Since the start of the separatist insurgency in Kashmir in 1989, the number of people seeking treatment for mental health disorders has skyrocketed. Both India and Pakistan claim to own the disputed region where the conflict has resulted in the death of more than 60,000 people and caused an inestimable amount of suffering for many more. But more efforts are now being made to help people deal with the stress and anxiety brought on by the fighting.
The Rainawari Psychiatric Hospital in Kashmir's summer capital, Srinagar, is a abuzz with activity. It is one of few facilities in the disputed region offering treatment for mental health disorders, many of which are brought on by Kashmir's separatist conflict.
Dr. Zaid Wani is a resident psychiatrist at the hospital and is doing research into how extensive mental health problems have become in Kashmir since fighting began in 1989. "In the 1990s, before the start of the conflict, around 1,700 patients visited this hospital. Last year in 2002, [there] were around 48,000 patients. So you have seen an exponential increase in patients of psychiatric disease," he says. "Most of these patients who come to us are [suffering] particularly of depression, anxiety disorders and Post Traumatic Stress Disorder."
Dr. Wani says Post Traumatic Stress Disorder, or PTSD, is one of the more serious mental health conditions a patient can face. He says a person who has a near-death experience, or who witnesses someone else being threatened or killed, may suffer flashbacks prompted by any number of cues - the sound of a gunshot, a shout, or even a knock on the door. "Whenever there is a cue related to that incident… they get palpitations, they get sweating and all those features," he says. "Again and again, just like a film they see it in front of their eyes and they have nightmares."
In Kashmir, there is reason for people to have nightmares.
Fighting between Muslim separatists and Indian security forces has led to the deaths of more than 60,000 people - many of them civilians. The two sides want control over the roughly three-quarters of Kashmir that falls inside India's boundaries.
Last month, 25-year-old Heena Rashid was at a computer school where she works when two militants tried to attack a government office across the street. They killed two Indian soldiers before fleeing into the shopping complex where Ms. Rashid's school is located - and made a stand against security forces. "I was just confused, all the time I was confused, all the time [I had] my hand on my heart, like this," she says.
Police helped Ms. Rashid and others escape six hours into the standoff and they killed the militants 24 hours after the siege began. But after the trauma of that event, Ms. Rashid says she still feels that more bad things might happen to her. "Anytime will be anything, especially in Kashmir, and I should be prepared for that. I'm preparing myself. I'm preparing myself in my heart and my mind…. I'll not forget that thing," she says. "Never."
The international non-governmental organization, Doctors Without Borders, has opened a counseling center at the Rainawari Hospital to help people cope with the feelings of chronic insecurity and depression caused by the on-going conflict.
Psychologist Saskia Ohlin says one of the first hurdles counselors must overcome with their patients is the belief that PTSD and other disorders are best treated with drugs. "They're used to getting drugs and a good doctor here might be considered someone who prescribes drugs. So if you leave the doctor without medication, people would find that very strange," she says. "But if you take the time to explain [to] people what they're suffering from and you work with them together to strengthen their coping mechanisms, they're actually very open to it."
Doctors are also doing what they can to raise awareness throughout the region about PTSD and other problems, so that Kashmiris do not go on suffering in silence. With no end to the fighting in sight, the trauma and anxiety brought on by war may still strike thousands more.