Doctors examine internally displaced children from North Waziristan Agency at a free medical clinic in Bannu, a district of Pakistan’s northern Khyber Pakhtunkhwa province. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Jul 21 2014 (IPS)

Some fled on foot, others boarded trucks along with luggage, rations and cattle. Many were separated from families, or collapsed from exhaustion along the way. They don’t know where their next meal will come from, or how they will provide for their children.

In the vast refugee camps of the Khyber Pakhtunkhwa (KP) province, civilians who fled the Pakistan Army’s military offensive against the Taliban in the country’s northern Waziristan Agency now walk around in a state of delirious confusion.

Medical officials here say that almost all the 870,000 internally displaced people in KP are deeply traumatised by over a decade of war in the northern provinces, where they were caught in the crossfire between government forces and militants who crossed the border from Afghanistan into Pakistan’s Federally Administered Tribal Areas (FATA) in 2001.

“We examined about 300,000 patients at the psychiatry wards of the KP hospital in 2013; 200,000 of them belonged to FATA. This included 145,000 women and 55,000 children." -- Muhammad Wajid, a psychiatrist at the Khyber Pakhtunkhwa Teaching Hospital in Peshawar
Now, as the army conducts air raids on the 11,585-square-kilometre North Waziristan Agency in a determined bid to wipe out the Taliban, war-weary civilians are once again bearing the brunt of the conflict, forced to leave their ancestral homes and seek refuge in neighbouring KP where shelter, clean water, food and medical supplies are stretched thin.

IDPs have been streaming in since the military operation began on Jun. 15, reaching close to a million by mid-July, officials here say. So far, aid has come in the form of food rations and medical supplies for the wounded, as well as those left dehydrated by the scorching 45-degree heat.

But very little is being done to address the psychological trauma that affects nearly everyone in these camps.

“The displaced population has been living in rented houses or with relatives where they lack water, sanitation and food due to which they are facing water and food-borne ailments,” Consultant Psychiatrist Dr. Mian Iftikhar Hussain tells IPS. “But the main problems are psychological disorders, which are ‘unseen’.”

Sitting in front of the Iftikhar Psychiatric Hospital in Peshawar, capital of KP and 250 miles from the largest refugee camp in Bannu, 50-year-old Zarsheda Bibi tells IPS her entire family fled Waziristan, leaving everything behind.

Far worse than the loss of her home and possessions, she says, is the loss of her one-year-old grandson, who died on the long and arduous journey to KP.

“She doesn’t sleep properly because she dreams of her deceased grandson every night,” says Iftikhar, who is treating Bibi for post-traumatic stress disorder (PTSD).

According to Javid Khan, an official with the National Disaster Management Authority, PTSD is one of the most common ailments among the displaced.

He recounts to IPS his recent interaction with a woman in a camp in Bannu, whose husband was killed by shelling in Miramshah, the headquarters of North Waziristan.

“Now she is completely disoriented and extremely concerned about the future of her three sons and one daughter,” he says, adding that those who were uprooted are sure to develop long as well as short-term disorders as a result of prolonged stress, anxiety and fear.

Other conditions could include de-personalisation, classified by DSM-IV as a dissociative disorder in which a person experiences out-of-body feelings and severe disorientation; as well as de-realisation, an alteration in perceptions of the external world to the point that it appears unreal, or ‘dream-like’.

Experts say that people torn from their native villages, thrust into completely new surroundings and experiencing insecurity on a daily basis are highly susceptible to these types of conditions, which are associated with severe trauma.

Khan says women and children, who comprise 73 percent of IDPs according to the World Health Organisation (WHO), are likely to be disproportionately impacted by PTSD, as well as disorders related to anxiety, stress, panic and depression.

Muhammad Junaid, a psychologist working with the displaced, says that victims are also suffering from poor self-esteem, as they are forced to occupy tents and shacks, in extremely unsanitary conditions.

Mothers are particularly impacted by their inability to provide for their families, he tells IPS, adding that permanent phobias are not uncommon.

Another major concern among health officials here is how the situation will affect children, many of whom are at a very sensitive age.

“From childhood to adolescence, a child passes through dramatic phases of physical and mental development,” Junaid says. “During this transition, they gain their identity, grow physically and establish familial relationships, as well as bonds with their community and society as a whole.”

Ripped from their ancestral homes and traditional communities, he says, this process will be interrupted, resulting in long-term mental conditions unless properly addressed.

Parents are equally worried about what displacement might mean for their children’s education.

“Two of my sons are very good at their studies,” Muhammad Arif, a shopkeeper from Mirali, an administrative division in North Waziristan, confides to IPS. “They would do well in class and get good positions. Now there’s no school and I fear they will not progress with their education.”

Even if they were to return to Waziristan, he says, the future looks bleak, since the army operation has devastated homes, buildings and business establishments. Everything will have to be built back up from scratch before the people can return to a normal life, he laments.

After nearly a month in the camp, Arif’s 10-year-old son Sadiq has all but given up hope. Through tears, he tells IPS that children like him have “no sleep, no play, no education.”

“I don’t know what the future holds for us,” he says.

For long-time health experts in the region, the situation is a frightening climax of a crisis that has been building for years, ever since the army began a crackdown on insurgents in the rugged, mountainous regions of northern Pakistan nearly 12 years ago.

“Around 50 percent of the residents of FATA have suffered psychological problems due to militancy and subsequent military operations,” Muhammad Wajid, a psychiatrist at the Khyber Pakhtunkhwa Teaching Hospital in Peshawar tells IPS.

“We have examined about 300,000 patients at the psychiatry wards of the KP hospital in 2013; 200,000 of them belonged to FATA. This included 145,000 women and 55,000 children,” he says.

Since 2005, nearly 2.1 million FATA residents have taken refuge in KP, according to Javid, posing a real challenge to the local government, which has struggled to balance the needs of the displaced with its own impoverished local population.

The latest wave of refugees has only added to the government’s woes, and many in the region fear the situation is on a knife’s edge, especially in the holy month of Ramadan, when there is a desperate need for proper sanitation and food to break the daily fast.

(END)

Wounded veterans attend a May 22, 2013 Memorial Day ceremony at which they are given Segway personal transporters to improve their mobility and independence. Credit: Senator Claire McCaskill/cc by 2.0

By Prashanth Kamalakanthan
WASHINGTON, Nov 4 2013 (IPS)

In his final letter to his family, 30-year-old Iraq war veteran Daniel Somers wrote of having never returned from war. “In truth, I was nothing more than a prop,” reads the suicide note dated Jun. 10, 2013, six years after his final deployment. “In truth, I have already been absent for a long, long time.”

As the U.S.-led war in Afghanistan draws to a close, Washington will tout the absence of combat troops in that country. Looking toward a scheduled withdrawal date of 2014, President Barack Obama has proudly announced that “our troops are finally coming home.”The heroic vocabulary of patriotic sacrifice papers over a miserable human reality politicians wish to ignore and soldiers need to escape.

But in what state he cannot say. For as the soldiers start streaming back, they will have absences of their own. Many will be disfigured, missing parts of the bodies they left with. Others will return in boxes, gone altogether. For some, like Somers, it will take longer to understand what was lost.

“There are some things that a person simply cannot come back from,” he wrote in anguish.

Though it’s the harshest condemnation we seem to hear, the horrors of war are not really “unspeakable.” The English language gives us many words to express the wretched realities of modern warfare: rape, mutilation, massacre, psychosis. But there are those that make our wars, and there are those who live them.

Both choose not to utter these ugly truths for their separate reasons. The heroic vocabulary of patriotic sacrifice papers over a miserable human reality politicians wish to ignore and soldiers need to escape.

Between them are the witnesses who find the voice to speak.

Ann Jones, the scholar, journalist and photographer who for decades has reported from the world’s conflict zones, turns in her latest book to those dealing with the silences surrounding the United States’ longest war. They Were Soldiers is an unwaveringly human narrative about the soldiers who return from Afghanistan, whole or in pieces, and the communities that put them back together, or not. It is not, as she makes clear at the outset, about “the pointless wars.”

From the outside, wars start and stop; they are planned, waged and, eventually, ended. For the people inside them, the violence never ceases. As Jones — the daughter of a WWI veteran whose trauma haunted him six decades after the Armistice and herself diagnosed with PTSD after her time in Afghanistan – observes, “often it merely recedes from public to private life.”

And so in her book, she begins with the end. In its opening chapter, she considers the dead, those termed in public-relations-speak “the fallen,” of whom all that’s left are “remains.” Those words, Jones notes, are a way of deemphasising how in Afghanistan soldiers often are not found intact.

Families are sent “literally whatever remains” in this new kind of war defined by catastrophic explosions, mostly roadside bombs (IEDs), instead of gunfire. Mortuary specialists have the gruesome task of identifying people who have sometimes quite literally “fallen to pieces.”

At each point of the impersonal systems of war, Jones listens as the human beings who care for those grievously damaged in Afghanistan (or sometimes the damaged themselves) tell their stories.

She speaks with specialists in Mortuary Affairs, whose job it is to collect partial humans and return them to their families. Many remain haunted by “the smell of dead meat,” the images of mangled bodies lingering “because, still, they looked like us.”

With Jones we take a C-17 medical evacuation flight as she talks to shaken doctors and boyish recruits. We follow her as she accompanies the wounded off the battlefield, first to the U.S. medical hub in Landstuhl, Germany, then on to Walter Reed stateside.

We hear how parents, strong for their children at the bedside, step out into hallways and “hang onto each other,” weeping. We see grueling prosthetic rehabilitation sessions that “begin to resemble a circle in hell,” as former warriors sweat, groan, and collapse in pain and frustration, while their families slowly accustom themselves to their newly limbless children.

We are invited, with Jones, into the broken homes that receive the mentally marred, sitting with mothers and wives unable to recognise their former children. We are there.

A women’s studies scholar and a longtime advocate for women’s rights, Jones devotes much of her book to this oft-overlooked women’s burden of war: rehabilitating traumatised men groomed into violence.

She sets the useless mantra of military therapists (give the returned soldier “his space”) against jarring news clips recounting the stateside abuse of spouses and children, stories long since forgotten by all but local journalists.

Nineteen-year-old Jessica Hine’s fate — to be beaten and murdered with her child by her Marine boyfriend, then left as a corpse sitting on a couch for nearly two weeks while he watched TV beside her — crystallises the epidemic of post-combat military murder for Jones.

“There’s the metaphor: the soldier with his perfectly silent uncomplaining woman beside him, giving him his space while he enjoyed the national game.”

But even in describing such brutality, Jones manages sympathy for the human beings involved, both sufferers and perpetrators of the violence. Her book reminds us that we are all made victims by warfare: the soldiers, their families, the strange human species that lacerates itself instead of living cooperatively.

“War is not inevitable,” she writes, “Nor has it always been with us. War is a human invention—an organized, deliberate action of an anti-social kind—and in the long span of human life on Earth, a fairly recent one.”

In this way, They Were Soldiers is as much about the debasement of military institutions as it is about the dignity of the people caught inside them. War simply passes from one body to the next, vessels for violence damaged along the way.

Jones follows this path of destruction unflinchingly, accomplishing one of the most moving antiwar texts we have today. And, still, it is no screed against U.S. foreign policy — only an ode to those who suffer by it. When one sees war in such basic human terms as Jones has, one understands the starkness of the choice: war or humanity. No having both.

“Not suicide, but a mercy killing,” Daniel Somers wrote of his own death. It’s a statement at once piercingly sad and honest. War is an industry that makes humans its raw material, a public policy choice that ends lives and destroys the living.

Ann Jones cuts past the words, the concepts, the mythos — and puts us in the thick of it. In facing war’s inhumanity and grasping its cost up close, we may become, in the end, a little more human ourselves.

A fisherman and other Gulf Coast residents at a community meeting in New Orleans in 2010. Experts say that trauma related to the record-breaking BP oil spill in the region could last for decades. Credit: Erika Blumenfeld/IPS

By Lucy Westcott
NEW YORK, Aug 15 2013 (IPS)

Although Hurricane Sandy made her final sweep through the Northeastern United States nearly 10 months ago, for many people the stress caused by the storm lingers.

(See Part One and Part Three of the series)

In Lower Manhattan, two hotlines, the Disaster Distress Helpline (DDH) and Project Hope, which is part of the New York City-wide helpline Lifenet, and specifically for those affected by Sandy, are at the frontline of disaster counselling, listening to myriad concerns ranging from queries about post-storm open hours of drug rehabilitation programmes to anxious parents reluctantly sending their children back to school in the days after the Newtown, Connecticut school shooting last December. Both programmes are administered by the Mental Health Association of New York City.

“Typically the kind of disasters that result in a spike of calls at the national level are those that are larger in scale. The impacts tend to be greater in terms of loss of life, loss of property or the potential for psychological distress on a sizeable population,” Christian Burgess, director of the DDH, told IPS.

Following the Sep. 11, 2001 attacks on New York City, there was a need for a nationwide, phone-based crisis counselling service, Burgess says. The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the Department of Health and Human Services (DHHS) established the National Suicide Prevention Lifeline in 2005, but created an entirely separate hotline for disaster counselling after the 2010 BP oil spill.

Transitioning from the Oil Spill Distress Helpline, the DDH went live in February 2012, receiving its first major spike in calls following Hurricane Isaac, which tore through the Gulf Coast on the seven-year anniversary of Hurricane Katrina.

“It’s not therapy, it’s not a substitute for therapy. Really, it involves listening,” Burgess says, comparing the helpline to triage for mental health.

Counsellors are trained to listen for symptoms of distress that may indicate the need for crisis intervention, like suicidal or homicidal intent, and callers may also be at risk of depression or substance abuse.

The DDH saw spikes in calls after the Newtown shootings, in which a lone gunman killed 20 elementary school students and six staffers, and the Boston Marathon bombing in April, as well as the Oklahoma tornadoes in May.

“School shootings in particular tend to trigger stronger feelings of distress, simply because it’s easier for a large part of the population to identify with the sadness and grief,” Burgess says. “It shakes our foundation of what is supposed to happen, the order of things… especially if you were already feeling vulnerable before the event.”

Burgess says that the majority of calls following the Newtown shooting didn’t come from Connecticut, but from all over the country.

After a major disaster, repeated coverage on the 24-hour news cycle, sensationalised headlines and the easy accessibility of Internet allow for the vicarious trauma of rewatching distressing events, which adds to anxiety, Burgess says.

“The event in and of itself is traumatic… but it’s heightened by the constant media exposure, particularly for those who would have been at risk before the event,” Burgess said.

Trigger events still loom, like the State Department’s closure of 19 U.S. embassies across North Africa and the Middle East in early August. The DDH have received calls from people concerned about what the terror alert means, Burgess says.

Calls related to Hurricane Sandy marked the first time the DDH received sustained levels of calls over a period of time, Burgess says. At its peak, Sandy resulted in a 2,000 percent increase in calls from two weeks prior, before the forecasts began to take shape. Texts increased by 600 percent.

“In December we were starting to get longer calls from people, and mental health concerns were coming to the surface,” Burgess says, due to fewer resources and the emotional fatigue of still-displaced people.

Melany Avrut, programme manager for Project Hope, which has received nearly 4,000 calls since the hurricane, told IPS that the needs of callers have changed. In the weeks following the storm, callers wanted to know about filing FEMA applications, but six months later, there were more concerns about anxiety, mood and children having trouble sleeping.

“A big component of Project Hope is using your strength… recognising what [people] have used in the past to get them through a hard time,” Avrut says. “They want to talk about what it was like to go through this traumatic experience.”

The World Health Organization (WHO) recently released new guidelines on how to care for those with mental health issues following trauma. The guidelines emphasise the use of behavioural therapies, such as cognitive-behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) rather than relying on medications.

Although unusual, EMDR can be effective, Dr. Mark van Ommeren, a scientist in the WHO’s department of mental health and substance abuse, told IPS.

It likely works when a patient, focusing on the traumatic event, follows a therapist’s hand with their eyes. The working memory is taxed as the patient thinks about both the event and their eyes working to track the hand. The painful memory becomes less prominent, and upon revisiting the memory, it is less vivid and emotional in the long-term memory, van Ommeren says.

For people living in disaster areas who are vulnerable to mental health issues, van Ommeren suggests that stress management is a good way to prepare, as it makes going through difficult moments a slightly easier, adding that there are no concrete studies about this.

To contact the Disaster Distress Helpline, call 1-800-985-5990, or text “TalkWithUs” to 66746. To contact Project Hope, call 1-800-LIFENET (1-800-543-3638). 

Excerpt:

“Help us find them” reads a sign with photos of victims of forced disappearance, put up by their families. Credit: Daniela Pastrana/IPS

By Emilio Godoy
MEXICO CITY, Jun 7 2012 (IPS)

Since the forced disappearance of his son Jethro in May 2011, Héctor Sánchez has found an outlet for his grief in activism. So far he has turned down psychological support offered by the Mexican Attorney-General’s Office and human rights organisations.

“I cope by keeping very busy with the school project. That’s how we channel our painful feelings,” said the 59-year-old owner of an automobile parts business.

Jethro Sánchez, an electromechanical engineer, was arrested by municipal police in the city of Cuernavaca, 90 km south of Mexico City, on suspicion of belonging to a criminal organisation. Then he was handed over to soldiers, who tortured and killed him.

His body was found in August 2011, and three members of the military are now in custody awaiting trial for the crime.

Experts say post-traumatic stress disorder (PTSD) and acute depression are on the rise in Mexico as a result of the increasing violence seen over the last few years. Scientists have evidence that communities and soldiers involved in armed conflict – among regular or irregular armed groups – are exposed to PTSD, a severe health problem.

“This disorder is spreading rapidly in populations like that of the capital and other cities in Mexico, where PTSD levels associated with violence are already high. We find similar patterns: people’s stress levels are directly proportional to their exposure to the mass media,” which transmit terror and panic, Mauricio Meschoulam, an academic at the Jesuit-run Ibero-American University, told IPS.

Meschoulam, an expert on terrorism, peace-building and mediation, co-authored a study that assessed the prevalence of PTSD in Mexico, which is caught up in a spiral of drug-related violence aggravated by the government’s militarisation of the country.

Based on 333 replies to a questionnaire, from respondents in 15 of the country’s 32 states, the “Estudio sobre efectos psicosociales por violencia en México” (Study on Psychosocial Effects of Violence in Mexico) found that 51 percent of those interviewed said the violence affected their work life, 72 percent their social life and 58 percent their family life.

Moreover, 42 percent of the sample said the violence had an impact on their economic status and 60 percent reported that it had affected their mental health.

The survey recorded symptoms of various disorders, like frequent anxiety attacks, frequent insomnia, and feelings of irritability and despair.

The survey participants are exposed, like the rest of Mexican society, to the daily scenes of terror splashed across newspapers, blaring from television screens and circulating in cyberspace through the social networks and blogs.

The violence began to escalate after President Felipe Calderón took office Dec. 1, 2006 and immediately deployed the armed forces in the battle against the drug cartels.

After nearly six years, the success of the strategy is doubtful, as more than 50,000 people have been killed, 250,000 displaced from their homes, 10,000 disappeared and 8,000 orphaned, according to human rights organisations.

At first the hardest hit communities with the highest levels of PTSD were found in the outlying states where the cartels are powerful. But the psychosocial damage has spread beyond those areas due to the heavy media coverage.

The disorder can occur when an individual directly experiences assault, kidnapping, rape or natural disaster.

However, “not only the direct victims of criminal acts are at risk of this kind of disorder, but also their communities, neighbours and relatives,” Edith Zúñiga, the academic director and founder in 1998 of Tech Palewi (which roughly translates as “I support you and help you grow” in the Nahuatl language), told IPS.

“Reporters who experience the thick of the battle can get PTSD,” she added.

“People have tried to pass off the violence as normal, and it has not been given the importance it deserves. Attention has not been given to the mental health risks that are incurred. Early intervention is important, but not enough people are diagnosed,” she said.

The Attorney-General’s Office records at least 2,886 police officers killed since 2006, while the armed forces report at least 250 fatalities among soldiers. Military personnel have been attacked nearly 2,000 times.

“The costs are high. For instance, soldiers’ families know when the troops go away on an operation, but they don’t know when they’ll come back,” Jorge Álvarez, head of a crisis intervention programme for victims of natural and social disasters at the National Autonomous University of Mexico (UNAM), told IPS.

“Moreover, they (police and military) are accused of many human rights violations, so people do not trust them,” he said.

Created in 1997, the UNAM programme trains people like firefighters, rescue workers and soldiers in psychological first aid, and helps victims and their families.

The study “Estrés postraumático en la población pediátrica atendida en el Hospital Infantil del estado de Chihuahua, México” (Post traumatic stress disorder in a paediatric population treated at the Children’s Hospital of the state of Chihuahua, Mexico), published in 2011 in the Medical Bulletin of the Mexico City Children’s Hospital, reported that PTSD has increased considerably among children in recent years.

Six researchers from the state Autonomous University of Chihuahua and the Chihuahua Children’s Hospital authored the study, which reviewed 125 PTSD patients treated by the child psychology department over a period of three months. Of these, 52 had been traumatised by violence and 73 by accidents.

The patients were aged 5 to 15, and the highest prevalence was in the 5 to 7 year age group.

Psychological support “should be a priority. First of all those responsible should be brought to justice and there should be an end to impunity. Then we ought to think about psychological treatment,” said Sánchez, who will open a school specialising in auto mechanics, named after his son, on Jun. 18.

“It is essential to work with vulnerable populations. I think the state’s response is too slow and it is failing to detect the problem in a comprehensive way,” said Meschoulam.

He said he intends to continue carrying out national surveys and research on the effects of violence, to assess the needs of at-risk groups (children, women, police, soldiers and journalists), reduce hurdles for access to health care, and train personnel.

Zúñiga said “This kind of care needs to become more widely available, because the losses are so painful. We want to train people in the states, so as to form human resources who can make positive interventions in circumstances of this kind.”