http://www.dailytimes.com.pk/default.asp?page=2009\12\05\story_5-12-2009_pg3_3
Saturday, December 05, 2009 view: The unseen trauma of war -Rafia Zakaria Undoubtedly the immediate needs of survival of the refugees such as emergency healthcare, food and potable water, sanitation and housing must be fulfilled According to the World Health Organization, 90 percent of the internally displaced people made homeless by the fighting in Northern Pakistan are living in host communities where few life-saving healthcare facilities are available. As has been widely reported, there is a critical gap between the needs of these war-torn communities and the service available to them. Particularly needed are the services of female healthcare workers who can provide for the vast number of displaced women in the area. The delivery of healthcare services in conflict areas has been a long-standing problem. Added to the structural problems of absent infrastructure and lack of facilities that are already present in many rural conflict areas are new and pressing problems of lack of security and the curbing of humanitarian assistance by various political interests. The most pressing and widely discussed issue facing healthcare provision in crisis areas is the prevention of the spread of communicable diseases. This was witnessed in the Pakistani context when in August of this year an acute outbreak of diarrhoea hit the Swat and Buner districts. According to Doctors without Borders, the outbreak caused the number of diarrhoea patient seen by temporary health centres to jump from 37 admissions in the first week to over 127 admissions the following week. Provision of healthcare was made more problematic in these areas by the fact that many people were abandoned at health centres by their families while the family moved on to a different camp. In addition to the spread of communicable diseases caused by families living in close proximity and with poor hygiene facilities, the existence of harsh climatic factors makes the situation even more dire. In the case of the diarrhoea epidemic for example, the situation was soon made far worse by the arrival of torrential rains that added to the near impossibility of providing adequate services to the affected people. However, one less discussed and even less addressed issue facing war-torn populations is the immense psychological trauma of displacement and conflict. Few studies have been commissioned on this issue and even less data is present for the Pakistani context. A global study looking at the psychological effects of war found that young children from birth to five years often show behaviours like incessant crying, clinging to their mothers, perpetual frightened expressions, nail-biting, bedwetting and refusal to interact socially. Slightly older children may become anxious, depressed, refuse to socialise with peers or go to school. Adolescents are often affected for a very long time, especially if they have lost family connections and community contacts; they may have thoughts of suicide and may even commit suicide (seen in the increasing numbers of suicides in Pakistan). Finally, traumatised adults exhibit signs of hyper-vigilance (they may startle easily), show a fight or flight response, suffer from nightmares and emotional detachment from themselves. They may also have distorted emotions and perceptions, and experience severe depression and thoughts of suicide. As can be seen from the findings of the study, the catalogue of psychological traumas that are experienced by war-afflicted persons is vast. In the Pakistani case, the tragedy is exacerbated by the fact that all current efforts are focused only toward providing non-psychological triage services. When displaced people return to empty homes, face the reality of family members who have died or are missing due to the fighting, see the damage to the villages and the loss to property and shops, it is very likely that their psychological trauma will be intensified. Furthermore, the difficulty that Pakistani security forces face in distinguishing fleeing tribesmen from the Taliban further exacerbates their already traumatised state. Undoubtedly, the immediate needs of survival of the refugees such as emergency healthcare, food and potable water, sanitation and housing must be fulfilled. Without the above, it would be impossible for those fleeing the situation to salvage their families, lives, and rebuild their communities. The insidious nature of psychological trauma is that unlike gaping wounds and starving bodies; they are not immediately visible to the rest of the world. This, however, does not negate their existence or the terrible cost they impose on those suffering from them. While immediate food and health services may allow the bodies of these destitute refugees to survive, they cannot assuage the tremendous emotional and psychological scars that they have borne owing to the conflict. Initial services may not have to take the form of full-fledged psychological health services but even the basic provision of accessible materials or training of health workers on the psychological consequences of trauma would constitute an advance. In the case of children, training health workers in play therapy or even providing simple resources like colour pencils and paper to allow them to express their feelings in a positive way may go a long way in addressing their needs before they suffer from mental health problems. In tending to the sick in war-torn regions, it is inevitable that the visible scars must be addressed before the psychological ones. However, as responsible global citizens who are educated and aware of the tremendous impact of psychological trauma on individuals, families, and most tragically children, it is imperative that we expand our focus to insist that these too get attention from those providing humanitarian assistance. While visible injuries pose risks to the individual, psychological injuries impose costs not simply on individual health but also on all those who have to helplessly witness the inexplicably changed behaviour of their loved ones. As people continually subjected to the trauma of incessant violence and seemingly unstoppable carnage, it is inevitable that many sections of our society are suffering from immediate or secondary psychological trauma. While Pakistan may not have the resources to address all of these issues, greater awareness among our population will at least allow people to recognise the symptoms and see them as treatable. Rafia Zakaria is an attorney living in the United States where she teaches courses on Constitutional Law and Political Philosophy. She can be contacted at [email protected] [Non-text portions of this message have been removed]
