Pakistan psychologists issue conflict health warning

Rifaat Ramzan lay in a hospital bed with a blank stare, still traumatized weeks after losing his best friend, Noman, to a suicide bomber.
"He had just told me how it is good to dream and we will achieve our dreams," said Ramzan, who began sleeping with a gun under his pillow, fearful he too will be killed in Pakistan's relentless violence.
"This man came and asked Noman if he could get a lift on his motorcycle to the police station. When they got there the man blew himself up. Noman and nine other people were killed."
In the conflict between Taliban insurgents and Pakistan's army, thousands have been killed in bombings of everything from military and police facilities to crowded street markets; even a volleyball match was attacked. Countless others have been wounded.
But the psychological toll often goes unnoticed, even though underfunded and understaffed hospitals are treating a sharply rising number of people who can't cope with bloodshed.
"This is alarming us," said psychologist Najam Younes.
Some people are too depressed to function. Others are gripped by anxiety attacks, paranoia and post traumatic stress disorder. Flashbacks are common.
It doesn't take much to destabilize minds.
Even headlines of smaller attacks that flash across news channels are enough to send people to psychiatrists seeking pills to calm them or help them sleep at night.
Luckily for Pakistanis, the stigma attached to mental illness has eased, making it easier for them to seek psychiatric care, psychologists say.
But the problem is that people caught up in the violence -- mostly living in the epicenter of the conflict in the northwest -- have no access to psychological care facilities. So they must take long, expensive journeys to cities like Peshawar for treatment.
Those who can afford it often don't get the attention they need because there are too few doctors, who are often overworked and cannot provide therapy, only medicine.

Peshawar's Sarhad Psychiatric Hospital, located on the same complex of a prison where militants awaiting trial and other hard core criminals are held, is one example. It is the only proper mental health facility in the northwest.
In the hospital courtyard, patients dulled by medicine sit on a cement floor in rows, quietly staring at each other. Some look lost. Others are suspicious. "Long live Pakistan", is scribbled on a wall behind them beside a drawing of a flower.
In a grim, tiny kitchen nearby, a cook slops stew into a huge pot beside steel bowls
Senior consultant Muhammad Tariq sometimes treats 100 patients a day. He is also the region's main forensic psychologist, so he must spend time in court. Scant funding at the state hospital means he has no computer to manage files.
"There is only so much I can do," he said.
Tariq says 10-15 new patients suffering mentally from the violence arrive every day. Many have lost their homes and livelihood.
Still, those are not the worst cases.
Handling people rattled by bloodshed who already have mental illnesses is far more challenging. They are the most vulnerable.
Muhammad Ikhtiar was lucky enough to have an Islamic charity pay for his schizophrenic son's medicines. Fighting distressed his son Muhammad's fragile mind.
"Sometimes he is scared of the Taliban and the army. Other times he is convinced he is the commander of the Taliban and the army," said Ikhtiar, a serious, elderly man with a white beard.
Ikhtiar's problems don't end there. Taliban militants would often hide in his maize fields, so government forces made him cut down the crop, he said. Now he has to find ways of making a living while caring for his son.
Doctors say the patients need family support. But because of the fighting, it's too dangerous for them to head home. Muhammad Iqbal, a sturdy man wearing a traditional flat wool chitrali hat, suffers from bipolar disorder. His moods often swing from depression to elation.
Doctors hope stabilizers will make him realize it's too risky to return to his four children in North Waziristan, which is infested with al Qaeda and Taliban militants.
"Right now he has no idea what is happening," said the hospital's Tariq. "He thinks he will return to a peaceful village with a nice forest."

U.S. problem in one word: Pakistan

Here we go again with Pakistan. This isn't deja vu. No, it's now a routine pattern in modern life: An Islamic fundamentalist trains in Pakistan and then flies to America or another Western state to wreak havoc.Look back decades. Ramzi Yousef, the 1993 World Trade Center bomber, was born of Pakistan parents in Kuwait and trained for the attack in Pakistan.Ramzi Bin al-Shibh, the Yemeni suspected of coordinating the Sept. 11 attack, was arrested the next year in Pakistan. Several men involved in the London train bombings five years ago trained in Pakistan. So did Richard Reed, the shoe bomber.Last year, FBI agents in New York charged Najibullah Zazi and his father with planning a terror attack in the United States after receiving extensive training in bomb making and terrorist strategies in a Pakistani camp.The litany of attempted and actual terror attacks offers at least half-a-dozen similar examples from Pakistan in recent years, and now comes the latest: Faisal Shahzad, the failed Times Square bomber, who trained in terror in his native country - Pakistan.How did this come to be? Syria, Libya, Algeria, Egypt ... many similar states are home to millions of people who hate the United States. None of them - in fact no other country, anywhere - so regularly sends miscreants to America. What makes Pakistan "special"?The common historical explanation lays blame in part on the United States for encouraging Pakistanis to fight the Soviet troops in Afghanistan during the 1980s. That probably played a role; it gave Pakistanis a taste of jihad. But I believe the Pakistani government holds the most responsibility.Why? Pakistan is one of those countries - and there are more of them than you might think - whose government does absolutely nothing for its people, except require the payment of taxes and bribes. It offers virtually no social services, and the society is so stratified that it falls into a de facto class structure, much like neighboring India, from which Pakistan was born more 60 years ago. Two-thirds of the nation's people live in the provinces, and they are the "underclass" - ignored by Islamabad, except when they are abused. Medical care is virtually non-existent. And schools, a Pakistani children's advocacy society declared last month, "suffer from the worst forms of negligence, indifference and apathy." The government spends 1 percent of its budget on health-care services, 2 percent on education.Much of the world is governed by leaders who do not see offering public works as part of their responsibility. The expectation that government will offer social services is a relatively recent phenomenon, and then only in developed countries. How much did the federal government do for Americans 100 years ago?The result in Pakistan is that the vast majority of people are poor and uneducated. Only about one-third of boys make it past elementary school and just over one-quarter of the girls. The average per-capita income is just over $900 a year, a figure that would be far lower if the state's multi-millionaire oligarches did not inflate the average.UNICEF says 42 percent of the state's children are so malnourished that they suffer from stunting, meaning they are not growing, physically or mentally. Forty-two percent! The damage is permanent. So when children grow up, generally they are poorly educated, and almost half of them have "stunted" intellects. All of them are still aware enough to breath in the anti-American ethos that animates Pakistani society. And right now, 44 percent of Pakistan's population is under 18. In this group is the next generation of angry, violent extremists.We've all seen movies or read books depicting smooth-talking mullahs in Islamic countries recruiting young men for terror groups. Pakistan is the model for this. There, children who agree to be recruited win new respect from their friends. In many cases what choice do they have? Job prospects range from weak to non-existent."If you have lost faith in the state," said Adil Najam of Boston University, who writes the blog All Things Pakistan, "anyone who comes along and offers you a glorious future, that is very attractive."I've said it before, and I'll say it again. America's problem is not Afghanistan. The problem is Pakistan. As Daniel Markey, a former senior State Department official, told Congress: "The United States should shift its strategic focus not just from Iraq to Afghanistan, not just to link Afghanistan and Pakistan, but to go one step further and place Pakistan at the center of our strategic concerns."
ABOUT THE WRITER

Joel Brinkley is a former Pulitzer Prize-winning foreign correspondent for The New York Times and now a professor of journalism at Stanford University. Readers may send him e-mail at: brinkley@foreign-matters.com