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 this 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, Islam 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 said, 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 still 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.
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 be reluctant to seek help because of the social stigma that is attached to mental problems, Sabur said.