Mental Health a Casualty of Afghan War

The scene plays itself out again and again inside Shah Mohammed’s head, a horrific image of war and death.

Afghanistan’s Islamic fighters are dueling with rockets. Bullets whistle past his head. A rocket hits nearby. Shrapnel peppers the ground. Dust and dirt fly into his face. He bolts.

Then comes his father’s scream, a tortured cry of pain.

“My father, I don’t remember!” Mohammed cries out to the doctor. “I heard a scream. He’s dead. I can’t find him. I want to go home.” Mohammed trips over his words, rushing headlong once more into a mental abyss overflowing with terrible memories.

The doctor, in a soothing voice, struggles to pull him back to reality. But reality is only a little better than the memories.

Mohammed’s battle fatigue is a common problem in Afghanistan, which has been battered by war since Soviet soldiers invaded in 1979 in a failed attempt to prop up a Communist regime. After four years of fighting among the rebels that ousted the Marxists, huge swaths of Kabul are rubble, at least 25,000 people are dead and nearly 1 million are living as refugees.

Kabul’s only psychiatric hospital is itself a victim of war: a fly-infested cement building with gaping wounds inflicted by rockets, mortar shells and machine-gun fire from rival factions fighting for control of the capital.

The white paint has long since turned gray. A filthy, green sign--Kabul Mental Hospital--hangs limply above a rotting wood door. Outside an armed guard eyes visitors suspiciously. Inside he pokes at patients with a 12-inch stick to keep them away from the door.

Their resistance is halfhearted. Several are asleep on the cement floor of an open courtyard swaddled in black wool blankets oblivious to the sweltering summer sun.

Their beds are severe steel cots. The only comfort are two-inch foam mattresses. No sheets, only blankets--all of them wool and all of them covered with flies.

Several flies have attached themselves to a festering wound on Mohammed’s ear, ignoring his occasional efforts to shoo them away.

As the doctor cajoles Mohammed, listening to his memories, trying to understand his pain, another patient, on a nearby cot, peeks out from beneath his blanket.

He listens for a minute, then he whispers, barely audible: “Everybody has fighting problems.”

Then he is gone, the blanket pulled back up over his head. Abdul Majid, another battle-fatigued fighter, can’t be persuaded to say more.

Mohammed, after much coaxing, can’t be stopped.

“I’m OK. I want to go home. I was sick, but not anymore. I’m OK now,” Mohammed says, becoming more insistent, his voice getting louder. Doctors move quickly to pacify him.

For several years Mohammed lived in the hills around Kabul, firing rockets at the city below. He was a soldier in the movement led by Gulbuddin Hekmatyar--an Islamic leader who tried for four years to take the city by force.

This spring, Hekmatyar gave up the fight after virtually destroying the city. He signed an agreement with his old enemy, President Burhanuddin Rabbani, and today is Afghanistan’s prime minister, a new ally in the war with still other Islamic factions.

But for Mohammed, the fight isn’t over.

“Sometimes he seems to understand and then he says he is ready to fight,” says Dr. Shareen Shahwazik.

Shahwazik says one of the most worrisome victims of 17 years of war is the mental health of Afghanistan.

“Most of the problem is depression,” he says in broken English and speaking through an interpreter. “It’s the war. It has made people crazy. Everyone has lost family members.”

In the small, locked women’s ward, patients mumble to themselves, hug each other, grasp strangers. They have all lost family members in the war.

Shahwazik says many patients are violent when they first arrive.

“They beat themselves . . . they want to kill themselves. They all try to kill themselves,” he says.

Several armed guards roam the three-story hospital checking patients to ensure they don’t hurt themselves or others.

“You have to watch them closely,” Shahwazik says.

But there is little the few psychiatrists remaining in Kabul can do, he says. “We just give them drugs.”