War Horrors Haunt Afghan Women

Zubaida and her mother Janat Bibi were visiting a neighbour when the rocket hit their home. When they rushed back, they saw a hand and a leg lying amid the rubble. Realising that this was all that remained of their family, Zubaida screamed and beat herself about the head before falling suddenly silent.

Ever since that day, more than a decade ago, Zubaida has swung between silent withdrawal and wild shouting. As they live in a rural village in Kunduz province, Janat Bibi had no resources to help Zubaida with her mental problems - only an amulet from the local mullah and some herbal medicine, neither of which helped.

Finally, Janat borrowed some money from a neighbour and brought Zubaida to Kabul for treatment at Afghanistan’s only psychiatric hospital. But the money was soon gone - and so has the mother’s hope of extra medicine for her daughter.

Her story is an all-too common one. Hundreds of thousands of Afghan women suffer from mental health problems, but there is very little professional treatment available.

In more than 23 years of civil war, women took on huge emotional burdens as their children and the men in their families were killed or wounded.

During the Taleban’s reign, they were denied the right to work or go to school, and even to live independently. Public executions, persecution of ethnic groups and reprisal killings were a part of daily life in Afghanistan.

A study by the Physicians for Human Rights organisation two years ago found that more than 70 per cent of Afghan women suffered from major depression, nearly two-thirds were suicidal, and 16 per cent had already attempted suicide. Even in areas not controlled by the student militia, the study showed that more than half “perceived their mental health as poor”.

Afghanistan’s health care system has been decimated by years of war and deterioration of training and facilities. Mental health care in particular suffers from a lack of qualified psychologists and psychiatrists.

Kabul Psychiatric Hospital has only 60 beds - half of which are allocated to women. Because of the high demand, the facility can only admit the most severely disturbed patients. Dr Temorshah, assistant director of the psychological ward, told IWPR that these patients normally require three to six months of treatment, through drugs and therapy.

Fereshta, 20, saw her father killed during fighting. “I couldn’t tolerate the sight of his bleeding body,” she said. A severe headache crippled her, followed by depression, which has led her to be hospitalised twice.

Another woman, Marzia, told IWPR that her mother was receiving treatment because she “screams and shouts, bites her hands, laughs and then cries repeatedly”. The woman had lost two brothers, her husband and two young children during the fighting.

Although the majority of patients admitted after the fall of the Taleban were women, in recent months the gender breakdown is closer to 50-50, Temorshah said. Men are now seeking treatment for depression as they adjust to joblessness and the economic problems blighting Afghan society.

Those whose condition is not deemed serious enough for admission to the hospital are given a prescription for drugs and follow-up visits from a social worker. But there, too, the demand far exceeds the hospital’s ability to give treatment.

The hospital supplies the expensive medicines, but patients have to pay for other, more common drugs that are available in the bazaar. As Janet and Zubaida found, the cost can soon outstrip one’s ability to pay.

There is also the difficulty of getting to Kabul in the first place. Only minimal health care and virtually no mental health treatment exist outside of the capital.

Some help is on the way, however. International Medical Corps, IMC, a United States-based humanitarian organisation, recently won a grant from pharmaceutical company Bristol-Meyers-Squibb to train mental health workers and treat women through IMC’s existing regional community clinics.

IMC has more than 30 clinics across Afghanistan, which provide maternal and child health care. The pilot program will attempt to serve 25,000 women in five districts in the Shomali Plain, just outside of Kabul.

Farida Nekzad is an independent journalist in Kabul