In Kashmir Valley, amid the world’s largest and most militarized territorial dispute between India and Pakistan, medical organizations are turning to mental health care as brutal clashes leave scores of distraught survivors in their wake.
A recent report by Doctors Without Borders (MSF) found that 93 percent of the Kashmiri population has experienced conflict-related trauma, and 45 percent – nearly 1.8 million adults – are suffering from “significant mental distress,” most notably depression, anxiety and post-traumatic stress disorder (PTSD). To combat that and assist with immediate relief efforts, Doctors Without Borders along with other medical organizations are focusing their efforts in Kashmir on mental health-care services, especially psychological first aid (PFA).
“People are understandably distressed, having often lost loved ones as well as a sense of security and safety,” Director of MSF India Magali Roudaut told Humanosphere. “PFA involves normalizing a person’s response to an abnormal situation as well as linking with services.”
The situation in Kashmir has been far from normal for decades, but the most recent wave of violent protests and attacks picked up in July. To subdue protestors, security forces have been relying on non-lethal weapons like pellet guns and tear gas. But at close range even non-lethal weapons are proving to be deadly, killing hundreds and maiming tens of thousands more. The most prevalent injury is severe and lifelong – an eye hit by the sometimes sharp projectile of a pellet gun. Those who are killed leave behind mourning loved ones; those who survive are haunted by physical and emotional wounds.
The World Health Organization defines psychological first aid as “humane, supportive and practical assistance to fellow human beings suffering serious crisis events.” It is recognizing people in distress, listening to whatever they have to say, and linking them to the services and support they need immediately, whether food, shelter, communication with loved ones or something else. It’s a response that was developed in contrast to “psychological de-briefing” – making a victim recount the details of their experiences – which Roudaut says has been linked to the later development of PTSD.
Best of all, psychological first aid doesn’t have to be administered by a professional. Organizations like Kashmir’s HELP Foundation have begun offering training workshops for volunteers from various fields – including journalists, teachers, social workers and lawyers – in order to reach more victims.
Critics questioned MSF’s lack of trauma care when the unrest first began over the summer. Even Pakistan’s prime minister claims he wrote a letter to MSF pleading for their assistance.
But Roudaut explained that although MSF is donating medical supplies to facilities treating victims, MSF India has been out of Kashmir’s primary health-care scene since 2011.
“There was better capacity in Kashmir,” Roudaut explained. “For us, for MSF, we don’t take over basically. We take over at one moment when there is a gap in the system, then as soon as we can see that we can hand it over to the minister of health, we do that.”
Instead, the organization decided to fill the gap in mental health care through counseling and education until the recent clashes called for the suspension of regular mental health services to concentrate on psychological first aid.
Attacks as recent as Sept. 18, which killed 19 Indian soldiers on the base near the town of Uri, have continued to fuel the conflict, and heated exchanges between the leaders of Pakistan and India offer little hope that a resolution is in sight. For medical aid workers like Roudaut, that means their work is far from over as well.
“We’re a medical organization so we’re just there to help the patients, particularly in mental health with coping mechanisms,” she said. “We’re not going to stop the conflict, but we can help you deal with your situation.”