For the first few months, Anayata Bibi, a 35-year-old widow who fled fighting in the north-western tribal region of Pakistan to live in the Jalozai refugee camp 35km southeast of Peshawar, barely spoke to anyone, and would not leave her tent. In bouts of anger, she would hit her four children, according to a report by the IRIN.
“I wept through the journey from my village to Jalozai. I never wanted to leave my home. I thought I would go back in 20 days. It has now been a year,” she said, sitting in the courtyard of a makeshift tent compound.
Bibi is one of hundreds of thousands of internally displaced Pakistanis who have fled fighting between insurgent groups and the Pakistan military in the Khyber Agency bordering Afghanistan.
Among other challenges, psychologists and aid workers say the displaced are at high risk of mental illness because of the stress of migration and exposure to violence. The diagnosis and treatment of mental illness, says the World Health Organisation (WHO) in a recent report, remains an unmet health priority at Jalozai.
Anayata was diagnosed with acute anxiety and depression three months ago by psychologists visiting Jalozai.
Doctors and aid workers at the camp say many of the nearly 65,000 camp residents are suffering from anxiety and depression, and showing symptoms of post-traumatic stress.
According to the camp management, 30 doctors and eight psychologists are currently working in the camp.
“We are always concerned about funding here for even basic things like food and medicines, so hiring psychologists is lower down the list,” one psychologist told IRIN, requesting anonymity.
“It is very important to ensure the mental well-being of the displaced population, but we need to prioritise.”
Sixteen-year-old Namro Bibi has given up hope of returning to the house in which she grew up.
She came to Jalozai three years ago with her family after fighting intensified in their village of Kalanga in Khyber Agency. They set up tents in a small compound with other families from their village, but proximity to thousands of strangers meant Namro was confined to her tent because of strict social norms. Within days, she started having panic attacks.
“I did not want to leave my home. I don’t like it here. My heart sinks and my condition gets really bad when I think about home, or when I dream about it,” Namro told IRIN, sitting on a rope-bed outside her small makeshift home, built with mud, straw and tenting.
Her condition was undiagnosed for over two years, during which time her mother, convinced she was possessed, took her to a Muslim cleric and asked him to perform an exorcism.
THERAPY:
Counsellors at the camp found Namro three months ago, and have involved her in women’s groups that use embroidery and craft projects as a form of therapy, and counsel her at centres in Jalozai built especially for women.
Her treatment seems to be working.
“I used to have a panic attack three or four times a day. Now it is much less, just once or twice a week,” she said. “I still miss my home, and don’t think the fighting will end soon. But I hope to go home one day.”
Dealing with psychological trauma is one of the most important aspects of rehabilitating victims of war like Namro Bibi. The task is made more difficult because of the stigma associated with mental illness, psychologists at the camp say. Most consultations happen at people’s homes, not at clinics or NGO-run facilities, because people prefer the privacy.
Akbar Khan*, 26 who used to work with the pro-government Khasadar paramilitary force, and his wife Ayesha Bibi*, fled Khyber’s Tirah region after militants threatened to kill him. For them, there is no chance of returning to Khyber any time soon.
“I can’t be seen much,” said Khan, sitting with his wife and two-year-old daughter Salma outside his tent. “If they find out I’m living here, they will send people to kill me,” he said, making a throat-slitting gesture with his hand.
Khan was diagnosed with acute depression by camp psychologists who say he is prone to violence. His wife also suffers from depression.
“I have no work, we have left everything behind,” Khan said. “How can I think about a future or a life after this when I can’t even sleep at night?”
“It is alright during the day, there are people and sounds. At night, in the silence, all I can think about is the war.”
*not a real name