MAZAR-I-SHARIF, Afghanistan (IPS/GIN) – Staring silently out of a window in the Shafakhan Mulki Hospital here, “Munira” contemplates an uncertain future in a country torn by a quarter century of superpower intervention and civil strife.

The mother of four suffers from depression, insomnia, heart palpitations and apathy.

“Hers is a case of panic attack and depressive disorder,” explains Mohammed Nadir Alemyi, head of psychiatry and neurology at this hospital.


Shafakhan Mulki Hospital is one of the few that survived the intense aerial bombardments and shelling by military forces of the former Soviet Union in the eighties and, more recently, in late 2001, of the United States.

Now 62 years into its founding, this hospital has withstood the test of time. There is no medicine, the equipment is ramshackle and the doctors too few, but it remains a last refuge of a people brutalized for the interests of others.

The Soviets, the “mujahideen” forces that were created to fight them, and the U.S.-led forces that turned around to destroy the “mujahideen” have all chosen not to target the hospital.

Women are the worst sufferers of Afghanistan’s more than two decades of civil war and turmoil.Various studies, including one by the Journal of American Medical Association (JAMA), have shown that more than 90 percent of women in Kabul, the capital, and in the refugee camps set up in neighboring Pakistan show signs of depression and anxiety.

But these studies were conducted before the last round of bombings, in retaliation for the Sept. 11 terrorist attacks, carried out by the United States and its allies that were bent on pursuing their “war against terror.”

The case of “Munira” (not her real name) adds to cold research statistics that show the extent of the problem in Afghanistan, although updated estimates on how many people are suffering from mental trauma are hard to come by.

According to research cited by the World Health Organization (WHO), overall statistics in normal circumstances suggest that more than three percent of the population suffer from a grave mental disorder at any point of time.

In conflicts, WHO says, a tenth of the people who undergo traumatic experiences are likely to end up with serious mental health problems, and another tenth likely to develop behavior “that will hinder their ability to function efficiently.”

“In Afghanistan, some five million people are very likely to be affected by psychosocial distress. The most common conditions are depression, anxiety and psychosomatic problems, such as insomnia, or back and stomachaches,” a WHO document says.

Aid workers here say that at least half of Afghanistan’s 27 million people need urgent medical attention. A report by WHO’s Project Atlas said that in 2001, there were only eight psychiatrists in Afghanistan, 18 psychiatric nurses and 20 psychologists.The situation is worse for those still recovering from injuries from bombs and landmines. Add to that, the sheer poverty that comes from a shattered post-war economy, and it is easy to see why life continues to be a struggle for survival in a land long after the U.S. bombings stopped and one-and-a-half years after the Taliban fell.

Already, voluntary agencies and international organizations in Afghanistan are dismantling their offices and heading for another shattered society–Iraq.

It would seem that even peace is adding to the Afghans’ miseries. Between March and September 2002, some 1.7 million refugees streamed back into Afghanistan from neighboring Pakistan and Iran as part of what critics have said is an unrealistic repatriation program.

At the hospital, there is an unending stream of patients arriving on foot, by donkey, horses and by bus and car from distant places, so that the doctors are never able to cope with the added pressure on the already poor health infrastructure.

“We need refresher courses on new developments in medical care and mental health,” says Mr. Alemyi.

Plans are now afoot to hand over the health care system to the private sector, but experts say this may not work, especially in the rural areas where few can afford to pay even for basic services.

Afghanistan has some of the worst health indicators today. One in four children do not survive beyond their fifth birthdays, and maternal mortality is at a high 1,600 deaths per 100,000 live births.

“In the absence of successful experiments, even in non-conflict situations, the sensitivity of the private sector to real needs is a matter of concern,” says S. Parasuraman, Asia policy coordinator of ActionAid, the international non-government organization that has taken on work in Afghanistan.

Even international agencies do not always recognize the psychosocial needs of the Afghans, says Mr. Alemyi, “Mental health is on nobody’s agenda.”