PHA-Exchange> Psychosocial needs of Afghan people

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From: "UNNIKRISHNAN PV (Dr)" <unnikru at yahoo.com>
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Dateline: Mazar-E-Sherief, Afghanistan, July first week, 2003
"If you are not with her, you are against her"

Psychosocial needs of Afghan people demand an SOS response.

Dr.Unnikrishnan PV

Life has gone for a spin for Munira (name changed). Looking tired and
anxious in the overflowing female ward of the Shafakhan Mulki Civil hospital
at Mazar-I-Sharif, this 35-year-old mother of four children, talks about her
uncertain future.

Over 27 million Afghan people have been caught up in violent wars, armed
internal conflicts, military action and super power occupation for the past
24 years. Life has been tough for Munira -- uncertain, uprooted and unkind.

As a result of her miseries, Munira now suffers from a loss of sleep,
sadness, palpitation, intolerance, and loss of interest in work. She also
weeps and cries intermittently and hits and harms herself from time to time.

"She is a case of panic attack and depressive disorder," notes Dr. Mohammed
Nadir Alemyi, the head of the psychiatry and neurology department of the
hospital.

About 97 per cent of women interviewed in Kabul and refugee camps in
Pakistan showed signs of depression, says a research study. The details of
the study published in the prestigious Journal of American Medical
Association added that 86 per cent of the women had significant anxiety
symptoms.

But the study came out before the last round of bombing by the US and their
allies. The bombings and the fighting that intensified have added to the
suffering of people like Munira.

Conflicts and war situations spawn psychosocial disorders. Research shows
that in conflict situations one-tenth of the people who experience traumatic
experiences will have serious mental health problems. Another one-tenth will
develop behaviour that will hinder their ability to function efficiently. In
real terms this means over 27 million people need immediate support.

Women and children are the most vulnerable in conflict situations. Loss of
family members, traumatic experiences, displacement and constant terror
rewrite their biography into a nightmare.

Worse is the situation of the people with other limitations. For example,
people disabled due to landmines are doubly disadvantaged. Poverty,
insecurity, uncertainties and other social factors complicate the plight of
the war-affected.

Life becomes a struggle for survival.

Referring to Munira's ailment, Dr. Alemyi notes: "Her anxieties originate
from financial insecurity".

Munira has four children, aged 19,15,13 and 11. All are struggling to find
employment, some means of survival. Her husband is a casual worker, who gets
up early and waits at the city market by 5 am for someone to give him the
day's work. On a rare lucky day, he earns 100 Afs (roughly US $2).

Packed in the overflowing wards of this hospital, which doubles also as a
referral hospital in the second largest city in Afghanistan, are people
identified with psychiatric and neurotic disorders and drug addiction.
Fazluddin, an 18-year-old boy is diagnosed with schizophrenia. The war has
split his personality.

The 62-year-old hospital has stood the test of the time, like the Shrine of
Hazrat Ali, the 15th century mosque that gives Mazar-I-Sharif its name -
Tomb of the Exalted.

The Soviets, Mujahideens, Talibans and the coalition forces that invaded and
controlled Afghanistan have left this hospital almost untouched, a rare
honour.

It is the last bastion of a brutalised people. Apart from the long-term
fallouts of the trauma and sufferings, the skeletal health facilities worsen
the people's plight.

Take the case of the ramshackle, ill-equipped section that passes off as the
psychiatry department. There are not enough doctors, no new equipments and
absolutely no medicine.

About a quarter of century caught in violent conflicts and nature's fury in
the form of droughts and earthquakes have taken a heavy toll on the Afghan
people. They are struggling to cope.

 Add to this the plight of the returnees who have been part of an
unrealistic repatriation programme. Between March and September 2002,
approximately 1.7 million refugees are estimated to have returned to
Afghanistan.

 This, in reality, means added anxiety and extra pressure on the local
people. A fact-finding mission to Pakistan found that 30% of the Afghan
refugees who seek medical care at local health care facilities are
presenting psychosomatic complaints resulting from psychological problems.

"New research and refresher courses are required," says Dr. Alemyi, who is
always in a hurry. An unending stream of patients come from far off places,
often travelling for seven days in buses, cars, on donkeys and horses and on
foot. The doctor cannot keep pace with the latest developments in mental
health care. Medical journals are not available; as for Internet, there is a
rare connection with the UN system in Mazar.

"There is an urgent need to undertake serious research to understand the
level of psychosocial morbidity amongst the Afghans," says Dr Alemyi. "The
situation in the villages are worse and a community based intervention is a
must." He runs a successful TV programme on public health and is a guest
columnist in the local newspaper, besides being a member of the Loya Jirga,
constitutional body.

Afghan families consider emotional and social development important for
their children is one of the key findings of 'The Children of Kabul', a
recent study by Save the Children and UNICEF.

Rural health care system is almost non-existent or remains in a shambles and
people have limited resources to pay even if services are offered. Plans are
on to hand over the health system to the private sector. But analysts say
may not work. "In the absence of any successful experiments elsewhere, even
in non-conflict situations, the sensitivity of the private sector has been a
matter of concern," says Prof. S Parasuraman, Policy Director of ActionAid,
an international agency that works in Afghanistan.

International humanitarian agencies and UN organisations do not recognise
the need to respond to the psychosocial needs of the Afghan people and
refugees. "Mental health is nobody's agenda," remarks Dr. Alemyi. Their
vision gets blurred in the high profile visible activities like
construction.

To make the situation worse, a few humanitarian and development agencies
still involved are leaving Afghanistan. Besides, their limited resources are
getting diverted to respond to the crisis in Iraq.

For women like Munira and the millions of uncertain Afghans urgent mental
health care at this stage is a matter of life and slow death. In this
struggle, if we are not with her, no doubt, we are against her.

(Dr.Unnikrishnan PV (unnikru at yahoo.com) is a medical doctor working on
humanitarian issues. He is Fellow: Humanitarian Action, ActionAid Asia
regional Office, Bangkok. He was in Afghanistan in July first week. The
opinions expressed need not necessarily reflect the views of the
organisation.)