Many of the donor agencies and non-governmental organizations that provide financial support for relief efforts, Akhtar said, "expressed concerns that little awareness has been raised on the psychological effects of the conflict," and some have largely ignored the issue.
In February, HCI helped sponsor a visit by a team of mental health care professionals who offered a two-day training session in trauma psychology. Led by Syed Arshad Husain, M.D., a child and adolescent psychiatrist who heads the International Center for Psychosocial Trauma headquartered at the University of Missouri in Columbia, the team's goal is to equip Afghan physicians, social workers and teachers living in Akora Khattak with the skills to help refugees, especially the children, overcome PTSD symptoms. In addition, a first-time-ever trauma counseling center staffed with two psychiatrists, a social worker and other health care workers will provide ongoing treatment and training.
While adults have their share of problems that must be addressed, Husain explained that the children's suffering is his main emphasis. Food and shelter are the greatest problems, and many children have lost families or work at menial tasks to provide meager, subsistence-level support. Stripped of an environment in which to grow normally, they suffer deficiencies in psychological and cognitive processes often induced by posttraumatic stress, he added.
Among Afghan refugees in Akora Khattak, intractable conflict has produced massive psychological casualties through the years. During the training session at Hope Village, Afghan participants estimated that as many as 80% to 90% of the children and adults living in Akora Khattak exhibited PTSD symptoms. Often induced by witnessing atrocities, the trauma's impact has been magnified by the effects of malnutrition and squalid living conditions.
Cultural and religious norms also have their effects. Many of the women lost their husbands during the conflicts or live with men who are too disabled to work. They are prohibited from venturing out alone to take jobs, and only their children can assume the burden of being family breadwinners. Usually employed at physically demanding manufacturing or assembly jobs, or subject to the vagaries of street vending, these children are commonly the targets of physical and sexual abuse. Thousands of children in the camps receive little or no education.
Venetta Whitaker, Ph.D., is an education specialist who provided training in art and storytelling therapies and in dispute-resolution techniques for children during the two-day session at Hope Village. She agreed that the decades-long conflict in the region and the resulting plight of Afghan refugees made their situation more dire than other war-torn areas she has visited.
In contrast, most of the refugees from Kosova who fled to Albania during the conflict in the former Yugoslavia were housed in local homes, either with family, friends or sympathizers, Whitaker said. Those maintained in camps had been there for only a short period of time, and they anticipated a quick repatriation or absorption. Whitaker said this made that situation more like a natural disaster, where the event was traumatic but of finite duration.
In Akora Khattak, however, "There was more of a sense of hopelessness," Whitaker said. Nevertheless, she said mental health interventions can help, particularly among the children. She explained that there are some children who would be more resilient than others and who could overcome their environment with help. That doesn't mean, though, that the camps are without their undermining influences, she added.