PTSD in Afghanistan

In west, only war veterans are believed to be victims of PTSD, but in Afghanistan it is totally a different scenario resulting from 40 years of war. Unfortunately it starts with child abuse, teenage marriages, laboring in early ages, bombing and loss of family members & close friends.

Living as a widow or living as an orphan, joblessness, poverty and drought and at times flood destroys the crops and mud houses. These are other huge challenges.

On the one hand, the anger of war, the anger of nature disaster on other, swinging in between these evils are poor afghan nationals. I believe that we Afghans are very strong, good or bad if such situation come to a nation what would they do?

PTSD afflict a person when he or she goes through an event of extreme nature where his or her life and safety have been threatened. Nightmares, flashbacks, getting anxious easily and being jumpy are some of the symptoms associated with PTSD patient.

After witnessing a traumatic event, many people will have a hard time adjusting to their daily routines for a while. But not everyone develop PTSD. With time and support most people bounce back and recover well.

Additionally to the actual crisis over, popular news TV channels repeatedly broadcast the violence occurring across the country which creates a unique exposure to trauma. Children witnessing their parents becoming victims of religious intolerance, jilted lovers throwing acid on women’s face, gas store accidents, honor killing and myriad of cases of domestic violence. All of these have strong potential to cause PTSD.

In 2015, MOPH (ministry of public health) Afghanistan, published a survey that 72 % of afghan women and 60% of afghan men are suffering from stress. Unfortunately, due to bombings and blasts, the attention of media and hospital is toward patients who are physically injured. Also due to stigma and lack of access to mental health facilities, mental illness is silent killer for Afghans.

After the attack on Kabul University, it was found that most of the victims were students and they were diagnosed with PTSD in survivors… Our team helped them and we uncovered a complex picture of mental health damage that will affect these students. The survivors will inevitably join the 60% of afghans, who according to WHO (world health organizations) suffer some form of mental illness.  Like these students many Afghans are experiencing trauma from the violence that grip their country. This only magnifies tension and anxiety with longer roots. Difficult family conditions, lack of money and every day stress of uncertain access to water, electricity and other basic needs and then, in a country of 37 million population only 110 psychiatrist working!

In afghan society, there is little misunderstanding about mental illness and a prevalent stigma against talking about it publically. Many Afghans think the symptoms have a super natural or religious origin, causing possession by spirit or is a cure test from god. People, sometimes visit faith healers who promise to exorcise the offending sprit or go for traditional healers, selling herbs cure, hoping their spiritual power can bring them physical and mental health. If those strategies don’t work, they may consult a physician. Only if, that too has failed then they may seek help of a psychiatrist. Hence, psychiatrists often don’t see patients until they are in advanced stage of the disease. The insecurity of displacement affect thousands of those who have fled fighting which triggers the mental health problems.

From past 2 years, focus on raising awareness in different TV channels, radio stations, and social media especially among the low socioeconomic individuals has begun but the psychiatry community feels the need of changes to be brought by MOPH (ministry of public health) in different aspects, especially in public awareness like advertisements through different Medias. Among stigmatized patients, it is found that girls are most prone in afghan society, they never tell anyone about their feelings and trauma as she is worried about being labeled “insane”…

Some other disease (general medical condition) may cause PTSD in Afghanistan like tuberculosis. Afghanistan faces the burden as it shares one of the highest number of patients in the world, around 13 000 Afghans die each year because of the disease. Leishmaniasis in Afghanistan is another challenge. It is highly endemic in Afghanistan and 10 out of 34 provinces is in high risk specially Kabul, the capital. It is mostly carried by immigrants and army personals. The estimated incidents at national level is 200000 cases and total population at risk is estimated to be 13million and this causes some cosmetic damages to the skin which is terrible and can PTSD among afghan population..  

A patient came to me, she was 16 years old she told “I am afraid that I may lose my chance of getting married because no one would want to get married to me, and I have to be quite and carry heavy weight of responsibilities” – beyond the isolation and stigma, PTSD causes us to lose our hope and give up on our goals …

Sometimes we try to avoid people, places and activities that remind us of the trauma – even today noises such as fireworks and underground trains make me feel unsafe and uncomfortable. I remember after bombing in our neighborhood for few weeks, I came home from school every day thinking that something horrible happened to my family – I could not focus on my studies. Many PTSD survivors I have talked with, avoid marriages because they think they may not live long and they are worried about children’s future.

After women, children are also much vulnerable to PTSD. Like children, working as a labor, going through child abuse or experiencing loss of a family member. They also experience the trauma indirectly through TV channels and this dilemma may get recorded in their unconscious and when the child grows up, they are prone to suffer from personality disorder like antisocial or avoidant personality disorder.

As a doctor no one can change the situation of war in Afghanistan but nobody deserve to suffer in silence and if there are some in your neighborhood, encourage them to seek professional help so they could recover and lead a normal life.