Pakistani earthquake survivor Shameen Akhtar orders her husband every day to dig up their three daughters.

The girls were killed in the October 8 earthquake - one in the rubble of their house, one in a landslide and the third when her school collapsed. Their bodies have not been recovered.

“Bring the dead bodies of my daughters. They need a funeral,” she cries, hiding her face in her hands outside her tent in the Mera Tanolian camp near the city of Muzaffarabad.

Her husband shouts back it is impossible.

The earthquake killed more than 73,000 people and seriously injured a similar number.

Many more are suffering from the effects of the trauma.

Khalid Saeed, a mental health coordinator with the World Health Organization, estimates up to 180,000 survivors have serious mental disorders, including severe depression, psychosis and anxiety.

Half a million face moderate mental problems, such as stress and flashbacks. Up to 2 million people need what he calls psychological first aid, which includes help in finding their way to relief workers and tracking down family members.

“Without treatment their problems will worsen,” Saeed said. “They won’t be able to resume their lives and take part in reconstruction. It will not only affect them but also their family and the community.”

Huma Gull, who heads a team of psychologists for the WHO and the Pakistani Ministry of Health in the Muzaffarabad area, said children suffering from trauma may develop anti-social personalities or stop studying.

Adults may give up their work, compounding their difficulties.

“This leads to economic problems and that creates another psychological problem, because they lose confidence in themselves and in life,” she said.

Up to 60 percent of quake survivors Gull treats suffer from post-traumatic stress disorder, acute stress reaction or depression.

Patients with stress disorder relive traumatic events over and over and many live in fear of another earthquake. They are restless and have reduced concentration, appetite and sleep.

Depression also makes people want to withdraw from life.

“I don’t like talking to people anymore. I just want to sit in my tent,” said Riaz Ahmad, a quake survivor who lives in the Mera Tanolian camp and works as a translator for an aid agency.

“The common question on people’s minds is ‘what is going to happen to us?’” he said.

Gull said hospitals have also seen many patients with conversion reactions where nothing is physically wrong, but they complain of physical problems.

“One child in the hospital complains that he is blind, but he is not. He pretends this because of the fear,” she said.

“NORMAL PEOPLE, ABNORMAL SITUATION”

Saeed said trauma patients can be treated with drugs, psychotherapy and counseling.

But he cautioned there was a need to create awareness about mental health problems to avoid stigmatization and ensure that those who need help make contact with one of the nine mental health teams set up in the area.

“Mental health care should be part of the general health care system. People with mental disorders are ill and they need treatment, just like someone with a broken leg,” he said.

Ambreen Arshad, a psychologist with the Turkish Red Crescent Society working in Mera Tanolian, is trying to help women in the camp overcome trauma and has put together a women’s committee.

“They just need to share, but they cannot, because everybody deals with the same grief,” she said.

“People have become aggressive, angry and frustrated. They are normal people in an abnormal situation.”

The first time the committee met most of the women just wept. But they have slowly started to take control over their lives, said Arshad.

“We want to turn these women from passive victims into active survivors,” she said. “They collect data about vulnerables like widows and disabled people and identify helpful contact persons. Being active reduces their grief.”

Camp manager Naeem Latif said the mood in the camp seemed to have improved since Arshad began work several weeks ago.

“There are still fights, but less,” he said, although many camp residents were still very frustrated.

“They don’t know what is going to happen to them.”

Saeed said some people had turned to religion, which could help them recover from trauma.

“People have been saying their prayers and they have been reading the Holy Quran. You highlight to them it is not only important to follow these guidelines, it is useful for your health as well.”