Psychological trauma, a new
concept, came to Pakistan in the early 1990s when Karachi was undergoing crisis
along with other social, geo-cultural and ethnic issues. This remained
unrecognized generally until the devastating earthquake in October 2005 for
which National Plan of Action for Earthquake Survivors was drafted that included
model of emergency and post emergency response based on a 8 point model. In
February 2007, the first national Centre for Trauma Research and Psychosocial
Interventions (CTRPI) was established which is carrying out indigenous research
projects and training activities. This article aims to examine the present
efforts to address the trauma related mental health problems in Pakistan,
identify the challenges we are facing and suggest future directions for services
and research. The article also aims to raise awareness and debate about a
crucial area of mental health which has become increasingly important with
ongoing violence in Pakistan but is largely neglected.
“Years ago I used to think it was possible for a novelist to alter the inner
life of the culture. Now bomb-makers and gunman have taken that territory. They
make raids on human consciousness. What writers used to do before we were all
incorporated” (Don Delillo)
The lack of a functioning judicial system in Pakistan, the breakdown of public
administration, the destabilization of the traditional protection structures
(family, communities) and the precarious nature of livelihoods leave women and
children exposed to all sorts of exploitation, abuse and sexual violence.
The report of Amnesty International published in March 2007 showed that the
humanitarian crisis and subsequent violations of human rights caused by the
displacement of hundreds of thousands of people have increased the vulnerability
of women. Women of all ages and all origins have been raped by all parties
involved in the conflict without possibility of accessing neither medical care
nor effective legal compensation.
Although adequate statistics on the situation are not available, qualitative
studies carried out by Save the Children show that nowadays sexual violence is a
very common phenomenon. Beyond being affected physically and psychologically,
victims of sexual violence are also exposed to HIV.
It was observed during flood rescue and early recovery at district Jaffarabad
and Naseerabad that the women and children were the most vulnerable section to
psychological trauma. The IDPs were offered meal by different people at the
arrival in Quetta in the camps. Unfortunately, most of these so called
philanthropists had mixed certain drugs so as to get the IDPs unconscious and
then looted their belongings. This left a deep scar on the mental health of the
women already worried about their settlements. In addition, as the number of
IDPs began to swell up, they were compelled to live in a tent with many
families. This multiplied the problems for women as sexual harassment, abuse and
rape cases increased. Moreover, the camps were not safe at all. Therefore, child
abduction particularly of girls became another menace. Furthermore, the IDPs
especially women faced difficulties in moving around the camps for their due
needs. These all had to finally affect the women’s mental and emotional health
leading to psychological trauma.
It is therefore, recommended that any rescue and rehabilitation effort must also
encompass the timely treatment of psychologically traumatized women. Is it also
vital from the perspective that women, if psychologically healthy, can bring the
whole family out of trauma. For this, women friendly spaces should be developed
wherein they can live with ease without any fear. Such friendly spaces will not
only ensure security but will also pass on women with much more comfort in tough
days of disaster. The women folk should be imparted with know-how of their
rights and confidence to respond to responsible one in case of any mishap. The
legal framework would help ensure prompt action against the culprit.
Psychologist should be available at camps level for timely treatment of such
women. Beside this, a regular plan of action should be developed to engage these
women and keep them busy. This will help reduce the effect of trauma.
At the level of social and health structures, there is no appropriate response
to these problems: only few hospitals ensure an effective response to cases of
sexual violence. Access to antiretroviral therapy and post-exposure prophylaxis
is equally limited. In view of this situation, prompt actions are needed in
order to i) mitigate the spread of STIs/HIV-AIDS. ii) Reduce the impact of the
psychological trauma suffered by the victims; iii) put in place a legal
framework aimed at preventing abuses, acts of violence and sexual exploitation.