India

The Silent Mental Health Crisis Among Women in Kashmir

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Srinagar, Indian-Administered Kashmir --- On May 19, 2020, the city of Srinagar, the summer capital of Jammu and Kashmir, awoke to a gunfight between the counter-insurgency grid of the Indian state and two rebels trapped inside a house in the congested locality of the old city. Acting on a tip that there were Kashmiri separatist rebels hiding out in Srinagar's Nawakadal locality, Indian security forces launched a cordon-and-search operation, in which they identified and trapped the two men, who first opened fire.

After a 15-hour standoff, Junaid Ashraf Sehrai, the top commander of a Kashmir-based rebel group and the son of a prominent separatist leader --- along with his associate Tariq Ahmed Sheikh --- were killed.

Three civilians were killed and at least 15 residential houses were destroyed. When the dust cleared, the neighborhood women gathered around the destruction and cried together as the men cleared the rubble.

Nighat's* home was among those destroyed. It caught fire during the gunfight, and now she lives in her uncle's home in another part of the city. Nighat and other residents accuse security forces of using heavy explosives to destroy the houses, a claim that they have denied.

"Within a few hours, it turned to debris," she said, tears rolling down her face. "It was the month of blessing [Ramadan], and suddenly it turned into doomsday."

Since then, Nighat told Women Under Siege that she's been seeing a psychiatrist to treat acute insomnia. "But they aren't even helpful now," she said, as she now has disturbing, violent dreams with images of security forces patrolling the street alongside her destroyed home. "I try my best to act strong in front of my children," she said. "But with each passing day, I am getting mentally weaker."

The conflict-torn Himalayan valley has seen a surgein mental health cases since the abrogation of the autonomous status of the region, with women among the most distressed.

'The most militarized zone in the world'

On August 5, 2019, the Indian parliament scrapped partial autonomy of Jammu and Kashmir in an effort by the ruling Bharatiya Janata Party (BJP), a Hindu nationalist party, to integrate the conflicted state with mainland India. Mass arrests of civilians to quell protest followed alongside the unabated imprisonment of political leadership from both separatists and pro-India leaders. A lockdown was imposed soon after, restricting the movement of the masses for months, as well as a communications ban and the longest internet blackout ever imposed in any democracy.

Thousands of extra troops flew in from different Indian states to keep Kashmiri people from hitting the streets in protest. Residents were forced to stay inside their homes, fearful and stressed for months, until restrictions were lifted in February 2020. Over a year later, communication has been restored, but a ban on high-speed internet remains in place in the region.

Counter-insurgency activities continue on a regular basis in the region, and civilians bear the brunt of operations by security forces to weed out militants or quash protests. According to a report by Jammu Kashmir Coalition of Civil Society (JKCCS), at least 229 killings and 48 cases of destruction of civilian property were reported in Jammu and Kashmir in the first six months of 2020.

Health experts say that the continued presence of extra troops on the streets of the world's most militarized zone and mass arrests of civilians have led to an increase in trauma and anxiety, particularly among women and children.

"Imagine the family of a person whose loved one has either been killed or [detained], or the families whose houses get damaged or entirely burnt down during the militant-military encounters," said Dr. Junaid Nabi, a psychiatrist at the Institute of Mental Health and Neuroscience (IMHAMS) in Kashmir. "Since women often find themselves the sole manager of the household, sole parent, or caretaker of elders in Kashmir, they suffer more."

A lifetime of trauma

Even before the events of August 2019, residents of the Kashmir Valley already showed symptoms of significant mental distress. A 2016 survey published by Doctors Without Borders (MSF) recorded 45 percent of the Kashmiri population (nearly 1.8 million adults) experiencing some form of mental distress.

According to MSF's "Kashmir Mental Health Survey 2015," 50 percent of women (compared to 37 percent of men) suffered from probable depression; 36 percent of women (compared to 21 percent of men) had a probable anxiety disorder; and 22 percent of women (compared to 18 percent of men) suffer from post-traumatic stress disorder (PTSD).

"It is clear that a higher proportion of women were classified as having all three mental disorders," read the survey findings. "This difference between the sexes was significant for all three disorders."

The survey also found that adults living in the Kashmir Valley either witnessed or experienced an average of 7.7 traumatic events during their lifetime; only 0.3 percent of the adult population surveyed had not experienced a traumatic event ever.

"For the past 30 years, the mental health of women has been [deteriorating], but it has worsened after the turmoil of last year," said Nabi. "Kashmiri women are strong, but decades-long pain has made them more sensitive, and emotional tolerance has been reduced."

Parveena, a school teacher and single mother in Srinagar, has been going to therapy since January. "Every day, I wake up to a different mixture of emotions, and there is general anxiety that something bad is going to happen," she said. "I don't let my son go out often. Even inside, I don't feel secure; I keep anticipating death in some form."

"In any conflict, women are more likely to suffer from mental health trauma," said Dr. Arif Magribi Khan, a renowned physiatrist based in Srinagar whose women patients mostly suffer from PTSD. "It is always the women who are more likely to be on the receiving end."

The social stigma around the subject of mental trauma further adds to the despair. Ufra Mir, a peace-psychologist based in Kashmir, who also works regularly with women patients, said that while almost every woman in Kashmir has likely experienced distress at some point in her life, they are also likely unaware of what they are going through psychologically. And among those who do know, she said, many choose to hide it.

"People here consider anyone visiting --- or even seen around --- a psychiatric clinic to be insane," said Mir. Women in need of psychiatric help often rely on faith healers instead, which helps with some emotional relief but cannot reliably stand in place of treatment from mental health professionals.

"Even the difference between psychologists, counselors, and psychiatrists is not known by many," said Mir. "That makes the healing process difficult."

Treatment under lockdown

Mir said she'd seen cases in which a prospective patient ends up forgoing treatment after discussing it with their families. However, she's seen less apprehension among younger generations. "With access to social media, many young girls [have written] to me to share and seek professional support."

But the communications blackout --- which was only partially lifted on January 15 of this year --- and the lockdown restrictions to contain the COVID-19 pandemic that followed, have made treatment challenging.

After communication was partially restored, MSF set up helpline numbers for women, which saw a dramatic increase in calls about domestic violence. "For some women, it turned out to be beneficial, as they didn't have to travel all the way to our clinics," said a MSF representative in Kashmir, who wished to remain anonymous. But for others, the lack of privacy or access to the phone made access to help nearly impossible, a challenge sharedwith many domestic violence victims around the world during the pandemic.

While the support infrastructure has had to adapt to tele-health and online modes of treatment, some things can't be replicated, the MSF representative said. "A major problem between therapist and patient over tele-counseling was that we were not able to read the facial expressions of the patient, which affected the treatment." In a conservative society where mental trauma is already stigmatized, the lack of option to meet in person is a critical impediment.

"The need for mental health support continues to be high," they said.

Meanwhile, according to the JKCCS report, security activities like the cordon-and-search operation that decimated Nighat's house and neighbourhood, have continued, and destruction of civilian property has actually increased during the COVID-19 lockdown.

While the government continues to neglect the civilian population caught in the middle of its counterinsurgency efforts in the region, and health professionals cannot freely access patients to treat them, residents---especially women---are left to fend for themselves to process the ongoing trauma on their own.

"No doubt mental illness is treated as a taboo the world over, especially in South Asian countries, but societies mired in nasty conflicts like ours should seek to address this issue in a different way," said Khan. "Collective traumas call for collective action."

* Nighat's name was changed for her protection.