Mustaq, a teenager who was trying to start a pashmina shawl business in Srinagar, the capital of India’s Jammu and Kashmir, disappeared one night in July 2001. Three days later his body was found dumped in a park not far from his family’s home.
His sister Saleema says the Indian authorities were responsible for the killing because they believed he had been involved in Kashmir’s separatist struggle. The 18-year-old had been shot in the head, back and thighs and, say the family, his heart had been removed.
So gruesome was the sight that Saleema was allowed only a fleeting glimpse of the body. This was enough to scar her psychologically, but not enough to convince her that her brother was dead. She vowed to keep Mustaq’s room as he had left it, with the desk, letters, pens, clothes and pictures awaiting his return.
In the months that followed, Saleema suffered from dizzy spells and violent mood swings. Such was the strength of her belief that anybody who said Mustaq was dead would endure a volley of angry words which, if they persisted, would be followed by plates and cutlery. She shunned friends and refused to leave the home she shared with her elderly mother.
Seeing six doctors in seven months did little to help: Kashmir’s medical system, once the pride of the state, has been brought to its knees by a 14-year conflict pitting Kashmiri separatists against Indian government forces. Physicians prescribed a cocktail of drugs, mainly tranquillisers. Saleema used them for three suicide attempts.
What she needed was counselling, to regain her mental stability. Médecins Sans Frontières, one of only two foreign non-governmental organisations working in Kashmir, helped to ease her condition with 15 counselling sessions over six months.
Today it is hard to imagine that Saleema, who now chats incessantly between handing over plates of kebabs and cups of warm tea, was for nearly 18 months a sullen, withdrawn woman. ”It was good to be able to talk with somebody,” she said. ”Before that, I could not speak about what had happened, so I did not talk.”
Saskia Ohlin, MSF’s mental health officer in Srinagar, said: ”In all societies there are rituals to acknowledge major events; so we have funerals for deaths. But Saleema only briefly saw her brother before he was taken away. It was not enough to convince her that he was gone.”
Through a series of counselling sessions, Saleema was gently coaxed back to normality. The process culminated with all of her brother’s belongings being locked away in a cupboard.
”When she put the things away, she said she could not open it,” said Farhat Mantoo, one of Saleema’s counsellors. ”But she had done so without a sense of guilt, which was important, because we did not want to forget her brother.”
Saleema is just one example of the enormous mental trauma that has been inflicted upon Kashmir by the years of violence. Civilians suspected of favouring either the Indian government or the separatists are targeted by the two sides.
The repressive atmosphere and the lingering threat of human rights abuse have meant thousands suffer from stress and depression.
There is no way the authorities can cope with the rising demand for mental health care. Srinagar’s psychiatric hospital, with just 10 doctors, sees the most serious cases of trauma. It dealt with 63 000 cases in 2003. In the previous year, the figure was 48 000.
For MSF, the first problem was being allowed into the region. The only international NGO allowed to work in the area had been the International Red Cross, which avoids commenting publicly on the situations in which it works. MSF’s tradition of speaking out made it harder to convince the Indian government that it could work in such a sensitive area without drawing too much attention to itself.
But MSF was allowed to start work in 2000 after receiving the Indira Gandhi peace prize in 1997 from the Indian government.
Another problem was that MSF did not want to substitute its work for that done by the main psychiatric hospital.
Instead it opted to staunch the flow of patients by getting to people before they developed more serious symptoms. In the past three years MSF has built a new treatment centre in Srinagar and it is setting up another in a village in the Kupwara district outside Kashmir’s capital.
In the fresh snow, MSF’s newly painted outpatient department contrasts with the nearby corrugated iron roof and bare brick walls of the psychiatric hospital. Inside, the difference is just as stark. While MSF has electric lights and a carpeted, heated waiting room, the corridors of the hospital are lined with Kashmiris looking lost and forlorn.
”There are real problems in getting people to come. This is a very closed society,” Ohlin said. ”Coming to the psychiatric hospital has a stigma attached to it, because it is in front of the jail and was used in the past as an overflow for difficult patients.”
More troubling is that suspicions are quickly raised in Kashmir about those who consort with foreign organisations. ”People find it difficult to come forward to discuss their experiences because they are worried about being marked as informants,” Ohlin said.
To help, MSF has used mosques and local radio stations to broadcast its message of help and hope.
In doing so, it hopes that it can help many more people like Saleema. ”When the imam of the village says that our counselling can help, people here listen,” Ohlin said.
The names of the patients have been changed. – Guardian Unlimited Â