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.
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.