Bruises, burns, and amputations; the never-ending conflict that plagues Waziristan has left its people scarred. There are those wounds you can see, those you can hopefully heal and then there are those that are invisible to the eye. Those that fester unseen, that poison not the body but the mind and soul.

It is an untold story, the tale of the toll this conflict has taken on the mental health of the people of the tribal areas and beyond. It is a suffering borne in silence, it is the unseen cost of war, one that cannot be measured in destroyed schools, lost lives and shattered homes.

Consultant psychiatrist, Dr Mian Iftikhar Hussain, understands the price being paid by the people of Waziristan better than anyone else. “Imagine living with flashbacks of women, men and children from your family being gravely wounded or even dying before your eyes,” says Dr Hussain. “Imagine ordinary people not being able to acknowledge the pain they live with, or even to talk about their trauma.”

Practising since 1986, Dr Hussain has witnessed the exponential rise in the need for mental health practitioners: more people in Waziristan and Federally Administered Tribal Areas (Fata) now seek treatment for their invisible wounds than at any other time since the turn of the millennium.

With few institutions dedicated to helping those with mental scars, Dr Hussain established the Iftikhar Psychiatric Hospital (IPH) in 2003. A 40-bed purpose-built facility located on the Ring Road near the Motorway Exchange in Peshawar, IPH has three psychiatrists, two psychologists and five psychiatric nurses on its staff roll.

By virtue of its location, the facility is easily accessible to people arriving from Fata or any district of Khyber Pakhtunkhwa (KP). Besides offering 24/7 in and outpatient psychiatric and psychological services at a nominal fee, Dr Hussain also holds free medical camps every Sunday to facilitate patients who can’t afford consultation fees or anti-psychotic medicines.

“Amidst an increasing sense of insecurity and uncertainty, those displaced by militancy and war suffer particular kinds of ailments,” explains Dr Hussain.

In the relative calm of the hospital, the mental illnesses braved by patients are varied: post traumatic stress disorder (PTSD), anxiety disorder, panic attacks, mixed anxiety depression disorder associated with threats to their lives and depression brought about by adjustment problems in new, sometimes unwelcoming, settings.

Dr Hussain and his team of psychiatrists, clinical psychologists, psychiatric nurses and social workers adopt a multi-pronged approach to treatment. They believe that prolonged bereavements suffered by patients often go unnoticed and don’t get the needed attention.

“We even organise social events like poetry recitals (mushaira) to increase awareness regarding psychological illnesses,” says Dr Hussain, explaining that each kind of trauma needs a separate outlet to be expressed and subsequently, treated.

In a culture where admitting to suffering mental trauma is akin to being considered weak, many who first arrived at IPH were shy in telling doctors about their experiences and the hardships they had gone through. With a touch of compassion and empathy, patients slowly begin to open up.

“It is important for us that our psychiatrists show empathy and breed trust in those who seek help,” says Dr Hussain. “Once there is a bond of confidence, trust and surety of confidentiality to the patients, they open up about their miseries. It is only through this exchange, once they narrate their miseries, that we begin constructing a patient’s complete medical history.”

What is a common trend, however, is that the un-prescribed use of psychotropic drugs such as diazepam, bromezepam and alprazolam has shot up among displaced people. Part of the reason for this rise is that mental illnesses are rife among women and children of conflict-ridden areas — medicines seem to be easy cures, but in truth, they are merely band aids.

“What is most unfortunate is that social taboos among tribal people have hampered the treatment of women the most,” claims Dr Hussain. “Mostly, men talk on behalf of women, since cultural customs don’t allow tribal women to be seen by male doctors without being accompanied by their fathers, husbands or brothers. In the presence of their male family members, women can’t express their feelings freely.”

Dr Hussain argues that women’s mental health conditions are exacerbated when they don’t venture beyond their homes for extended periods. Men, meanwhile, are able to seek and utilise entertainment opportunities easier. Displaced women, in particular, face mental illnesses because they have been moved away from their “native environment”. At the hospital, for every man coming in for treatment, there are two women seeking mental health care.

Children brought to IPH chiefly have behavioural problems such as irritability, stubbornness, manipulative and demanding behaviours, fighting, refusing to go to school, and lack of constructive and goal-directed behaviour. “War has taken stability away from children”s lives. Many also get adversely affected by overcrowding in accommodation facilities or having to brave new and unwanted situations,” explains Dr Hussain.

“Men typically arrive with marked irritability and aggressive behavioural. They also express their feelings relatively better. Apart from their psychiatric problems, they talk about the hardships of life, difficulties in survival, financial constraints, difficulties in jobs and business, and also the burden of responsibility of their families,” says Dr Hussain.

The experience of running a psychiatric facility has taught Dr Hussain many new lessons, but one sticks out: mental illness in KP has increased fourfold. There’s little or no government help for the people of conflict-ridden; most try to cope with their problems on their own. They seek different types of jobs and make efforts to do small business with the support of their close and distant relatives.

“Displaced people blame both the Taliban and the army for their woes. They are confused about both. They blame the government only in passing as they feel that it doesn't exist in any real sense; the actual forces are the army and the Taliban,” Dr Hussain says.

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