Earthquakes rank as the deadliest and most expensive natural disasters globally (WHO, Psychosocial consequences of disasters: Prevention and management (No. WHO/MNH/PSF/91.3 Rev. 1), World Health Organization, 1992). Earthquakes bring sudden devastation, aftershock risks, and long-term rebuilding, often triggering mental health problems such as depression, anxiety, PTSD, insomnia, and even substance abuse. A powerful earthquake (6.4 magnitude) struck Latur, India on September 30, 1993 at 3:56 AM, devastating the Marathwada region, of Maharashtra state, India. The epicenter was located near the village of Killari in Latur District. The early morning timing coincided with religious celebrations for the Hindu deity Shiva, resulting in some residents already being awake. The earthquake caused widespread devastation and significant loss of life.: there were 1220 deaths in Killari alone, over 7500 total fatalities, and 30,000 families displaced. Latur and Osmanabad districts faced a tough disaster response due to the widespread poverty and illiteracy in the region, resulting in low preparedness at both the community and administrative levels. The Marathwada earthquake response was praised for its relief efforts (military, civilian, national and international NGOs) and a comprehensive rehabilitation plan funded by the World Bank and the Indian government mainly focused on providing rescue, relief works, providing shelter, food, sanitation and immunization. This time, however, in contrast to past disasters when mental health needs were neglected, the state’s investment in the Maharashtra Institute of Mental Health (established in 1991) provided a pool of trained professionals to deliver comprehensive mental health care to the affected population. However, there were gaps in delivering the services due to limitations such as resource constraints, accessibility gaps, and the need for culturally sensitive approaches. The key learnings from the Marathwada earthquake response included the need to provide continuous mental health care, outreach services, and training local personnel to ensure long-term support for the affected people. Thus, this comprehensive review aims to track the psychosocial care and mental health services carried out during the Marathwada earthquake, its effectiveness, and the scope for future improvements.