Psychologists warn children are the most at risk of PTSD, as survivors of the deadly eruption cope with the trauma.

San Juan Altoenango, Guatemala – Six-year-old Caty told her mum that she didn’t want to die as a thick, dark cloud engulfed their village of El Porvenir one week ago.

Caty, her parents and four-year-old brother Anthony were among the more than 12,000 Guatemalans who were evacuated following the eruption of the Fuego volcano, which left at least 110 people dead.

“She was crying and hugging her cousin while Anthony just stared at me,” Mirza Toma, Caty’s mother, tells Al Jazeera.

“He’s too young to understand what’s going on,” 28-year-old Toma says.

Toma and her children now sleep on a foam mattress in a cramped shelter in the town of San Juan Alotenango, where they have to wait in a long line to receive food and use the toilet.

Meanwhile, her sisters scour the morgues in search of their missing daughters, aged six and 14.

They were last seen running down the street and are among the 197 people who are still missing.

“When she sees me cry, I try to pull myself together and be strong for her,” says Toma, her eyes welling up with tears. “‘Your cousins are in heaven,’ I tell her.”

While Caty plays with a toy stethoscope, she whispers that the family’s cat got left behind and she’s afraid that looters might steal it.

As the communities most affected try to cope with the scale of the disaster, psychologists and other health professionals warn that children, like Caty, are the most vulnerable victims of the Fuego volcano eruption.

‘We need to assist them now’

A day after the eruption, rescue workers were horrified to discover the charred bodies of six young children huddled together on a bed, in the village of San Miguel Los Lotes, which was completely buried by volcanic matter.

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Last Wednesday’s rescue operation was more hopeful after six-month-old Esmeralda Lopez, dubbed by the local media as “the miracle child”, was pulled out of the wreckage, alive and well, without so much as a scratch.

The same day, six children with severe burns, aged one and a half to 16, were flown to the Shriners Children’s Hospital, in Galveston, Texas, as part of the US government’s relief effort.

Eight-year-old Edwin Bravo, however, died from his injuries in the San Juan de Dios Hospital, in Guatemala City, the night before.

Child psychologist Leonel Dubon, explains that infants have been traumatised by the loss of parents and siblings, their pets and belongings, as well familiar surroundings – including their homes and schools.

Dubon is the director of Refugio de la Ninez, a child-protection NGO that has deployed 32 child psychologists specialized in trauma, to provide counselling services for the youngest victims of the tragedy, in the 21 shelters where 4,175 survivors and evacuees have been temporarily housed.

Some children are suffering from nightmares and while others are quiet and withdrawn. Volunteers have encouraged them to draw in order to help them process the trauma. Some have drawn lava and stones, while others have drawn dead trees.

“We need to assist them now in order to prevent the onset of post-traumatic stress disorder (PTSD),” says Dubon.

We were happier in El Porvenir. I used to have a swing. Now it's gone. Caty, six years old

Joseline Xeron is another young mother who was also evacuated from El Porvenir and is staying in another shelter in San Juan Alotenango. Her husband lost nine family members during the eruption.

She’s worried because her three-month-old baby is sick and her five-year-old daughter refuses to eat.

“All we’re getting is protemas (a soy-based supplement) and she doesn’t like that. I’m also sick with diarrhoea,” Xeron says.

Back home, her children were used to eating chicken stew or fries with mayonnaise.

Xeron complains that evacuees are only allowed to leave the shelter between 10 and 11am local time and are not allowed to buy their own food. “If we’re not back by 11, we’re not allowed back in. We came here seeking help and wound up in a prison,” she says.

Psychologists and other health workers warn that children are the most vulnerable victims of the Fuego volcano disaster [Louisa Reynolds/Al Jazeera]

While Xeron waits in line to be seen by a doctor, a group of university students entertain the children by helping them to break a pinata shaped like a purple bird with orange feet. They cheer gleefully when a hole appears on its side and sweets pour out.

“They’re smiling now, but the moment we leave they go back to reality. They miss their home, their toys; they’re in a cramped space and seeing so many new faces is upsetting for them,” says 23-year-old volunteer Joseline Perez.

As Caty puts her pink stethoscope away, she says wistfully: “We were happier in El Porvenir. I used to have a swing. Now, it’s gone.”