For over three decades, the Afghan people have lived with armed conflict. The all-pervasive violence has not only caused physical wounds.
Inconsolable sorrow after a devastating suicide attack
There is a part of Kabul, the capital of Afghanistan, which Afghan taxi drivers normally try to avoid. When foreigners ask them, "are there terrorists?", their simple answer is: "No, junkies".
Junkies were a totally unknown phenomenon in Afghanistan until quite recently, which is why most people are at a loss to know how to deal with the growing number of addicts. In a way, it is the same with traumatized or depressed people. The society at large and even their own relatives mostly react to mentally disturbed people with a lack of understanding or even with shame.
Female drug addicts at one of the few treatment centers in Kabul
Hiding away the patients
Many try to cover up the problem, says Ahmad Shafiq Behrozian from the western city of Herat. "We Afghans have no idea how to interact with mentally ill persons. Mostly we treat them as dangerous and crazy individuals. Sometimes they are chained or locked away in a separate room by their own relatives."
Doctors reckon that the growing number of the mentally ill is due to a number of reasons: war, experience of violence and subsequent traumata. In addition, poverty and malnutrition can also contribute to a disease, because physically healthy persons are more resilient when they experience emotional stress.
Afghanistan's hospitals are ill equipped to treat psychiatric patients
When the stress becomes unbearable or, as in the situation of permanent conflict in Afghanistan, when it piles up and people have no chance of getting it out of their system, they can experience a breakdown. Tragically, this changed behavior is normally not recognized as an illness, explains Fatema Jafari, a member of the provincial council in Herat.
"You can easily tell that there is a high number of mental disorders here in Herat, simply from the high incidence of self-immolations, violent attacks in public as well as domestic violence. But nobody is interested in the real causes, no one talks about it. More than 60 percent of the population have mental problems."
Lack of psychiatric services
Making it worse, not even doctors diagnose the illness at times. Muhammad Ghulam Ali from Herat says, "We have a mental patient in our family. We took him to see several doctors, but to no avail. He can't control himself and is violent. Only when we keep absolute silence in the room, he can relax to some extent."
Children are especially vulnerable
In this situation, qualified doctors and especially psychiatrists are badly needed, as are psychiatric wards in the hospitals, says Peter Graaff from the World Health Organization, the WHO. "And yet, investment in mental health services is very limited at best."
For example, there are currently only about 200 beds for psychiatric services in the country."And there are no services targeting children specifically," he adds. In fact, it is the children who would need medical care most urgently.
Authors: Ute Hempelmann, Hoshang Hashemi (tb)
Editor: Arun Chowdhury