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A People Coming
Apart at the Seams Page 28 Six days a week from early morning
to dusk a slow-moving stream of patient locals snakes up a creaky
staircase off a dusty road in Srinagar’s Hazratbal neighborhood, turns
left through a bright red door and drifts down a hallway to a smallish,
nondescript physician’s office. Dr Mushtaq Margoob’s services are in
high demand. David Lepeska reports
from Kashmir on the anguish, trauma and psychological fallout of a
never-ending war. “The truth is that everybody here experiences mental and emotional adversity," he said during a recent interview in his office. “And the majority suffer horrible trauma.” New York-based Human Rights Watch offered testament to that adversity in a report released September 12th that detailed gross human rights violations on the part of both Indian security forces and separatist militants. Bombings, beatings, torture, unjustified arrest and detention, extrajudicial killings, and, among the Indian military, impunity from prosecution, were among the violations recounted. Such abuses have gashed the local psyche. “Suspicion and fear continue to permeate in the Kashmir valley," the report warned. “The psychological trauma related to the violence has been enormous, as life itself is constantly under threat……creating among the civilian population a pervasive climate of fear, distrust, and sadness.” Welcome to Kashmir, where despite considerable cooling in the seventeen-year insurgency the predominantly Muslim residents remain wedged between a rock and a hard place. The 600,000 Indian security personnel toiling in the state are ubiquitous, stationed at every intersection, along major streets and bridges, in bunkers, and behind coils of razor wire in sand-bagged bomb shelters, peering out through gunny sacks and brandishing automatic weapons with nervous fingers. Just fifty kilometers to the west is Pakistan, which with its financial and material support of misbehaving militants has lost prestige in the last decade. All have betrayed your average Kashmiri citizen, who in late 2006 is as likely to offer a pox on all your houses broadside as to acknowledge any loyalty. With mental illness skyrocketing, countless detentions and disappearances undercutting the traditionally-strong family unit and frequent rights abuses haunting the local populace, the shadows of horrors past and a Damaclean state of psychological siege have begun shredding the societal fabric. In the complicated, still-bloody muddle that is the Kashmir conflict the news has been good. Total fatalities dropped from 4507 in 2001 to 1810 in 2004 and again to 420 through May of this year, according to the Delhi-based Institute for Conflict Management. Major bomb blasts, shootings and other deadly attacks totaled 27 through July, likely the lowest total since the violence began. Before a series of deadly grenade attacks on tourist buses in that month, domestic and international vacationers had been visiting the valley in droves, leading state tourism officials to predict a record 1 million tourists for the year. Terror group and independence figurehead Hizbul Mujahideen, led by Pakistani-based Syed Salahuddin and frustrated with a lack of progress and the death or capture of key commanders, made the startling and unprecedented mid-August offer of dialogue with New Delhi, potentially signaling a twilight for terror in Kashmir. Most positively, Pakistani President Pervez Musharraf and Indian Prime Minister Manmohan Singh offered an encouraging joint statement after a mid-September meeting on the sidelines of the Non-Aligned Movement summit in Havana. As the war has loosened its grip, however, the fallout has squeezed the populace in a psychological vice. From around 1700 mental patients in the Kashmir Valley in 1990 the sufferers have mushroomed; to 48,000 in 2002 and over 62,000 in 2004, and a lingering stigma against mental problems suggest these numbers are just the tip of the iceberg. Margoob, a professor at Government Medical College here, guest-edited the most recent volume of JK-Practitioner, a quarterly medical journal, which in the results of a half dozen psychological studies details how that iceberg may be nearing a perilous tipping point. Nearly sixty percent of all Kashmiris will be exposed to major trauma and one out of six will suffer from post-traumatic stress disorder at some point in their lives, two of his studies found. A third revealed that forty percent of orphaned children, of which Kashmir has over 100,000 according to non-profit Chinar, suffer from a serious psychiatric disorder. Because of traumas and the constant threat of danger, over one third of locals will at some point suffer from a medication-necessitating mental disorder, and a joint study by Action Aid India and Kashmir University released in late August found over forty percent of youths aged 15-25 were consuming some kind of recreational drug. Piled one on top of the other these afflictions are eroding the very foundations of Kashmiri society. A male breadwinner is arrested by security forces or killed in a grenade attack, say, in 2004. His mother slips into complete denial as his wife and two children fight to feed themselves and keep a roof over their heads. After going a year or two without counseling or medical attention the mother settles into morbid depression, with suicidal tendencies, while the wife is embittered and her two children, wan, withdrawn and fearful, turn to drugs, militancy, or crime. Multiply that by ten, twenty, or thirty thousand and spread across three generations in a population of 5 million. “This is happening on such a vast scale," says Margoob, admitting that Jammu & Kashmir State lacked the appropriate psychological support systems. “It will significantly weaken our sense of community in Kashmir and radically alter behaviors in a negative way, endangering society as a whole.” Political and cultural psychologist Ashis Nandy, Director of the Delhi-based Center for the Study of Developing Societies, believed such a deep wound would leave a lasting scar. “The Kashmiri society has been devastated psychologically and it will be difficult for it to recover over the next two generations," said Nandy, comparing Kashmir to Cambodia, Bosnia, and Rwanda, with its impoverished community and culture and an epidemic of mental disorders that will further reduce Kashmir’s self-confidence. “The insurgency may be defeated but it will be a pyrrhic victory; for, what you see in the psychiatric wards today you will see in politics and public life tomorrow.” Sensing a decimated populace and a dearth of local psych services, international health and aid organizations have begun to appear. Doctors Without Borders (MSF) set up mental health clinics in Srinagar and Kupwara in 2000, and EU and UK-funded Action Aid India came two years later. The latter focuses on mental health and livelihood and has augmented its local presence in recent months. MSF Project Coordinator Tim Baerwaldt said patient totals have increased in recent years, up to 6800 through July of this year, and that over half of them display symptoms of depression. By building up trauma response and mental health systems, eliminating the mental illness stigma and increasing awareness of all concerned parties, especially immediate caregivers such as friends, family, and patients, these three outfits - Margoob and his Government Medical College team, Action Aid, and MSF - are working to reverse the trend. But however you slice it, Kashmir is in for a long, tough slog. Nandy saw a ray of hope in the valley’s troubled past. “India and Pakistan may have come to believe that, after nearly sixty years of bitter quarrel, all that remains to be done is to divide or dispose of the carcass," he said. “But Kashmiris have shown enormous resilience over the centuries in resisting external intrusions and cultural dominance…Pakistan and India think that things will be different this time but Kashmiris, some may argue, know how to outlast their oppressors.” |