Institute for War and Peace Reporting | Giving Voice, Driving Change

Karabakh War Lingers In The Mind

Nagorny Karabakh’s psychological therapy centre has treated thousands of patients, suffering the traumas of war – including children born after the conflict ended.
By Marina Mkrtchian

Eight-year-old Tigran is too young to remember the war over Nagorny Karabakh. But he came to sessions at Stepanakert’s Psychological Therapy Centre, because he was afraid of certain sounds and even felt ill if someone raised their voice.

It transpired that Tigran’s phobia came from his grandmother, who had been frightened by artillery bombardments and shuddered at any loud noises.

More than eight years after the ceasefire that ended the Armenian-Azerbaijani war over the territory of Nagorny Karabakh, scars remain. Local people are still coming to the centre in Stepanakert with nervous disorders, left over from the three-year conflict.

With the help of Medecins Sans Frontieres Belgium, the centre was opened in April 1994, only a few weeks before fighting ended, leaving the Armenians in full possession of Karabakh.

The Belgian psychologist Dmitri Aikin was the first person to take an interest in the psychological health of enclave’s children and at first the centre worked only with youngsters.

Before that parents had been asking for help from doctors, complaining about their kids’ nervous problems and phobias. Each bombing raid increased the number of applicants. The kids were afraid of water, of chickens, of loud noises.

Since then 9,000 patients have passed through the centre – this in a region whose entire current population may be no more than 100,000 inhabitants. Only in the last year, the facility has treated 1,500 people and it is currently giving therapy to 500 patients.

The centre is located in a restored section of Stepanakert’s children’s hospital. It is a cosy place, full of toys and games and the walls are hung with kids’ drawings. The atmosphere is conducive to confidential conversation.

Since MSF Belgium left Karabakh two years ago, the clinic has run into financial problems. It is supported by the local health ministry and collaborates with two centres in the Armenian capital Yerevan. But on May 15 it was forced to introduce charges, asking patients for 500 to 1000 drams (one to two US dollars) for a session.

The centre employs six psychotherapists, who also help mothers in Stepanakert’s maternity home and travel out to the regions of Karabakh.

They use individual and group therapy and work with families. In one-on-one situations, the therapist observes the behaviour of the patient. He builds a picture of his or her relations with other people, from their stories and views on different questions. The therapist then takes the patient into a group, where their behaviour with other people can be observed.

The therapists stress that they are not solving patients’ problems, but helping them change their attitude to their problems.

Most of the people who come to the centre are now adults, many of them with psychosomatic disorders, phobias and nervous conditions linked to social problems. However, the majority of ailments are still associated with the war.

In the course of therapy, it turns out that phobias are a result of memories of artillery fire, bombs or forced flight from home, lingering in the subconscious.

“Seventy per cent of our patients have so-called post traumatic shock syndrome,” said the director of the centre, Anait Lalayan. “People come to us with psychosomatic disorders. And, interestingly, the anxieties of parents are passed on to their children, who were born in peace time.”

Zoya Mailian, another psychologist at the clinic, tells of another case, where a pregnant woman was terribly afraid of losing her child. It turned out the woman linked her pregnancy with that of her own mother, who had lost a child during the war.

Perhaps the biggest problems are suffered by those who fought in the war and are now experiencing “Karabakh Syndrome” - akin to “Afghan Syndrome” or “Vietnam Syndrome”. After the horrors they saw during the war, they find it hard to adapt to peacetime.

This often manifests itself in psychosomatic conditions. “A young man, who had fought in the war, complained of heart pains,” said Armida Badalova, one of the psychologists. “Naturally he went to see a cardiologist. However, a check-up showed that his heart was completely healthy. Only then did he come to us and it turned out his sickness was a psychological one.”

Another patient suffered from nightmares. During the war his friend had died in his arms and the former soldier blamed his death on his own carelessness.

Adapting to peace can be a very painful process. In wartime other rules prevailed. The goals were clear and people knew what they were doing. Now many veterans cannot find a place in society. Many did not manage to get an education because of the war and now face unemployment.

The therapists at the centre say they see a lot of ten- or twelve-year-old children, who were born during the war. Many are the children of those killed or missing in action. These children draw a lot of pictures with tanks, soldiers and airplanes. But, happily, they also draw pictures with brighter themes as well.

Aram, aged 12, lost his father in the conflict and is too young to remember him. But when asked to draw a picture, he drew a whole family: mother, father and himself. Asked, “What is war?” Aram answered, “When people fight.” And to the question, “What should be done so there is no war?” he replied, “People should be friends.”

Marina Mkrtchian is a journalist working with Nagorny Karabakh Television.