July 22nd 2011 was the day Norway cried. On this peaceful summer afternoon, we experienced two sequential terrorist attacks. First, a car bomb was detonated in the Government Quarter in Oslo, the capital of Norway. Eight people were killed in the explosion, and many more were hurt, 10 were admitted to hospital with severe injuries. In the midst of the chaos and the rescue operation, the terrorist moved to Utøya Island, 30 km north of Oslo, where the Norwegian Labor Youth party was hosting a summer camp with 564 participants. The assailant shot all those he came across – most were adolescents or young adults. The Utøya shooting lasted approximately 90 minutes; it left 69 people dead, and many with severe injuries. The days following the attacks were characterized by the clean-up, search, and identification on Utøya and in the Government Quarter. Across the country, people reacted with sadness, feelings of unreality, and fear, and more than 150,000 Norwegians took to the streets carrying red and white roses to honor those who had died. The brutal reality of the event hit hundreds of families across the country as parents, siblings, and friends desperately searched for their loved ones among the survivors at the temporary emergency center or at the hospital where the injured were fighting for their lives. The feeling of déjà vu was not obvious during those chaotic days in July almost seven years ago, it was so strange, so unreal, there could be nothing at all familiar about the event and the cruelty people had experienced. It became clear that the Norwegian society and health services were not adequately prepared, and questions immediately arose regarding how the shootings would affect the survivors and their families, and how health care authorities should respond. The severity of the event and subsequent life stress are the most important predictive factors for mental health problems after traumatic events, in addition to emotional reactions during the event, physical injuries, and the loss of loved ones. This knowledge, and reports suggesting that survivors’ needs were not being met, called for a national plan. On July 28th, the recommendations were implemented in 120 affected municipalities. The outreach program was based on three main principles: proactivity in early outreach, continuity in responses, and targeted interventions for individuals in need. The goal of these recommendations was to ensure that all survivors who developed a need for services were identified and offered relevant attention. Four to five months after the terror attack, the survivors participating in “The Utøya Study (2011)” reported levels of PTSD six times higher than those found among the general population, 70% needed specialized mental services and faced considerable difficulties in returning to school and work. Parents struggled with similar levels of psychological distress. Despite an ambitious outreach program and extensive use of services, the event impacted both survivors and their families to a great extent. Déjà vu?