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Afghans suffer mental toll in decades of war

Dr. Awara
Dr. Abdullah Ahad Awara, assistant director of Kabul's mental hospital, treats dozens of patients daily for depression.  

KABUL, Afghanistan (CNN) -- Everywhere in the Afghan capital there are constant reminders of 22 years of war: ruined buildings, abandoned tanks and a crumbling infrastructure.

The scars of war are not only physical, but they are mental as well.

While no research exists on the effects of stress on the Afghan people under the current circumstances, the World Health Organization (WHO) cites research on other conflicts that found up to 20 percent of a population can have severe mental health problems or diminished capacity to function after experiencing the trauma of conflict.

"Not only does Afghanistan hold the unenviable position of one of the worst health-care situations in the world, it is also grappling with a hidden medical crisis: severe mental suffering resulting from decades of conflict and repression," according to a WHO report issued in November.

Dr. Abdullah Ahad Awara, assistant director of Kabul's mental hospital, runs an outpatient clinic, treating dozens of patients on most days, all suffering from symptoms of depression.

CNN's John Vause reports on the psychological damage to many Afghans after more than 20 years of conflict. (December 29)

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"From my 14 years in the psychiatric field, in each family I have met, there is at least one person who has psychological problems," he said.

Taliban treatment of women a factor

A typical patient is Hamayoon, an Afghan man who lost his government job when the Taliban came to power. He said he doesn't want to be around people and lost interest in his family.

"I suffered from insomnia, and it got worse," he said. "Then I became apathetic."

Salam, a 15-year-old girl, said she's been taking medication for depression for four years. She blames the Taliban's treatment of women for many of her problems.

The WHO report emphasized the psychological stress faced by Afghan women. It cited a small study of 160 Afghan women conducted in a refugee camp five years ago and published in the Journal of the American Medical Association that found 97 percent showed signs of depression and 86 percent suffered symptoms of anxiety.

A report released in 2001 by Physicians for Human Rights found an increase in the prevalence of major depression over the last two years, particularly in women living under Taliban control.

The study surveyed 1,100 Afghan women and found that 78 percent of women in Taliban-controlled areas showed symptoms of major depression. Twenty-eight percent of women in areas not controlled by the Taliban showed symptoms of major depression, and about 73 percent of Afghan women living in refugee camps in Pakistan also had major depression, according to the study.

The study also found that 65 percent of women living under Taliban control reported having persistent thoughts of suicide. In non-Taliban controlled areas, it said that 18 percent of Afghan women reported frequent thoughts of suicide.

Children have not been spared. The United Nations estimates that 7 percent of Afghan children under 16 have witnessed violence and 65 percent have experienced the death of a close relative.

Few resources available

Hamayoon said he became apathetic after losing his job when the Taliban came to power.  

Mohammas Asad, a pharmacist at the Kabul hospital, has little medication, only what was donated by WHO months ago.

He mostly uses mild sedatives to treat depression. He said he knows it isn't ideal but adds he has little choice.

Some Afghans use heroin to escape their problems, easily available in a country that is one of the largest producers of the poppies used to make the drug.

Awara said doctors can do little to treat patients because they lack the resources.

There's no way to know how many Afghans are suffering from some form of depression as no official numbers are kept. There are few physicians, with the United Nations estimating there is one doctor for every 50,000 people. WHO found eight psychiatrists, 20 psychologists and 18 psychiatric nurses in the country.

"Mental health resources in most countries are grossly insufficient, but the lack of available care in countries in conflict, such as Afghanistan, is especially alarming," said Dr. Shekhar Saxena, coordinator in the WHO Mental Health and Substance Abuse Department.

Doctors in Afghanistan said mental suffering is common and widespread -- hardly surprising given everything that has happened in the past two decades.

Still they said a new government and renewed optimism may help cure this national depression. But doctors and aid workers said they worried about what might happen should this administration go the way of so many before it.

CNN Correspondent John Vause contributed to this report.




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