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