Decades of war have had a disastrous effect on Afghans’ mental health, according to panellists in a series of IWPR-organised debates.
At one event held on February 1 at the women’s affairs department in the Wardak province, southwest of Kabul, Dr Hanifa Yusufi noted that decades of conflict had had a profound impact, especially on women and young children.
She gave the example of a woman from the Chak district who had lost her four-year-old and seven-year-old children in conflict, and now had severe mental health problems.
Conflict also had physical effects, Yusufi said.
“We can see today that mothers miscarry or give birth to disabled children,” she said, suggesting that these problems were a legacy of some of the weapons used in Afghanistan.
Jan Mohammed Hikmatju, a psychological expert, said conflict could have a traumatic impact on children, even unborn children.
A mentally ill Afghan patient sits chained to a wall at the Mia Ali Baba holy shrine in the village of Samar Khel on the outskirts of Jalalabad on May 16, 2013. At the Mia Ali Baba sanctuary the patients, presumed to be possessed by jinns (demons), are chained by the wrist inside, or in the open air to a tree, for 40 days. (Photo: AFP)
“War has a direct impact on the mental wellbeing of pregnant women. It can also cause miscarriage or leave a child at risk of disability,” he said. Other problems noted in children included heart defects and “selective mutism”, a disorder that prevents them from speaking.
Wahida Shkulay, a member of the High Peace Council in Wardak, criticised health provision in the region.
“There is a high level of violence in Wardak, which means there are more mental health patients, but there isn’t a specialised hospital to treat them,” she said.
At another debate held in the Behsud district of Nangarhar in eastern Afghanistan, civil society activist Mohammed Anwar Sultani similarly complained that there was no dedicated psychiatric hospital for the province.
Although local hospitals have psychiatric wards, Sultani said that a province with a population of over a million needed better provision.
“The consequences of war are poverty, unemployment, injustice, illiteracy and more. All these things cause psychological problems,” he said.
Psychiatrist Fazil Rahim Naseri agreed that the “painful events” of war affected people’s mental health. He said there were links between the psychological trauma a mother experienced while pregnant and the future mental health of her child.
Another guest, Zabihullah Halimi, head of Loy Nangarhar, a youth development group, noted that unemployment was a major factor in mental health.
“There are hundreds of young people in our association who have completed bachelor degrees but don’t have jobs – and war is the reason,” he said.
In Kandahar, civil society activist Abdul Wahab similarly identified unemployment as a key contributory factor to mental health problems among the young.
“Most young people have to stay at home because they’re unemployed,” Wahab said. “So they use drugs because of the various problems they have, and this puts them at risk of psychiatric illness down the line.”
Health workers said that in Kandahar, scene of some of the fiercest fighting in the 13 years since the fall of the Taleban, the psychological trauma has been severe.
Activist Salahuddin is part of a 120-member group that visits remote areas of the province to promote non-violent solutions. He estimates that “over half” of the 350,000 people living in Spin Boldak district have suffered mental trauma.
“More than 100 people come to us for psychiatric treatment every month,” said Dr Muhibullah, who heads the general hospital in Spin Boldak. “That shows that there are a lot of people suffering from mental health issues.”
Emal Sapai, a doctor at the Kabul Psychiatric Hospital, told IWPR in a telephone interview that as many as 90 per cent of all Afghans had suffered mental health problems, and conflict, poverty and unemployment were among the main causes.
People affected directly by war, for example those caught up in serious attacks, risk developing anxiety disorders which can lead to severe depression. He estimated that between 25 and 30 per cent of Afghans suffered from this.
“Depression follows soon after anxiety,” Dr Sapai said “People affected by it lose strength, they have trouble sleeping, and they withdraw from society and become isolated. If they don’t get treatment, they are at risk of suicide, because they think of killing themselves all the time.”
This report is based on an ongoing series of debates conducted as part of the IWPR programme Afghan Reconciliation: Promoting Peace and Building Trust by Engaging Civil Society.