AFGHANISTAN: Inadequate Care for Trauma Victims

Photo: IRIN

The government says that up to 85 percent of the population may have psychological disorders

KABUL, 13 February 2007 (IRIN) - In October 2006, Jamila, a resident of Panjwai district in the southern province of Kandahar, fled to Kandahar city after heavy fighting between the anti-government insurgents and NATO-led forces. Every day she has flashbacks to the planes flying overhead and bombs being dropped. She knows these images are not real but cannot stop herself from shouting out.

Jamila’s experience is not unusual. The psychological fallout from the conflict over the past three decades continues to be neglected, although estimates suggest huge numbers suffer from varying degrees of trauma. A spokesman for the Ministry of Health, Abdullah Fahim, said psychological disorders could be affecting up to 85 percent of the population, while the World Health Organization (WHO) spokesman, Sayed Saeid Azimi, said the WHO estimated half the population had some psychological problems or disorders.

Often invisible and largely unquantifiable, mental health has been pushed into the background while agencies and health personnel focus on the more visible physical ailments.

Only [having] medicine, food, clothes and household appliances cannot help them recover.

“Only [having] medicine, food, clothes and household appliances cannot help them recover,” says Hafizullah Hafiz, programme manager of mental health at Healthnet, a non-governmental agency.

WHO estimates the country has just two qualified psychologists in its health system and there is only one mental health hospital, in Kabul.

Traumatised by bombing

Mahmood, a resident ofa Sperwan village of Panjwayi district, has personal experience of the inadequate mental health facilities. A young girl from his village was traumatised by the bombing. Mahmood and others have taken her to “all the doctors in Kandahar city”; the doctors say the girl is mentally ill but have not been able to help. “We cannot tolerate listening to her crying. We are so troubled about her. We would be happy if she dies.”

According to a 2006 WHO report on the mental health system in Afghanistan, the budget allocation for mental health in 2004 was US$100,000 out of a total health budget of $289.4 million.

“Taking into account the budgetary problems, the Ministry of Health has identified a series of basic health services to address the health emergency problems of the patients and psychological/mental problems are prioritised in the second line of this process,” said Health Ministry spokesman, Abdullah Fahim.

Ruhullah Nassery, the national mental health coordinator in the Ministry of Public Health, reckoned mental health was the most neglected aspect of healthcare in Afghanistan and said a larger allocation for the sector had been sought in the forthcoming budget. Nassery expressed hope that the donor community would pay more attention to this aspect of healthcare.

We cannot tolerate listening to her crying. We are so troubled about her. We would be happy if she dies.

Despite earlier declarations by the Ministry of Public Health, the country has yet to initiate a mental health policy and legislation.

Nassery said there was a need for integrated mental health services in the provinces as part of basic primary healthcare. However, although training in mental health issues has begun, funding constraints have limited numbers.

Efforts by NGOs have been sporadic and are largely limited to urban centres, especially the capital, Kabul. Yet the effects of psychological trauma are being felt most acutely in the rural areas of the southern provinces where violent fighting increased dramatically in 2006, and is expected to worsen in 2007. Several agencies IRIN spoke to, including the Afghan Red Crescent, United Nations High Commissioner for Refugees, and the International Security Assistance Force’s provincial reconstruction team, all said they had no programmes for mental health in the south.