On the evening of August 4, Hanine Abdel Rahman was enjoying a coffee in a cafe in Beirut’s Gemmayze neighborhood, when a deafening explosion ripped through the building, instantly shattering windows and sending metal beams crashing to the floor.
The 35-year-old’s leg was torn open from the knee to the calf and required 50 internal and external stitches. But her injury was not only physical.
A week on from the blast at the Beirut port that killed at least 170 people and wounded over 6,000, Abdel Rahman still has trouble processing what happened.
“Every time I look down at my leg I am completely overwhelmed,” she told Al Arabiya English. “I am on edge - I become immediately alert at the smallest sound.”
The accumulated stresses of a devastating economic crisis, the COVID-19 pandemic and the tragic explosions are leading to an “exponential rise in the level of need for mental health care” in Lebanon, said Dr. Rabih El Chammay, the director of Lebanon’s National Mental Health Programme.
Multiple survivors of the blast told Al Arabiya English that they were experiencing psychological responses to the traumatic experience ranging from loss of appetite and anxiety to lack of motivation and flashbacks.
Perla Khattar, a 22-year-old student, was at home in the eastern suburbs of Beirut when the force of the explosion threw her four meters from her couch and flipped furniture.
“I can’t sleep longer than 90 minutes - I wake up with nightmares, reliving the traumatic episode,” she said on Monday, six days after the blast.
“What is important to acknowledge is that these reactions are normal and to be expected after such a traumatic event,” explained Dr. Chammay.
“However some people are experiencing them for the first time” and need additional support, he added.
Therefore, the first step in the direct aftermath of the explosion, he continued, is the normalization of these feelings and providing basic coping mechanisms via public awareness campaigns.
Non-governmental mental health organizations have also rushed to respond in the aftermath of the explosion by setting up support tents in the worst-affected areas of the city, and dozens of psychologists and therapists are offering their services for free.
Among them is Diala Itani, a psychotherapist and counsellor who is using her skills to provide free sessions via phone or video call to those affected by the incident.
“I’ve had at least 10 people call me so far, and each person has reacted to the trauma in their own way and at a different pace,” Itani said.
What I am encouraging, she added, is that people try their best to express themselves and allow time to process the emotional shock of such a singularly tragic event.
“Now is the time to be sad and to be mad.”
Children are particularly vulnerable to the psychological impact of a traumatic event, explained Joy Abi Habib, a mental health and psychosocial support specialist at Save The Children.
“Children could be fearful that the explosion could happen again, they could be on edge, cling to parents or experience night terrors,” she said.
Rola’s* 20-month-year-old daughter still mimics the sound of the explosion, which she heard first-hand in her family home in the town of Awkar and has since watched countless times on TV news bulletins.
“Even when my phone rings, she startles and tells me she is afraid,” said her 37-year-old mother Rola, who is herself struggling with sleeplessness, anxiety and the guilt of surviving when so many did not.
With time and support, most people will likely recover from the traumatic event and their initial psychological reactions will fade away, Chammay said.
Others, however, may develop longer-term psychological disorders - particularly if they have an existing history of mental health issues.
The same is true for children, according to Abi Habib, explaining that a mixture of factors including a child’s previous experiences and support network, could cause behavioral changes to persist.
Chammay is leading work to ensure Lebanon is equipped to cope with mental health needs on the longer term - developing mental health support for frontline responders, ensuring the Embrance LifeLine (1564) is operational around the clock, and rehabilitating healthcare facilities, many of which were damaged or completely destroyed in the blast.
Justice essential to recovery
For some Beirutis, Tuesday’s catastrophe brought long-buried memories of civil war and political assassinations back to the surface.
Georges Haddad lives on a side street leading to Sassine Square in the Achrafieh neighborhood. He has lived in the area since before October 2012, when it was rocked by a car bomb that killed Lebanese security chief Wissam al-Hassan along with seven others, and wounded around 80 more.
At that time, he said, we would dash past every parked car, afraid it was loaded with explosives.
“Now, whenever I hear a loud noise, my heart skips a beat," he said.
Beirut has previously suffered from explosions, assassinations and bombs as warlords-turned-politicians grappled for power and regional conflicts played out on a Lebanese stage.
This time, it was the corruption and negligence of the Lebanese politicians that brought the capital and its people to their knees.
For Chammay, holding the people who were responsible for the deaths and injuries of thousands of people to account is an essential part of survivors’ long-term recovery.
“It is absolutely crucial that people get the truth about that happened and that justice is upheld.”
*Rola asked for her name to be changed to protect her anonymity.