Scars Visible & Invisible: Afghanistan’s Mental Illness Epidemic
A former warlord and a Talib chained together at a mental health unit in Herat, WEstern Afghanistan. 
A former warlord and a Talib chained together at a mental health unit in Herat, WEstern Afghanistan. (Photo courtesy: Sahar Zand)

Scars Visible & Invisible: Afghanistan’s Mental Illness Epidemic

Twenty years after seeing a haunting photo in her father’s newspaper, Sahar Zand travelled to Afghanistan for BBC Our World to investigate the lasting effects of conflict in the country. Here she recounts her experience.

When I was 8 years old, playing with a new Barbie doll, I happened to look up and see a harrowing photograph on a page of the tabloid my father was reading. “Dad, what are those kids doing?” My father quickly folded the newspaper away. “They’re playing games darling, just like you.” I looked down at my beautiful doll; it looked nothing like what those kids were playing with. Hesitantly, I asked, “are they playing with hands?”

My father went on to explain to me that these children were in fact playing with amputated limbs, and it is a conversation which has stayed with me my whole life. Indeed, I was so affected by it that 20 years on, I travelled to Afghanistan for BBC Our World – BBC World News’ international current affairs programme, to see for myself where that photograph was taken, and how the people there now live, in the aftermath of civil war and Taliban rule.

The author at Herat Mountains. 
The author at Herat Mountains. 
(Photo courtesy: Sahar Zand)

Herat, Western Afghanistan: I’ve come here to visit the country’s only secure mental health unit. In a small walled-in courtyard, I find myself standing no more than a few metres away from two former enemies, now chained together. The first is Muhammad Davoud, a former warlord, and the second, Muhammad Issa, a former Taliban fighter. Both men are dangerous, and both are suffering from severe psychiatric conditions. All 300 inmates spend their days in this courtyard. “This place is for people who are a threat to society, for those who are mentally unstable”, I’m told by Dr Saljooghi, the unit’s only psychiatrist.

Without warning, the former Taliban fighter lifts up his top and shows me a scar as big as his hand on his stomach. “Look, I was shot here, by the Americans.” Rubbing his balding head he proudly tells me that he killed four of them. Frowning, the former warlord says that he has always hated the Taliban: “They are savages; they beat people up and force them to pray.”

These two men appear complete opposites, but the chain around their ankles isn’t the only thing that connects them; both have been affected by a war which has led to serious and long-term psychological illness on all sides of the conflict.

Behind these chained enemies is a large one-storey room where the patients sleep.

Ali is the unit’s most dangerous patient. 
Ali is the unit’s most dangerous patient. 
(Photo courtesy: Sahar Zand)
Looking up, I see a young man – Ali. He has a lazy eye and a big smile which shows off his missing front tooth. I ask him why he’s up there on the rooftop. “So that I can’t hurt anyone”, he explains calmly. Pointing at his lazy eye, he tells me it has seen a lot of trauma. His smile then disappears as he adds, “and when violence enters my mind, I see nothing else.”

Dr Saljooghi tells me that Ali, or ‘Bruce Lee’ as he’s known, is the unit’s most dangerous patient. He is kept isolated after an incident when he once bit off a fellow patient’s ear. Throughout Ali’s life, and that of many other Afghans, war and violence have been a constant presence, with more than two million civilians killed since the Soviet Union invaded the country in 1979. Ali escaped Afghanistan, as a child with his family, by moving to neighbouring Iran, but was deported back after his psychological condition worsened and he attacked some people on the street. His family were not informed, and don’t know he’s back in Afghanistan.

Children of patients at the unit. 
Children of patients at the unit. 
(Photo courtesy: Sahar Zand)

Many of Dr Saljooghi’s patients have lost contact with their families. After nearly four decades of war, many families have been scattered. This means that despite being ready to be discharged, some patients are obliged to remain at the unit.

Suddenly, I remember the scenes I had been confronted with when I first arrived at the institution – some patients begged me to help them get out, and one woman had cried until she was taken away. The realisation that some patients are fit to leave but just have nowhere to go, sends shivers down my spine.

The patients here receive basic treatment from a small team of over-stretched staff. Decades of war have left a terrible legacy of mental health problems in Afghanistan.

Some estimates say three quarters of Afghan women, and more than half of men, suffer from mental health problems.

As the war continues, the demand for mental health services grows, but in a country where mental illness is often viewed with suspicion, the challenges of dealing with it are immense. However, there are an increasing number of people who are recognising this mental health epidemic.

During my visit to Herat, I met a man called Farhad at the city’s football stadium. He has suffered from PTSD since witnessing a suicide attack four months ago, in which he lost his teenage brother. Unlike the majority of Afghans, he is seeking professional help at the city’s main hospital’s psychiatric unit, as well as volunteering to counsel others.

Farhad is seeking medical help for PTSD. 
Farhad is seeking medical help for PTSD. 
(Photo courtesy: Sahar Zand)

Sitting in the Herat football stadium with him is a strange experience - not because I have to wear a hijab, or because I’m the only woman sitting amongst hundreds of rowdy Afghan men, but because watching Herat’s top football players on the pitch, it’s easy to forget the stadium’s dark past. It used to be an execution ground for the Taliban – where the photograph I had seen 20 years earlier in my father’s newspaper was taken.

The Herat football stadium was formerly a Taliban execution site. 
The Herat football stadium was formerly a Taliban execution site. 
(Photo courtesy: Sahar Zand)

Farhad came here regularly as a child to watch those executions. “Back then we used to get so excited; this was like a hobby for us”. He shouts encouragement to the players on the pitch, and then continues: “Witnessing violence and execution used to be a normal part of day-to-day life and it didn’t faze us”.

I told him about the photograph I had seen 20 years earlier – he said, jokingly, that perhaps the child I had seen playing with the severed hands was him.

“I do remember this one time, right there” he says as he points at the centre of the pitch, “a Talib chopped off what they consider to be a criminal’s hand and threw it up in the air.” What he never forgot, he tells me, was that the hand was still moving, even after it landed.

What my dad told me that day, twenty years ago, was that war and suppression don’t just leave behind ruined buildings and corpses. They leave ugly images in people’s minds that can be just as destructive, if not more so, as they get passed down the generations.

The author with her father. 
The author with her father. 
(Photo courtesy: Sahar Zand)

That day, my father showed me the photograph in the paper again, and said that I should not be scared of what I saw, but rather I should fear being ignorant of what’s going on in this world. He said, just because I had a pretty Barbie doll with a pink dress, and a warm and comfortable house, it didn’t mean that everyone else did. After travelling to Afghanistan for BBC Our World, I finally understand what he meant.

Just because some scars aren’t visible, it doesn’t mean they aren’t there.

(Our World: The Trauma of War will air on BBC World News on Saturday 10th February at 5pm and 10pm with repeat on Sunday 11th February at 11pm.)

(This is a personal blog and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)

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