Increasing number of Turkey-Syria earthquake survivors show signs of PTSD

"Initially the patients ... were those who sustained injuries under the rubble... now more of the patients are coming with post-traumatic stress disorder, following all the shock that they've gone through during the earthquake and what they have seen," said Indian Army Major Beena Tiwari.

Many people were coming with panic attacks, she added.

The combined death toll in Turkey and Syria exceeds 37,000, and the earthquake and its aftershock has destroyed whole cities in both countries, leaving survivors homeless in the bitter cold, with many struggling to find shelter and basic sanitation.

The extent of the trauma survivors have experienced is enormous. Some have been pulled from the rubble after hours in the cold and darkness to discover family members have died or are missing, and the busy neighbourhoods where they lived have been reduced to mounds of shattered concrete.

Tiwari is part of a team of almost 100 experts from India who established a field hospital to treat survivors of the earthquake, one of the worst in Turkey's modern history, after a local hospital was destroyed.

PTSD is caused by very stressful, frightening or distressing events, and people with PTSD can relive the traumatic event through nightmares and flashbacks, and may have difficulties sleeping and concentrating.

"People only now are starting to realise what happened to them after this shock period," said a Turkish medical official.

Across the border in Syria, a makeshift centre run by UNICEF provided children with "psychological first aid", encouraging them to play and feel safe.

Staying at the shelter was 9-year-old Ahmad.

"With any loud voice or movement, he gets scared. Sometimes when he is asleep he wakes up and says 'earthquake'," said his father Hassan Moath.

INFECTIOUS DISEASES

Iskenderun hospital commander Yaduvir Singh said they were also seeing more patients with infectious diseases and upper respiratory infections, and the thousands of people living in tents outside in freezing temperatures would be suffering hard.

"Initially, we were having lots of trauma cases, people who were buried in the rubble for a long time, for 72 hours, for 90 hours," he said.

"On one person we had to do an amputation to save his life ... there were life and limb-saving surgeries. Now the case profile is changing."

The World Health Organization has launched a $43 million appeal to provide trauma care and rehabilitation, essential medicines, mental and psychosocial support, and to continue routine health services in Turkey.

"The needs are huge, increasing by the hour. Some 26 million people across both countries need humanitarian assistance," said the WHO's Europe Director Hans Kluge in a statement.