Quetta:Pakistan’s border regions have lived through some of the worst conflict in recent years and have scars to prove it. In Balochistan, the southern province that shares border with Afghanistan, psychological disorders have shown a marked increase in the wake of conflict since 2001, say mental health experts.

In absence of research, it is hard to put a figure to quantify the extent of damage done to people’s mental health in a province wracked by insurgency, militancy and sectarian violence. However qualitative insight gathered from treating patients of depression and anxiety in the province points to the long-term debilitating effects of living with absence of peace, says Dr. Ghulam Rasul, a psychiatrist based in Quetta.

“Over the last fifteen years, incidents of violence such as suicide attacks, bombings, and sectarian killings have left deep psychological impact on people and the society,” Dr Rasul told News Lens Pakistan. “Depending on the number of patients from cities and towns that have been hit the worst and those that have been relatively safe, there has been a 10 to 25 per cent increase in psychological disorders like stress, anxiety and depression.”

Dr. Rasul said psychiatrists believe this estimate is realistic because psychological conditions are prompted by three big factors:  The first impact [of conflict] is on the society structure, second on social life and third on human psychological health.

“In case of Balochistan, we have witnessed that conflict has threatened all three,” he said.

A 60 year old Zarmina (not her real name) told News Lens Pakistan that she suffered severe depression and anxiety after her brothers, sons and a relative were killed in a suicide blast and target killing in Quetta. 

“I have lost five members of my family including brothers, sons and a cousin within 8 years,” said Zarmina. “Our family still lives in the fear.”

According to a paper titled “Impact of Terrorism on Pakistan” by the Khyber Pakhtunkhwa Public Service Commission (KP-PSC), “Some cities are more affected than others within these [border] provinces/regions. In Balochistan, it‘s the city of Quetta, in KPK, Peshawar has seen more bomb blasts than any other and in FATA, Kurram, Khyber Agency as well as North and South Waziristan Agencies have borne the highest death tolls. These three areas are the most affected firstly because of their geographical proximity to Afghanistan and have borne the brunt of spillover effects of war in neighbouring Afghanistan. Secondly, due to lack of proper governance and development, these areas have been the breeding ground for terrorism. Thirdly, most of the suicide attacks, all of military operations, most of the attacks on the military as well as drone attacks have taken place in these areas which has cost more lives.” 

Research and studies on conflict in the border regions including Balochistan focus on the security aspect and human and economic cost of it. There is little by way of research to shed light on the social and psychological impact of absence of peace in the region. “It is difficult to assess the exact total cost of war on terrorism,” says the KP_PSC Paper. “But a rough estimate of the direct and indirect cost incurred by Pakistan during the past 10 years (2001-2011) as calculated by the Ministry of Finance in its annual Economic Survey of 2010-2011 amounts to almost $68 billion.”

According to the Center for Disease Control and Prevention, “between 30 and 70 percent of people who have lived in war zones bear the scars of post-traumatic stress disorder (PTSD) and depression.”  Across the border, in Afghanistan, where conflict and war has continued for more than three decades now, the World Health Organization (WHO) says more than 60 percent of Afghans, mostly women, suffer from psychological problems or mental disorders due to decades of war. Most of these patients travel to Pakistan to seek treatment for their mental and physical conditions, says Dr. Rasul.

There is only one psychiatry hospital in the province with few doctors to care for the entire province and a large number of Afghan patients, says Dr. Rasul.

“While Millions of people have been psychologically affected by the conflict, very few can get treatment,” he says. “Only eight to ten percent of the patients are treated locally because of lack of facilities and trained human resource.”

He suggest that the government should open psychiatric units at the divisional, district and Tehsil headquarters level all over Balochistan to address the psychological problems of the people.

“Because of absence of disaster management mechanisms, psychology departments and counselling centers for victims and their families, psychological problems are on the rise in the province,” says Dr. Rasul. “At a time when other provinces of the country are making mental health policies in view of the conflict, the government of Balochistan should seek to pass an act and devise health policies according to it.”

Morever, says Dr. Rasul, the health system in the province cannot cope with peace time healthcare demands, let alone “provide emergency care to people in conflict.” 

While there are no official figures available, Abdul Khaliq Baloch, General Secretary of the National Party that is in power in Balochistan told News Lens that “forty percent of the population of Makran Division has been displaced due to insurgency there.” He said a similar situation existed in other parts of province like Kohlu, Dera Bugti and Nasirabad.  The Chief Minister Baluchistan Nawab Sanaullah Zehri recently told a seminar in Quetta that a 100,000 Punjabi settlers have left the province due to conflict.

Samina, a 55 years old displaced widow, said her son disappeared 5 years ago, leaving her hopeless, vulnerable and distressed. “I have searched whole cities for my son but I haven’t found him,” says Samina, whose name has been changed to protect her identity. “I am still searching.”

Altaf, 51, has suffered from PTSD since a deadly bomb blast in Quetta killed three of his brothers. Within a year of this incident, he lost his son in a targeted attack. 

“I have become irritable, aggressive and often feel like killing someone and killing myself,” said Altaf, who has been on tranquilizers to escape anxiety and depression since he was injured in the bomb blast that killed his brothers.

Looking at pictures of his brothers and his young son, Altaf wipes away tears from his eyes. “It feels like my heart and head will explode,” he says.

A source in the government of Balochistan who wished to stay anonymous because he was not authorized to speak to media told News Lens Pakistan that what the psychiatrists had been saying may be accurate but “the authorities have not seen any report, data, facts or figure from international and national organizations.”

“Given that no one including commissioners in the districts has flagged the issue of mental health crisis, the Balochistan Government has not allocated any special funds to treat psychological disorders,” he said.

He said the Balochistan government has been providing opportunities for healthy activities to the public like the recent Balochistan Sports Festival in March. The government, he said, also compensates victims of terrorism.

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