In light of the recent takeover of Afghanistan by the Taliban, it seems appropriate to reflect back on the past two decades that Afghanistan has been stuck in a war between the United States and its allies and the Taliban. A war spanning over 20 years has inevitably had its impact on every stakeholder involved. These include the oppression of women and the lack of access to education for children but also the psychological impacts of the war that have not been adequately discussed.
In one study, Miller et al. found that it is not only the direct impacts of war on mental health (e.g., through the destruction of people’s homes, the disappearance of death of family members) but also the indirect impacts of prolonged violence through the production of stressful social conditions that affect the overall psychological wellbeing of Afghan men and women. In fact, the International Psychosocial Organisation estimates that up to 70 percent of Afghanistan’s 37 million people are in need of psychological support.
However, despite the dire state of mental health in the nation., Afghanistan severely lacks the appropriate medical infrastructure to deal with these issues. The World Health Organisation estimates that there are only 0.23 psychiatrists per every 100,000 people and 0.3 psychologists per every 100,000 people in Afghanistan. Furthermore, the 2019-2023 National Mental Health Strategy concluded that less than 10 percent of the population is getting the medical help required to treat their mental disorders. But the lack of infrastructure is most acutely seen when the nation has only 320 hospital beds reserved to treat patients with mental health issues.
This often results in Afghanis not seeking help or being sent away with psychotropic medication. Furthermore, the lack of mental health literacy in the nation results in widespread misuse of psychotropic medication and other harmful drugs, in fact, Afghanistan has the highest number of opiate users in the world. This lack of mental health literacy also creates a stigma surrounding mental health that results in families resorting to pseudo-therapies like chaining individuals with mental health issues in shrines for extended periods of time, which only exacerbates the existing psychological conditions.
However, the effect of political conflict on mental health is not equitable for every individual. Afghan children and women experience disproportionate impacts of war on mental health. A study by the Christian Children’s Fund in Afghanistan found that children who have been exposed to armed violence are more likely to experience depression, difficulty concentrating, night terrors, sleepwalking, aggressive behaviour, and muteness. In addition, a 2019 report by Save the Children wherein interviews of Afghan parents were conducted stated that 73 percent of parents reported their children having heightened anxiety and fearfulness and 38 percent reported that their children self-harm.
In terms of the impact on women, a study by Jewkes et al. found that Afghan women exposed to trauma were more likely to experience intimate partner violence and to have beaten a child in the past 4 weeks. The women were also more likely to express depressive symptoms and symptoms of PTSD. Furthermore, a joint report by Action on Armed Violence (AOAV) and Chatham House showed that women also have greater difficulty in accessing mental health resources. In a country where infrastructure for treating mental disorders is already poor, this only exacerbates the problem. The report showed that the difficulty in accessing resources may be attributed to cultural factors such as women refusing to accept treatment by male doctors. This is particularly problematic in rural areas where the lack of freedom of movement prevents women from traveling to regions where female practitioners are available. Finally, the prevailing norm in Afghanistan that women need to seek permission from a male family member to access care further aggravates the problem.
With the dire situation of mental health in Afghanistan and the lack of infrastructure to better the problem, community-based interventions have been identified as an effective method of addressing the problem. However, with the recent takeover of Afghanistan by the Taliban, the future of the nation is still in question and in the chaos, mental health has taken a back seat.