Endless Conflict in Afghanistan Is Driving a Mental Health Crisis

A generation of Afghans came of age amid relentless violence. Saturday’s election offers little hope for help.

Afghan schoolchildren study amid the rubble of Papen High School in Nangarhar province on July 25.
Afghan schoolchildren study amid the rubble of Papen High School in Nangarhar province on July 25. Noorullah Shirzada/AFP/Getty Images

A decade ago, Afghanistan was the worst place in the world to be born, according to UNICEF. That may still be true today. Poverty, lack of electricity, lack of clean water, and widespread sexual abuse of women and girls are simply facts of life. The country has seen some 40 years of violence, with 18 uninterrupted years of conflict following the U.S. invasion in 2001. Young Afghans are facing a crisis of hopelessness.

Saturday’s presidential election offers few prospects for relief. After the collapse of U.S.-Taliban peace talks earlier this month, violence has spiked. The Taliban have carried out a string of suicide bombings in Kabul and across the country in the run-up to the vote, which has already been delayed several times over security concerns. In response, U.S. and Afghan forces have ramped up raids and airstrikes. A U.S.-backed Afghan commando raid in Taliban territory earlier this week left up to 40 civilians dead.

The violence has had a suffocating effect on the lives of millions of Afghans. Conflict dominates politics, leaving little room for discourse or action on a raft of sorely neglected social and economic issues. The young are carrying the heavy burdens of the past and receiving little support from a government dominated by elders, from the Taliban in areas they control, or from the United States.

The ramifications of prolonged violence and uncertainty extend beyond the realm of politics. Afghans’ psyches, like the country, have been ravaged by war. As countries struggle to cope with the legacy of conflict, the psychological damage often goes overlooked. No matter the outcome of the presidential election or of a future peace deal with the Taliban, collective war trauma will continue to haunt the next generations of Afghans if it goes unaddressed. I am one of the many children of Afghanistan left scarred by the war. The image of a young, nervous U.S. soldier pointing a rifle at my forehead because he suspected I had a bomb underneath my shirt haunted me for years.

A Gallup poll released earlier this month revealed just how devastating conditions in Afghanistan have become: 85 percent of respondents said they were “suffering.” No respondents said they were “thriving.” When the same population was asked to predict their quality of life over the next five years, they predicted it would decline. The majority of the adults interviewed were aged 35 or younger. Afghanistan’s young people have reached consensus on pessimism.

Violent conflict is the main cause of social and economic turmoil in the country. It has displaced millions of people and limited opportunities for them to improve their livelihoods. While the government is preoccupied with maintaining its grip on power and the Taliban with enhancing their legitimacy and bargaining position, many Afghans are stuck in the middle. Anxiety, depression, and PTSD are unavoidable consequences.

International aid to Afghanistan usually comes in the form of food packages, medicine, vaccines, and funds for infrastructure. Although those resources are critical, they neglect an invisible necessity: mental health. The World Health Organization estimated that over 2 million people in Afghanistan suffer from depressive and anxiety disorders. However, the results of the Gallup survey and other estimates suggest that the real numbers are likely much higher. Millions more almost certainly require some form of psychological support.

The Afghan Independent Human Rights Commission reported last year that some 3,000 Afghans attempt suicide every year—and women make 80 percent of those attempts. In the country’s highly fixed patriarchal society, women and girls face the most extreme conditions and have limited resources for assistance and treatment. Forced child marriage, domestic abuse, and social pressures are only a few of the obstacles they face. Since mental health care and suicide are extremely stigmatized in Afghanistan, many suicide attempts and severe mental health crises go unreported.

Mental health facilities in Afghanistan are scarce. As of last year, the country had only one psychiatric hospital. According to the WHO, health care centers throughout the country have long experienced a “lack of trained psychiatrists, psychiatric nurses, psychologists and social workers.” The services that do exist lack proper funding.

If Afghans are to climb out of darkness and build better lives, every province at minimum needs rehabilitation centers and publicly available mental health care services, especially in rural areas. These would need monitoring and supervision to ensure quality care. The government must also roll out awareness campaigns to fight the mental health stigma in Afghanistan, focusing on the struggles of women and girls face. With much of the country caught in perpetual turmoil, even these basic standards can prove unachievable.

I am one of the many children of Afghanistan left scarred by the war. The image of a young, nervous U.S. soldier pointing a rifle at my forehead because he suspected I had a bomb underneath my shirt haunted me for years. Fortunately, I was able to seek the proper care and treatment in the United States to battle my post-traumatic stress disorder. Most other Afghans, some just like me and some who have suffered far more, do not have that opportunity. Their pain endures, while the government, which claims to represent them, remains silent.

Today’s generation of Afghans has known nothing but war and chaos. Whoever wins Saturday’s election, the new government must understand that it cannot overlook this terrible state of affairs. The future of Afghanistan depends on it.

Afghans need help to heal. The country’s people have proved that they are survivors. But even under peace, their nightmares will not fade without proper care. Only then will the country be able to flourish.

Sohrab Azad is a business development intern at Foreign Policy.
 Twitter: @azadsohrab

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