Psychological health: impact of Kashmir conflict

It was a cold January 6th morning in 1993, we were about to start the regular workday, and suddenly a deep gloom fell over the entire Sopore town. Indian Border Security Forces (BSF) massacred more than 60 innocent humans in Sopore in Indian occupied Jammu and Kashmir (IOK) after an unknown person allegedly snatched a rifle from a soldier. People who took shelter inside the shops were burnt alive. An ill-fated bus en-route to Bandipora was indiscriminately fired upon and later set on fire with 21 passengers burnt to death.

Like Sopore massacre, IOK has witnessed many such chilling mass killings at the hands of Indian Army, which include: Gawkadal massacre, Kananposhpora mass rape, Handwara massacre, Khanyar massacre, Bijbehara massacre, Zakura and Tengpora massacre, Hawal massacre, Kupwara massacre, etc. Every Kashmiri has been directly exposed to at least one such massacre. It is estimated that over a hundred thousand lives have been lost since 1989. Besides physical injuries and huge economic losses, the mental health issues that this violence has wrought is immeasurable. Psychological trauma is one of the direct consequences of this conflict and direct relationship has been established between Kashmir conflict and increased prevalence of posttraumatic stress disorder (PTSD), depression, anxiety, and behavioral and psychosomatic complaints among Kashmiris. American Psychiatric Association characterises PTSD by persistent intense fear, over-arousal and hypervigilance, helplessness, intrusive thoughts, images and nightmares, avoidance of stimuli associated with trauma, detachment and general numbing of general responsiveness, and consequent impaired functioning (American Psychiatric Association, 1994).

Post-traumatic stress disorder (PTSD) survey performed in 2006 across all the districts of Kashmir revealed an alarming lifetime PTSD rate of 15.19%, which is much higher than the average global PTSD rate seen in populations subjected to overt trauma (Margoob et al, K-Practitioner2006;13(Suppl1)). Furthermore, the magnitude of the violence can be comprehended by the fact that the PTSD rate of 15.19% is very close to the PTSD values reported in populations subjected to terror attacks. The high PTSD rate was patently attributed to the long running Kashmir dispute with young people representing the vulnerable section and are more likely to get exposed to the traumatic incidents. In the same study, the PTSD rates were found comparable between Kashmiri male and female populations which is in sharp contrast to the findings reported from Western countries where PTSD rates were found in 2:1 ratio between female versus male populations, further validating the mass traumatization of the entire population. The male and female populations witnessing firing or explosions were 82.4% and 79.68%, respectively. Predisposing trauma factors for PTSD such as physical assaults (being shot, stabbed, threatened and severe beating) were reported by 53.97% males and 32.42% females. The situation is compounded by the multiple traumas of assaultive nature to which entire population has been subjected to for more than 3 decades.

In another study, a quantitative population survey was performed by Médecins Sans Frontières (MSF) in 30 villages of IOK with the objective to assess the frequency and nature of violence faced by the population living in IOK and evaluate its impact on psychological health and socio-economic functioning. The direct confrontation with violence rank ordered as exposure to crossfire (85.7%)> round up raids (82.7%)> witnessing of torture (66.9%)>rape (13.3%)> self-experience of forced labour (33.7%)> arrests/kidnapping (16.9%)> torture (12.9%)> sexual violence (11.6%).

Torture during detention was reported by a high percentage of people proving violence is used as a systematic and strategic tool against civilians, which has had a significant impact on the mental and physical health of individuals (de Jong et al, Conflict and Health 2008, 2:11). Number of confrontations with violence were significantly higher for males than females for events such as witnessing persons being arrested, maltreated, tortured, or wounded, or hearing about and witnessing a rape. One-third of the population was reported to be suffering from psychological distress and contemplating suicide owing to the exposure to high levels of violence and feeling of insecurity. The factors precipitating psychological distress were violation of modesty, helplessness due to witnessing of killing and torture, forced displacement and physical disability resulting from the violence.

The above studies were performed prior to 2008 and since then IOK has seen an alarming rise in violence. Major violent episodes took place in 2008 and 2016 when hundreds of protestors were killed by the Indian paramilitary forces. More recently, on 5th August 2019, after the Indian Government unilaterally and illegally revoked the article 370 of the Indian constitution that granted special autonomous status to the IOK, the valley has been under curfew ever since with all the modes of communication including internet, cell phones and land lines suspended. More than 13000 boys as young as 8 years old have been imprisoned and widespread torture and mass blinding has been reported. Considering the chronic exposure to trauma, it is argued that the adaptive mechanisms both at individual and community level are bound to fail as recovery from PTSD is primarily dependent on the trauma severity and environmental conditions post trauma. With population constantly exposed to the extreme forms of violence and solution to the conflict not in sight, the PTSD rate is likely to have significantly increased from a 15.19% value reported in 2006.

The author is a Research and Development Consultant