It's been months since Norwegian murderer Anders Breivik was imprisoned for killing 77 people last July. But a study shows that 70 percent of survivors of his crimes suffer psychologically, many showing signs of PTSD.
"There was no qualification in the selection of who died and who survived, it was purely random," said Tore Bekkedal at a busy café in Oslo, near where he works. Bekkedal considers himself one of the lucky ones in surviving the Utoeya massacre committed by Anders Breivik in July 2011. He told DW he's been able to return to a more or less normal life.
But it hasn't been easy. Bekkedal managed to survive the mass shooting by hiding in a toilet block at the camp on Utoeya. When he emerged from his clandestine spot, nearly seventy of his fellow Labour youth party members lay brutally murdered across the small island. "Visions of these unspeakable scenes will stay with him for life", he said.
"I work as an engineer, so I rely on my mind to work properly, It didn't do that for the first nine months after this [attack]. My body was still in emergency mode and I was always extremely alert and would startle at any sharp sound."
"That is extremely tiring and after the first four hours of the day, I would be completely exhausted and would have to go home," he recalls.
Bekkedal is now one of 325 participants in a study aiming to map how Utoeya survivors deal with the trauma. They were first interviewed just weeks after the event. Now, a second round of interviews has started, and a final round next year will conclude how the respondents' mental states have changed over a total of three years.
"They saw their friends being shot and killed," said Grete Dyb, who heads the study at the Norwegian Center for Violence and Traumatic Stress Studies in Oslo. "Some of them had to hide under dead bodies and had terrible witness experiences."
Dyb is concerned that so many of the respondents show signs of post-traumatic stress disorder, or PTSD - a condition often found in victims of war.
"We realized that almost half of the youth that were at Utoeya had levels of PTSD reactions on a clinical level - that is, a high degree of symptoms impacting them in daily life. And that includes re-experiencing the event, having pictures or thoughts or memories that are intrusive and repeated over time," said Dyb.
Symptoms of avoidance - avoidance of places and thoughts about the event - are also part of the disorder, Dyb explained.
"Last but not least, hyper-alertness, difficulty in sleeping, irritability, and difficulty in concentrating" are all part of the malfunction, the researcher said.
The survey conducted by Dyb's center also shows that more than 70 percent of the respondents suffered various degrees of depression five months after the massacre.
Trial over, struggle continues
In August this year, a judge in an Oslo court handed Anders Behring Breivik down a sentence of 21 years imprisonment for his twin terror attacks, with the possibility of an extension to life at a high-security prison. The media focus on both him and his victims was relentless throughout the ten-week trial.
But with the cameras and microphones now having disappeared, there's a danger that people will forget about all those who are still suffering, and who will have to deal with their problems for a very long time, Dyb said.
"Unfortunately, some of the reactions will not go away during the first years," she noted.
"But when you see people in the court or when you talk to them, symptoms are not visible. The impact on sleep, the impact on concentration - these are symptoms that are not so obvious to us," she reflected.
The survivors have to sometimes be prompted to speak. "You have to ask them 'how are you coping with your daily work? How is your sleep?' And a lot of young people still struggle with it even though they work full-time. A lot of them are struggling with achieving as much as they did before."
A cry for help
Most of those who survived Utoeya were of school age. Many now struggle to keep up in class. Some have not returned to school at all. And although most local municipalities offered survivors psychological help in the aftermath of the massacre, not all smaller communities have the capacity to follow up those who might need long-term help. There are simply too many.
Yet Tore Bekkedal, sitting in the Oslo café, said he is fortunate that he was able to see a psychologist, and now feels able to move on. But he's still quite aware of the challenge so many others are still facing.
"There have been people who are unable to eat jam on their toast because it reminds them too much of all the blood," he said. "I seem to be doing fairly well and there are others, my best friend for instance, who is regularly seeing a psychiatrist. Everybody deals with it in different ways."