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The hidden cost of war on Mental Health


A young child, Akbar walks to the supermarket, happy and looking forward to getting an ice cream from his pocket money. Suddenly there is a loud explosion. The impact is so severe that the child is thrown back. He sits up, his ears ringing, shattered glass around him and wounds on his body. What he sees in front of him will leave a mark on his mind for the rest of his life. He sees many people shouting, screaming for help. Their wounds so severe that many will not survive. He then sees dismembered parts of others. The innocent mind of the child has been scarred forever.

He looks around stunned, not knowing what to do, feeling helpless and frightened. The picture of the world in his mind has been changed forever. He now sees the world as frightening and dangerous. He slowly, falling and tumbling makes his way home crying. He reaches home to find his mother rushing out to hug him but he is mute and confused.

Meanwhile from another road, a young man, Sadiq, rides his motor cycle, making his way to work. He takes this route everyday and works as a clerk, sole bread earner for a family comprising of three children and his wife. The explosion is far enough for him to survive but the impact strong enough to throw him off his bike and roll a number of times backwards. He has broken an arm and a few ribs. The state of confusion is such that he is not aware of this. There is dust everywhere and he can hear the screams of various men, women and children in a distance. Some of them screaming for the last time before their souls go to Heaven. Sadiq is from an area where he has witnessed such incidents as a boy. Reflexively he thinks of his family and struggles to get home to check on his family. Fortunately his family are safe but the images of the destruction and horror are fresh in his mind.

Akbar and Sadiq will go through a process similar to grieving but there is a high chance their lives have been changed forever. The initial recovery can be helped greatly by support from others.

Children such as Akbar may go on to develop symptoms/ signs ranging from anger, irritability, aggression to anti social personalities etc. Children in various stages of their development can present with different symptoms.

Young adults such as Sadiq, especially who have witnessed trauma in the past are more likely to go to on to develop mental health problems. Symptoms/ Signs ranging from shock, denial, disbelief to full blown depression and anxiety disorders. They start isolating themselves and their ability to function deteriorates at every level.

Although the above accounts are fictional, similar incidents and I dare say much worse have gripped Pakistan for many years. Although there has been some improvement in the security situation, a lot of work still remains. We have a generation of people traumatised by such events. Some are more resilient than other, however the scars of such events will never leave their minds. Many will go on to develop more severe mental disorders.

If the symptoms/ signs are more prolonged than a few months or rapidly deteriorate, then a specialist should be Consulted. Women are affected more than men, as are children and the elderly. If such problems in childhood are not resolved they can have a long lasting impact with children seeing the world as a dangerous place and entering adulthood with a sense of fear and helplessness. Adults who are already under stress or have suffered losses are more prone to being traumatised as are people with a history of trauma in the past.

WHO data collected through WHO-AIMS in 2008 quotes a health budget to GDP ratio of 3.9. Mental Health expenditure out of over all Health Expenditure is 0.4%. There is <1 hospital bed for every 100,000 population. There are 342 Psychiatrists for every 100,000 population and 25,782 other doctors not specialised in Psychiatry. In 2007 0.002 doctors graduated as Psychiatrists from academic and educational institutions.

With a constant brain drain problem facing Pakistan, I fear the figures would be worse now than in 2008. It is imperative that appropriate steps are taken to address this hidden problem as this will become a widespread problem in years to come. Awareness is a key issue and is also necessary to mobilise public support. Many times due to lack of awareness, the above problems are not identified even by parents or family members of the affected person.

Author: Dr Asad Hussain
Consultant Psychiatrist
MBBS(PAK), MRCPsych(UK), DPM(UK), CCT(UK), QESP(UK)
Currently working at Quaid-e-Azam international hospital, Islamabad

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