PAKISTAN: Pakistan's earthquake survivors need not just surgery but help to talk about the trauma of October 8th.
In the chaos of Mansehra hospital, one long tent is made from a soft drinks banner draped over a wooden frame. They call it the "Pepsi" ward. Halfway down, in bed 18c, Aisha Bibi screamed. Writhing like an eel, the four-year-old thrashed the air with a bandaged stump which was once her right foot. Her eyes still foggy from the fading anaesthetic, she cried: "Allah! I am in pain!"
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. The doctors had promised to do their best to save Aisha's foot, which was crushed by a toppling wall. But it was too late. The gangrenous rot had advanced too far, withering her flesh and blackening her bones. Her foot had to be amputated.
A generation of children has been lost to the earthquake. Some died, crushed by walls and roof beams. Others survived but are grievously traumatised.
When the ground jolted violently on that fateful morning the concrete slab roofs of schools across Kashmir and North-West Frontier Province fell like tombstones, crushing children at their desks. Yesterday, Unicef estimated that 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 spokeswoman 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. Long delays in reaching safety resulted in stinking, infected wounds. Many limbs were amputated.
Many of the younger quake survivors wear the vacant look of traumatised war veterans. 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 eyes staring vacantly out the door. "She hardly sleeps, she is very nervous and fearful," said Mr Munir. "Her two sisters died, but she won't talk about it. She just stays quiet, hardly moves and almost never cries."
Not only the wounded are traumatised. In a swelling refugee camp on the edge of Mansehra, Durray Shehwar (4) clung to her uncle. "She saw four people die before her eyes - a grandfather, grandmother, an uncle and his wife," said Ghulam Abbas. "Now she won't even go into the bathroom. She's afraid of anything under a roof."
The scale of the task facing relief workers 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.