RIO DE JANEIRO - Like she has so many other nights, Ana María Gomes is awakened by the cries of her husband and tries to calm him as he shouts for help from his mine coworkers. She convinces him the dam collapse that devastated their city of Brumadinho and killed at least 270 people happened a year ago.

Sebastião Gomes, who worked in the environmental clean-up division of the mine in Brazil’s Minas Gerais state, recounted the episode and said he’s learning to live with the nightmares. He is also undergoing psychiatric treatment, still amazed that he survived the wall of mud that buried so many of his friends one year ago Saturday.

And he is not alone. Brumadinho is a city of 40,000 residents tortured by its past, and struggling to find a future, with doctors reporting spikes in the use of anti-anxiety medications and anti-depressants.

“The city is torn apart. A year has gone by chronologically, but it’s like it happened yesterday,” Gomes, 54, told the Associated Press by phone.

The rupture of mining company Vale’s dam created a wave of mud and debris that buried the equivalent of 300 soccer pitches. Families lost children in the mud. Some bodies still haven’t been found, and perhaps never will be. And its destruction hasn’t halted; it continues to roar through residents’ minds, the local economy and the environment.

On Saturday, relatives of the victims held a memorial on the anniversary. They released balloons inscribed with the words: “The way that you left hurts too much.”

Gomes was one of the lucky ones who barely avoided death. As the mud charged towards him, carrying everything with it, his friend and coworker Elías Nunes said, “It’s over. We’re going to die right here.”

They sought refuge within a truck, and drove forward. Regretting that, they slammed the car into reverse. But there was no escape from the mud that flowed like lava. Resigned to their fates, they began to pray. The wave projected the vehicle to the mud’s surface, saving them, as hundreds of friends and colleagues were crushed and suffocated beneath them.

For survivors and family members of victims, the dam’s collapse was only the beginning. Use of anti-depressants jumped 56% in 2019 between January and November from the prior year, while anxiety medication rose 79% in the same period, according to data from Brumadinho’s city hall.

“The impact on the population’s mental health is similar to that caused by a huge disaster, like Fukushima, or September 11 in the U.S.,” said Maila de Castro Neves, a professor of psychiatric care at Minas Gerais state’s federal university.

De Castro will evaluate the impact of the dam’s collapse on the local population over the coming years. She said local residents are in a “vulnerable state,” at risk of anxiety, post-traumatic stress disorder, substance abuse and even suicidal behaviour.

The human toll from the disaster isn’t even fully clear; the search for corpses continues. Rescuers are digging in the mud, trying to locate the bodies of 11 missing victims. They are “shredded jewels,” in the words of Andressa Rodrigues, 42, who lost her only son, Bruno, in the disaster. His body was found 105 days after the dam collapse.

Rodrigues, a teacher and councilwoman, lives in the same house she shared with her son, a recent engineering graduate who had attained his dream job working for Brazil’s biggest mining company, Vale. Bruno’s room remains intact, as though Rodrigues expects her son to come home for dinner, like any other night before the catastrophe.

“I still can’t free myself from the mud,” said Rodrigues, who admits her life now revolves around all kinds of medications, including sleep aids and anti-depressants. “A mother’s heart beats with that of her son, and mine is there. They buried him alive, and I’m with him in that bloody mud where I lost him.”

The eve of the disaster’s anniversary brought some hope to victims’ families that their loved ones may find justice. Public prosecutors charged Vale, German auditing firm TÜV SÜD and 16 employees for intentional homicide and environmental crimes. Among the accused is Vale’s former CEO, Fabio Schvartsman.

Prosecutors say there is evidence the companies knew the mine was operating with “unacceptable” safety conditions, putting at risk the lives of its employees. Vale and TÜV SÜD executives face up to 30 years jail time.

“Our kids were working with a ticking time bomb over their heads,” Rodrigues said. “Every day the rage grows because we’re sure it wasn’t an accident. They were murdered.“

In a statement, Vale expressed that “the accusations of fraud are perplexing” and said it is collaborating with authorities. Schvartsman denied the charges against him and TÜV SÜD has said the cause of the dam failure still hasn’t been conclusively clarified, adding that the company continues to co-operate with the investigation.

The paralysis of mining activity, which generated about 60% of town revenue before the tragedy, has left Brumadinho’s economic future unknown.

Paradoxically, the economic impact was initially positive, as the city received an infusion of emergency funds from Vale and carried out recovery works. The company paid out more than $6 billion in compensation, heating up local activity. Stores increased sales, people bought cars, and home-building projects proliferated, according to reports in local press.

“We are aware that the increase in economic activity is temporary, and we are greatly concerned about the future in the medium- and long-term,” said Brumadinho´s mayor, Avismar de Melo Barcelos, in an emailed statement from his press office .

The punishment was worse for riverside communities and farmers who relied on the Paraopeba River, the town’s main source of water, for irrigation and fishing. In three collection points along the river within Brumadinho, the result was the same: horrible water quality, suitable only for boats, according to non-profit group SOS Atlantic Forest. According to the report, heavy metals including iron, manganese and copper were detected at levels above those permitted by law.

For Gomes, the ex-Vale worker, everything changed. That day he suffered only scratches on his arms and knees, but the mental damage endures: he has to undergo various psychological treatments and remains medicated.

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The money he received from Vale has afforded him financial stability - though he remains in litigation with the company - and he’s writing a book for catharsis. He also gives paid talks about mining to raise awareness about its risks.

Despite everything that transpired, Gomes is hopeful that he -- and Brumadinho -- can find their way and turn the page. But the disaster will remain forever etched in their history.

“Life is full of ups and downs. The tragedies and the losses will always leave wounds, but the town will overcome,“ he said.