Mental wounds from the Madrid bombings could linger for years and damage Spanish society if victims are not helped, psychologists who provided emergency help after the attacks said on Wednesday.

Madrid’s psychologists leapt into action after the attacks, setting up a 24-hour hotline within 90 minutes and offering help at temporary morgues and crisis centers.

“Within five years we could have a much larger population consuming (illegal) substances, having problems with anxiety, phobias and stress…with family relations,” said Itziar Iruarrizaga who worked at one of the morgues.

The emotional impact of the explosions was difficult to calculate immediately, the psychologists said.

One possible precedent was that some 60 percent of people caught up in the September 11, 2001, attacks on the United States suffered from post-traumatic stress, they said.

The pain is only just beginning for some almost a week after the attacks, as the most badly damaged bodies had to be identified by DNA testing.

“There are still families who are just now hearing the news that one of the bodies is that of their loved one,” said Fernando Chacon, dean of Madrid’s College of Psychologists, adding the worst affected may still need counseling in two years.

Fear of getting on trains and public transport has been one of the most immediate impacts in Madrid, much as fear of flying and fear of tall buildings surged after suicide pilots flew two planes into New York’s World Trade Center towers.

Spanish psychologists are liaising with U.S. colleagues.

Other symptoms haunting those affected by the explosions - which killed 201 people when they blew apart packed carriages on four commuter trains - include panic attacks, flashbacks, silence and worry about the future.

Counseling needs to continue and those suffering should keep looking for it to ensure unhealed wounds do not lead to wider social problems, Iruarrizaga warned.

People who were not at the scene of the bombings or helping in their aftermath have also been emotionally damaged, with callers to the hotline traumatized by images and accounts of the bloody explosions, rather than living through them, Chacon said.

Spain may have been somewhat prepared for the emotional impact of the attack, however, because of dealing with a 36-year campaign by violent Basque separatist guerrillas ETA that has killed around 850 people, he added.