Demons of war that haunt the Afghan people

Sunday Herald

AFGHANISTAN: Years of conflict take toll, with 68% of population thought to have mental problems

POLICE found the girl’s body wrapped in a bag and dumped in one of the open sewage trenches that line Kabul’s roads.

No one knows for sure what happened in the previous 90 minutes.

But the police report states the four-year-old girl had been stolen from a home in one of the Afghan capital’s less salubrious neighbourhoods, after her grandmother failed to humour an intrusive beggar with rice and oil. The girl’s hands had been cut off. Her throat had been slit. And the flesh on her arms, legs and chest had been eaten.

Few people seem to care what motivated the prime suspect, Jabakhel.

“She had a psychological problem,” shrugged General Ali Shah Paktiawal, Kabul’s police chief. Anyway, he pointed out, crime was crime.

“No-one understands what kind of illness this is,” said the head of the branch of the attorney-general’s office dealing with the case. But he said he had seen an equally grisly incident at his last posting in one of the provinces. “It seems to be a kind of illness affecting women,” he concluded.

For some Afghan tribes, custom dictates that the death of a child will exorcise djinns – evil spirits – and though the full details of what happened to four-year-old Haifa may never be known, her murder is an extreme example of a pervasive problem in Afghanistan: mental illness.

In the wake of the 2001 US-led invasion, the new Afghan government identified mental health as one of its top five priorities. Later, the World Health Organisation reported that: “Due to the long period of conflict, over two million Afghans are affected by mental health problems, with high cases of post-traumatic stress disorder, depression and severe anxiety, particularly among women.”

More recent studies paint a far bleaker picture. Dutch humanitarian organisation Health Net Organisation (HNO) estimates that a staggering 68% of Afghanistan’s population of 33 million suffer some kind of mental condition. Women and children are particularly at risk, HNO reported last month. Only Nepal has a greater proportion of children with mental health problems.

HNO said the main reasons for the mental problems affecting children in Afghanistan are war, poverty and domestic violence.

The majority of sufferers have mild conditions. Traditionally, mentally disturbed people have visited the shrines of spiritual leaders, been locked in cells, or given talismans by mullahs. At the Mia Ali sanctuary in eastern Afghanistan, inmates are chained to a tree for a month as a form of spiritual cure. Most people believe that illnesses come from God – and that what the Lord giveth, the Lord can take away.

But at nearby Jalalabad public hospital, the head of the mental ward, Ahmad Zahir Allahyar, agreed with the findings of the HNO report. “War is the main cause for developing this kind of disease. Most of them have histories of losing members of their families,” he said.

For those with severe mental health problems, the number of hospitals catering to them is slowly increasing. Aliawat Hospital falls under the auspices of Kabul Medical University. As well as caring for patients with neuro-vascular diseases, a team of two psychiatrists and 10 trainees treats people with schizophrenia, psychosis, dementia, anxiety and depression.

Dr Hidayat Danish marched down the white-tiled corridors to a ward where Sharifa, a 20-year-old woman, chewed her lips and played with a blue headscarf. She looked terrified and was consumed by visions of “floods, rivers and clean pure waters”, she said. She had not slept for five days.

“Initially we thought she was suffering from anxiety,” said Danish, “but ended up having to treat her with anti-psychotic drugs. It’s unclear what prompted the onset of psychosis-other than 30 years of war and domestic violence.”

But there is widespread confusion about mental ailments, and a cultural inability to understand or articulate the problems. Sharifa still believes her hallucinations are the product of an infectious disease. And while drugs may help treat some mental health problems, they are powerless to change the circumstances that drive people insane in the first place.

For some, the only cure appears to be death. At Marastoon, an asylum on a windswept plain west of Kabul, men and women eke out sedated lives without hope of recovery. The female doctor running the clinic said: “Those who can’t get better they send to us. Most of the patients are unrecoverable. We are just struggling to keep them calm.”

Kairun Nisa, whose name means “the best of women”, says she is from far, far away. Her family is also far away. Furthest away is her husband, who died in a rocket attack.

Nasrin saw one of her brothers burn to death in a fire. Another brother was killed fighting. An arranged marriage was the final straw and she went “completely mad” according to one of her caretakers.

In sight of the compound is a patch of broken stones and tumbleweed – a cemetery for those inmates who never manage to exorcise their djinns.

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