On a chilly December afternoon, pedestrians in downtown Cairo were shocked to see a hysterical young woman running in the street. The sobbing girl was holding an empty bullet casing in one hand and a patch of blood-soaked cloth in the other. Every now and then, she would stop stunned passers-by and show them what she was holding.

“Look at the blood,” she would scream. “They’re killing us!”

The girl is 21-year-old Lina Megahed. The incident took place during what is now known as the “Cabinet clashes,” when the army tried to violently disperse a demonstration against newly appointed Prime Minister Kamal El-Ganzouri. The clashes left dozens dead, including a personal acquaintance of Megahed.

“I was walking in the square collecting empty bullet casings from the floor,” the young woman recalls. “Then I remembered that, before the clashes, I had planned to go on vacation and I thought to myself, ‘I’m supposed to be on the beach collecting seashells’ – and the two images converged in my mind.”

Then, as she was walking, she stumbled upon a horrific image.

“I saw a really long trail of blood – really long – about 23 metres maybe,” says Megahed.

Traumatised, she recalls picking up a patch of bloody cloth from the ground and just running.

“I just couldn’t take it anymore,” she says. “I lost control completely.”

Megahed's breakdown came at the end of a particularly difficult year for thousands of Egyptian young people. In the last twelve months, they have seen friends shot dead and others badly injured. They have learned the price – the hard way – of trying to build a new life for their country.

Hundreds died in last year’s 18-day uprising against the Mubarak regime, and more than a hundred have died in the ensuing violence. Most of those killed were young people.

“Horrible things have happened to most of my friends,” says Megahed. “I can’t think of anyone I know who didn’t suffer a bad experience during the last year.”

Grizzly Education

One of Megahed’s friends is 21-year-old Mahmoud Hany, who, like her, was often at the frontlines when clashes erupted. Hany has a young bearded face and the haunted eyes of someone who has seen too much.

“Since the revolution began, with the exception of the month of August, I’ve lost at least one friend every month,” Hany says.

Even before the revolution, Hany was politically active. He used to attend numerous anti-Mubarak protests, when the notorious state security forces would frequently treat protesters violently. But nothing prepared him for what he was about to experience when the uprising began in January 2011.

He smelled tear gas for the first time on 25 January of last year, saw the first person die in front of him on 28 January, and visited a morgue to identify a friend for the first time in April.

After a year of being on the receiving end of assaults by security forces against protesters, Hany has acquired an uncanny knowledge of the different kinds of weapons being used against him and his friends.

There are three kinds of tear gas used on protesters, Hany explains. The one with the red label is manufactured in the US; the one with the blue label is British-made. He also knows that there are two different kinds of rubber bullet: the copper, which comes in six sizes, and the rubber, which only has one size. He knows that a live bullet is 9 mm long, and that a sniper-rifle beams a green light before it hits its target.

As time went on, and clashes escalated, Hany and his friends invented new ways to deal with these weapons. At first, they used vinegar and Pepsi to counteract the burning effects of tear gas on their eyes and faces. Later, however, they learned that yeast and medical drips work better.

“We learned these things from trial and error. Now, we’re so experienced that we can help the injured more than the medics,” he says. “Some people have also started using face masks to stop themselves from inhaling the gas. But I like doing things old school – I just use my Kuffayah,” he smiles.

And after one year of on-again, off-again post-revolutionary violence, Hany has also learned what no one his young age should: what the face of a dying person looks like. “Usually their mouth is open, they look pale, their eyes are unfocused and their breathing is unstable,” he says.

Even more horrifying is how well acquainted Hany is with the interior of Cairo’s notorious Zeinhom Morgue. The things that he witnessed in there, he says, will haunt him for the rest of his life.

“The stench was horrifying,” he remembers. “The drawers meant to hold the bodies are all broken, so bodies are often piled on top of each other haphazardly. In order to identify one body, you have to see all of them.”

Many of the corpses Hany saw in the morgue bore traces of the as-yet-unidentified gas they were subject to. “Some of them had weird skin eruptions and colours all over their bodies; others had completely lost their facial features,” he recalls.

Dying a Thousand Deaths

Needless to say, the psychological impact of these horrifying scenes, especially on a young mind like Hany’s, is devastating.

Before last year’s revolution, Hany was a three-time national champion in Karate and was training to compete in the world championship. He was also studying to be a mechanical engineer. He lived the healthy, clean life of an athlete, avoiding smoking, and eating nutritiously.

Now, by contrast, he’s lost a great deal of weight, barely eats, and has such bad insomnia that at one point he went a full nine days with little or no sleep.

“I feel so alert all the time. I just can’t relax enough to sleep,” he complains. “And when I do finally sleep, I have terrible nightmares in which I can see people dying.”

He’s also angry – so angry that several of his neighbours have started avoiding him. After a university friend was shot dead in one of the recent clashes with security forces, Hany stopped attending university all together.

He recently met the grief-stricken mother of a friend of his who had been killed, about whom they reminisced fondly. The pain became unbearable. By the time he returned home, he was so furious that he smashed the furniture in his room. He also almost attacked his mother, who had come in to see what the commotion was about. Since then, he has taken to taking his anger out on himself.

“For weeks, I would get so angry that I would repeatedly punch the wall in my room,” says Hany. “I didn’t even feel it. It was only later when my hands would be bleeding and my mother was sobbing in front of me that I realised what I had done.”

The loss of so many loved ones in recent months, he added, had made him feel that life was no longer worth living.

“With the death of each friend, I die a thousand times,” he says. “Now I just want to die to be with them.”

Coping with Anger

The horror of these experiences has impacted many other young protesters. One of Hany’s friends, Abdel Rahman Zein El-Din, 19, has also struggled to cope with the past year’s trauma.

At one point, Zein El-Din was hit with 17 birdshot pellets all over his body. Three of them still remain in his head and have not been removed due to their precarious location. Another time he was electrocuted when he tried to jump an electric fence to get out of the line of fire. And another time he was caught in a violent clash while on his way to celebrate his birthday – during which he was badly cut in the face with a piece of ceramic thrown from the top of a building.

Zein El-Din, a member of the Ultras White Knights – hardcore football fans – since 2008, had participated in numerous clashes with security forces before last year’s revolution. Nothing, however, compared to the strain he experienced over the last year, he says. One of his fellow Ultras was beaten to death, several friends were shot dead, and another had been riddled with 108 birdshot pellets all over his body.

“I’ve seen people die, people get shot,” Zein El-Din says. “I saw a guy’s face split in two after he was hit with a teargas canister. I’ve seen body parts and pieces of someone’s liver on the ground after one of the clashes.”

Like his friend Hany, Zein El-Din, too, is no stranger to the morgue. “The first time I went in there, it was horrible,” he says. “I saw things there that no one should ever see.”

For days afterward, he could not speak to anyone from shock.

At one point, he was also kidnapped and tortured by security forces for several hours before being dumped – bloody and terrified – in the middle of nowhere. And when the 1 February Port Said football tragedy took place, in which more than 70 people were killed in Port Said Stadium, Zein El-Din found out that one of his friends had been attending the match. Although his friend’s name was not on the initial list of victims, Zein El-Din’s relief proved short-lived as subsequent reports confirmed that his friend had indeed been killed in the violence.

“I had known that guy for seven years,” he says. “He died from suffocation. Now I feel like I want to die to join all my friends who are gone. What’s the point of living if everyone you love is not there anymore?”

The emotional anguish, he says, has changed him. Now he has frequent nightmares and is short-tempered with his friends. He says he has also become more violent – indeed vicious – when standing on the frontlines.

“Now I just throw stones and whatever else I can at them,” Zein El-Din says. “I just don’t care anymore.”

The anguish, however, has not stopped Zein El-Din – or many other young protesters – from going to the frontlines whenever fresh clashes erupt.

Babes in the Woods

Junior Malek, 17, is another young Egyptian whose life has becomes a jumbled blur of clashes, injuries and violent death. During one particularly violent episode, he was beaten so badly that he developed a blood clot in his brain and was confined to hospital for two days.

Most traumatically, however, Malek has seen protesters killed in cold blood by security forces. “That’s the most difficult part,” he says. “Because you keep thinking, ‘He won’t do it; he won’t pull the trigger’ – but then he does. And it’s just shocking and incomprehensible.”

During one of the recent clashes, Malek sought refuge in a hotel in downtown Cairo. When he finally left, he saw several dead protesters being thrown by security forces into a garbage dump. “It was a horrible sight,” he shudders. “I’ll never forget it.”

Malek is currently a senior in high school, but his attendance has dropped off sharply since the revolution began. “I find it difficult to attend classes as normal,” he says. “My life now is divided into two worlds. In one world, everything is normal; and in the other, people are dying.”

Like many young Egyptians, Malek doesn’t fear the bullets so much as he fears his parents finding out about his involvement in the clashes. At one point, his father was so worried about him that he went to Tahrir Square during a sit-in, climbed up on a stage and shouted out his son’s name – to the latter’s mortification.

On more than one occasion, Malek has had to hide his activism from his family.

“One time I went home after having been hit with birdshot in several parts of my body,” he recalls. “When my father asked, I told him it was dirt because I hadn’t showered in a while.”

Like his friends and colleagues, Malek has also been having nightmares and has struggled to cope with daily life. Nevertheless, he says, he has no plans to quit any time soon.

“Taking part in the clashes has become a kind of addiction,” he says. “It’s not just about the cause anymore – it’s about the people who died. I feel it’s my duty to get justice for them.”

According to Mona Hamed, a psychiatrist at the Cairo-based El-Nadeem Centre for the Rehabilitation of Victims of Violence, the extent of the psychological trauma of such violence on these young Egyptians depends on several factors.

“These factors include the person’s age; affiliations; personality; personal beliefs; whether they have access to a strong support group or not; how intense the trauma was; and whether the violence affected them, or someone they know, directly,” Hamed explains.

During incidents of extreme trauma, says Hamed, the brain struggles to simultaneously process all the pain.

“So the brain employs a defence mechanism,” she says. “Since the brain can’t take all the pain at the same time, it lowers a kind of curtain. The victim tells himself or herself that it didn’t happen; that they aren’t sad, and can even laugh and joke.”

Hamed compares the process to the experience of seeing a very bright light. “When you see a very bright light, your reflex is to close your eyes,” she explains. “This happens psychologically when the trauma is particularly severe.”

Months, maybe even years, later, the victim may begin to show signs of Post Traumatic Stress Disorder (PTSD), Hamed says.

Post-Traumatic Stress 

The classic symptoms of the PTSD include flashbacks, in which the victim not only remembers but literally relives the experience, as if it were happening again. This can happen either while they are awake or while they are sleeping, says Hamed.

Another symptom of PTSD, Hamed explains, is "avoidance," by which the victim shuns or ignores any object, person or place that reminds them of the traumatic incident. “In some cases, they might even avoid people entirely unconnected to the incident simply because they fear that the subject may be opened,” she says.

Yet another sign of PTSD is hyper-arousal, in which the victim remains in a state of perpetual alertness and has difficulty relaxing or sleeping.

What’s more, many victims of violence also often struggle with a hefty dose of survivor’s guilt.

“They always feel that what happened to them wasn’t that bad,” says Hamed. “If they were injured, they feel bad for not having been killed; if they were tortured for a day, they feel for others who were tortured longer. If a bullet hits someone next to them, they think, ‘Why didn’t I die?’”

This sense of guilt can become so overwhelming that victims often refuse to seek help, believing that to do so would be tantamount to betraying those who were continuing to die in the street.

According to psychiatrist Basma Abdel Aziz, the victim’s brain goes into “fight-or-flight” mode during clashes, which serves to temporarily numb their feelings.

“In fight mode, all the body’s organs are focused on the battle at hand, so they don’t feel the losses,” says Abdel Aziz. “Then when it’s over, they think, ‘Oh my God, my friend died in my arms and I didn’t have time to grieve.’”

For fulltime activists, adds Abdel Aziz, the impact may be less, since they often feel they are sacrificing for a larger cause. Those who are not, however, tend to suffer all of the full blown symptoms of PTSD, she says.

Others, meanwhile, can become desensitised to the violence, although Abdel Aziz stresses that some experiences are impossible to normalise. “Under any circumstances, having to identify someone in a morgue who’s been violently killed is deeply traumatic,” she says.

Other victims may become so distressed that they resort to displacement. Since they can’t properly express their anger at security forces for killing their colleagues, they aim it instead at friends and family members. In some extreme cases, the trauma may be so excruciating that they resort to committing suicide.

Many young Egyptians suffer at least some of these symptoms as a result of the ongoing violence. And if left untreated, experts caution, the effects can bode poorly for their futures. For this reason, several mental health centres, including El-Nadeem and the General Secretariat of Mental Health in Cairo’s Abbasiya Hospital, where Abdel Aziz works, have opened their doors to victims of recent trauma. A telephone hotline has even been set up to take calls from those seeking help.

“We have social workers, psychologists and psychiatrists on hand,” says Abdel Aziz. “We will open our doors once a week, and provide support groups and individual sessions. We can also issue free medication from the Abbasiya Hospital pharmacy for anyone who may need it.”

But the problem, says Abdel Aziz, is that many victims refuse to seek help due to the stigmas associated with mental health care in the local media. In Egyptian movies, for example, mental health facilities are consistently depicted as loony bins or torture centres in which screaming patients are treated with electric shock therapy.

Additionally, Egypt’s former regime had been known for exploiting the issue of mental health to eliminate particularly troublesome critics. One of the more recent cases of this was that of dissident blogger Mikel Nabil, who was sent to Abdel Aziz for assessment last October after going on hunger strike to protest a three-year jail verdict handed down by a military court.

“People need to understand that there is no such thing as ‘crazy’ in the field of mental health,” stresses Abdel Aziz. “The violence has been terrible. People need to come forward and seek help.”