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.
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.
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.