The impact of a blast is judged by "how many dead?" The next number we value is "how many injured?" At some point during the countless blast in the last two decades these two figures became the markers for how seriously we should mourn and condemn an attack.

Of late, support groups have also been formed for families of those whose loved one’s were injured or passed away -- especially with regards to the attack on the Army Public School in 2014 and the Easter blast in Lahore in 2015. Little thought, however, has been spared for witnesses and survivors of a blast who appear physically unharmed.

Although the dust at the site of an explosion in Lahore on February 17 seems to have settled, in that DHA’s thriving shopping market is more or less functional now, and that after much back and forth between the government, witnesses, experts and journalists, about whether it was a terrorist attack or a cylinder blast, most have moved on from the explosion, there are still some who are struggling to forget the events of that morning.

Louis*, a stylist at Toni&Guy, which is located almost directly opposite the building that housed the explosion, was retouching a client’s roots when he heard the explosion a little before half past 11 in the morning.

For the first few seconds, Louis recounts that there was silence, and then the screaming began. He cautiously peered out the salon’s windows facing the street. He remembers seeing black smoke, debris and in between all that, bodies thrown atop parked cars. It’s this image that he can’t forget.

"Even when I blink, I see the smoke, debris and bodies -- no matter what I do, I can’t forget that scene," he says. At this point it’s been more than 10 days since the blast.

A security guard, Akram*, employed by a bank in the area surrounding the blast is suffering in a similar manner: he does not have a single scratch to show, but his mental health has been compromised.

"I saw it all. I saw mens’ bodies hurtling in my direction along with the broken glass in the dark black smoke," says Akram. Since the day of the blast, he can’t seem to fall asleep before tossing and turning for many hours. "I doubled my intake of filled-up cigarettes, thinking that would help. But the smoke from my chars just reminds me of the smoke from that day," he complains. Lately, he’s been constantly asking himself why he was spared?

Uzma* is also battling to forget that morning. The 19-year-old recently took up her first-ever job at a salon in the neighbourhood, and is now questioning whether it was wise to start working in a city so dangerous. "Whenever I shut my eyes I see the images from the site. Eventually, I sleep and when I wake up for the first few moments I believe I am at the site surrounded by debris and bodies." Far from offering help, Uzma’s employer has strictly instructed her not to talk to anyone about the blast. "She says the best way to forget is by devoting myself to work and pretending it didn’t happen."

Another physically unharmed witness of the DHA blast is Umme Laila Azhar. She was clearing a cheque at UBL, which is situated in the building next to the explosion, when she heard the deafening bang. "Miraculously, I am unharmed except a minor scratch on my face."

After the blast, witnesses and volunteers immediately begin sizing up people, says Azhar. "Everyone told me I was okay, so amidst the dead and injured bodies, and the debris, I found my car and even though all its screens were shattered I somehow believed I could drive it home," she says.

Azhar made it only about 500 metres to Pot Pourri, where she parked and called her family to collect her, before realising she was not "okay". "My hands were trembling, then my heart rate increased and by the time I reached the hospital I was having a full-blown panic attack".

That was also when the guilt began to set in. Typically, the first part of the guilt is concerned with why the witness didn’t or couldn’t do more to help others. To defeat this, Azhar is considering receiving first-aid training. And the second angle of the guilt is concerned with why she survived, when others didn’t? For this, along with the anxiety and flashbacks from the explosion site, Azhar has decided to go for counselling.

"I am lucky that I have a background in psychology so I know how easily these memories can move from my subconscious and settle in my unconscious. Unless I seek help, I may be dealing with crippling anxiety for the rest of my life," adds Azhar.

Louis, Akram, Uzma and Azhar are all suffering from acute stress disorder, according to Dr Ali Madeeh Hashmi, a psychiatrist and the coordinator at the Punjab Psychotrauma Centre, which is housed in King Edward Medical College’s Department of Psychiatry -- the centre was created after the attack at Army Public School, to specifically deal with witnesses and survivors of deadly blasts. "But it’s been mired with red tape. We can’t do anything until we receive a letter from the Health Department instructing us to help a group of people," says Dr Hashmi. "We are expressly prohibited from helping people without instruction from the department."

Increased anxiety, bad dreams, jumpiness, irritability, guilt about surviving and flashbacks are all typical symptoms of acute stress disorder, and they are to be expected when a blast like this occurs, says Dr Hashmi.

"Fortunately, for most people the anxiety and flashbacks will stop in a few months, but 20 to 30 per cent of the survivors and witnesses will never forget. Their experience will turn into Post Traumatic Stress Disorder (PTSD) and this will seriously hamper their day-to-day abilities." That means that it’s likely that either Louis, Akram, Azhar or Uzma, and their families and loved ones, will have to deal with PTSD for the remainder of their lives.

"The concept of psychological first-aid is most helpful in the first few days after the incident," says Hashmi. "A few weeks after the event the witnesses can be helped through support groups -- a space where it’ll be safe to vent and talk. A support group being conducted by an experienced professional will also help identify who is experiencing anxiety and depression, and hence more likely to develop PTSD. Then they can be helped further," says Hashmi.

But who can we expect to arrange these support groups? While the stylists at the Toni&Guy say they would readily participate in a support group, their managers say this is something their bosses haven’t yet considered; Akram is convinced that since he is physically unharmed he doesn’t need any doctors besides his boss hasn’t even come around to ask him how he is, much less offer him psychological services; and Uzma has been instructed to forget that this ever happened. Azhar is the only person who has a chance to battle her flashbacks.

In this year alone, Pakistan has been hit 18 times. Countless people saw scenes that they have been unable to forget. If the government is immobile on the matter, then perhaps community leaders and business owners can arrange group therapies for witnesses and survivors. "There would be many doctors willing to lend a hand, such sessions are inexpensive and effective at battling symptoms of acute stress disorder," says Dr. Hashmi.

*Names have been changed to protect witnesses.