Kashmir’s mental health crisis

According to a recent report, 1.8 million Kashmiri adults suffer from some form of mental distress.

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Hafiza looks through a window covered with a polythene sheet. The family doesn't have glass for their windows [Baba Tamim/Al Jazeera]

Indian-administered Kashmir – Sometimes 52-year-old Hafiza Bano can be seen counting the wooden planks in the ceiling, or the lines on the doors, or the flowers imprinted on the rug.

Her house has three small rooms and a kitchen. In one of the mud-plastered rooms, a disabled relative lives; in another room, guests are greeted. The third is also occupied – by the memories of her dead daughter and “disappeared” son. 

This is where Hafiza sleeps – a picture of her son, a jar full of the different medicines she must take and a broken radio tied with a piece of cloth beside her bed.

Almost every night, she dreams of buying her son clothes for Eid. Almost every morning, she wakes up crying.

READ MORE: What mental illness means to me 

Her family gave her the radio in the hope that listening to music might distract her from her thoughts. But it proved to be as delicate as Hafiza’s mental health, and there is no piece of cloth that can hold her together.

Hafiza is mentally ill. And she isn’t alone.

When Doctors Without Borders (MSF) recently released a comprehensive report [PDF]on mental health in Kashmir, it concluded that half of all residents of the valley have “mental health problems”.

The report found that nearly 1.8 million adults – 45 percent of Kashmir’s adult population – suffer from some form of mental distress. A majority – 93 percent – have experienced conflict-related traumaAn average adult was found to have witnessed around eight traumatic events during his or her lifetime. More than 70 percent of adults have experienced or witnessed the sudden or violent death of someone they knew.

According to the report, 50 percent of women and 37 percent of men are likely to suffer from depression; 36 percent of women and 21 percent of men have a probable anxiety disorder; and 22 percent of women and 18 percent of men suffer from post-traumatic stress disorder (PTSD).

The report was the third of its kind on mental health carried out by MSF. Its first two were in Iraq and Syria.

Hafiza cries as she stands at the spot where she says her son was taken [Baba Tamim/Al Jazeera]
Hafiza cries as she stands at the spot where she says her son was taken [Baba Tamim/Al Jazeera]

Transmitting trauma

Indian-administered Kashmir consists of three regions: Jammu, the Kashmir Valley and Ladakh. The nearly 27-year-old armed rebellion against New Delhi’s rule has been centred in the valley, where the highest rates of mental illness are now reported.

Armed groups have been fighting against the hundreds of thousands of Indian troops stationed there – some seeking independence and some accession to Pakistan.

READ MORE: Disease, discrimination and dignity 

In 1989, the year the conflict started, around 1,700 people visited Kashmir’s only psychiatric hospital [PDF]. Last year, that number topped 100,000

“It’s a crisis,” says Kashmiri psychiatrist Mushtaq Margoob.

“Before 1989, there were no PTSD cases, but now we have an epidemic of disorders in Kashmir. Generation after generation has been at the receiving end; anybody could get killed or humiliated – [it’s] a condition of helplessness. So, it is a transgenerational transmission of trauma.”

The ruling People’s Democratic Party (PDP) agrees. “Because of both [the] military and [the] militancy, people and their mental health becomes [a] casualty. We have been trying to explore options to try to address the issue,” says Waheed-ur-Rehman Para, a PDP spokesperson. 

“When you live in a violent place, it affects your psychology and mental setup. All the violence, restrictions, strikes and curfews do have an impact on destabilising mental health … [The] government needs to have a comprehensive policy to deal with this grave issue.”

Hafiza’s ordeal began in the winter of 1993, when she says soldiers from the Indian Border Security Force (BSF) took her 13-year-old son Javed Ahmed as he was eating lunch with his family at their home in the southern district of Pulwama.

READ MORE: ‘Welcome to Kashmir’ 

Kashmir was under curfew as armed fighters were engaged in a standoff with Indian troops at a shrine in the Hazratbal neighbourhood of the summer capital, Srinagar.

Hafiza recalls that time.

“[The shrine] was under siege, so Javed had no school because the whole valley had [been] engulfed in tension. He had gone out to play with the children in the neighbourhood. And when he got back for food, in no time a group of troops barged into our house. In front of every one of us, they took my son. We pleaded before them, but they wouldn’t listen.”

He was never returned, she says, crying.

It was November 3, 1993. The family say they reported the case to the police and, a week later, received a copy of the First Information Report, a police report registered once a complaint is received. 

The report alleged that the 13-year-old was a member of an armed group and that while he was being transported, fighters ambushed the troops in whose custody he was, triggering a gunfight on the evening of November 4.

The report claimed that Javed was able to escape under the cover of darkness during the gunfight.

But the family rejects this version of events, insisting that their son was just a normal schoolboy and that if he had escaped, he would have contacted them. 

The family say they sold everything they had to hire lawyers and visit jails and military camps, searching for Javed.

“I have no idea how much money we have spent in the courts to seek justice. I sold every valuable in the house, even the carpet material,” says Hafiza’s husband, carpet-weaver turned auto-rickshaw driver Ghulam Nabi Mattu, 55. That is why, he says, their was not in a suitable living condition.

Hafiza prepares food for the family [Baba Tamim/Al Jazeera]
Hafiza prepares food for the family [Baba Tamim/Al Jazeera]

‘Getting mentally weaker every day’

Located in the village of Mongehoum in Pulwama province, their home is made of mud and wood. Until recently, it didn’t have any windows. But then the Association of Parents of Disappeared Persons, an NGO, installed new wooden ones.

Three years after his disappearance, Javed’s sister, Ruksana, died of a heart attack. She was 14.

“My daughter died of a heart attack during Ramadan [in 1996] while searching for her brother,” Hafiza says. “She would accompany us everywhere [to look for him].”

Now, Hafiza and Ghulam are left with one child – their 30-year-old daughter Shafiqa. 

“We are facing tough times. I am getting mentally weaker every day. I sought to look for a man for my daughter to marry, but they didn’t find our household to be up to their reputation and denied to marry her,” Hafiza says.

Ghulam’s disabled brother, Wali Mohammad Mattu, also lives with them.

“My disabled brother-in-law has been bedridden for the last six years. I take him out to go to the toilet and bathe [the bathroom and toilet are outside of the house] with the help of a boy from the neighbourhood every day since my husband drives an auto-rickshaw in the city [Srinagar]. If we don’t take care of him, what will people say?”

Hafiza rarely sleeps. According to her medical reports, she is suffering from a “severe reactive depression” with somatisation and migraines.

Hafiza, left, with her daughter, Shafiqa, and her husband, Ghulam [Baba Tamim/Al Jazeera]
Hafiza, left, with her daughter, Shafiqa, and her husband, Ghulam [Baba Tamim/Al Jazeera]

She stopped taking her anti-depressants a week ago because the family cannot afford to pay for them.

Ghulam has his own health problems. He suffers from severe back pain, but says that if he pays for hospital tests and pain medication, his family will have to go without food.

“His old auto-rickshaw will be banned in a few months as the model is old,” Hafiza explains, worried about what the government regulation intended to control pollution levels will mean for her family.

“Why did this happen to my family?” she asks as her tears begin to fall again.

Ghulam chips in to say that he sometimes feels as though his wife has gone mad. Had Javed been here, he says, things would have been much better for their family.

“We would have definitely had a better life. He would go to school and also work part-time in the apple orchards,” Ghulam reflects.

His son used to sell ice-cream after school and had always been responsible, he explains.

“If Javed were alive, he would have been a great son and a support to the family.”

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Hafiza must take six types of tablets a day for her medical problems, but the family says they can no longer afford the medication she needs to treat her depression [Baba Tamim/Al Jazeera]
Hafiza must take six types of tablets a day for her medical problems, but the family says they can no longer afford the medication she needs to treat her depression [Baba Tamim/Al Jazeera]
Source: Al Jazeera