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How Violence In The Valley Is Taking A Huge Toll On The Mental Health Of Its Women

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By Baseera Rafiqi:

Zahida Bano, 62, lives with her ailing husband in a far off village in Bandipora district of Jammu and Kashmir. After mechanically going through the day’s chores she sits at the window sill of her small home in the mountains for the remainder of the day with her hands on her face. It was way back in 1993 that her eldest son Mohamad Asim, 27 at the time, had left home and he hasn’t come back since. She believes he will return and that is why she keeps up her daily vigil at the window, hoping to catch a glimpse of him. “Asim will come,” she remarks, her eyes welling. Doctors believe that Zahida is otherwise okay, it’s just her grief that is making her sick.

In strife torn Kashmir, where displacement, violence, and gun fights have been a part of everyday life for decades now, there are thousands of women – mothers, sisters, wives – who are struggling to keep their sanity. In fact, with more than 8,000 disappearances over the past two decades there are many Zahidas who are just hanging by the thread.

“We have been living in a continuous state of fear and that has lead to a rise in patients of depression, anxiety, and other conditions related to mental health. No matter how fast we think we are moving towards peace and development, there is always a lurking fear of being killed, or getting caught in a curfew, or being targeted by a mob, or hit by the police,” points out Dr Aadil Bashir, a sociology professor from University of Kashmir.

Women in Kashmir have been living in a continuous state of fear and that has lead to a rise in depression and anxiety among them.

A recent report released by Medicines Sans Frontiers (MSF) claims that one in five adults in Kashmir is living with Post Traumatic Stress Disorder (PTSD), and that the prevalence of mental distress is significantly higher among women. It states: “Fifty per cent women and 37 per cent of men have probable depression, 36 per cent women and 21 per cent men have a probable anxiety disorder, and 22 per cent women and 18 per cent men have probable PTSD.” The study was conducted by MSF, in collaboration with University of Kashmir and Institute of Mental Health and Neurosciences (IMHNS), from October to December 2015 in 399 villages across the Valley.

Dr Bashir states, “Women who have been either directly or indirectly affected by conflict today suffer from various mental health ailments. It seems to me that we are heading towards a major mental health disaster and we are unable to do anything to reverse its impact.”

The long queue outside the Out Patient Department (OPD) of the Valley’s sole mental health hospital, the Government Psychiatric Diseases Hospital in Rainawari, only reinforces Dr Bashir’s observations. And, unfortunately, women form the bulk of the patients waiting for treatment. Dr Arshid Hassan, a renowned psychiatrist from IMHNS in Srinagar, and one of the authors of the study, shares some of the reasons for this obvious gender bias. “Women form the bulk of the patients as they are the largest survivor group. Also, they are biologically and psychologically predisposed to develop certain conditions, especially depression, anxiety and PTSD. Apart from the obvious violence, social factors contribute to making women more depressed. We have some community data available which reveals that more than six per cent of females suffer from depression in Kashmir.”

Although seeking professional help to work through one’s mental health issues, especially in the case of women, is still considered a taboo, Dr Hassan believes that things are improving. He is not wrong because, as per data shared by the Rainawari facility, around 100 female patients come to seek treatment there on an everyday basis. “The stigma is gradually reducing because there is an improved access to treatment and care. More government as well as private clinics have come up.” The experts are unanimous that women’s health, be it physical or emotional, is crucial for any society. “Women are central to the family, its wellbeing. So when they are sick it affects everyone,” points out Dr Hassan.

Ulfat Altaf, 38, lost her husband in the 2001 state assembly bomb blast, leaving her all alone to fend for her nine-month-old baby boy. Burdened by grief and her tough circumstances, she battled with depression for a whole year before she sought professional help. That was the best decision she took for herself, because the treatment enabled her to overcome her problem. Now she is working and raising her child with dignity. “The idea of living alone with a child and no job made me feel extremely weak and vulnerable. Although my family tried to help me with whatever means they had it took me almost a year to come to terms with everything. Ultimately, my doctors helped me get over this difficult phase. The several sittings and a change of environment pumped new energy in me and I decided to start working,” she shares candidly.

In strife-torn Kashmir, women generally experience a lot of pain and an overwhelming sense of loss.

Dr Hassan says, “Many women who lose their loved ones in a conflict do experience PTSD but, in time, they make their peace with the incident. It’s the ones whose relatives have disappeared who are the most difficult to reach out to. We can’t come up with a solution or an explanation for them to hold on to. I had a couple of patients whom I was unable to help because there wasn’t any tangible resolution to offer. There is an endless stress that keeps on mounting on the patient. Professionally, we refer to them as undefined syndromes. It is grief but it is of a very complicated kind and their illnesses are much more severe.”

So how can these suffering women get the help and support they need? “If we talk about societal support, in general, that is dwindling nowadays. The main reason being that whereas earlier there were mechanisms and systems to cater to them and children, in the last 25 years or so their numbers have decreased exponentially. They used to be entitled to three types of support – familial, community and, lastly, the state. But the resources are stretched and everyone can’t be looked after anymore,” explains Dr Hassan.

As the MSF report suggests “a comprehensive and integrated decentralisation, prevention and care and treatment programme is the need of the hour in the Valley.” Of course, this is even mandated under the Mental Health Act, 1987, which directs states to make mental health facilities available at the district level. “However, the reality is that at present we don’t even have a tertiary facility let alone there being ones at the district level. Counselling centres affiliated with the IMHNS along with trained frontline health workers will make a huge difference to women’s lives,” says Dr Hassan.

Bringing treatment to the grassroots and adopting a more sensitive and open approach to this issue can really make life easier for women who are anyway on the brink.

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Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

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The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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Find out more about the campaign here.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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