Gaziantep, Turkey – When Elmas Abdulghani has a flashback, her body still shakes like the floor of her apartment on that early February morning a year ago.
She was woken up by the screams of her husband, crying: “Elmas, wake up! Save your life!”
“I just remember fear and confusion,” 35-year-old Abdulghani says, almost tearing up as her mind travels back in time.
Abdulghani’s husband did not survive the first magnitude 7.8 earthquake, followed by a second magnitude 7.6 one later in the day and hundreds of aftershocks, that killed more than 50,000 people in southeastern Turkey and northern Syria on February 6 last year.
But Abdulghani did and, since that day, she has had to deal with the restlessness of mind that came from losing the love of her life and her home in Gaziantep, an important city in the southeast a few kilometres from the epicentre.
Primitive defence mechanisms
The earthquakes created unimaginable psychological stressors for survivors like Abdulghani, from injuries and lasting fear of aftershocks to experiencing the destruction, displacement and deaths around them.
A few weeks after the physical emergency needs were met, groups of volunteer therapists and mental health NGO workers were deployed across the region to support victims and help them process their trauma.
“I’ve worked on other earthquakes and natural disasters in our country, such as the 1999 earthquake in Izmir, but this was different from any other,” says Hayal Demirci, a psychotherapist from the EMDR Trauma Recovery Group, which has deployed teams of mental health workers in tented settlements, container cities, hotels and temporary dormitories since early March last year.
In the first few weeks of their deployment, Demirci and more than 1,000 volunteer therapists worked to provide a physically safe environment to reduce people’s acute reactions and, after a while, to establish a safe therapeutic bond and work with these reactions.
Demirci explains that when the normal bonds between people disappear, the mind triggers the most primitive defence mechanisms to face a harsh reality.
“There have been way too many losses of family members, friends, limbs, homes, cities and hope for the future.
“When these defence mechanisms are active, the sympathetic nervous system is on duty and … the person [feels] like they are in danger all the time. It’s not possible for people who don’t feel safe anywhere, at any time, to eat, sleep or meet their basic needs properly,” she says.
Most people, even after the aftershocks eventually disappeared, felt restless for months.
“Even though my family house was declared safe one week after the earthquake, I still didn’t feel safe staying inside,” says Mert Ozyurtkan, a 22-year-old engineering student at Gaziantep University.
“I would constantly stare at water bottles to see if the water was moving or at ceiling lamps to check if they were swinging slightly. It increased my anxiety levels, and affected my grades.”
While most mental health support in crises focuses on a short-term, emergency approach, Demirci underlines the importance of continuing to work with victims online to address triggers and control flashbacks to reduce any symptoms.
For some, the earthquake changed entire lifestyles. Neslihan Hicdonmez and her husband Ali Ozaslan started living in a camper van and kept their camping sleeping bags at hand because they no longer felt safe in their own home.
“The earthquake totally impacted our way of living. We had never thought of abandoning our newly bought house, but we constantly live with the fear that something of that magnitude may happen again.”
The effect on children
If adults find the effects catastrophic, for children in their early development the disaster left an indelible mark.
Sare Bitir, a fourth-grader at Ilkokulu Elementary School in Gaziantep, still brings her doll to school for comfort.
“It’s the first object I brought with me when we ran out of the house,” she says. “It kept me company for three days while we were sleeping in our car because our house didn’t make us feel safe. It gives me confidence.”
Children are among the most exposed group, says clinical psychologist Zeynep Bahadir, who has expertise in post-traumatic stress disorder (PTSD) and volunteered for six weeks with the Turkish Red Crescent as an emergency online psychologist for families with young children.
She adds that whether children have been directly affected or experienced secondary trauma, “they can be at the risk of post-traumatic stress disorder symptoms, including nightmares and avoidance behaviour”.
Separation anxiety specifically has shown up in school settings. When she returned to school in September, Sare did not want to enter the class, too afraid to say goodbye to her parents.
It took a very patient teacher and friendly classmates to bring her inside, although, for the first few weeks, she couldn’t focus. Some children avoided school for several weeks in a row.
According to Bahadir, fear can persist in children long after the earthquake has passed, which “sometimes can be temporary, but can also adapt into their lives forever”.
Reliving the trauma of death and loss
The situation has been worse for Syrian refugees in Turkey who fled there during Syria’s war, says Yara al-Atrash, a mental health worker at INARA NGO.
Al-Atrash has been in charge of psychological assistance to Syrians living in container camps and assisted many who have lost homes and children, just like they did during the war back home.
“Having to live again the trauma of death, loss and displacement, as well as realising that the new place that gave them safety was no longer safe, was a last blow to those who had survived the Syrian conflict,” she says.
Abdulghani, who lived through an offensive in her hometown of Homs, Syria, says the earthquakes reawakened traumas she thought she had healed.
She had not sought therapy, even after the war, but her restlessness as the one-year mark since the earthquake neared finally made her seek help about two months ago.
Now Abdulghani has been living in Istanbul since February 2023, incapable of returning to Gaziantep and reliving her trauma. In therapy, she hopes to address this fear to be able to finally return.
“Therapy culture is not yet something known in our region, especially in the earthquake zone and villages, which were however the most impacted,” Demirci says.
Many said they were not ready for therapy, but emergency workers tried to encourage them to speak about their wounds. “Those who do not receive support in the acute period may, in the long term, suffer from addictions, including alcohol and drugs, anger and impulse control problems, or even somatic issues such as fibromyalgia, or migraine,” Demirci adds.
“The consequences could be as devastating as the earthquake itself in the future.”
Demirci’s work with survivors will continue for at least three more years, the minimum time required to make sure their healing path will be effective.
As aftershocks in the region continue, people say that coping with them as part of daily life is their new normal.
Songul Dogan, who moved to Gaziantep after her home was destroyed in the earthquake last year, was paying a visit to her native Malatya this past January 6 when a magnitude 4.5 earthquake hit the town.
“We can no longer trust the ground we walk on,” she says bitterly. “How can we keep going and still feel safe without losing our minds?”
