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Victims at the Lady Redding Hospital, Peshawar: Photo by News Lens Pakistan / Ghulam Dastageer

PESHAWAR: Danyal Ali, a student at the Army Public School, has grown quiet. The 4th grader who saw the massacre of his class fellows at the hands of militants last month has been exhibiting “visible behavior changes”, according to his father.

“Danyal used to be an active and naughty child”, said his father, Mushtaq Ali. “But since the attack he has grown absent-minded and reflective.”

Danyal’s response to the massacre is indicative of the community’s psychological state.

On December 16, seven militants stormed the Army Public School, killing 151 people including 134 children. The Tehrik-e-Taliban Pakistan (TTP), a major militant group fighting Pakistani security agencies, claimed responsibility for the attack.

The carnage at the school in Peshawar, capital of northwestern Khyber Pakhtunkhwa province, shocked the world. It will have far-reaching psychological impact and consequences for children that witnessed the gory incident and families that lost children, according to psychiatrists.

Dr Mian Iftikhar Hussain, a Peshawar based psychiatrist, told News Lens that the incident will continue to haunt the children, their parents and family members for a long time to come.

“Students and their parents have developed post-traumatic stress disorder, depression and anxiety”, said Iftikhar.

Numan Khan, a sixth grade student, was traumatized to the extent that he did not speak for two days after the incident. “He is still very afraid,” said his father Haroon Khan. “We had to struggle to get him to talk so he can come out of the shock.”

Haroon Khan had two sons who were at the school when militants attacked. The family says both are still traumatized and scared. “They ask me not to leave home, something they never did in the past”, Haroon told News Lens.

Children may have been visibly traumatized the worst, according to the psychiatrist Dr. Mian Iftikhar Hussain, but their parents are equally suffering, albeit silently.

Haroon, for instance, is having trouble sleeping at night and his appetite has disappeared – conditions that are symptoms of depression and anxiety, according to Dr Iftikhar.

“I can’t sleep at night”, said Haroon. “I keep thinking about the security of my children and the incident, which I’ll never forget for the rest of his life.”

Like most parents exhibiting post-traumatic stress, Haroon has vivid memories of that day that continue to haunt him: “I reached the school immediately after the attack. I heard gunshots and blasts but could not do anything. I will never forget the helplessness, insecurity and sadness I felt during the hours I waited outside the school, hoping and praying my children would come out safe.”

According to Iftikhar, feeling of hopelessness, helplessness, grief and vulnerability has increased among the parents. He said the attack was devastating and unprecedented and would have immediate, short and long-term psychological impact upon children, parents, their friends and family members.

Arshad Alam, a lawyer who has two nephews in the school that survived the incident, told News Lens thatthe attack has shattered his sister, the boys’ mother. “She has become so insecure that she has decided to join the school as a helper so she can be with her kids all the time,” said Arshad Alam.

In view of the severity of the incident, the Ministry of National Health Services (NHS) will soon be starting counseling sessions on “post-traumatic stress management” for children who survived the attack, said an NHS release.

The ministry of NHS has formed a committee with members from the Army Medical Corps, psychiatrists from Peshawar and Islamabad and representatives from the UN agencies – the World Health Organization and UNICEF, the United Nation’s fund for children.

The committee will chalk out a plan for comprehensive counseling of children from the Army Public School and their parents. It will also organize counseling sessions for children of other schools.

Iftikhar stressed the need for immediate psychological treatment of parents and students that were injured and survived the attack.

“Immediate intervention will help prevent post-traumatic stress disorder and full-blown psychological disorders in future”, said Dr. Iftikhar. “Psychological support should also be provided to children in other parts of the country who, although geographically distant, may still be troubled by the gory incident.”

According to a 2009 World Health Organization report “Mental Health System in Pakistan”, Pakistan only had 342 psychiatrists and 478 psychologists.

“The government needs to put together all its resources and immediately start rehabilitation of children and their families,” said Dr Abdul Ghafoor, the former Director Health Services, Khyber Pakhtunkhwa.

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