People displaced by militancy and the military operation wait to get registered in Jalozai refugee camp near Peshawar. Credit: Ashfaq Yusufzai/IPS.

PESHAWAR, Pakistan, May 2 2014 (IPS) – Every night in his sleep, Rizwan Ahmed sees his sons being killed. “When he wakes up, he starts crying. He realises they are dead and it was the nightmare he has been having,” says Dr. Mian Iftikhar Hussain, the psychiatrist treating him.

Ahmed, 51, used to be a school employee in Bara Khyber Agency in Pakistan’s militancy-hit Federally Administered Tribal Areas (FATA) before tragedy struck almost a year ago. “He lost his two sons in the violence back home. His grief mounted every passing day.The loss of close relatives, displacement, and the conditions in which they now live has led to widespread mental disorders.

“He was brought to our hospital in December last year in the last stage of a mental disorder. Now his chances of improvement are thin. Had he come earlier, he could have been treated,” Hussain, executive director of the Health Promotion Welfare Society (HPWS), told IPS.

HPWS runs the 40-bed Iftikhar Psychiatric Hospital (IPH) located on the outskirts of Peshawar, to help mentally ill patients from FATA.

More than two million people have been displaced from FATA, adjoining the northern Khyber Pakhtunkhwa province of Pakistan, due to militancy and military operations. The loss of close relatives, displacement, and the conditions in which they now live has led to widespread mental disorders.

But the majority of these patients go unnoticed due to a shortage of psychiatrists and counsellors, and lack of awareness about mental and psychological ailments.

“Patients often dream of the charred bodies of their near and dear ones, killed by bullets and rockets. Such people require continuous treatment,” Hussain says.

“After completion of treatment, we also provide vocational skills to patients,” he told IPS.

Women and children are the worst victims.

The wife of Ziarat Gul, a farmer from Bajaur Agency, is another patient at IPH. “Her son was killed while playing outside their home. When she saw his blood-spattered body, she was overcome by trauma,” says Gul, 51.

Now she is showing signs of improvement thanks to medication, says Gul, who is himself unhappy as he can no longer tend to his sprawling agricultural fields due to the violence.

Endless conflict and the subsequent military action against militants has taken a heavy toll on families from FATA. “Our children have grown up amid violence. They talk about the army, the Taliban, shelling, drone attacks and curfews,” says Gul.

After U.S.-led forces toppled the Taliban government in Afghanistan towards the end of 2001, many militiamen crossed over to Pakistan and took refuge in FATA. Made up of seven districts, FATA is teeming with Taliban and Al-Qaeda militants at war with Pakistani forces.

Ordinary people are caught in the crossfire. Displaced from FATA, they are scattered all across Khyber Pakhtunkhwa.

According to the World Health Organisation, 10 percent of Pakistanis suffer from psychological problems. Pakistan has 300 psychiatrists, one for every 80,000 adults.

Violence-prone areas don’t have psychiatrists and few affected people are able to travel to Peshawar, capital of Khyber Pakhtunkhwa province.
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Ajmal Shah is a 10-year-old resident of Khyber Agency from where, according to the National Disaster Management Authority, 73,562 families have been displaced in the past two years. The boy recounts the sight of his elder brother being killed by a toy bomb three years ago.

“He picked up a plastic toy horse from the sand and was looking at it when it blew up. I saw his flesh floating in the air. I cannot forget it,” says Shah.

According to the Khyber Pakhtunkhwa health department, 82,345 patients were treated at government hospitals in 2013, and nearly 60,000 of them came from FATA to seek treatment for psychological ailments.

“The female-male ratio among affected people is 2:1. Women are more prone to post traumatic stress disorder than men as women stay inside their homes due to social taboos while men can go out for entertainment,” Dr Murtaza Ali from Mohmand Agency in FATA told IPS.

The majority of displaced people have psychological problems, he says. Extreme poverty has hit them hard.

Dr Syed Muhammad Sultan, head of the psychiatry ward at Khyber Teaching Hospital, says the patients require counselling and psychotherapy. Rehabilitation and occupational therapy after treatment are also important to prevent a relapse, he says.

“The use of psychotropic drugs has shot up in FATA. More people are falling victim to mental disorders due to which they use tranquillisers, sedatives and anti-depressants,” he says.

Many in the conflict zone complain of sleeplessness. “Most fear a grim future. They are gripped by anxiety which affects their health.” The situation can only become worse as no end to the conflict is in sight, he says.