BEIRUT — The teenage boys hoisted the white coffin to their shoulders and stepped into the mourning crowd, moving in quiet rhythm as they carried their friend past classmates, teachers and the school where they all had met.

On their last walk together with Elias Khoury, who died of injuries sustained in the massive Aug. 4 explosion in Beirut, the pallbearers seemed to carry the weight of an entire country’s sorrow. Video of the funeral procession was viewed worldwide. But it is in private that Elias’s closest friends and family are now contending with the trauma they have endured.

“I fear every single day that something like that might happen again, because if it does, I don’t think I can take another blow,” said his sister, Nour, who was also badly injured in the explosion. She said she jumps at every small sound, overcome by memories of how the blast crushed her home.

Social workers and other specialists working with survivors say many are showing signs of extreme stress, including flashbacks, nightmares and difficulties falling asleep. Half of the respondents in a recent UNICEF survey in Beirut said that the behavior of children in their household had changed or that the children were experiencing symptoms consistent with trauma and stress. One-third said adults in their household were also exhibiting signs of distress.

Beirutis are still astonished by the destruction wrought across much of the capital by the explosion at a warehouse storing ammonium nitrate. Nearly 200 people were killed and thousands injured. Hundreds of thousands were displaced.

In the weeks since, residents have experienced post-traumatic stress, which is common in the aftermath of unexpected disasters such as earthquakes, said Elie Chedid, a psychiatrist treating victims of the blast.

When a huge new fire erupted at the Beirut port on Thursday, it triggered panic across much of the city as many residents, alarmed by the all-too-familiar sight of smoking billowing into the sky, fled the surrounding area, with some piling into cars and preparing to abandon the capital. Even the unexpected sound last week of French and Lebanese military aircraft conducting a flyover was enough to cause widespread jitters across Beirut.

Since the explosion last month, some Beirutis have been experiencing survivor’s guilt, and many children are struggling to understand what happened.

“It is the first time that they’ve seen blood and destroyed buildings and roads and cars, so for them it’s something very apocalyptic,” Chedid said.

Caregivers have reported a wide range of symptoms in children, including involuntary urination and social withdrawal, said Nisrine Tawily, a child protection specialist at UNICEF. Aid workers have responded by ­gathering children for community activities, creating safe spaces for them to play in public parks and offering basic psychological care. Some children, as well as adults, will require additional assistance as the city continues to rebuild.

“This is still a very normal reaction to a very abnormal situation,” Tawily said.

Strong social support networks and sharing the burden of grief are helping some people carry on. But Chedid said many are discussing leaving the country, which was already suffering through an economic crisis before the explosion. He said he worries that abroad, some Lebanese will lose “the spontaneous social support they get here.”

'Usurped from their dreams'

Nour Khoury, 20, was at home with her younger brother, Elias, and their mother, Mireille, on Aug. 4 when they noticed a fire at the port through their windows. Then the force of the explosion threw them to the floor.

All three were seriously injured. Nour required surgery on one of her hands, and Mireille, who hurt her back and ribs, remains in a wheelchair.

For about two weeks, as Elias clung to life in intensive care, the family held on to hope that their shy, clever boy — so determined as a child that he taught himself to swim and ride a bike, each in a single day — would pull through.

His friends, unable to visit him, turned to prayer. His father, Bassam, uttered reassurances by his bedside and played recordings from his mother, who was being treated in another hospital. She hoped the comfort of her voice would be enough to shake her 15-year-old son awake.

“I always had the impression that a miracle would happen,” Mireille recalled.

On a recent afternoon, the friends who carried Elias’s coffin to his grave and several of their mothers gathered in the apartment his family rents because their home remains damaged. They are learning to cope with their loss, they said, in part by spending time with one another.

The teenagers listened quietly as Elias’s parents lamented that they are grieving not only for their son but also for his friends. In an instant, the teenagers were thrust into the troubles of adulthood in a country that is coming apart at the seams, Mireille said.

“A child of his age . . . dying in his own room?” she said. Gesturing toward the group, she added, “They are being usurped from their dreams, their aspirations, their lives.”

Elias’s friends described him as the peacemaker among them — a kind, popular boy with a musical ear and aspirations to follow in his father’s footsteps as an architect. In recent months, as the coronavirus pandemic limited their time together, they met online, where they played Fortnite and Call of Duty, sometimes until 3 a.m. Now, his friends don’t want to play. When they log on, they still search for his name.

One said he dreamed he saw Elias at the mall and called out to him to stay away from the windows. In photos that the boys have taken since the blast, arms thrown around each other’s shoulders, one always poses with an arm extended in the air, making space for their friend as if he is still beside them.

“Whatever we do in our lives, we will do it for him,” said Cyril Hobeika, 16. But their view of life has been shaken. “If it taught us anything, it is that nothing in life is permanent,” he said.

'I'm always scared'

Across Beirut, parents described the aftermath of the explosion as the final unraveling of childhoods already marred by Lebanon’s political upheaval and dire economic crisis.

No one in Bechara and Nicole Sacre’s immediate family was seriously injured in the explosion. But their home was badly damaged, and their children, Lara, 17, Sarah, 16, and Paul, 9, discovered their grandmother on the floor of her apartment after she’d been knocked down and was crawling toward her door to seek help.

Since then, they have been startled by loud noises and reluctant to play outside, where they were in the moments before the explosion, their parents said. “What makes us sad is to see that this is how they spend what is supposed to be these beautiful days of their lives,” said Nicole, 53. The family, like many others here, is encouraging the children to think about pursuing their studies and careers abroad.

Aisha Walid Staify’s family was sitting down to dinner in their small apartment near the port when the explosion shook the building, sending their plates flying at the wall. The blasts reminded them of the civil war in Syria, which they fled in 2013.

For several nights afterward, her two youngest children couldn’t sleep for longer than 30 minutes at a time. The family still jumps at the sound of fireworks and planes.

“I’m always scared something else will happen,” Staify said.

For the Khourys, their lack of trust in the Lebanese government’s investigation into the cause of the explosion has added to their grief, they said.

Each day feels like a waking nightmare. So Mireille and Bassam search for their son in their dreams. One night, Bassam fell asleep and caught a glimpse of him walking, but he was just out of reach. “It was too short,” he said, choking back tears.

“He’s being stingy. Give me a dream!” he begged as though speaking to his son. “At least to see you in my dreams.”

Nader Durgham in Beirut and Suzan Haidamous in Washington contributed to this report.