more than 3,700 social workers to support the survivors across the quake zone.
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Volunteers with Izmir-based group, Sokak Sanatlari Atolyesi, dress in Superman and clown costumes and run activities for children living in tents at a shelter in Hatay province.
But a large 6.4 magnitude earthquake last Monday shattered efforts to give the children some feeling of normalcy, amid weeks of terrifying aftershocks.
A video, provided by Erdal Coban, one of the volunteers and the Art Director of the Sokak Atolyesi, shows the children's cheers and singing turn to screaming.
"Stay calm," one yelled as another held on to a toddler she was carrying.
"Constant, chronic stress"
Turkish people had already been under significant pressure, said Ayse Bilge Selcuk, psychologist and a professor at MEF University, due to rising poverty and the impact of the COVID-19 pandemic. Now, the earthquake has taken it to the next level.
"The stress is chronic and constant, and it is now beyond a level that we can cope with," Selcuk said. "For this nation to get back on its feet, we need to find that strength within us, and that starts with our psychology," she added.
President Tayyip Erdogan has pledged to rebuild homes within a year, but it will still be many months before thousands can leave tents or shipping containers and daily queues for food and move into permanent housing, key to gaining the sense of normalcy and safety they lost.
People look numb, likely a defence mechanism to deal with insurmountable stress, according to Selcuk. Anxiety, helplessness and depression are likely to be common, and young people could feel a sense of rage.
Rebuilding efforts should include mental health, Selcuk said, urging the government to provide funding for trained psychologists to be sent to the quake zone and stay there. "Sustainability is key. We shouldn't withdraw our attention three months later," she said.
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