SAVAR, Bangladesh — Rafiqul Islam can't recall how many people he pulled from the rubble of Rana Plaza, the eight-story factory complex that collapsed in April, killing more than 1,100 people. But he knows how many he cut out with a hacksaw blade — eight. He did so in spaces so cramped that at one point he became trapped himself.
Those 18 days as a volunteer rescue worker left their scars. Islam has suffered memory lapses and had a series of violent outbursts, and wound up losing his job. Now he wanders alone most days, not sure where to go — until the voices bring him back to the place where he saved so many people and lost himself.
"I hear them still, calling for me," he says, staring into a mound of broken concrete, torn fabric and twisted iron.
Nearly five months after the deadliest incident in garment manufacturing history, the suffering is far from over for the victims, their relatives and the rescue workers. Many families have received only part of their promised financial compensation. And activists and health-care professionals decry a lack of psychological and financial support for scores of survivors and rescue workers stricken with invisible handicaps.
"After the Rana Plaza tragedy, people are so concerned with the physical impact, but they are completely ignoring the psychological," said Abdus Sabur, an adviser to the Sajida Foundation, a leading Bangladeshi social development organization. "Mental health is not taken seriously at all in this country."
According to the Solidarity Center, a nonprofit group affiliated with the AFL-CIO, the Bangladeshi government has paid settlements to dependents of 777 of the 1,131 confirmed dead in the disaster, in amounts ranging from $1,250 to $5,000. An additional 36 garment workers who lost limbs or were paralyzed have received between $15,000 and $18,750 each.
Smaller amounts have come from a British chain, Primark, which used a supplier in Rana Plaza, and the Bangladesh Garment Manufacturers and Exporters Association, which represents the $20 billion-a-year industry. A group of Western clothing brands are also discussing providing a lump-sum payment for the suffering experienced by the victims of Rana Plaza.
So far, none of the 4,000 families affected by the Rana Plaza disaster have received the full payments promised by the government or association, says the Bangladesh Institute of Labor Studies, a labor advocacy organization.
Survivors are struggling to cope with not just physical and financial burdens but also with deep emotional wounds.
Visible and invisible signs
Razibul Rahman Kari, 20, a sewing machine operator, was luckier than most when the factory complex collapsed April 24 on the outskirts of Dhaka. Pinned by a heavy slab, he eventually managed to dig himself out with the help of a local man.
But spending hours in the dark amid muffled screams took its toll: The young man has fresh scars on his wrists from cutting himself with a knife while locked in his bedroom. Sometimes when his mother has tried to bring him food, she said, he has beaten her. Without his $70-a-month salary to support them, the family relies on handouts.
The Center for the Rehabilitation of the Paralyzed, a large private facility in Savar, has worked beyond its capacity to care for Rana Plaza's injured. But because of a dearth of trained mental health professionals, patients with symptoms of acute psychological trauma receive "a minimum" of counseling before they are discharged, said Hossain Mehedi, a doctor at the center.
Other victims may refrain from seeking help because of the social stigma attached to mental problems, Sabur said.
Majeda Begum, 23, another garment factory employee, grapples with severe headaches, disorientation and a paralyzing fear of closed indoor spaces. She lives within walking distance of the rehabilitation center, which provides her with free medication — but that's only if she manages to show up, and these days she tends to gets lost.
'Am I gonna be psycho?'
As the government struggled to organize a relief operation at Rana Plaza after the disaster, many local residents rushed to the factory ruins, playing a critical role in rescuing survivors.
One of them, a young mechanic named Omar Faruque Babu, was celebrated in media reports for pulling more than 30 people from the wreckage. When the rescue effort ended, he was checked into a hospital, where he hanged himself in a bathroom.
A part-time teacher, Faizul Muhid, 27, spent three days and nights mining the rubble for the living, and then moved on to a local high school where victims' bodies were left for relatives to claim.
As the corpses rotted in the heat, he did what no one else would do: searched the rows of remains for items — cellphones, nose rings, scraps of paper — that might help with identification. Late one night, he and another volunteer had to fight off a pack of dogs that had gotten hold of an open body bag with a corpse inside.
These days, he self-medicates with a cocktail of antidepressants that he buys with assistance from friends. "Am I gonna be psycho?" he asked one recent afternoon.
Muhid initially resisted psychological help. Now he thinks he could use it, but it's expensive and scarce: There are no more than a dozen certified counseling psychologists in this country of more than 160 million people, according to several doctors and activists.
Sheikh Yusuf Harun, deputy commissioner for the district of Dhaka, said, "It's true — no one is taking responsibility" for the mentally damaged. "They are not reported to us," he said.
Once compensation packages are finalized, Harun said, Prime Minister Sheikh Hasina is planning to address the matter. He offered no details on what kind of long-term support might be made available.
To fill the void in psychological services, several grass-roots organizations are working in hospitals with victims of Rana Plaza, forming support groups that encourage patients to share their stories. Groups are also training counselors to canvass neighborhoods and offer help.
Though the outreach is generally well received, it remains "pretty ad hoc" and covers just a fraction of those affected, said Sadaf Saaz Siddiqi, who works at Naripokkho, a nonprofit group that helps garment workers.
No one has yet reached Islam, the rescue volunteer. A medal from a local workers' rights organization sits on the nightstand of his tin shack, the only nod to his sacrifice.
After spending three weeks in a hospital facility, largely unattended to, he left to be with his wife before the birth of their fourth child, a son. He wants to support them, he said, but thoughts of the bodies he left behind still make him angry and restless.
When he's not home, his wife usually knows where to find him.
On April 24, 2013, the dark side of the garment industry was laid bare with the collapse of the Rana...