They call it the ”Pepsi ward”. In the chaos of Mansehra hospital, one long tent is made from a soft-drinks banner draped over a wooden frame. Halfway down, in bed 18C, Aisha Bibi screamed.
Writhing like an eel, the four-year-old thrashed the air with a bandaged stump that was once her right foot. Eyes still foggy from the fading anaesthetic, she cried some of the only words she knew: ”Allah! I am in pain! Allah!”
Her father, Shafi ur Rehman, leaned over her shuddering body and clamped her flailing arms in his hands. They had come by helicopter from the Alai Valley, a mountain fastness about 80km to the north, he said. The doctors promised to do their best to save Aisha’s foot, which had been crushed by a toppling wall. It was too late. The gangrenous rot had advanced too far, withering her flesh and blackening her bones, he said. They had amputated an hour earlier.
”The pain will stop soon, my love,” Rehman murmured tenderly into her ear, his face creased with worry. ”Soon it will be better.”
A generation of children has been lost to the October 8 South Asian earthquake. Some died, crushed by walls and roof beams. Others survived but are grievously traumatised.
It started like a normal school day, which was the problem. By 9am, the men of many Himalayan communities had left for the fields. The women were inside, cooking and washing or tending to their children. And thousands of pupils had crowded into their classrooms.
When the ground jolted violently, the concrete slab roofs of schools across Kashmir and North West Frontier province fell like tombstones, crushing children at their desks. On Monday, the United Nations Children’s Fund (Unicef) estimated 17 000 pupils had been killed and 10 000 schools destroyed.
”The impact has been monumental. We’re terming it the children’s catastrophe,” said spokesperson Katey Grusovin.
The physical trauma is easiest to quantify. In ward after ward across the quake zone, dazed-looking children encased in plaster and swaddled in bandages attest to thousands of mashed hands, crushed hips and amputated limbs.
The harsh geography made it worse, doctors say. The jolting journey down steep mountain paths caused patients with back injuries to become paralysed. Long delays in reaching safety resulted in stinking, infected wounds. Many limbs were amputated.
”It’s heartbreaking,” said one surgeon in Mansehra. ”In all my career I’ve never seen a wave of injuries like this.”
Aid workers are planning to import large stocks of wheelchairs and miniature prosthetic limbs.
But the invisible scars run deepest and may be hardest to heal. Traumatised by the loss of a limb or having suffered the death of a parent or a sibling, thousands of children are plunging into depression, psychologists warn. Nightmares, insomnia and intense anxiety attacks are common, said Dr Iftikhar Hassan, of the Fatima Jinnah Women’s University in Rawalpindi.
”We have some children who have gone mute, others who blame themselves for surviving while their friends died. Teenage girls may be feeling suicidal,” she said. ”They tell us they wish they had died … There is an urgent need for more supportive counselling.”
Many of the younger quake survivors wear the vacant look of a traumatised war veteran. Asmat Bibi clung to her father’s shoulders as he carried her from the X-ray tent at an Italian-run field hospital in Mansehra. Reaching the bed, Muhammad Munir propped her up against a pile of blankets. But the 12-year-old seemed not to notice, her pond-like eyes staring vacantly out the door.
”She hardly sleeps, she is very nervous and fearful,” said Munir. ”Her two sisters died, but she won’t talk about it. She just stays quiet, hardly moves and almost never cries.”
In another ward, Iftikhar Shah (15) described watching his best friend, Shariq, bleed to death at their school in the village of Paras, near Balakot.
”His face turned blue and we were all weeping,” said the 15-year-old. ”We promised him we would keep him alive. But he said, ‘No, I can feel that I am dying.”’
Continuing aftershocks fray nerves further. More than 1 000 have rocked the area since October 8, often sending the injured leaping from their beds. Not only the wounded are traumatised. In a swelling refugee camp on the edge of Mansehra, four-year-old Durray Shehwar clung to her uncle, munching absently from a bag of crisps.
”She saw four people die before her eyes — a grandfather, grandmother, an uncle and his wife. She was lucky to get out alive,” said Ghulam Abbas. He pointed to a portable toilet. ”But now she won’t even go into the bathroom. She’s afraid of anything under a roof.”
In other ways, children are more resilient than adults, psychologists say, and have a better capacity to put tragedy behind them. Friendship and toys also ease the trauma, said Brigadier MH Rana, an army psychologist in Rawalpindi.
”We have sent other children to play with them and it makes an amazing difference. The quake victims project themselves through the toys, using them to show how the walls came falling down,” he said. ”But you really have to persevere. It takes a lot of time.”
Officials say a comprehensive approach is needed, involving social services, education and healthcare. Unicef is sending 2 000 ”schools in a box” to kick-start the education system. The Red Cross and other NGOs plan to reunite families and the World Health Organisation is training teams of counsellors.
The scale of the task is daunting, and time is pressing. An estimated 120 000 children are still stranded with their parents in mountain hamlets, cut off from aid by landslides. The Himalayan winter of smothering snows and sub-zero temperatures is just three weeks away. — Guardian Unlimited Â