The 8th of September 2023 is a day etched in the memory of children in Morocco’s High Atlas Mountains. A powerful earthquake that day killed 2,800 people and injured 3,000 more, but it also left thousands of young survivors with hidden scars, their lives teetering between trauma and resilience.
In the small town of Amizmiz, at the foot of the mountains in al-Haouz province, the atmosphere the week after the earthquake struck was heavy. Large parts of the town had been reduced to rubble. Wherever the eye fell, modest makeshift tents had become a sanctuary for families whose homes had crumbled, and thin blankets, also serving as mattresses, were children’s only playmats.
"Every time I think about it, the fear returns and my heart starts racing. I am lucky. Thanks to God, my family is still alive,” said seven-year-old Salim*. His two friends, Mounir, eight, and Omar, 10, listened on quietly. They had all lost one of their friends, Youssef, to the earthquake.
Their silence was shattered by a helicopter slicing through the sky. The three boys exchanged glances before directing their gazes upwards. "I will be a pilot one day!" exclaimed Salim, his eyes sparkling with enthusiasm. "Maybe a fisherman!" teased his friend Mounir. They burst into laughter, before Mounir gave his friend a soft tap on the ribs, and they raced off, their laughter echoing in the street.
According to UNICEF figures, the earthquake, which was the strongest to hit the North African nation in over six decades, has affected more than 100,000 children. Many have been displaced or have seen their homes destroyed, and access to safe drinking water, food, and education have been disrupted, the agency said.
In a country where there are only 50 child psychiatrists (who can provide talk therapy as well as prescribe medication), and only 14 outpatient mental health facilities for children and adolescents, UNICEF has called for urgent child protection services, which it described as “critical in helping children and parents process their distressing experiences”.
Amidst these limited resources for children, and as impacted families try to restore normalcy in their lives, some local mental health workers are stepping in to try to fill the gap.
"The impact of a trauma, like an earthquake, on a child's development can be profound. This distress may manifest in academic difficulties, often due to concentration issues,” Khalid Dahmani, a clinical psychologist in Morocco, told The New Humanitarian.
Traumatised children
In the small community of Talilit, located about four kilometres from the centre of Amizmiz, eight-year-old Salima said she still dreams of becoming a vet and hopes her life will regain some semblance of normality. Salima and her younger sisters had not yet returned to school when The New Humanitarian visited in the week after the earthquake, but classes in the region have since resumed.
“I want to become a veterinarian. For that, I will have to go back to school. But I don't want to, because I would be alone. All my friends are dead," Salima said.
When the earth shook, Salima thought she was dizzy. She instinctively touched her head and feared she was in the grip of a hallucination. Then, the sound of plates breaking alerted her that something else was going on.
"I started crying because I was very scared, and I worried about my parents: If I died, I would leave them alone," she said.
Parents told The New Humanitarian they have grown more concerned as their children have started to exhibit signs of stress and anxiety, manifesting in nightmares and a struggle to accept the gravity of what happened.
“Every day, at the same time when the earthquake happened my girls start screaming and shaking. They want to run in fear it will happen again,” said Salima’s mother, 48-year-old Saadia Badou.
Malika Mzan, 54, mother of 10-year-old Maria, said it is painful to watch her daughter overwhelmed by constant fear that has crippled her ability to resume her daily routine and affected her desire to play and interact with others.
“Since the day of the earthquake, my daughter has been waking up in the middle of the night, terrified. Even going to school has become difficult for her,” Mzan told The New Humanitarian.
“She's constantly afraid, which makes it hard for her to focus,” she added. “Before, she loved to be around people, talk, [and] play, but since that day she’s been isolating herself and doesn't communicate that much with us.”
According to Dahmani, children with unresolved trauma are at risk of developing a range of emotional disorders, such as depression or anxiety. Symptoms include sleep disturbances or persistent phobias, “all of which [can] limit their interactions and personal growth", he said.
A local initiative
Understanding the serious repercussions of unresolved trauma, local aid groups, the UN, and international humanitarian organisations quickly began working to help children process their post-earthquake shock.
“I can tell you that 15-25% of the patients we've seen exhibit alarming symptoms and are at risk of developing post-traumatic stress disorder, thus requiring specialised intervention.”
Psychologues Maghreb, an initiative launched days after the earthquake by a group of young Moroccan psychologists, has extended its support to children psychologically impacted by the disaster. They focus on talk therapy as, unlike psychiatrists, they can’t prescribe medication.
The team consists of 35 people, including 32 psychologists, with varying specialties, and three legal advisers. They have assisted over 1,200 individuals through phone consultations and provided direct aid to 40 people in affected areas, including children.
“I can tell you that 15-25% of the patients we've seen exhibit alarming symptoms and are at risk of developing post-traumatic stress disorder, thus requiring specialised intervention,” Souhail Abounnaim, a member of Psychologues Maghreb, told The New Humanitarian.
The initiative has organised five trips to earthquake-affected regions, departing from Marrakech. The visits last two to three days, during which psychological support is provided to children, predominantly in-person.
After making an initial general assessment of the children’s mental health state, the psychologists then conduct follow-up sessions during subsequent visits to help prevent long-term impacts on their education and social interactions, explained Abounnaim.
“The main objective was to provide psychological support and assistance to the affected individuals,” the psychologist said.
“Initially, active listening, acknowledging the feelings experienced, and normalising them were paramount. Subsequently, in collaboration with willing psychologists, each patient embarked on a psychological journey aimed at helping them overcome their trauma,” he added.
Long-term psychological support, however, remains a challenge and largely depends on whether the initiative will be able to find more financial sponsors to allow them to conduct further follow-up visits, according to Abounnaim.
Educating parents and teachers
Psychologues Maghreb’s programme also involves training and workshops with teachers and parents, followed by interactive sessions and activities with the children, Abounnaim explained. The objective is to raise awareness about the potential effects of the earthquake on children, in addition to teaching the parents and teachers how to recognise post-traumatic stress symptoms in a child.
“Identification was a crucial step; based on the training they received, teachers and parents were able to identify children who were more or less affected psychologically by the earthquake. This helped the team of psychologists organise individual meetings with the children to address their needs and assess their mental state,” said Abounnaim.
“Every child needs a space where they feel safe to express their feelings and share their concerns.”
In addition to financial sponsorship, the initiative also faces challenges when it comes to securing permission from Moroccan authorities to set up tents to receive clients. Language can also be a barrier, as some patients only speak Amazigh, which only a few volunteer psychologists are fluent in, according to Abounnaim.
“Additionally, ensuring continuity in treatment, scheduling appointments, and coordinating with the therapists can pose logistical challenges. Finding a slot that suits everyone involved requires careful planning and coordination,” he added.
International humanitarian organisations such as UNICEF, the International Federation of the Red Cross and Red Crescent Societies (IFRC), and Médecins Sans Frontières (MSF) have also been providing psychological first aid to survivors, local organisations, and frontline workers, in a country where a quarter of Morocco’s population of 37 million people reportedly suffered from depression, even before the earthquake.
MSF, in collaboration with two local non-governmental organisations, has organised three visits to the worst-hit villages, Marie-Christine Ferir, a member of MSF’s emergency unit in Brussels, told The New Humanitarian. Each, she said, consisted of two Moroccan psychologists, one health promoter, one logistician, and one experienced expatriate psychologist.
“In the villages, teams lead group sessions, followed, when necessary, by individual sessions,” Ferir said. “Some children participated in group sessions, and, depending on the villages, we also organise more fun activities, such as drawing sessions and animation, with them.”
It takes a village
Dahmani emphasised that the support system surrounding the children, including parent and teacher involvement, plays a crucial role in the healing process. A sense of security can be achieved by returning to a daily routine to establish a semblance of normalcy in lives that have been abruptly disrupted.
“Active listening is paramount,” he said. “Every child needs a space where they feel safe to express their feelings and share their concerns.”
The Ministry of National Education, Preschool, and Sports has also been working to help children in earthquake-affected regions return to school, including by setting up 150 makeshift schools in al-Haouz province to allow children to resume their education. The schools are also helping to provide psychological support by allowing the students to share their thoughts and emotions, including through educational and recreational activities under the supervision of specialised social workers.
In many cases, teachers’ awareness of mental health can make a significant difference.
“I've been closely observing the children in the aftermath of the earthquake. It's clear that many of them are experiencing signs of stress and anxiety,” Meriem Morchidi, a teacher in a makeshift primary school in al-Haouz province, told The New Humanitarian.
Morchidi said she had seen several tell-tale symptoms, including noticeable changes in behaviour, varying from increased quietness to moments of restlessness.
“We're re-establishing routines to provide a sense of normalcy and predictability,” she said. “Our goal is to foster a safe space where children feel comfortable sharing their emotions and restoring their personalities and traits they had before the earthquake shook their lives.”
*All parents were asked for their consent before the children were interviewed.
This feature has been produced in collaboration with Egab. Edited by Eric Reidy and Hanan Nasser.
