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Dire need for child and adolescent psychiatrists in Afghanistan

The number of psychiatrists currently working in the country can be counted on one hand, and psychology and psychotherapy are so underdeveloped as to be virtually non-existent. The situation for the mental health problems of children and adolescents is even worse.
Gul G. Manalai
21 May 2011

Afghanistan, a country victimized by civil war for decades, is in dire need of re-building and rehabilitation. Decades of war and conflict in the country have ruined all aspects of the nation's infrastructure, including healthcare facilities. Afghanistan is among the poorest countries in the region in terms of human suffering, lack of basic necessities, access to basic health care and sanitation.

The people of Afghanistan are constantly struggling to live under conditions of insecurity, inadequate health care, lack of education and other public services, as well as gender inequalities. While malnutrition, preventable infectious diseases and maternity complications destroy many thousands of lives, ongoing war inside the country, unexploded mines and continuous violence put another burden on the exhausted shoulders of the nation. 

In such conditions, mental health and especially children's and adolescents' mental health has received little if any attention in the country. According to WHO estimates, about 20-30% of the population is suffering from mental disorders; moreover, about 30-40% of Afghans are facing psychological problems which interfere with their daily routines and could lead to serious disorders in the future. However, due to people’s cultural beliefs, having a mental disorder is a big stigma, and neither patients nor their families tend to seek medical help for such afflictions. It is widely accepted in Afghan communities that mental disorders are not medical problems; rather, they stem from the penetration of bad creatures (Jennies) into the bodies of individuals.

As a result, people with mental disorders are subject to a wide range of human right violations. They are outcast from society and do not receive the care they need. In many parts of Afghanistan, mentally ill patients are put in chains and are brought to particular shrines with no proper clothing and sanitation. It is also believed that keeping these patients hungry will improve their condition and they are exposed to prolonged starvation as well. Beating the patients is another ‘treatment’ in such places in order to indirectly ‘banish the bad spirits (Jennies) from the patient’s body'.

There are few mental health facilities in the entire country and these facilities are facing problems with human resources, medication and required equipment. The number of psychiatrists currently working in the country can be counted on one hand, and psychology and psychotherapy are so underdeveloped as to be virtually non-existent.

The situation for children and adolescent’s mental health problems is even worse. As one out of five children in Afghanistan does not see his/her fifth birthday due to malnutrition, respiratory disorders, diaorrhea and related complications, infectious diseases including tuberculosis, and many other preventable diseases, mental illnesses and the needs of mental health patients are completely neglected. Children are exposed to numerous physical and psychological human rights violations. They are deployed in manual work and involved in strenuous physical activities; they are also the only breadwinners in most families. Verbal and physical abuse is very common. Many girls are mothers and caretakers for the entire family by the time they turn 15; thus, they are subject to conflict-prone large family systems. Many children have witnessed violent scenes of loss of lives and mutilations (i.e. military conflicts, tribal/religious animosities, landmines, etc.). All these factors collectively put the children in danger of developing mental disorders. A large number of children suffer from Posttraumatic Stress Disorder (PTSD), with no help in sight.

In spite of such distressful living conditions for the children, child psychiatry has received virtually no attention in Afghanistan.  In cases when mental illnesses are being diagnosed by pediatricians, there are no mental health facilities available to refer children to; most commonly, inadequate and sometimes inappropriate treatment is embarked on by pediatricians without any proper psychological evaluation being carried out. 

For any individual, physical, social and mental health are vital for their overall well-being. Mental health is as crucial for healthy living as physical health and is required for a purposeful, productive life. Developing mental health infrastructure and nurturing psychiatrists and psychologists are essential and should receive proper attention. Child psychiatry should be developed in Afghanistan as children are building blocks of strong and powerful nations. 

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