When she went to work, Amrita said a grim goodbye to her three children and asked relatives to take care of them if she didn’t come back. She felt as though she were going to her death.

That was April 24, the blackest day in the history of Bangladesh’s garment industry: 1,127 people were killed when the Rana Plaza building in Dhaka collapsed. An inspector had warned it was unsafe; nevertheless, factory bosses ordered the workers back to their machines.

Amrita — not her real name — obeyed. Now a jobless double amputee, the young mother is going through the most wrenching experience of her 22 years, deeply traumatized and struggling to salvage what is left of her life.

She is one of 170 emotionally and physically shattered survivors who have received counselling from teams trained by Médecins Sans Frontières (Doctors Without Borders). Dozens of others will also receive help.

“The survivors found themselves amputated, paralyzed and depriving their families of income when they were the only ones working,” said Montreal-based Charlotte Sabbah, an MSF mental health officer who has just returned from two months of training psychology students and outreach workers in Bangladesh.

“They are not only suffering from fear, flashbacks and nightmares, but guilt because they are no longer supporting their children.”

Amrita’s story is the stuff of nightmares. But it is not unusual among the survivors of the catastrophe that injured hundreds of people and left 600 missing after dangerous cracks opened up in the flimsily constructed factory building.

“She was buried under four dying colleagues, her legs were stuck under a beam, and if she moved, more beams would fall,” said Sabbah. “She was trapped for a whole day, and finally when they came to rescue her, they had to cut off both her legs.”

The sole support of her near-destitute family, Amrita was afraid to refuse the demands of her employers in spite of serious fears about the safety of the building, which had been temporarily shut down the previous day.

After the disaster, says Sabbah, the survivors “had lost control of their body, of their environment and anything they expected in life.”

Using a program based on cognitive behavioural therapy, Sabbah trained volunteers to do short-term counselling that helps those with post-traumatic stress to regain control of their emotions and mobilize the strength to carry on with their lives.

One woman who lost three of her best friends and housemates “felt as though her whole life had gone away. Only one of their bodies was found. Spiritually and symbolically, she had to bury them.”

Most of the factory victims were women, who suffered additional stress because of social norms. “It’s terrible to see that their self-image was destroyed,” said Sabbah. “In Bangladesh women don’t have much status. They’re valued for their looks, or the money they bring in, or the children they can bear.”

But men also suffered from post-traumatic stress: the dozens of rescue workers who struggled for 18 days to locate survivors and bodies in perilous conditions and searing heat. Some are now terrified to walk into a building or an enclosed room.

“They were having flashbacks and nightmares,” said Sabbah. “They thought bodies were under their beds. They were startled by any noise that took them back to that terrible scene. They were unable to function.”

The MSF team located traumatized people with the co-operation of hospitals, the Red Cross and community volunteers who gave up days of work to help the survivors.

Some victims who left hospital returned to their family villages to try to start over. “Sewing is the only thing they know, so they are hoping to start small businesses,” Sabbah said.

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For many the outlook is dim, in a country where social support is as negligible as justice for the poor. Three months later, says the Wall Street Journal, the authorities have made arrests but no one has yet been charged with a crime. Meanwhile many survivors have yet to obtain compensation.

For Amrita, the disaster brought a tiny glimmer of good news. The 10,000 taka (about $132) she received for the loss of her limbs went to buy her unemployed husband a rickshaw to support the family.

“These people have experienced something so terrible, and in spite of it they want to survive because of their children,” said Sabbah. “I came back impressed and humbled.”