Be­yond the Poppy Fields

In a land marked by war, many of Afghanistan’s women are turn­ing to makeshift ther­a­pists to help them deal with their pain.

Southasia - - CONTENTS - By Mahrukh Fa­rooq

Ac­cord­ing to a study, based on Afghanistan’s Min­istry of Health records and hos­pi­tal re­ports, which was con­ducted in 2010 by for­mer Deputy Health Min­is­ter Faizul­lah Kakar, it is es­ti­mated that up to 1.8 mil­lion women in the 1540 age bracket are suf­fer­ing from se­vere de­pres­sion. The re­port cited so­cial dis­or­der, the loss of loved ones, dis­place­ment, food in­se­cu­rity, poverty, il­lit­er­acy, law­less­ness and a lack of proper ac­cess to qual­ity healthcare ser­vices as the main causes be­hind the rise in this fig­ure over the years.

Although the study’s find­ings have not been con­firmed by the Afghan Min­istry of Public Health ( MoPH) or the Min­istry of Women’s Af­fairs (MoWA), sta­tis­tics from other sources suf­fi­ciently back this the­sis, fur­ther con­firmed by the sheer rise in the num­ber of pa­tients seek­ing treat­ment at a men­tal dis­eases hos­pi­tal man­aged by the NGO In­ter­na­tional As­sis­tance Mis­sion (IAM).

Ac­cord­ing to an of­fi­cial at the hos­pi­tal, Khadim Hus­sain Rahimi, the hos­pi­tal re­ceives up to 50 pa­tients ev­ery sin­gle day; a num­ber that is much higher than what it was back in 2000, when the hos­pi­tal had first opened.

A gen­der-based vi­o­lence data­base main­tained by the MoWA has so far recorded over 1,900 cases of vi­o­lence against women and only 37 sui­cides in the past two years. Yet, as this data is based on re­ported cases only, there is con­cern that the fig­ure is ac­tu­ally much higher. In fact, over 100 cases of self-im­mo­la­tion were reg­is­tered at the burns ward of the Herat City Hos­pi­tal dur­ing 2009-2010, out of which 76 died. In the view of Mo­ham­mad Arif Jalali, head of the hos­pi­tal’s burns ward, a sub­stan­tial num­ber were women suf­fer­ing from de­bil­i­tat­ing men­tal dis­or­ders.

In such cases, the ex­is­tence of ther­a­pists such as Farkhunda Sha­hab is prac­ti­cally con­sid­ered a god­send. De­spite the fact that ther­a­pists like Sha­hab have very lit­tle for­mal train­ing in the field, she and other women like her have be­gun to play an in­te­gral role in the cam­paign to im­prove men­tal health in the re­gion. Pa­tients come from far and wide to see these ther­a­pists whose sole re­spon­si­bil­ity is to lend a sym­pa­thetic ear and of­fer guid­ance and ad­vice on how to make their lives bet­ter. Amid a re­gion torn apart by war, it is per­haps the only source of com­fort Afghanistan’s women can ever hope to at­tain.

Afghanistan had barely gath­ered its bear­ings af­ter a bru­tal civil war that lasted 5 years (1996-2001) when the United States an­nounced its de­ci­sion to in­vade the coun­try in re­sponse for the car­nage on Septem­ber 11 in New York and Washington in 2001. Ever since, Afghanistan has been in a con­stant state of chaos and de­struc­tion, with hun­dreds of ca­su­al­ties on both sides. Even though the U.S and NATO ended its com­bat oper­a­tions in De­cem­ber 2014 and handed over the full re­spon­si­bil­ity of the coun­try’s se­cu­rity to the gov­ern­ment of Afghanistan, the coun­try still faces a mul­ti­tude of prob­lems; its econ­omy is in a sham­bles, its po­lit­i­cal sit­u­a­tion is in com­plete dis­ar­ray and its state of law and or­der worse than ever be­fore. All this has con­trib­uted to the de­cline in the over­all men­tal health of Afghan women, a fact that was re­cently high­lighted in a se­ries of de­bates or­ga­nized by the In­sti­tute of War and Peace Re­port­ing (IWPR).

Held at the Women’s Af­fairs Depart­ment in Afghanistan’s War­dak Province as part of the IWPR Pro­gramme, Afghan Rec­on­cil­i­a­tion: Pro­mot­ing Peace and Build­ing Trust by En­gag­ing Civil So­ci­ety, the de­bates shed light on a num­ber of ex­am­ples of women and chil­dren who have had to face the dis­as­trous ef­fects of war. Jan Mo­ham­mad Hik­matju, a psy­cho­log­i­cal ex­pert, went to the ex­tent of say­ing that con­flict could have a trau­matic ef­fect on even un­born chil­dren. “War has a di­rect im­pact on the men­tal well-be­ing of preg­nant women,” says Hik­matju. “It can also cause mis­car­riages or leave a child at the risk of de­vel­op­ing a dis­abil­ity, which can in­clude heart de­fects or ‘se­lec­tive mutism’, a dis­or­der that pre­vents them from speak­ing.”

Another prob­lem that has been ex­ac­er­bated as a re­sult of so­cial and eco­nomic up­heaval is drug abuse. Ac­cord­ing to the Afghan Min­istry of Public Health, there are nearly 1 mil­lion drug users in the coun­try aged be­tween 15 years to 64 years. This con­sti­tutes nearly 8% of the coun­try’s en­tire adult pop­u­la­tion. Many women have also fallen vic­tim to the ad­dic­tion, their num­ber rank­ing at a whop­ping 120,000. Add do­mes­tic vi­o­lence to the mix and you have a tick­ing time bomb of prob­lems that is just wait­ing to ex­plode.

“For us, it has be­come a vi­cious cy­cle of re­peated trau­matic ex­pe­ri­ences over years and years,” says Dr. Su­raya Dalil, a for­mer Afghan min­is­ter of health. “It’s been too much, not only on in­di­vid­u­als, but also on so­ci­ety, which is just wait­ing for a spark to let out the anger.” Inge Miss­mahl, the di­rec­tor of the In­ter­na­tional Psy­cho­log­i­cal Or­ga­ni­za­tion, which trains ther­a­pists across Afghanistan, re­it­er­ated Dr. Su­raya’s views. “If you are in a con­tin­ued en­vi­ron­ment of vi­o­lence, with­out em­pa­thy, it is dif­fi­cult to sur­vive psy­cho­log­i­cally,” says Miss­mahl. “You have to pro­tect your­self some­how, to sur­vive in ev­ery­day life.”

For Sha­hab, her job as a ther­a­pist re­volves around that very con­cept. Mar­ried to an opium ad­dict with whom she has three chil­dren – the old­est is 12 – Sha­hab knows all too well the ef­fects of liv­ing amidst such chal­lenges. “In my vil­lage alone, I know of 50 ad­dicts,” she said. “When my hus­band goes out of the house, they are across the street call­ing for him. Some vil­lagers taunt me some­times: ‘You are a psy­cho­log­i­cal coun­selor. How come your hus­band is an ad­dict?’ ” Still, her strug­gles have helped lend in­sight that helps oth­ers cope with their pain. Now, two years on the job, Sha­hab con­sid­ers her job as a re­lief from her suf­fer­ings as she has learned to leave her pain be­hind. “My train­ing has helped me put up with my hus­band’s sit­u­a­tion. When he doubts me, when he is dif­fi­cult, I un­der­stand,” she said. “Now when he curses at me, I just smile.”

Although the Afghanistan gov­ern­ment has made men­tal health a pri­or­ity for only the last four years, one min­istry of­fi­cial claimed that men­tal health is still a hard sell for in­ter­na­tional donors and se­nior Afghan lead­ers. With a pop­u­la­tion of nearly 35 mil­lion, there are only 260 coun­selors in the coun­try. Still, the fact that such non-med­i­cal ser­vices are be­ing of­fered is a big step, ac­cord­ing to Miss­mahl. “This is cer­tainly not enough, but it is al­ready a won­der­ful achieve­ment,” she said. “It helps peo­ple to cope bet­ter with their ev­ery­day life.”

In re­sponse to such pos­i­tive re­sults, the Health Min­istry has striven to make care more af­ford­able as well as to de­crease the stigma at­tached to it by in­cor­po­rat­ing coun­sel­ing into the pri­mary health care ser­vice that it pro­vides across the coun­try, plac­ing ‘psy­cho­log­i­cal coun­selors’ like Sha­hab in some lo­cal clin­ics. Even though Afghanistan still has a long way to go be­fore its peo­ple can even hope for a nor­mal way of life, it helps to know that at least some work is be­ing done to al­le­vi­ate the suf­fer­ing of those in need of help.

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