IT has long been established that armed conflicts and the subsequent mass dislocation of population results in significant psychological and social suffering.
While the impact of such a situation may be acute in the short term, it also undercuts the long-term mental health and psychosocial well-being of the affected populations. This, in turn, has serious implications for social development, governance and human rights.
According to preliminary surveys on the ground, the displacement of some 800,000 people from North Waziristan Agency, where a military operation is under way, has triggered a wide range of psychosocial problems at the individual, family and community levels, by destabilising what are normal support systems. Many families have been torn apart and their community structures and resources severed.
Even prior to the recent displacement, these families experienced years of conflict trauma, exacerbated by terrorism and drone strikes. Their distress, while not pathological, is still overwhelming. There is also the increased risk of worsening pre-existing social deprivation including poverty and socio-political oppression.
Urgent psychosocial care is needed for the displaced.
The most vulnerable groups include women and children. Most of these women had never stepped outside their courtyards, as there is a strong culture of chadar and char dewari. Others at risk include the elderly, those with physical and mental disabilities, people exposed to severe traumatic events and those at risk of human rights violation (minorities and political activists).
Perhaps the most pervasive threat facing the IDPs is the prevalence of severe mental disorders that are known to spike by 3pc to 4pc in affected populations. This means that an estimated 30,000 IDPs will be in desperate need of treatment for severe mental disorders this year.
Another 15 to 20pc are likely to suffer from mild to moderate disorders. Nearly an equal number of people needing psychiatric care already exist in Bannu district that is hosting the displaced. Put together, this amounts to a staggering health challenge for the state.
Presently, there is only one psychiatrist for just under a million residents in Bannu. Since the crisis began, the understaffed and resource-constrained teaching hospital here is best able to offer only a few minutes’ consultation in daily clinics swamped with hundreds of patients.
The current humanitarian crisis in Fata is enormous in scope, in an environment with poorly developed infrastructure and struggling systems where basic mental healthcare is non-existent. What, then, is the necessary intervention?
Contrary to the misplaced enthusiasm for immediate ‘counselling services’, it is well established in medical literature that there is little advantage in providing vertical ‘trauma-focused’ services without a long-term plan for strengthening mental health services.
The composite term ‘mental health and psychosocial support’ (MHPSS) serves to address the need for diverse, complementary approaches in providing appropriate support in such situations. MHPSS refers to any type of local or outside support that aims to protect or promote psychosocial well-being and prevent or treat mental disorder.
Mental health services are often the forgotten stepchild of relief and rehabilitation drives in humanitarian crises. Primarily, it is the responsibility of the provincial health department to take immediate and appropriate measures towards providing psychosocial care to the IDPs.
The effort needs collaboration with aid agencies (including national and international NGOs) so that psychosocial support services for the IDPs both in refugee camps and those seeking temporary shelter within the community can be started without delay.
For this purpose, the major interventions include awareness campaigns and training community workers in psychological first aid. This involves emotional support, covering basic needs, protecting from further harm and reinforcing social support networks.
In the long term, the solution clearly lies in strengthening primary healthcare by integrating mental health services in the affected areas — in other words, training all doctors working in primary care to recognise mental disorders and treat the common ones.
The World Health Organisation has developed guidelines and training packages for these purposes, which need to be implemented. There should be effective referral systems to tertiary or specialist care for serious mental disorders.
Cost-effective medication for treating common mental disorders must be available. Specialist service at the tertiary care hospital in Bannu’s must be urgently strengthened, both in terms of posting specialists and supporting an academic department that can actively contribute towards undergraduate and primary healthcare staff training and supervision.
This is the bare minimum that is needed to organise mental healthcare for the IDPs.
The writer is a psychiatrist.
Published in Dawn, July 13th, 2014