It will likely be impossible for Americans of this generation to hear the date September 11 without remembering the emotional pain and sorrow generated by the attacks on the World Trade Center and the Pentagon. The tragic events of that day traumatized this nation's people as they suffered a firsthand initiation into the brutalities of world terrorism.
No more than a month later, U.S. bombers began missions in Afghanistan aimed at toppling the Taliban regime that was accused of harboring Osama bin Laden and his Al Qaeda terrorists. In concert with the indigenous Northern Alliance, U.S. ground troops then made quick work of its objective of removing the Taliban from positions of leadership in most of the country's major cities.
While the United States' "war on terrorism" marked a new direction for its foreign policy, in Afghanistan it brought just more of the same. For over two decades, the ravages of combat have turned much of the country's civilian population into refugees, many of them left to struggle for survival in bordering nations. Psychologically damaged after witnessing destruction of their family homes and atrocities against family members that included deaths, rapes and physical injuries, the refugees have, for the most part, languished in camps -- their trauma untreated and exacerbated by the desperate conditions in which they live.
In Pakistan, for instance, as many as 3 million Afghan refugees have crossed the border in more than 20 years of fighting, many of them still occupying a string of camps along that border. One of those camps, Akora Khattak, has existed since the Soviet invasion of Afghanistan in 1979. Approximately 100 km west of the Afghan border, it occupies a barren desert parcel near the city of Peshawar in Pakistan's Northwest Frontier Province.
Once a tent city, Akora Khattak's row-upon-row of mud huts at times has housed as many as 250,000 people, although its current population is estimated at 15,000 families comprising 110,000 refugees. Deep gullies run between the ramshackle dirt houses carrying away sewage in the open. Wells supply the only water, and food is in short supply. Many children eat only once every 24 hours. Sparse resources mean medical care is often unavailable, and mental health care is, for the most part, nonexistent.
Some of the residents have been in the camp since its creation, while others migrated to it as Afghan warlords fought each other after the Soviets left, or during the national bloodletting that brought the Taliban to power, or to escape the recent battles with the United States. Following each wave of conflict, innocents -- many of them children -- exhibited symptoms of posttraumatic stress disorder; for the most part, however, the depression, anxiety, nightmares and night terrors, sleeplessness, memory loss, and behavioral problems have gone unattended.
Hope Village, a school and social services facility near Akora Khattak, is operated by Human Concern International (HCI), a Canadian human rights organization. Although it has done what it can to help, even its executive director, Kaleem Akhtar, concedes nothing much has changed in 20 years, with refugees surviving at bare subsistence levels. Despite the hoards of journalists who arrive in Pakistan when combat erupts, there has been little, if any, news coverage of the long-term mental health consequences civilians face, he said.