July 1, 2008
Conflict Takes Its Toll in Kashmir
SRINAGAR, India _ Ever since he saw his handicapped son shot dead by soldiers in the street outside his home, Rehmatullah Bhat has not been able to sleep.
His daughter still cries every day, and his wife experiences prolonged headaches and back pain. Bhat, 53, runs the family's small bakery shop but "only because we would starve without it," he said.
"We have not been thinking as we used to think. Almost all of us are ill," he said, fighting back tears. Since his son died two years ago, felled by security troops who say they mistook him for an insurgent, "we have not been mentally fit," he admits.
Indian-controlled Kashmir had one of the lowest suicide rates in the world until 1989, when an uprising by Pakistani-backed separatists, quickly answered by a vigorous Indian security crackdown, launched the territory into nearly two decades of violence that has left tens of thousands dead and thousands others missing.
Today, as insurgents continue to spar with the Indian security forces that blanket the region, the once peaceful Himalayan valley has racked up one of the highest suicide rates in the Muslim world, on a par with that in Lebanon. Under Islamic law, suicide is forbidden and considered a deep affront to God.
The near daily shootings, bomb blasts and disappearances that once terrorized Kashmiris have abated somewhat in recent years, as peace talks between India and Pakistan progress. But in a region where nearly every family has lost someone to the fighting or witnessed brutal violence, chronic mental health problems have become an epidemic.
"We have a national burden of stress," said Dr. Arshad Hussain, one of only 14 practicing psychiatrists in a state with more than 5.7 million people. Before the conflict, "bipolar disorders, schizophrenia were what we used to see. Now it's depression, post-traumatic stress, sleep disturbances, learning disabilities," he said.
At Hussain's private clinic in Srinagar, patients jam the waiting room well into the evening; even more are waiting for him at the lone state psychiatric hospital, where he works a few days a week. On weekend trips to his home village, he said, he ends up running an informal clinic for those who inevitably stop by to consult with him.
In 1989, he said, the state psychiatric hospital saw 1,700 patients. Last year, that hospital and a psychiatric clinic at the general hospital in Srinagar together saw 100,000.
That is in a country where "mental health is still a taboo" subject, Hussain said.
The number of people still not getting help is evident in Kashmir's newspapers, which are full of near-daily stories about youths leaping from bridges into the Jhelum River or women swallowing bottles of pesticide or toilet cleaner.
At least 60,000 Kashmiris committed suicide last year, a record number of deaths, mental health groups estimate. Even the Indian security troops patrolling the conflict-torn region have proved susceptible. Newspaper reports suggest at least 60 _ stressed by separation from their families and daily fear of militant attacks_took their own lives last year.
"In this valley, every home is suffering. We are all suffering mental depression," said Nissar Ahmad, 26, a family friend of the Bhats who saw his own elder brother vanish 17 years ago in the conflict.
Gradually, however, help is starting to reach at least some of those in need. Doctors Without Borders, an international medical charity, has worked with the government to set up basic psychiatric units in a growing number of medical clinics around the country, trying to improve access to mental health services in rural areas and to pull in patients who, because of the stigma surrounding mental illness, are more comfortable visiting a regular medical clinic than a psychiatric program.
The organization also runs a twice-a-week radio program in which actors portraying an educated young woman and a respected village elder talk through mental health issues. The program, in simple language, has helped dispel myths _ for example, that the mentally ill are possessed _ and helped families recognize symptoms of depression, from lack of socializing with friends to an unusually short temper.
"We still have a long way to go, but the changes are apparent," said Naheed Hamdani, a spokeswoman for Doctors Without Borders in Srinagar. "People have started seeing mental health as a general health problem, not something that necessarily has to ostracize them from the rest of the community."
Still, persuading Kashmiris they need help, and making services accessible, remains a considerable challenge. It is even harder to bring any measure of peace.
For the past three months, Bhat has been seeing a psychiatrist but has yet to find any real relief from his agony, his friends say.
"The pain never lets him sleep. No medicine can help if you lose someone. It only gives you a short time of relief," said Ahmad, the family friend.
What might help, Bhat said, is seeing the troops who shot his crippled son punished. But despite security officers admitting the killing was a mistake, the men involved were quickly transferred away from the observation post that faces Bhat's house, he said. Today they remain protected from prosecution under Indian law, which gives security officials in "disturbed" regions like Kashmir the right to shoot on sight any suspected insurgent.
"They said we'll be given justice, don't worry," the baker said. But "they are just procrastinating. If they had a decision to give, they would have given it by now."
Meanwhile, armed security troops continue to patrol across the street from his shop, near a sign reading, "Our ultimate aim is your well-being."
Hussain, one of the region's leading psychiatrists, agrees that justice is the best treatment for Kashmir's pain.
"After trauma, the best healing that happens is when people feel they have gotten justice," he said. "Wanting vengeance has to go, and a feeling of justice has to come for the ultimate healing of the community."
(c) 2008, Chicago Tribune.
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