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Countless Nepalis face long battles with anxiety and depression after the country's devastating recurring earthquakes and hundreds of aftershocks, aid workers and mental health professionals warned.
Delilah Borja, Save the Children's country director in Nepal, said the organization was "extremely concerned about the emotional well-being" of kids who were caught up in the two major quakes.
"The second quake in particular has created a new level of terrifying uncertainty as those affected must now ask themselves if another deadly earthquake is coming," she said in a statement released on Wednesday.
A major 7.8-magnitude quake struck on April 25, killing at least 8,150 people and injuring more than 17,860 as well as destroying 600,000 homes. Tuesday's 7.3-magnitude quake came just as many were regaining a sense of security.
Nursing student Shristi Mainali's life had was returning to normal until Tuesday's tremors. Her family had begun sleeping inside their Kathmandu home after spending nights in their garden out of fear of being crushed in another temblor. Shops and schools were reopening, and the 21-year-old was getting ready to return to college on Friday.
But now "everybody is terrified, even if they have no physical damage, no property damage, mentally they are deeply affected by this," she told NBC News. "It is the only thing that people have been talking about."
Survivors have reported constant feelings of anxiety, depression, sleeplessness and flashbacks. Many traumatized children can cry inconsolably or in turn remain quiet and despondent.
Aid workers have witnessed firsthand the ongoing trauma affecting whole families.
Brad Kerner, who is Save the Children's adolescent health specialist, traveled to Nepal within days of the April 25 quake. He recounted hearing the distress every night, literally.
“When I was sleeping outside with everyone else, every time there was an aftershock, the dogs start barking violently, and then the babies start crying," he said. "I can only imagine how traumatized children are now, [and] how hard it is for parents to console them, being scared and traumatized themselves."
Save the Children has set up a series of "child friendly" spaces that allow kids to "work through their own fear or just play a game," Kerner said. This, in turn, takes pressure off parents and allows them to "go and do what they need to do — find clean water, food, make sure they have what they need," he added.
Trauma is common for all natural disaster survivors, who often worry whether they will ever be safe again. Katie Longest, of Bridge Creek, Oklahoma, was recently saved from her home after a tornado ripped through her town. But the fear didn't go away.
"We've already been hit — are we going to be hit again?" she asked on Saturday.
One disaster like a tornado or Nepal's April 25 earthquake can shatter any normal person's sense of security and well-being, according to Stephanie Haen, director of behavioral health at the Fairfield, Connecticut-based Family Centers, which has a long history of helping individuals and communities deal with trauma.
"When it occurs again and so soon, when you haven't completed getting your things back into place, feeling safe, it is gong to impact you," she said. "A lot of these folks are going to be pretty stressed, pretty anxious and probably pretty depressed for a very long time just because it is going to take a long time to get their lives back together."
And the invisible emotional scars can be as devastating as the physical ones, aid workers warn.
France Hurtubise, a spokeswoman for the Canadian Red Cross, told NBC News the emotional impact of the recurring earthquakes was "absolutely crucial to speak about, and the main thing we often forget about in these events."
Hurtubise said her organization had a member of staff specifically employed to speak to parents, children and teachers who had lived through the traumatic events.
"The children are especially important because they might not speak about what they've seen unless they are encouraged," Hurtubise said. "We will be starting very, very soon to start training the Nepalese teachers to make sure the kids talk about what they've gone through."
Hurtubise is based in the village of Dhunche, a five-hour drive into the mountains north of Kathmandu. She said most people in the remote area were still living in tents from the initial disaster last month.
United Nations Children's Fund has also warned that kids' mental well-being must be top of mind for those helping in the recovery.
Indeed, Mainali's 12-year-old brother Deepesh was having a hard enough time before Tuesday's quake.
"He has been shouting in his sleep, saying: 'Earthquake is coming! Earthquake is coming!'" she said. "He couldn't sleep, couldn't go anywhere alone because he was afraid. Now he keeps saying, 'What if an earthquake comes? Let's sleep outside, let's sleep outside.'"
NBC News' Alexander Smith and Emma Ong contributed to this report.