By Michael Kugelman October 17, 2019
Last week, the U.S.-led war in Afghanistan marked its 18-year anniversary. U.S. forces have now been fighting there for nearly two decades.
Afghans, however, have experienced conflict for twice as long. Before U.S. troops arrived in October 2001, there was a period of Taliban rule, and that was preceded by civil war. And before that, in the 1980s, there was the Soviet occupation.
Afghanistan has suffered through so much violence for so many years—and yet today, the bloodshed is intensifying. Over the last few years, amid an ever-strengthening Taliban insurgency, Afghan casualties—both security forces and civilians—have soared to record-breaking levels.
This relentless violence has taken a devastating toll on human lives in Afghanistan. What we hear about a lot less is the psychological toll on the Afghan populace.
An alarming essay by a young Afghan, Sohrab Azad, published last month for Foreign Policy, paints a heartbreaking portrait of Afghanistan’s multifaceted mental health crisis: 85 percent of the population says that it is suffering. More than 2 million Afghans have depressive or anxiety disorders. Three thousand Afghans attempt suicide every year. And yet the country only has one psychiatric hospital.
An October 9 World Bank blog post offers more troubling data:
According to the 2018 Afghanistan National Mental Health Survey, over 66 percent of Afghans have personally experienced at least one traumatic event. More than 77 percent have witnessed at least one such event, and 84 percent have either personally suffered or witnessed a traumatic event. Though public health figures indicate that over half of Afghanistan’s population suffers psychological distress, the country counts only around 300 psychiatrists.
In effect, according to these figures, 23 million Afghans (in a country of 35 million) have directly experienced trauma, and about 18 million experience psychological distress. And yet there are only 300 psychiatrists, which equates to one psychiatrist for every 117,000 people in Afghanistan.
Psychological trauma, of course, is common in conflict zones everywhere. One doesn’t need to be a physical victim of violence to be scarred by it. At the height of the drone war in Pakistan, there were reports of residents of the tribal areas becoming terrified by the mere sound of drones in the distance—an ominous and foreboding buzz or hum.
But what stands out about Afghanistan is an immense demand-supply imbalance. There are so many people psychologically scarred, but there is so little professional help for them.
“Afghans need help to heal. The country’s people have proved that they are survivors. But even under peace, their nightmares will not fade without proper care. Only then will the country be able to flourish.”
The good news is that several academic institutions in Afghanistan are stepping up efforts to groom future psychiatrists and others qualified to help their fellow Afghans tackle mental health challenges. But this will amount to a mere drop in the bucket; we’re talking here about a huge and complex problem—because of the scale, to be sure, but also because it is such a sensitive and even stigmatized subject in Afghanistan.
Here in Washington, and beyond, the focus on the war in Afghanistan tends to revolve around the Taliban’s growing strength, the efforts of the Afghan National Security Forces and their U.S. partners to rein in the insurgency, the escalating levels of violence, and a peace and reconciliation process that largely remains elusive despite a series of hopeful but ultimately false starts.
Lost in the shuffle are the many millions of traumatized Afghans forced to be the silent bystanders to an unending U.S. war and to nearly 40 years of violence and conflict. If, as is quite likely, American forces begin withdrawing from Afghanistan in the coming months, raising the risk of even more violence, then a traumatized population will become even more so. And most of them wouldn’t get the support and care they so badly need.
In an era of donor fatigue, and at a moment when the future of the U.S. presence in Afghanistan is uncertain, this may be an inopportune time to make a pitch for stepped-up funding to a nation already deeply dependent on international support. But given the scale of Afghanistan’s mental health crisis and the lack of capacity and resources to properly address it, the international community clearly has a role to play.
As Azad writes: “Afghans need help to heal. The country’s people have proved that they are survivors. But even under peace, their nightmares will not fade without proper care. Only then will the country be able to flourish.”
One can’t overstate the importance of continued international support for education, infrastructure, and counterterrorism initiatives—efforts that can go a long way toward contributing to eventual stability and development in Afghanistan. And yet, the country will struggle to move forward in meaningful ways so long as much of its population remains so traumatized.
Follow Michael Kugelman, deputy director of the Asia Program and senior associate for South Asia, on Twitter @MichaelKugelman.
The views expressed are the author’s alone, and do not represent the views of the U.S. Government or the Wilson Center. Copyright 2019, Asia Program. All rights reserved.
The article appeared in the WIlson Center’s newsletter on 15 October 2019