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Coping with a traumatised nation

By Martin Patience
BBC News, Kabul

Patient at Kabul mental hospital. Photos by Mahfouz Zubaide
Patients have just one dedicated mental health facility in the nation (Photos: Mahfouz Zubaide)

At a small, white-washed building on the outskirts of Kabul, a handful of doctors try to cope with one of Afghanistan's biggest problems.

Rugs hang from doorframes to keep out the bitter winter cold, and patients, along with their visiting families, crowd into the bare hospital wards.

According to studies cited by the Afghan health ministry an astonishing 66% of Afghans suffer mental health problems.

And yet this hospital is the only facility in the country dedicated to mental disorders - and there are just 40 beds.

The resident psychiatrist, Musadiq Nadimee, has a weary look as he paces up and down the building's corridors.

"This hospital is just for the complicated cases that are referred to us from across the country," he says with a resigned shrug.

One father has admitted his teenage daughter, Hamida, who suffers from schizophrenia. "She's got a lot better," he says, a smile breaking across his face.

'Vicious cycle'

But most experts agree that the mental health problems here go far deeper than the illnesses that are commonly found in almost all countries.

Dr Abdullah Fahim
There's little trust between people. Sometimes cruel acts committed are seen as part of normal life for Afghans. If this continues then our future will be dark
Dr Abdullah Fahim

Afghanistan is a traumatised nation. In 30 years, hundreds of thousands of Afghans have died and most of its people have witnessed horrendous violence at some point in their lives.

Many of the mental disorders are connected to these experiences, say health officials.

Local journalist Hanif Sherzad says that Afghans continue to be traumatised by their past and the continuing violence.

"Many people don't feel safe, they simply don't feel secure," he says.

"Even those people that have good physical health and are living in secure places are constantly hearing bad news. It affects them and the vicious cycle continues."

The Afghan health ministry readily admits that there simply are not enough facilities or doctors to even begin dealing with the most serious cases.

Other health issues - such as infant and maternal mortality - have taken priority.

But a senior adviser to the health minister, Dr Abdullah Fahim, worries that if the issue of mental health is not addressed immediately, it will continue to have a slow, corrosive effect on Afghan society.

"There's little trust between people," he says. "Sometimes cruel acts committed are seen as part of normal life for Afghans. If this continues then our future will be dark."

Mental health hospital in Kabul
The hospital close to Kabul has only 40 beds

Because of a lack of understanding, many Afghans suffering mental health problems are believed to be possessed.

Some are chained in rooms or even caves until it is believed that the "jinns" - evil spirits - have been exorcised.

But others are simply abandoned by their families because they can no longer cope or afford the medication that is required to treat their medical conditions.

A small number of mentally ill people are cared for by local charities.

At one such centre run by the Red Crescent Society, a group of women crowds round the director, Mohammed Zahaid.

Mr Zahaid says that one of the women refused to eat and drink for days. She was constantly crying and kept asking about former Afghan President Najibullah.

When the staff got the woman a picture of the ex-president she immediately perked up - and began eating and drinking again.

But she is one of the fortunate few.

In a country wracked by problems, mental health is an issue that is largely forgotten.

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