Asia-Pacific, Development & Aid, Headlines, Health

HEALTH-AFGHANISTAN: War Trauma Continues to Take Heavy Toll

P V Unnikrishnan

MAZAR-I-SHARIF, Afghanistan, Jul 21 2003 (IPS) - Staring blankly out of a window in the Shafakhan Mulki Hospital here, Munira (not her real name) contemplates an uncertain future in a country torn by a quarter century of superpower meddling and civil strife.

This mother of four suffers from depression, insomnia, heart palpitations and apathy – symptoms typical of the trauma that too many of Afghanistan’s 27 million people suffer from with little chance of relief.

”Hers is a case of panic attack and depressive disorder,” explains Mohammed Nadir Alemyi, head of psychiatry and neurology at this hospital.

Shafakhan Mulki Hospital is one of the few that survived the intense aerial bombardments and shelling by military forces of the former Soviet Union in the eighties and, more recently in late 2001, of the United States.

Women are the worst sufferers of Afghanistan’s more than two decades of civil war and turmoil.

Various studies, including one by the prestigious Journal of American Medical Association (JAMA), have shown that more than 90 percent of women in Kabul, the capital, and in the refugee camps set up in neighbouring Pakistan show signs of depression and anxiety.

But these studies were conducted before the last round of bombings, in retaliation for the Sep. 11 terrorist attacks, carried out by the United States and its allies that were bent on pursuing their ‘war against terror’ in this forbidding land of rugged mountains and uncompromising religious ideology.

Munira’s case adds to cold research statistics that show the extent of the problem in Afghanistan, although updated estimates on how many people are suffering form mental trauma are hard to come by.

According to research cited by the World Health Organisation (WHO), overall statistics in normal circumstances suggest that more than 3 percent of the population suffer from a grave mental disorder at any point of time.

In conflicts, WHO says, a tenth of the people who undergo traumatic experiences are likely to end up with serious mental health problems – and another tenth likely to develop behaviour ”that will hinder their ability to function efficiently”.

”In Afghanistan, some five million people are very likely to be affected by psychosocial distress. The most common conditions are depression, anxiety and psychosomatic problems, such as insomnia, or back and stomachaches,” a WHO document says.

But many aid workers here say that at least half of Afghanistan’s 27 million people need urgent medical attention. A report by WHO’s Project Atlas said that in 2001, there were only eight psychiatrists in Afghanistan, 18 psychiatric nurses and 20 psychologists.

Particularly vulnerable are women and children, often bereft of support from family and communities destroyed by decades of fighting. Often, too, they do not male family members who traditionally might have provided some protection against destitution.

The situation is worse for those still recovering from injuries from bombs and landmines.

Add to that the sheer poverty that comes from a shattered post-war economy, and it is easy to see why life continues to be a struggle for survival in a land long after the U.S. bombings stopped and one-and-a-half year after the Taliban fell.

Already, voluntary agencies and international organisations in Afghanistan are dismantling their offices and heading for another shattered society, Iraq, which was targetted in the second phase of the U.S. ‘war against terror’.

Munira’s ailments, which make her try to harm herself, stem as much from trauma as from having to face a life of hopeless poverty. ”Her anxiety originates from financial insecurity,” says Alemyi.

Munira’s husband works as a casual labourer and hangs about the streets of this city, the second largest in Afghanistan, hoping that someone would give him a day’s work.

On a rare, lucky day he may earn a princely two U.S. dollars. Compared to the world outside, the overflowing wards of this hospital seems like a haven even if they are packed with people identified with psychiatric and neurotic disorders, and drug addiction.

Now 62 years into its founding, this hospital has withstood the test of time. There is no medicine, the equipment is ramshackle and the doctors too few, but this hospital is the last refuge of a people brutalised for the interests of others.

The Soviets, the ‘mujahideen’ forces that were created to fight them, and the U.S.-led forces that turned around to destroy the ‘mujahideen’ have all chosen not to target the hospital along with the 15th-century mosque and shrine to Hazrat Ali that gives Mazar-I-Sharif (Tomb of the Exalted) its name.

It would seem that even peace is adding to the Afghans’ miseries. Between March and September 2002, some 1.7 million refugees streamed back into Afghanistan from neighbouring Pakistan and Iran as part of what critics have said is an unrealistic repatriation programme.

At the hospital there is an unending stream of patients arriving on foot, donkeys, horses and by bus and car from distant places, so that the doctors are never able to cope with the added pressure on the already poor health infrastructure.

”We need refresher courses on new developments in medical care and mental health,” says Alemyi, who is always hurrying to his next patient or to his duties as a member of the Loya Jirga, a traditional governing body.

Plans are now afoot to hand over the health care system to the private sector, but experts say this may not work especially in the rural areas where few can afford to pay even for basic services.

Afghanistan has some of the worst health indicators today. One in four children do not survive beyond their fifth birthdays, and maternal mortality is at a high 1,600 deaths per 100,000 live births.

”In the absence of successful experiments, even in non-conflict situations, the sensitivity of the private sector to real needs is a matter of concern,” says S Parasuraman, Asia policy coordinator of ActionAid, the international non-government organisation that has taken on work in Afghanistan.

Even international agencies do not always recognise the psychosocial needs of the Afghans, people like Alemyi say. ”Mental health is on nobody’s agenda,” remarks Alemyi.

 
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