One month after the deadly Beirut port explosion, how is Lebanon coping?

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“The brain does not forget.” Those were the words of one doctor when talking about the August 4 Beirut port explosion.

One month on, Lebanese are still reeling from the blast caused by a fire that ignited 2,750 tonnes of ammonium nitrate stored at the port. People are still putting lives and homes back together, and on Friday, the search still continued for survivors. In a country accustomed to war and violence, Lebanese are now trying to cope with a new kind of emotional trauma.

The explosion is largely regarded as the result of government negligence, where subsequent governments knew that the chemical substance had been stored at the port since 2014, and a paper trail shows that all who knew failed to act.

Dr. Georges Karam, Chairman of the Department of Psychiatry and Clinical Psychology at Saint George Hospital, was in the Gemmayze neighborhood near the port when the ammonium nitrate exploded, shaking Beirut to its core. The blast, felt in Cyprus some 200 km away, killed 191 people, injured over 6,500, and left tens of thousands, potentially hundreds of thousands, of people homeless.

No number of days, months, or years could wipe out the memory of the catastrophe that decimated Lebanon’s capital on that fateful Tuesday.

Just like 30 years were not enough for Karam to overcome his own trauma from the Lebanese Civil War that lasted 15 years, ending in 1990, Karam fears no amount of time will allow Lebanese to forget the events of August 4. The blasts, for Karam, triggered his own troubled relationship with the war and resurfaced nightmares.

As a mental health professional, he understood the urgency of seeking help to process the explosion and the unimaginable losses wrought by it.

In partnership with the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), the first non-governmental organization dedicated to mental health in Lebanon, the Department of Psychiatry and Clinical Psychology at Saint George Hospital launched a free walk-in mental health clinic.

In the first ten days after the blast, the clinic was receiving up to 20 patients per day. Today, an average of 8 to 10 people are still coming into the clinic, with common symptoms being anger and irritability, lack of sleep, recurrent nightmares, loss of appetite, survivor guilt, dissociation, numbness, depression, and more, according to Karam.

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Post-traumatic stress disorder, or PTSD, is a real concern for those in Beirut. Medically speaking, those who do not see symptoms subside within 30 days are at risk of developing PTSD, according to Karam.

He estimated that 15 percent of people will still be emotionally scarred in the following months and will need to come into the clinic for follow-ups and medical treatment.

What about the physical scars?

While the emotional scars from the blast are invisible to the naked eye, the deformed faces, missing eyes, and amputated limbs are a permanent reminder of what many consider the crime committed by Lebanese authorities against their own people.

In the past 30 days, plastic and reconstructive surgeon Dr. Joe Baroud has operated on more than 150 patients free of charge. Cases ranged from wound infections to improperly sutured injuries to surgeries to minimize scars.

“Once the initial shock passed, we were left with complications that had to be attended to,” he explained.

Many patients were treated hastily in the blast’s immediate aftermath. As hospitals were overwhelmed, hospitals, parking lots and streets turned to operating areas as bloodied people staggered in and exhausted healthcare personnel worked relentlessly to save as many lives as possible, while simultaneously processing their own trauma.

More than half of the hospitals in Beirut were damaged, and emergency rooms, operating rooms, and intensive care units were at full capacity just moments after the blast. Outside one hospital, doctors treated patients in the street as the hospital lost electricity. A newborn, baby George, was even delivered with the aid of cell phone light.

Today, third year digestive surgery resident Dr. Christian Mouawad tells us that these floors and units at Saint Joseph Hospital in Dora, a suburb just 7 minutes away from Beirut port, and Hôtel-Dieu de France University Hospital in Achrafieh, one of the oldest neighborhoods east of Beirut, are almost empty of blast victims, and that the hospitals have cleared the material damages.

What about the city?

While the Beirut port is now fully operational again, according to its newly appointed director Bassem Al Qaisi, businesses and homes have yet to be rebuilt.

At the end of 2019, more than 465 restaurants and cafes had closed due to the economic crisis and subsequent diminished purchasing power, the Syndicate of Owners of Restaurants, Cafes, Night-clubs and Pastries in Lebanon reported.

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The coronavirus pandemic and the blast destroyed the last bit of life in Beirut, and the sector is now on its knees. According to president of the syndicate Tony Ramy, financial losses in the sector are estimated to be around $1 billion, with no one to bear the brunt besides already-struggling business owners.

For restaurants who were able to pull themselves up and reopen their doors, business is slow and government aid is nowhere to be found. In the aftermath of the explosion, citizens picked up brooms and took to clean up their city where the government was absent.

Huwaida Rajab, co-owner of Orenda, a vegan eatery in the Mar Mikhael neighborhood that was hit hard from the port explosion, told Al Arabiya English how reconstruction efforts for the restaurant were supported through a fundraiser.

“No one from the government reached out,” she said. “No one at all.”

Other cafés and restaurants have launched similar fundraisers to help rebuild.

Read more: Beirut explosion: One Lebanese restaurant to redirect state taxes to aid efforts

Rajab and her partner Mirna Harb knew they had to do something and that they couldn’t sit idly by. Despite sustaining major damages to both their business and their home, they reopened Orenda, investing once again in the homey cafe. While the duo is still in shock, they’re trying to adapt to the new “normal” and pick up where they left off.

This, according to Chief Psychiatry Resident at Saint Georges Hospital, Dr. Tatiana Warakian, is another common response to crises.

How are people coping?

This “resilience,” Dr. Warakian pointed out, was noted in the attitude of volunteers who took to the streets the morning after the blast. Slowly going back to work, to school, to the site of the blast, and to simple activities that Lebanese once enjoyed is part of the grieving process.

She explained that exposure is much more beneficial than avoidance, adding “the earlier you process the incident, the better.”

By re-telling her story, Rayan Khatoun, Human Resources Manager, is trying to do exactly that. Khatoun experienced the blast first-hand when she was in Gemmayze, another hard-hit area adjacent to Mar Mikhael, and was left with multiple injuries on her back, arms, face, and head.

After many sleepless nights and personal efforts to provide disaster relief, she is now emotionally well and physically healing. But even though she has the choice to go back to “normal” now, she refuses to do so.

“If I do, it means I am alright with what was done to me and to hundreds of others,” she said. “I refuse to forget. I refuse to be beaten to within an inch of my life, left with tens of millions in car damage bills and medical bills, and then one day wake up and say ‘Oh, it’s fine now.’ It’s not.”

Despite slowly settling into a new normal, Khartoun and many others are still waiting for an apology and for those responsible – largely regarded as the government – to be held accountable.

On August 5, Lebanese President Michel Aoun gave an investigation committee five days to find answers and present them to the judiciary. While arrests have been made, there has been no formal announcement of the findings, and a month on, Lebanese are still waiting to find out who holds culpability.