KABUL: On a low bed in a quiet, all-female hospital ward, a depressed Afghan teenager huddles silently under blankets, her mother close by. In a nearby room are men suffering from schizophrenia, delusions of persecution and power, anxiety and panic disorders.
Among them are some of the unseen victims of the war in Afghanistan: a generation of people mentally damaged by their exposure to incessant conflict.
The accumulation of psychological problems could begin to undermine national reconstruction and development, say health workers at the country's only facility for treating mental illness.
Ghazia Sadid, a 26-year-old mother, endured depression for years after a family member was killed in a bomb attack, and she fled her home in fear of more violence.
“I still hear the sounds of explosions. I still remember the fighting, but since I have come here my behaviour has changed,” she said, speaking at the Kabul Mental Health Hospital, a green-walled building on the outskirts of the city.
“I was totally lost and my life was over. After two years of treatment, now I love my children,” she said. “I loved them then too, but in my imagination I had done something wrong.”
The concept of mental illness is alien to many in Afghanistan, where the public health system, like much of the country's infrastructure, has been wrecked by decades of war.
Frequently, people suffering psychological disorders are thought by their families to be under the influence of malign spirits, or showing symptoms of a physical ailment.
The Kabul hospital, which has 60 beds for in-patients and another 40 in a separate facility for drug addicts, is run by the government in partnership with US-based nonprofit group the International Medical Corps. It gets funding from the European Union. Psychologists working there say children who have known nothing but fighting since the US-led overthrow of the Taliban government more than a decade ago are especially vulnerable.
“The generation born after 2001 when the international community entered Afghanistan might be 10, 11 year olds now, and I've been seeing 11 year olds and 10 year olds nowadays who are presenting with so many mental health problems: nightmares, depression, anxiety, incontinence,” said Mohammad Zaman Rajabi, clinical psychology advisor at the hospital.
Men, women and children come for treatment with drugs, counselling, group therapy and cognitive behavioural therapy.
“If, in a family, there are problems every day it's obvious that the family members are not well and cannot serve each other properly,” said Taiba Alkazai, a psychologist at the hospital.
“In the same way, if there is fighting in a country then its people won't be happy.”
The fear of suicide bomb attacks, roadside bombs, and the overall level of violence in Afghanistan — of which civilians bear the brunt, with the number killed rising in 2011 for the fifth straight year to more than 3,000, according to the United Nations — can lead to anxiety, panic and obsession.
“The physical aspects of war (last) for a limited time, but the psychological aspects of the war extend for many years. Day by day the mental health problems caused by the war are increasing,” said consultant psychiatrist Said Najib Jawed.
Just as socially damaging is the risk of a generation for whom violence has become the norm.
“One of the examples I always give is that when you talk to an Afghan boy, you can easily get into a physical fight because they just wait for it, they don't know any other ways of dealing with a problem than fighting,” Rajabi said.
“All these things will lead to a generation of people who are not very healthy mentally, and this will affect everything in the country: education, relationships, families, generally the development of the country.”