Beirut, Lebanon

We are psychiatrists based at the American University of Beirut Medical Center, one largest psychiatric departments in Lebanon. Since October, 2019, Lebanon has navigated through several crises. It started with unremitting political unrest, national bankruptcy, and currency devaluation. The COVID-19 pandemic complicated situation by stretching health-care system to its limits. Our ordeal would culminate non-nuclear explosions history. afternoon Aug 4, 2020 was meant be a typical summer afternoon, closing on warm eastern Mediterranean sunset. At 6:08 pm, dull sound first explosion disrupted our train thoughts made us gaze into sky sight mushroom cloud, which we later know had specific rather amusing name—the pyrocumulus. Whether behind wheel negotiating evening traffic or from comfort home, senses were alerted but still confused while attempting decipher level threat. is city used tragedy pain, amount devastation that befall port dense urban centre surrounding it nothing short biblical. 3000 tonnes abandoned ammonium phosphate stored harbour turned world shattered buildings, street rubble, crushed vehicles. Of course, causes blast not apparent until much later, fuelling panic fear air raids coordinated terrorist attacks. A true apocalyptic silence followed hundreds anguished screams all around…including ours. Amidst went flight, fight, freeze response no particular order. fascinating how absurd futile one's initial such events is. Still shaken vulnerable, also concerned for fate family, friends, colleagues. Death never been close, 200 victims unfortunately too close. realisation survival result sheer casual circumstances, as being far window having driven minute earlier, sent psychological shockwave ripples this day. Within 24 h, recovering personal level, put clinician hats once again returned clinical practice hospital, whose façade seriously damaged. Many patients affected others attended fresh stitches casts. 2 weeks, joined colleagues volunteering launch Trauma Assessment Support Clinic department. Listening patients’ narratives clinic prompted spontaneous empathic connectedness compassion. Yet challenged ability stay mindful own emotions given vivid experience event. This beyond vicarious trauma seen often felt risk re-traumatisation. Ultimately, role alleviating emotional suffering survivors contributing healing community humbling rewarding. nurtured growth sense belonging, both helped boost morale. More than 4 months have passed since explosion, resolution out reach. unavoidable daily journey past site reminder frailty, conditions allowed happen remain firmly place. While investigations ongoing, people grieving their losses trauma. emergence expected long-term sequelae will require advanced interventions including pharmacotherapy, focused therapy, availability inpatient emergency care. compromised medication shortages resulting destruction stores lack foreign essential medical equipment drug importation. Additionally, absence adequate insurance coverage mental health services alongside an aggravated limiting access, especially further voluntary exile professionals aspiring better future abroad dire economic professional horizon. Despite countless adversities, aftermath Beirut's disaster fostered open discussion about general. validated various individual experiences acknowledging normal responses well awareness acute post-disaster phase. Building momentum fundamental achieve aspiration all. cannot without improving access care legislation, policy, investment training services, finally combating societal stigma. As us, lived traumatic August reinforced staunch belief should always core management.