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An Account of Trauma and Health-related Work in Kashmir
I first visited Kashmir valley in the summer of 1980 with my daughter who was then six years old. I can still recall the sense of wonder and joy with which she explored and absorbed the serene beauty and peace that surrounded us there. During that visit, we met many people who befriended us and introduced us warmly to the tastes and textures of life in the valley. It was a completely new world for my daughter whereas I was aware, though only dimly, of the history of the place and the people who lived there. Yet, it was also new for me in the sense that what I knew in theory slowly began to gain life and the images I had formed now became more tangible. As I remember, there was no thought or threat of violence then. Everywhere people worked hard to prepare for the long and severe winter months ahead. Wherever you looked, there was bustling activity-on the streets, in the fields, within homes. Children could be seen playing games in open fields and playgrounds. Cool evenings drew people out of their homes and some of the main city areas wore an almost festive look. When people left home in the morning, they were not consumed by fear or the nagging uncertainty that they may not return home in the evening to their loved ones. Life was as one had seen and experienced it elsewhere-'normal', except that here it was endowed with a rare sensibility that is often born out of living in such close proximity to nature. I had grown up to believe, quite proudly, that Kashmir was an integral part of India. I was even boastful at times that we lived close to a 'paradise' on earth. It was a few years later that cracks began to appear in my cherished belief. This happened when reports of the intense and large scale violence that was rapidly engulfing the state began to appear. I watched anxiously and with concern as a popular movement turned militant as a result of India's continuing claim to Kashmir and the (counter insurgency) measures it employed to brutally suppress people's demands, aspirations and struggles. The cycle of political violence had begun, ravaging, devastating and destroying ordinary lives that were hitherto unfamiliar with the language or use of such violence. It had begun to alter, in no uncertain manner, the trajectory of people's lives - they now found themselves caught between the brutality of the Security Forces and the (f)ire of the militants. Despite the shattering of my 'dream', I had always wished to return to Kashmir. This I was able to do recently as a consultant with Oxfam, as part of its Violence Mitigation and Amelioration Project(VMAP), a project set up to look at the impact of conflict on people's lives within India and across borders, and to work towards conflict mitigation and resolution. My brief was to examine, empirically, the psychological impact of violence on people's daily lives and to attempt to understand the various ways in which people, both at an individual and collective level, coped with the immediacy and the aftermath of violence-loss, prolonged grief and stress, unforeseen hardships, suffering and the intense trauma these entailed.
Until I returned there, I was deeply concerned, as most of us have been, about the situation in Kashmir but I must confess that I was not prepared to be confronted with such a collossal human tragedy. The challenge I faced, as an activist, a researcher, and a field-worker was not so much in terms of collecting data and testimonies as much as in being able to question and accept my own ignorance regarding the scale of this tragedy and to to begin to absorb and understand this calamitous change I was witnessing. At the same time, I had to try and come to terms with the shifting, fast eroding and crumbling beliefs which I had so far held of the Indian State and its treatment of the Kashmir conflict. The nature of this conflict and its far-reaching implications for people were now unfolding before me in their various dimensions.....
My first impression, on my arrival in Srinagar, was that I had perhaps entered an 'occupied' state. Why was there such an obtrusive presence of the Security Forces everywhere? So many bunkers and check-posts on the streets where ordinary people were being stopped and searched routinely? Why were guns being pointed at those who were unarmed? Why was I repeatedly being asked to produce proof of my identity? Why were people in such a hurry to return home at the first sign of darkness? Why was there such a pervasive and palpable sense of fear and insecurity among people everywhere? 'Peace,' as I had known and sensed it earlier, had certainly vanished and while the 'beauty' of the place remained unchallenged, people's lives, their very existence had been severely and brutally curtailed. More than a decade of violence had already claimed nearly 70,000 lives, leaving scores of others with physical, emotional and psychological injuries and scars. The number of widows and orphans had gone into thousands. Women and children, rendered more vulnerable in this situation, had to slowly learn to cope with the trauma of sudden loss, death and destruction on such a large scale. Women had to adjust to their new roles, as breadwinners, to support and sustain their families in the absence of their men who were either killed or 'missing'. Are they, are any of us, equipped to deal with such a calamity? To live with this deep sense of loss, insecurity, fear and the constant shadow of death, and within this, to search for new sources of livelihood, comfort and trust - a rare commodity in such hostile environment This concern remained with me wherever I went, and with whomever I met. According to a district chief medical officer, 'one of the most negative and critical outcomes of this prevailing atmosphere of violence has been the loss of trust and confidence in oneself and others. I say this with a sense of pain because this basic ability to trust has been integral to our character, our personality and our very existence as Kashmiris but this has been destroyed over the years. Suspicion stalks everywhere. Young men are picked up on suspicion of being militants, parents often suspect their sons to be militants. As for me, I have been picked up on suspicion of nurturing links with militants simply because, as a doctor, I have treated many young men who came to me with bullet injuries. I was kept in a cell for three months and tortured. If this can happen to a government employee, imagine the plight of ordinary people on the streets, in the villages. To be made to suffer such inhumanity and indignity can easily lead to a loss of self esteem, confidence, trust, and one's ability to live without fear...' When I first heard someone say to me that when he left home every morning, he was not at all certain whether he would return alive in the evening, I took it as a stray comment; his individual anguish. But it soon became a refrain, irrespective of gender, age, class or profession-the collective anguish of a people learning to live as 'normally' as possible in the midst of the most abnormal and trying situation. As I met and interacted with different people, visiting bereaved families, hospitals, schools, chemist shops, orphanages and shrines where many went to seek solace, I did not come across a single family in Kashmir that had been spared; each had a 'story' to tell, of having experienced violence and its aftermath in one form or another. A mother searching frantically for her young son for ten years, a wife waiting endlessly for her husband, unable to overcome the grief, a young widow looking after her two small children, a student grappling with the humiliation and pain of being let off after severe interrogation and torture, old parents holding out photographs of sons killed in front of them, children filing past for their daily meal in an orphanage - the list of 'casualties' was endless. 'Are we paying for our sins ?', asked an old woman, her eyes streaming, trying to locate a reason for this 'senseless' violence. 'My son never missed a day of work. He had nothing to do with all this, yet he was killed. He was the only earning member in the family. If our house had burnt down we could have built another, but how do we get our son back? My old husband is inconsolable, my daughter hardly ever speaks anymore. We have to pull out our remaining son from school so he can go out and earn. We never imagined this could happen to us. 'I am frightened of the dark - I can't sleep at night - how can one live in such conditions ? No one is safe, not even inside homes.'( Raat ko bohut darr lagtha hai. Neend nahi aati. Is halath main kaise koi jiye? Koi bhi mehfooz nahin hai, ghar ke under bhi nahin" (we feel very scared at night. In another house a few yards away, an old couple and their two daughters welcomed me. I had heard that their son had been killed in a mine blast a few months ago. 'It was the 3rd of January,' he began, his voice breaking, 'we were sitting inside the house when a neighbour came and told us that there was a blast in the subzi mandi(wholesale vegetable market) where my son used to work as a munshi. He was matric pass. I went outside the house and had walked some distance when I heard people screaming. Someone was shouting to tell me that my son was among those killed. Yes he was. But he had three bullet shots in his body. Then they told me how, after the blast, when people started running in panic, the BSF jawans opened fire. That's how my son was killed. He had left home at 7.30 that morning for work. At 10.30 we brought his body home. Neighbours console us that just as God gives life, He also takes it away. It's hard to believe that he took away my hard working son. We live from one day to another. We feel so afraid. No one is safe anymore. I worry for my young daughters. I hide them when the jawans come. This is not our story alone. It happens in every home (yeh ek ghar ki kahani nahin hai. Ghar ghar mein yeh ho raha hai.). As I was preparing to leave, he pulled out a dusty file containing some papers and a photograph of his son. 'I cannot bring myself to put his picture on this form. It breaks my heart,' he said. His wife took the photograph from him, touched it to her eyes, kissed it and began to cry.... Evening was drawing in and I had been advised to return before it became dark. As I walked, I saw many others returning: the sight instilled in me a sense of hope and despair at the same time. I knew that the streets would soon be deserted but the homes I had visited and many more I hadn't, were brimming over with sorrow for those gone and courage for those able to return. I wondered how people- men, women, children- coped with a tragedy of such magnitude in their lives? The 'event' that caused the pain may have occurred a long time a go but the memory of it was still fresh, the pain almost raw. 'Each day here is a day of judgment for us, when we are called upon to prove our innocence,' (Har din ek nayi qayamat hoti hai jab hame sabit karna hota hai ke hum beqasoor hain ) someone had told me on the first day of our meeting. He was talking about the spectre of crackdowns, cross-firing , cordon and search operations which they had to live with and their consequences: death, destruction, loss and indignity. 'Violence has acquired such a terrifying regularity that we remain conscious of it all the time, even in our sleep. Yes, time heals but there are certain wounds that become nasoor(cancerous), that cannot be healed.'
During my visits to the only existing government hospitals for psychiatric diseases in Srinagar, I interviewed doctors and also spent time observing/meeting patients who had come with complaints of acute depression, frequent palpitations, heart pain, lack of concentration, loss of appetite, sleep disorders and intense anxiety. The rooms in which the doctors sat were small for the large number of patients who had to jostle for the doctor's attention. I soon learnt that in the past 25 years, while the number of doctors (psychiatrists) had remained stagnant at 5, the number of patients had increased dramatically. From 1700 patients in 1971, their number had gone up to 32,000 in 1999. According to one doctor, at least 80-100 patients visited the OPD daily compared to 10-15 of them in 1993. 'Medication alone is not the solution as the majority of patients are highly traumatized and require sustained counselling,'said a doctor. The few doctors on duty are unable to provide such counselling due to paucity of time, space and the fact that the State health authorities do not consider this to be an essential service despite the fact that more than two-thirds of the population today suffers from chronic psychological disorders. According to them, 'what the majority of people are coping with today is not 'ordinary stress but catastrophic stress' something which happens when people are witness to sudden killings, disappearance and torture of their close relatives or loved ones. Since this has been a common occurrence in the last decade, patients come with psychotic symptoms such as delusions and severe hallucinations. The quality of their lives is very akin to schizophrenia. Even remote reminders of the actual event can trigger extreme fear among them, leading sometimes to their refusal to go out or meet people. One individual's psychotic state can often be the cause of family illnesses where all members, particularly women, begin to suffer similar symptoms. Some officials in the health department admitted that it was beyond their capacity to address (or redress) a tragedy and trauma of such magnitude among people, many of whom are faced with no other option than to consume a variety of psychotropic drugs on a daily basis (such as anti-depressants and tranquillisers), in order to survive. This was corroborated by a leading chemist, according to whom, there is a 100 per cent increase in the sale of such drugs. Men visit the hospital more often than women, said the doctors, even though women and children are more prone to depression and anxiety. Out of 10 cases of acute depression, 7-8 are reported to be those of women patients as they struggle to keep the family together, often neglecting their own health in the bargain. What keeps many women away from the mental hospital is also the fear of social ostracization, particularly young women whose marriage prospects, parents fear, may get jeopardized. Added to this there is the problem of the long distance people have to cover to reach hospitals. Hospitals are understaffed and overcrowded, doctors have a very limited amount of time to give to each patient, with the result that many come back unattended. I was told that if the fear of social ostracisation and retaliation had not been a real constraint, not only would more women visit hospitals but many more cases of rape would also be reported and treated. Suppression of this brutal reality has caused women to suffer in isolation. The problem is further compounded for women as the village level health workers are now conspicous by their absence. Their fear of the ever present security forces preying upon them, as well as the repeated threats they receive from the militants and the warnings to stay away from duty or face the bullet (as any work related to family planning or abortion is, as a decree, 'forbidden' by the militants), is the cause of this.
Doctors report an increase in the number of cases of attempted suicides, particularly among young girls. According to a study on the rate of suicides in the valley (department of sociology, Kashmir University), more than 2000 persons have committed suicide in the last decade and the trend, particularly among women and younger people, has become more prevalent in the last few years. 'Although, according to unofficial estimates, only 40 per cent of the existing suicide cases are reported, an average of 15 persons kill themselves each month making it one case of suicide every alternate day.' The most active suicidal age group, according to the study, belonged to the 16-25 years(76.92per cent) followed by 26-40 years age group(20per cent). The report cites women as the most vulnerable group accounting for 77.41 per cent of all the cases of reported suicides. Today in Kashmir, all age groups are exposed to symptoms of Post Traumatic Stress Disorder (PTSD). Prior to 1990, only those above the age of forty complained of high blood pressure, hypertension and heart ailments but now, the age-group of such patients' is 18-35 years. In a situation like this, children become susceptible to high emotional stress often leading to various behavioural disorders. They suffer from fearfulness, irritability, instability, unwillingness to be alone and a general lack of concentration. 'Children born in 1985 are now 15 years old. They have grown up in this hostile and violent environment. They have not seen normalcy or known what it means to lead a normal life. They perceive this abnormal situation as normal, until they are able to go out of Kashmir and see the difference. Most children of this age have not seen life outside the Valley or life as it was before this toofan (storm) began,' said a middle aged father who is also anxious about the well being of his own children.
Children constitute nearly 38 per cent of the state's population and it is well known that thousands have been orphaned in the course of the conflict. However, there are no official figures relating to the number of orphans. 'Unofficial' estimates put the figure at 40,000. So far, there are only three government orphanages which house 58 boys in one and 25 girls in another. One orphanage is meant only for the Gujjar Bakerwal community and has 100 girl orphans. While hundreds of orphans are reported to have taken shelter in their relatives' homes, the majority of them remain uncared for. The more fortunate among them have found homes in private orphanages run by local NGOs. But the NGOs also have limited capacity and they are often short on resources. Combined with growing and continuing deprivation, this has led to an increase in child labour with more and more children going in for petty jobs. Also, the traditional carpet weaving industry that provides many children a source of livelihood. There have been reports of children suffering from malnutrition and mental degradation with no recourse to social, legal and emotional protection. Disruption in normal life, for example, which includes an uninterrupted access to education and health has exposed a large number of children to unforeseen risks and hardships.
Even though the state government has instituted a few compensation/rehabilitation schemes for orphans and widows, these fall far short of the actual needs and requirements of those who have suffered and borne heavy losses due to the continuing violence of the last twelve years. In fact, as one travels through the Valley, there is a sense of a loss, a virtual breakdown of governance everywhere. There are clear signs of a near complete structural collapse of social services particularly in rural areas. The state only recognises 'victims' of militancy as beneficiaries of its rehabilitation schemes, and people have to go through time consuming and cumbersome procedures. This is why all the others who have been, and continue to be, victims of the excesses committed by the security forces, have nowhere to turn for their grievances. Left to fend for themselves and their families, many of them, women and men, have been protesting against these injustices and many more are engaged in long-drawn legal battles against severe human rights violations. On any given day, a large number of people; old men and women, young women with small children, can be seen in the premises of the high court where they come either to file or pursue the habeas corpus petitions regarding the whereabouts of their missing relatives. The phenomenon of 'enforced' disappearances in Kashmir is as old as the armed conflict there. The heavily deployed security forces ('nearly five hundred thousand, the highest number...during 'peacetime' anywhere in the world') have resorted to this brutal method of unwarranted arrests and enforced disappearances as part of its campaign against armed militants. However, as every Kashmiri , particularly young men, is a suspect in the eyes of the security forces, a large number of innocent persons have become victims of such disappearances. According to unofficial sources, more than 3000 men - a majority of whom are economically and socially underprivileged - have disappeared since 1989 after their arrests by the 'law enforcing' agencies. Among families of the disappeared, there is large scale ignorance regarding their legal rights, leading to loss of precious time, energy, and the meagre resources in their search for the missing person. Along with the deep social and economic instability that a disappearance entails for a family, the close relatives also suffer constant agony as the disappeared person is neither declared dead nor alive. Women whose husbands are missing are known as 'half-widows', and are therefore not able to claim any compensation which a widow is entitled to. Many such women are left with no earning member in the family and have had to go out in search of, not only their husbands, but also for means of livelihood. I met scores of such families where the sudden hardships, prolonged grief and sorrow seem to have touched, shaded and altered all other aspects of their lives. Their vacant, sorrowful eyes implore that justice be done, that their long wait bear fruit and their loved ones be returned to them....if not alive then at least their dead bodies be handed over to them so that they are able to bury their grief along with the bodies, to put a closure on the suffering......Yeh aisa dard hai ki raat ko neend nahin aati aur din ko aaram nahin milta.Jab bhi darwaze par aahat hoti hai tho lagta hai ki mera beta wapas aa gaya hai .Bolo phir neend kaise aayegi? (This pain and sorrow is so deep that I cannot sleep at night. I cannot rest, Every time there is a knock at the door, I think my son has come back. Tell me, how then can I sleep ...) This is how an aging mother expressed her grief as she continues to search for her missing son even after ten years. He was 16 years old then and she is waiting to see how he must look as a young man now, refusing to even consider the possibility that he may not be alive anymore... Earlier she never so much as stepped out of the house, and remained busy its four walls. The outside world was taken care of, she said. But all this changed for her as she began to traverse different corners of the state, visiting jails, law courts, government offices, demanding that she be allowed to meet her missing son or at least be told of his whereabouts. 'Ladke ke saath mera dar bhi kho gaya' (along with my son, I have lost the sense of fear),she said. Today she heads the Association of the Parents of the Disappeared Persons(APDP) and mobilises similarly affected families for a collective struggle, redefining and transcending boundaries and lending a new meaning to 'victimhood'.... Having crossed the threshold of their homes, their patience and endurance, women are now negotiating at different levels in pursuit of justice, for an end to mindless violence which has not only claimed thousands of lives but has also created unprecedented challenges and transitions for them. Their men who are missing may never return but there is hope in their hearts that peace will...
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