The rescue operation is usually treated as the end of a building collapse. For survivors, it may be the point at which a less visible phase begins. Building collapse survivors can leave hospital with injuries that are documented and treated, while continuing to experience fear, disturbed sleep, intrusive memories and anxiety linked to the hours they spent under debris.
The experience of Dr Aastha, who was trapped for nearly five hours after a building collapsed in Said-ul-Ajaib on May 30, illustrates the gap between physical rescue and longer-term recovery. Six people died in the collapse. Aastha, who had been studying at a mess next door, was rescued and treated at the AIIMS Trauma Centre, where she spent five days, including two in intensive care. More than three months later, the experience remained present in her daily life.
She described being unable to understand what had happened, struggling to breathe and eventually realising that she was trapped under rubble. A phone call with a friend became a lifeline while she waited for rescuers. After her release, she spent time bedridden in Guna, her hometown, with swelling in her legs and injuries affecting her right hand and leg. The physical consequences were accompanied by an aversion to videos of building collapses, which made her feel as though she was still trapped under the debris. She told the Times of India that she did not receive psychological counselling after the incident.
That absence is significant because a collapse creates more than an emergency medical problem. It creates a period of life-threatening stress in which a person may experience helplessness, pain, sensory deprivation and uncertainty about whether help will arrive. The hospital can address fractures, muscle injuries and other immediate conditions, but the psychological effects may only become clearer after the survivor returns home.
## The recovery that follows physical rescue
Dr Rajesh Sagar, a psychiatry professor at AIIMS, described a building collapse as a form of life-threatening stress. According to him, some survivors may develop acute stress symptoms soon after the incident. In others, symptoms can persist and cross the threshold into post-traumatic stress disorder. These may include anxiety, repeated recollection of the event, flashbacks, distressing dreams, depression, emotional numbness and detachment.
Other survivors may experience less severe but still disruptive symptoms, including irritability, mood swings or persistent anxiety. Sleep is one of the most important warning signs. Difficulty falling asleep, repeated waking, waking too early or being jolted awake by dreams can indicate that the person continues to relive the event.
The significance of sleep extends beyond comfort. A survivor who is unable to rest may struggle to return to study, work or ordinary routines. Yet these changes can be misread by families as a personality shift or a failure to move on. Sagar said the response begins with recognising that such symptoms may be consequences of what the person has experienced, rather than simply changes in behaviour.
The source report does not establish how many survivors of building collapses receive counselling after discharge, or how consistently such follow-up is provided. But Aastha’s account points to a practical gap: emergency response can be organised around extraction and hospital treatment without creating an equally visible pathway for psychological recovery.
Support does not necessarily begin with specialised treatment alone. Sagar identified family and friends, a return to routine, hobbies, breathing exercises and mindfulness as potentially useful forms of support. Cognitive behavioural therapy may help, while medication may be considered when clinically necessary. The appropriate response depends on the survivor’s symptoms and clinical assessment.
The need for follow-up also extends to people whose health problems existed before the collapse. Disasters can worsen pre-existing mental or physical illnesses, and disruption may lead some survivors to stop taking regular medication or abandon treatment. Screening and follow-up therefore have to look beyond the injuries caused directly by falling debris.
## Rescue decisions can shape long-term outcomes
The mental-health consequences of a collapse cannot be separated entirely from the conditions of the rescue itself. A trapped person may spend hours in darkness, dust and heat, unable to move and uncertain whether rescuers know where they are. The way rescuers communicate, identify voids and remove debris can affect both survival and the risk of additional injury.
Dr (Maj) Rajesh Bhardwaj, founder of Med First ENT Centre, said rescuers should resist the instinct to rush indiscriminately onto unstable rubble. Adding weight or deploying heavy machinery too early can destroy air pockets in which trapped survivors may still be breathing, he said. His account emphasises silence, careful identification of voids, safe extraction and immediate attention to the airway.
The warning also concerns how an exposed victim is moved. Bhardwaj said victims should not simply be pulled out by their limbs because spinal injuries can convert an otherwise survivable injury into permanent disability. This places technical judgment at the centre of the first response: speed matters, but speed without structural and medical discipline can create further harm.
For cities, this makes collapse response a coordination problem rather than a single rescue action. The operation involves locating trapped people, stabilising or reading an unstable structure, managing machinery, communicating with victims and transferring them to medical care. It also raises the question of what happens after the ambulance leaves the site.
The supplied report does not identify a formal citywide protocol connecting rescue agencies, trauma hospitals, psychiatrists and families for long-term follow-up. It does, however, show why such a connection matters. A survivor may be physically stable but psychologically distressed. Another may have a pre-existing illness that is interrupted during displacement. A third may appear to recover while sleep disturbance, flashbacks or avoidance continue unaddressed.
## From disaster response to survivor care
Urban disaster systems are often judged by visible milestones: how quickly a site is reached, how many people are extracted and how many emergency beds are made available. Those measures are important, but they do not capture the entire recovery period. A collapse can continue to affect survivors after the rescue equipment has left and the news cycle has moved on.
A more complete response would treat discharge as a transition rather than a conclusion. The issues identified by the experts in the report suggest several points at which survivors may need attention: psychological screening after the immediate medical crisis, monitoring of sleep and distress, continuity of medicines and treatment, family guidance, and referral for therapy or psychiatric care when symptoms persist.
This does not mean that every survivor will develop a psychiatric disorder. Sagar’s description distinguishes between acute stress, longer-lasting post-traumatic stress disorder and milder reactions such as irritability or anxiety. The relevant point is that the range of responses is broad, and the absence of visible injury does not prove that recovery is complete.
The same principle applies to rescue methods. A trapped person’s chance of survival depends not only on the existence of rescuers but also on the decisions made around unstable debris, air pockets, airway management and spinal protection. The operational choices made during the first hours can determine whether a victim is safely extracted or suffers additional injury.
Aastha’s account brings these two timelines together. The first ended when rescuers reached her after nearly five hours and took her to hospital. The second continued after discharge, when videos of other collapses triggered memories of being under the rubble and when physical symptoms affected her mobility. The fact that she did not receive psychological counselling makes the distance between rescue and recovery visible.
The evidence in the report supports a narrow but important conclusion: building-collapse response cannot end with extraction or hospital discharge. What remains uncertain is how routinely survivors are screened, referred and followed after such incidents. Future assessments of urban disaster preparedness should therefore examine not only rescue capacity, but also the systems available to help survivors recover from the injuries that cannot be seen.
