PESHAWAR, July 26: Liaqat Ali is a victim of one of the country’s worst bombings, but his injuries are not visible to the naked eye.
The 47-year-old government clerk and part-time lab assistant was walking home through the grounds of a hospital in Peshawar in 2009 when he stumbled upon the carnage left by the blast. Scores of bodies were packed into vehicles.
Bleeding survivors with missing limbs and severe burns were scattered everywhere. Ali has suffered from severe depression and anxiety ever since and is dependent on antidepressants to make it through the day so he can provide for his wife and four children. His plight has become increasingly common in Pakistan’s northwest – the main Taliban sanctuary in the country – where psychiatrists estimate millions are suffering from Post-Traumatic Stress Disorder (PTSD) and other psychological illnesses after years of militant attacks, army offensives and US drone strikes.
Many don’t receive treatment, largely because of an acute shortage of psychiatrists and psychologists. “I think what we see is only the tip of the iceberg,” said Firaz Khan, a psychiatrist at the mental health ward at the government-run Lady Reading Hospital in Peshawar, where most of the 40 to 50 patients who come in each day are suffering from violence-related trauma.
“Most victims remain at home and are not getting help.”
Peshawar has been a major target for the Taliban since they started their insurgency in earnest in 2007. At times, the city was bombed almost daily. Violence has fallen significantly in the last 18 months. Fear and anxiety remain.
Ali’s nightmare began on Oct 28, 2009, when militants detonated a car bomb in a market crowded with women and children. More than 100 people were killed. The dead and wounded he encountered at Lady Reading Hospital on his way home from work are etched in his mind.
“Some of them had lost arms, others legs. Some of them had burned faces,” said Ali, becoming visibly disturbed during an interview at a private psychiatric clinic in Peshawar where he was being treated.
“So many dead bodies were stuffed in a vehicle, as if they were not humans but slaughtered animals.”
Within days, Ali was having trouble sleeping, experiencing flashbacks and intense fear. “It would come to my mind that everybody will die. The world was going to end,” Ali said.
The northwest is filled with similar cases, according to psychiatrists.
A 9-year-old boy suffered PTSD after witnessing a deadly bomb blast in Peshawar. He became irritable, aggressive and said he wanted to kill someone. He couldn’t sleep, had flashbacks and stopped going to school.
A 30-year-old woman in North Waziristan suffered severe depression and fainting spells after her cousin was killed by a mortar shell on his way to Afghanistan.
An 18-year-old boy in the Bajaur tribal area suffered PTSD after witnessing a Taliban fighter behead an alleged spy. He felt severe anxiety every time he recalled the incident.
The psychiatrists asked that the names of the patients be withheld to protect their privacy.
These kinds of experiences have tripled the number of patients seeking help from psychiatrist Mian Iftikhar Hussain since he opened his clinic in Peshawar in 2004 after a career in public medicine. He now sees over 60 patients a day and cannot handle anymore.
While there are no official figures, Hussain and another psychiatrist with a clinic in Peshawar, Wajid Ali Akhunzada, estimate that up to 60 per cent of the more than 20 million people who live in the country’s northwest could be suffering from violence-related psychological issues. They base this figure on the number of patients who visit psychiatrists in the area daily.
Only five to 10 per cent of patients treated by Dr Hussain and Dr Akhunzada have PTSD, but almost all of them suffer from some combination of depression, anxiety and lack of sleep caused by the violence around them. They are generally treated with a mix of drugs and psychotherapy.
Use of antidepressants and anti-anxiety medication in Peshawar has more than doubled in the past few years, said Riaz Hussain, president of a wholesale drug association.
“Previously these medications were mainly used by Afghan refugees,” who have declined in number, he said.
There are no psychiatrists or psychologists based in the remote tribal region, where fighting between the Taliban and the army has been fierce and US drones rain missiles down from the sky, said Hussain. Many dealing with mental trauma don’t understand why they are feeling miserable and assume they must be physically ill. They often turn to spiritual healers, knowing that seeing a psychiatrist or psychologist can mean social stigma.
The trip from North Waziristan to Peshawar on a minibus takes eight to 12 hours and costs about $6.50, a significant sum in a country where the UN estimates about a quarter of the population lives on less than $1.25 per day.
Visiting a doctor at a public-run hospital is free, but antidepressant or anti-anxiety medications cost at least $5 per month, and can be much more if multiple drugs are prescribed. Each session at a private clinic, where treatment is better, costs roughly $8.50, and can be more if the patient needs to be admitted.
Dr Hussain said it was critical to find a way to help the large numbers of people suffering in Pakistan. “If we don’t understand them, analyse them and address them,” he said, “they will worsen day by day.”—AP