The suffering of the Pashtun people

The Psycholgical effects of terrorism

A psychiatric patient waits in a crowded hallway to see a doctor at the Shafique Psychiatric Clinic. There are only 30 licensed psychiatrists in the war-torn Northwest Frontier Province

Rahimullah tries to calm his father, Khairullah, with prayer beads at the Shafique Psychiatric Clinic in the Pakistan city of Peshawar, where violence has become a constant scourge causing epidemic mental distress.

At the Khyber Teaching Hospital in Peshawar, a distressed patient waits for aid. The province has only 250 psychiatric beds available for a population of over 25 million.
In the Qisa Khawani bazaar in Peshawar’s old city, shops are left charred after a bomb hidden in a motorcycle tore through the area on May 28. Constant bomb blasts have pushed many Peshawaris to the edge of madness
With no end to violence in sight, psychiatrists in Peshawar fear that the constant psychological pressures like those that haunt Khairullah could have tragic consequences for future generations as well.
“In Peshawar, violence leaves deep psychological scars
an article by Adnan R. Khan
According to Dr. Wajid Ali, resident psychiatrist at the Hayatabad Medical Complex in Peshawar, as many as 70 percent of the population in NWFP is affected by acute psychiatric illnesses. “Those are the clinical cases,” he says, flipping through a mound of patient files on his desk, “the ones that need medical intervention. But everyone is suffering from some degree of psychological trauma – depression, anxiety, agoraphobia. The entire society is feeling the pressure.” Incessant violence is the reason. In the NWFP alone, more than 400 people have been killed in terrorist attacks since October 2009, nearly matching the total number of civilian deaths in the province for all of 2004. A truck bomb killed nearly 100 people at a New Year’s Day volleyball tournament in Lakki Marwat near the South Waziristan tribal agency, where an ongoing military operation has prompted the Pakistani Taliban to unleash a wave of attacks across the country.
Innocent civilians have borne the brunt of the bombings. “We used to say bad things only happen to bad people,” says Dr. Ali. “These days, bad things happen to good people.”
Children are some of the worst affected by the violence in NWFP, says Dr. Sayed Mohammad Sultan, head of the psychiatry department at the Khyber Teaching Hospital in Peshawar. “We are seeing a lot of children suffering from phobic anxiety disorders. They are in a constant state of fear – of Taliban attacks and from seeing dead bodies hanging in trees.” The long-term effects could be devastating, he warns.
One particular case highlights the danger young people exposed to constant violence face. Abdullah, a 17-year-old student from the Swat valley, used to be a normal, outgoing teenager, says his father. But in early 2008, things began to change. After months of violence and uncertainty in Swat, once considered Pakistan’s tourist mecca, Abdullah began to show signs of psychological trauma.
“We didn’t realize what was happening at the time,” says his father, requesting anonymity because the family is now in hiding in Peshawar, fearful of Taliban reprisals. “He became withdrawn and angry. He stopped listening to his mother and would even yell at her, something he never did before.” When the Pakistani army began its major offensive in Swat in the spring of 2009, Abdullah disappeared, and friends told the family he had joined the Taliban.
“We were in shock,” says his father. “My son had never held a gun in his life. He was peaceful and fun-loving, but all this killing … it changed him.” Fortunately for his family, when the fighting peaked, Abdullah escaped the Taliban and returned to his family. They then moved to Peshawar, where they’ve spent the last nine months rehabilitating their son.
“This is a common story,” says Ali, who has authored two reports on the effects of the war on the psychological health of Pakistanis. “I can tell you hundreds more – like the one about the 12-year-old child who was confronted by the Taliban and told to take a bomb to his school. They said they would kill his family if he didn’t listen to them. Can you imagine? Can a child forget such a thing?”
Yet as violence escalates in Pakistan, there has not been any effort to confront the psychological effects of it. According to Ali, there are fewer than 30 qualified psychiatrists in the NWFP and a mere 250 psychiatric beds available for a population of more than 25 million. “But that’s just the NWFP,” he adds. “We’re also dealing with patients coming over from the border in Afghanistan. There are no facilities there for them, so they come here to Peshawar.”
Consequently, the city’s poorly funded psychiatric wards are stretched to the breaking point. Patients who require long-term care are being prescribed drugs and sent on their way, only to turn up later in worse condition. Dr. Sultan, at the Khyber Teaching Hospital, blames both the Pakistani government and the international community for failing to recognize the central role psychological health plays in confronting violent extremism. The U.S. consulate in Peshawar has promised millions to beautify the city, but Sultan scoffs at that approach. “We need programs, not parks,” he says derisively.
What’s missing, he adds, is long-term thinking. He suggests that the United States is only interested in stabilizing the country as quickly as possible, while the Pakistani government is just trying to survive. Neither government, let alone the Taliban itself, seems to care that a society’s psychological ill-health can fuel the cycle of violence.
“This is the hidden enemy,” says Ali. “And unless we confront it, Pakistan is destined to become another Afghanistan.”

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