0:00:00 > 0:00:01For nearly 40 years, Afghanistan has been in a constant
0:00:01 > 0:00:04state of war.
0:00:04 > 0:00:08How has this affected the mental health of its people?
0:00:08 > 0:00:15Afghanistan has been at war for nearly 40 years.
0:00:16 > 0:00:20A conflict that has claimed over two million civilian lives.
0:00:20 > 0:00:24They are from 40, 50 years ago, and it just really shows how long
0:00:24 > 0:00:28war has been going on in this country.
0:00:28 > 0:00:32And the cost to the nation's mental health has been enormous.
0:00:41 > 0:00:44It's estimated that three quarters of Afghan women and more than half
0:00:44 > 0:00:51the men suffer from mental health problems.
0:00:51 > 0:00:59With rare access to the country's only secure psychiatric unit and one
0:00:59 > 0:01:02of the largest hospitals, I meet the medical staff trying
0:01:02 > 0:01:03to deal with the mental health emergency.
0:01:08 > 0:01:15And the patients traumatised by decades of conflict.
0:01:36 > 0:01:40Herat, in western Afghanistan, is the country's third largest city.
0:01:40 > 0:01:43As war continues in much of the country, the demand
0:01:43 > 0:01:46for mental healthcare is also skyrocketing.
0:01:46 > 0:01:50This is the psychiatric unit in the city's main hospital.
0:01:50 > 0:01:56I've come to meet Dr Wahid Noorzad who, at 33, is the man in charge.
0:02:09 > 0:02:14Azata is 14 years old and has been brought in by her mother.
0:02:49 > 0:02:52Like many other young Afghans, traumatic events have been a big
0:02:52 > 0:02:54part of Azata's childhood.
0:03:00 > 0:03:02Dr Noorzad suspects that Azata is suffering from PTSD -
0:03:02 > 0:03:05Post Traumatic Stress Disorder - a type of anxiety disorder triggered
0:03:05 > 0:03:13by traumatic events, often seen in soldiers.
0:03:13 > 0:03:15PTSD is increasingly common amongst Afghanistan's
0:03:15 > 0:03:20war ravaged population.
0:03:48 > 0:03:52Social taboos around mental health make it difficult to get patients
0:03:52 > 0:03:56through the door and that's why Dr Noorzad takes every opportunity
0:03:56 > 0:04:01to reach out to the public.
0:04:03 > 0:04:06At a local Herati TV station, Dr Noorzad is being interviewed.
0:04:06 > 0:04:09He's a regular guest and gives mental health advice to people
0:04:09 > 0:04:12who call in.
0:04:54 > 0:04:57Dr Noorzad holds a weekly outreach programme, an opportunity for more
0:04:57 > 0:05:06people to get help, it's free and has been running for four years.
0:05:16 > 0:05:18Farhad is a trained counsellor and a volunteer
0:05:18 > 0:05:23who runs the sessions.
0:05:29 > 0:05:33Farad himself suffers from PTSD and is also a patient of Dr Noorzad,
0:05:33 > 0:05:36but unlike the majority of Afghans suffering PTSD,
0:05:36 > 0:05:43he's seeking professional psychological help.
0:06:01 > 0:06:06A very recent traumatic event led to Farad getting PTSD.
0:06:06 > 0:06:12On the 1st August 2017, two men walked into the Jawadia
0:06:12 > 0:06:14mosque and opened fire on 300 worshippers gathered
0:06:14 > 0:06:15for evening prayers.
0:06:15 > 0:06:18They then detonated their suicide vests, killing 38, including Farad's
0:06:18 > 0:06:22teenager brother, Hossein.
0:06:22 > 0:06:26Dozens of others were injured.
0:06:26 > 0:06:29Jawadia is a Shia mosque and that's why it was targeted.
0:06:30 > 0:06:32Sunni militants like Isis and the Taliban regard
0:06:32 > 0:06:37the Shia as heretics.
0:07:05 > 0:07:10Farad comes here every day.
0:07:10 > 0:07:17For him, the trauma of the attack is still very raw.
0:07:31 > 0:07:37Photographs of the 38 victims, some as young as two years old.
0:07:37 > 0:07:41All are given the title 'Shaheed', meaning martyr.
0:07:41 > 0:07:54CRYING
0:08:32 > 0:08:35Ghulam Haider Sobhani has been the Imam of this mosque for the last
0:08:36 > 0:08:4025 years, he was also here on the day of the attack.
0:09:27 > 0:09:30Speaking to the Imam, the challenge faced by Dr Noorzad
0:09:30 > 0:09:32and his team becomes clear.
0:09:32 > 0:09:45The taboo around mental health is rooted deep within the culture.
0:09:45 > 0:09:56For many Afghans, war and violence have been a constant presence.
0:09:57 > 0:10:00More than 2 million civilians have been killed since the Soviet Union
0:10:00 > 0:10:01invaded the country in 1979.
0:10:01 > 0:10:04Herat even has its own museum dedicated to war.
0:10:05 > 0:10:13These are really old, mostly Russian weapons
0:10:13 > 0:10:16and ammunitions and they are from 40, 50 years ago,
0:10:16 > 0:10:19and it just really shows how long war has been
0:10:19 > 0:10:20going on in this country.
0:10:20 > 0:10:23I mean, we hear four decades, but seeing these really makes
0:10:23 > 0:10:28it more tangible.
0:10:28 > 0:10:31The Soviets' withdrawal in 1989 was the start of a ten
0:10:31 > 0:10:34year-long civil war.
0:10:34 > 0:10:38This led to the rise of the Taliban, who continue their bloody insurgency
0:10:38 > 0:10:46to this day, funded by a booming opium trade.
0:10:46 > 0:10:522017 saw a bumper opium poppy crop in Afghanistan.
0:10:52 > 0:10:55Perhaps as a form of self medication for the trauma of war,
0:10:55 > 0:10:58many Afghans use opium.
0:10:58 > 0:11:01An estimated 10% of the population is now addicted to the opium
0:11:02 > 0:11:08poppy derivative, heroin.
0:11:08 > 0:11:11Some of these addicts end up here, at the country's only
0:11:11 > 0:11:15secure psychiatric unit.
0:11:15 > 0:11:20It's home to about 250 men and 50 women, many of whom are suffering
0:11:20 > 0:11:26from drug induced schizophrenia and psychosis.
0:11:26 > 0:11:30Mohammed Essar is a former member of the Taliban.
0:11:30 > 0:11:37Mohammed Davood is a former member of the Mujahideen.
0:11:37 > 0:11:40Both men were drug addicts and suffer from PTSD and were sent
0:11:40 > 0:11:43here by their families.
0:12:19 > 0:12:24Without a resident psychiatrist, the unit relies on outside help.
0:12:24 > 0:12:29Dr Saljoochi is the visiting psychiatrist.
0:12:42 > 0:12:45The most dangerous patient, Alli, is kept isolated from everyone else
0:12:45 > 0:12:48after biting off a staff member's finger and the ear
0:12:48 > 0:12:52of a fellow patient.
0:13:29 > 0:13:32Many patients' families have left for neighbouring countries
0:13:32 > 0:13:37because of war and cannot be contacted.
0:13:50 > 0:13:54Jaffar is here because of depression and schizophrenia.
0:13:54 > 0:13:58This led to an out of control drug habit and later to violence.
0:13:58 > 0:14:01He was sent here by his parents.
0:14:35 > 0:14:39Like so many other patients here, Jaffar is well enough to go home,
0:14:39 > 0:14:41but he's not sure when he can leave.
0:14:44 > 0:14:48Through a locked metal gate is the female section.
0:14:48 > 0:14:54About 50 women live here, some with their children.
0:15:40 > 0:15:45Some have been here for years and look likely to stay.
0:15:49 > 0:15:52A couple of days later, I've come back to the psychiatric
0:15:52 > 0:15:56unit because I've heard some news about Jaffar.
0:16:08 > 0:16:16After three years at the psychiatric unit, Jaffar really is going home.
0:16:56 > 0:16:58Jaffar's dad has made the 800km journey from Kabul
0:16:58 > 0:17:03to collect his son.
0:18:22 > 0:18:26Back at Herat's main hospital, Azata, the 14-year-old we met
0:18:26 > 0:18:29earlier who was diagnosed with PTSD, is back to see Dr Noorzad
0:18:29 > 0:18:35for her first follow-up appointment.
0:19:04 > 0:19:06For Azata, the long journey to recovery is just beginning
0:19:07 > 0:19:18and she's lucky to have her family's support.
0:19:21 > 0:19:24For Farad, the volunteer counsellor who we met working with Dr Noorzad,
0:19:24 > 0:19:29recovery from his PTSD seems a long way away.
0:19:39 > 0:19:44The trauma that took his brother away is still too recent and raw.
0:20:36 > 0:20:38Farad's recovery is being aided by the treatment and friendship
0:20:38 > 0:20:42of Dr Noorzad.
0:20:42 > 0:20:45At the local football stadium, we've all come to watch
0:20:45 > 0:20:47a game together.
0:20:56 > 0:20:59Seeing these players run around today, it's easy to forget this
0:20:59 > 0:21:02stadium's dark past - an execution ground during the reign
0:21:02 > 0:21:04of the Taliban.
0:22:33 > 0:22:36Seeing the scale of the problem, it's hard to imagine how
0:22:36 > 0:22:42and when the country will heal, but there is hope.
0:22:42 > 0:22:46The effects of recent decades of war on people's mental health
0:22:46 > 0:22:49is being recognised and some help given, and it's clear that many
0:22:49 > 0:22:51Afghans are determined that they and their country
0:22:51 > 0:22:58will overcome the trauma of war.