Children of Conflict: Millions of Kashmiri Children Growing Up in a Perpetual Siege

LIVING in a conflict zone often confuses one’s existence. The perpetual state of war alters human behaviour, beliefs, and emotions. Growing up in the valley of Kashmir with never ending uncertainties, fear, and insecurity has a deep disturbing effect on the psyche of the local population especially children.

The lockdown in Kashmir has entered its fourth month now with children being the worst victims. About 1.5 million children are cooped up in their homes with parents playing the role of teachers and guards. Rounding up of underage children by the state makes the situation unprecedented. Reportedly, scores of minors have been detained without any legal recourse. With no schools, curfew, and volatile situation, it is not hard to imagine how they cope. No education and no play cannot make any child content with their existence.

Happy childhood is a key to a happy life. There is enough evidence that negative childhood experiences are key to many mental health issues in adulthood. Children look for constant stimulation and activity for engagement, otherwise, they get bored which can lead from minor behavioural problems to severe mood changes. With no schools, the forced holidays have become a burden.

Parents trying to keep children safe often restrict their movement. Children lose the freedom to play, explore and learn from natural surroundings. This is akin to be born in prison where you are caged in a scary basement completely deprived of outdoor play. They cannot even watch their favourite videos and programmes due to continued internet blockade. After being born is conflict, growing up in siege, they live under constant reminder of abnormality without any reasonable explanation as to why they cannot attend school, play or even socialise.

Children have also become victims of state politics to showcase normalcy. Recently the government tried to force them to attend schools and attend examinations. One could argue that their safety and wellbeing is put under risk to score brownies merely by forcing the local population to surrender and humiliation. With mass arrests of people, it is clear that children again bear the burden of not seeing their parents, and are constantly reminded of living in a society which is under collective punishment.

How would a tender fragile mind deal with such severity? Having a role model sans ambiguity in a child’s life is a key to development of the kid as a confident adult with self-esteem. Even a minor parental discord or conflict can ruin a child’s life forever. Now imagine a tender population with lack of direction, clarity, multiple connotations, ongoing reminders of trauma, and unnatural normalcy.

The suffering of children does not stop here. When one is born in such circumstances and grows up in such abnormal surroundings with reminders of pain, barbed wires and locked schools, without any semblance of what normal childhood looks life, the trauma becomes generational. How does generations cope and what becomes of them can ever be underestimated?  There have been numerous research studies and reports, documenting the scale of psychological trauma the population has experienced over the years. The current generation is virtually born in the shadow of the gun and continues to experience the conflict daily.

There is no family in the valley which has remained unaffected. The number of killed is reportedly more than one hundred thousand, many more orphaned, enforced disappearances in thousands, most men and youth having been subjected to some kind of torture, beatings, bullying, and the list goes on. Anyone who makes out of jail will give you a heart-wrenching account of torture from being beaten-up black and blue, paraded naked, cuts, electric shocks, sexual abuse to third-degree torture being used with impunity. Humiliation and denigration go hand in hand in the process.

Psychological issues are bound to creep up with children showing signs of distress- like irritability, behavioural changes, aggression, self-harm, suicidality, and predilection towards illicit drug use. It is hard to fathom how to help them unless the psychological and physical siege is addressed for good. With hardly any access to relaxation, entertainment, and means of education, such problems are bound to become deep-rooted.

There is no access to child counselling or for that matter mental health first aid when required. With a complete ban on internet access and wobbly phone connectivity, professionals willing to intervene are themselves helpless. The dismantling of civil society and voluntary organisations with no local governance catapults the melancholy of these children. I shiver thinking about the children living in hundreds of orphanages across the erstwhile state. The silence of world powers and people who could drive an impactful, sustainable change in the lives of these children, is equally baffling.

https://caravandaily.com/children-of-conflict-millions-of-kashmiri-children-growing-up-in-a-perpetual-siege/?fbclid=IwAR0WvbaQ8Y1N6a8nPOWNQpJGCpCeLReD69BpQc_K-0L7WyOBg2gKVASTrEE

Kashmir- Mental Health Crisis

The lockdown in Kashmir is nearing four months now since the complete annexation and demotion of the Jammu and Kashmir state on 5th August 2019. The entire population is under a physical and mental siege, official and unofficial curfew, with no public transport. There are numerous reports of intensifying health crisis with people finding it hard to reach hospitals more so in emergencies. The entire population remained without any phone connectivity for more than 2 months with people not able to reach their loved ones in and outside the state. Internet access remains suspended. Because of the uncertainty, and not able to know about the wellbeing of old, unwell, and frail, the entire population has been plunged into an anxious state of being. Moreover, the political situation has created a state of despondency, hopelessness, and a sense of grief. There does not seem to be any agency or person to whom people can turn for help or support.

There have been numerous reports in international and local media about the physical health crisis due to the ongoing war-like situation, including deaths of pregnant women, cancer patients, and mostly the undocumented deaths of those not able to reach for help.

When it comes to the mental health of the besieged Kashmiri population and Kashmiris living in India and other countries, it can be summed up as a collective trauma and punishment. A recent review in the Lancet suggests that 1 in 5 people living in conflict zones suffer from mental health problems including depression, anxiety, and Post Traumatic Stress Disorder.

It is known that conflicts involving killings, disappearances, rape, torture, collective punishment, arrests and lack of access to optimum healthcare are fertile grounds for both physical and psychological morbidity and mortality. With 8 million people put under such conditions, it is not hard to fathom the hidden epidemic of mental health problems which the local population is suffering and dealing with in utter silence. Overall, it is very hard to predict the scale of the adverse psychological impact of the lockdown and associated political connotations.

Kashmir was already known for the high prevalence of mental health problems including depression, anxiety, and other stress-related disorders due to the ongoing conflict situation from many decades. One in ten has lost an immediate family member and one third has lost someone in the extended family. These figures are from a decade ago and with the current unprecedented situation when around 8 million people are being put under lockdown, one can argue that entire Kashmiri populace is experiencing some kind of psychological trauma and distress. This is worsened by the mass arrests and alleged torture which is reportedly being broadcasted on loudspeakers in some places. Thousands have been put behind bars, including minors with no legal recourse. This is a perfect breeding ground for the development of many mental disorders.

Not only Kashmiris living in the valley but those living outside India and other countries are equally suffering due to the uncertainty of the situation. A survey revealed that more than 90% of Kashmiri diaspora showing symptoms of anxiety and depression in the first month following the lockdown with predominant symptoms of acute stress, insomnia, and impending doom due to inability in contacting their loved ones.

Children are the most vulnerable group of the population who have been deprived of schools, play, and any sense of normalcy, which is essential for optimal child development. It is a known fact that childhood adversity plays a major role in the development of many psychiatric problems in later life.

A secure, stable and memorable childhood is a key to productive adulthood, to be able to lead a normal life, have families and function as a responsible member of society. With millions of children being brought up in utter confusion, siege, and uncertainty about the safety of their families, is likely to produce a generation of traumatised people like in any war zone. A sense of security is important for children growing up, but if adults are not safe themselves, how can they make sure that children grow up confident and secure. This is likely to lead children to develop behavioural problems, insomnia, irritability, poor academic performance, just to name a few.

There were some reports of a dearth of psychotropic medications but more importantly, it has been the hesitation to seek help or attend consultations with doctors which has made many to relapse in their symptoms. The attendance in the hospitals had sharply declined more so in the first two months and only desperate families would somehow try to bring their patients to the hospital when not able to manage at home. Many vulnerable psychotic patients who usually don’t seek help and roam freely on the streets have been put under risk and some have been admitted to hospital. At times they have been shot dead in the past for wandering in prohibited areas. There are also reports that people with dependence issues are relapsing due to non-availability of drugs or access to treatment. Overall, the silent epidemic of trauma has become a part of daily living in Kashmir.

One wonders how things can change for better unless the political situation improves, and there is some respite for people. Lest the basic human rights are respected and people feel safe, no amount of medication or counselling even if it was available would help. Repeated exposure to trauma, no sense of belonging, and total helplessness do not let patients recover in the best possible settings. To help recover from this psychological trauma and prevent further harm, there is a need for immediate action both politically and on the ground to address basic human rights, recourse to legal help, re-joining families, letting minors go home and finally resolution of the dispute. Doctors and therapists can only then be able to treat people.

The question remains, is anyone listening?

https://www.ha-asia.com/in-kashmir-the-situation-is-triggering-a-new-wave-of-mental-health-issues/?fbclid=IwAR2QEgTLbuEQHwTBbnjBN6ydwCbdCsb5WGPtLazlKtvxlL9gFvXisRO2kog

Kashmir- The curious case of Indian Collective Conscience

Kashmir has been cut off from the rest of the world for more than two months now, with little certainty about what is coming next.  Kashmiris living in and outside the erstwhile state of Jammu and Kashmir remain disconnected with hardly any means to communicate with each other. Just a few days ago some mobile connectivity was restored.  Terrible stories of loss, grief, and mourning are making rounds on social media, few news outlets, and mostly within the minds of Kashmiris.  The days of siege have become another statistic with most losing count.  People are hearing about the deaths and ill-health of their loved ones with little detail or ability to make it to the funeral or the bedside.  No one is talking out about the children stuck in homes, shut schools, and not to mention those beaten, tortured, and incarcerated.  People with chronic and acute diseases are dying undocumented with only God to blame.  The collective punishment of Kashmiris is working.

The perpetual worry about that ‘phone call’ has traumatized so many.  One fears that people are developing traumatic stress even when not physically present in the valley.  Even when people do manage a phone call after begging or borrowing, the harrowing silence on the other side says it all.  Although most people talk about everything being well, the deafening silence you hear even when words are being spoken is unmissable.  How does a nation reconcile and sleep at night with this travesty in their name?  Here a billion or more souls if not always celebrating, are content with what is being done to millions of other human beings in an alleged part of the same country in their name.  Who shares the blame if something wrong is happening?  The home minister of India declared that ‘It is all in your mind’ and everything is ‘normal’ in Kashmir.  You may refuse to agree with him but most of the Indians, educated, illiterate, liberal, religious, atheists, left-wing, right-wing, rich, poor, men, and women are convinced that Kashmiris need disciplining and that this is for their best.  How does one argue with that?

Most Indians are ordinary, hardworking, friendly people, who claim to love animals and would not harm a fly.  How do they reconcile with what their state is doing to fellow human beings?  Indian friends, the close ones, like others, decided to remain silent.  They would not even ask if the family was alright and did we manage to get in touch.  They will bleed for you in case of an accidental injury to you and will remain by your bedside till recovery.  But what is happening here then?  What kind of morality has been created?  Would sympathizing with Kashmiris mean a betrayal of their own country?  What about the claim of belonging to the same country?  Please feel free to ponder. Something has happened.  Somewhere the fear of the other has been used so convincingly that it has managed to break all the bonds, be it of friendship or simply of being human.  After all, India claims to be the propagator of vegetarianism, desperately trying to save cows even if that means ignoring the lynching of fellow citizens while practising ahimsa and non-violence.

Lately, the concept of the ‘nation first’ is doing rounds.  Nothing can be said or written against ‘the nation’. But what makes the nation; the current ruling party and the Prime Minister, the land, or the idea of a map in one’s head?  Or it is the religion of the majority, the conquest of minorities or something else. What about the people who live in that besieged piece of land?  Do they also make the nation?  Maim, punish, and kill people to save the nation from some unknown force.  Does the nation need saving or a self-fulfilling prophecy of destroying the nation is in action?  Treating Kashmiris as an extension of the neighbouring country and punishing them collectively to revenge generational hate for the neighbour only proves Kashmir is not part of the ‘alleged nation’ on whose name all this is being done.

History is a witness that nationhood was used by most tyrants, convincing the majority using fear, prosperity, and superiority as tools to rise to power.  Once in power, unimaginable things were done in the name of the nation, building on the fear of minorities and weaker sections.  Although none of the fascists remained to live their dreams and were victims of their own cruelty, but in the process the death and destruction they managed to offer humankind is unimaginable.  Once they are done with one group, they do have to go after others.  You cannot fathom that a fire set in a neighbour’s backyard will not spread to burn the whole village.  It has already started, people are even being booked for writing open letters, and students are being thrown out of colleges just for some minor criticism of the dear Prime Minister.

The generational trauma, displacement, and human suffering change the course of history both for good and bad.  What is then the solution, dignity in living or living with dignity?  It does not take long to realize that putting others through pain and suffering does not make any nation happy.  You may think that whatever is happening has nothing to do with you, but everything done in your name is your burden.  More so, instead of thinking and questioning, blindly condoning the state action seals the deal.  Some argue that if Kashmiris did not create trouble, in other words, aspire for freedom and demand a referendum as per the promises made to them by all the parties involved, Jammu & Kashmir will still have been a statehood the least. Blaming victims is not a new strategy.  Like Kashmiris have a choice to decide.  They are still to make to the table allegedly meant to decide on their fate. Who does not desire freedom?

Lastly, it is not late to question yourself, if not the state.  Are you sure you know what is being done in your name?  Are you the nation or the next victim of the nation?  If you are the nation, then own it and live with the consequences.  Democracy cannot be imposed, neither can freedom.  Everyone knows it is not about development, freedom of women or education of youth.  Neither is it about terrorism as mostly purported to slander Kashmiris.  There is still time to question the alleged truth unless you have decided to be the hangman in a mask.

https://countercurrents.org/2019/10/kashmir-the-curious-case-of-indian-collective-conscience?fbclid=IwAR1nUEhD6tI51FfbZZMqFbkdzZQSQv1Z2i4U_gFj-4TSjfLYDZUpyaPCwp4

We shall talk

https://mudasirfirdosi.wordpress.com/2019/09/14/we-shall-talk/

Doctors, Veterinarians & Psychiatrists Of India – First Do No Harm

The situation in Kashmir is no mystery these days when it comes to the international media, organisations of repute, and academics.  Kashmir is ‘normal’ when it comes to the Indian government and Indian media houses.  For Kashmiris who live in a total information blackout, day to day survival is the only thing which matters.  Being a psychiatrist who has trained and worked in Kashmir, I cannot stop thinking about the mental anguish, fear and uncertainty which the entire population is facing.  Not able to get through to loved ones locally or from outside the state, just makes the agony worse. I had numerous calls from people around the world, strong men and women, breaking down in tears, experiencing panic attacks and some deciding to go back into the unknown, just to be with the family, no matter what the consequences.  After all, is it not better to share the tears and pain than face the numbness on your own.

With all the major news outlets around the world talking about lack of access to healthcare, baby food and essential medicines, many reputed journals like the Lancet and the British Medical Journal (BMJ) wrote editorials urging and cautioning about the worsening of health of besieged population. Not only the physical health but the ongoing mental trauma people experience made worse by virtually living in an open prison with total information blockade.  As a doctor, I was relieved like many other likeminded professionals who understand the need for professional organisations to raise their voice and at times question politicians, when it comes to the health, safety and wellbeing of people.  Then came the time to face reality, that not all doctors who work under strict professional and moral code, no matter in which country they practice, writing scathing criticism of the Lancet and how dare it take a view on the ongoing suffering of millions of people.  The reality started hitting when in some of the WhatsApp groups; doctors started signing petitions and even planned on trolling the Lancet journal on social media, arguing that it will prevent others from following the Lancet.  The minute I questioned them, asking don’t you need to look at the evidence, the reports of looming health disaster, shortages of medication, the result was not different. National interest comes first; the mood of the nation comes first, no matter if eight million people are caged in their homes not having access to basic amenities necessary to sustain life.

Then came the open letters from Indian Medical Association (IMA), various other doctors organisations and even the Indian Veterinary Association (IVA), not only criticising the Lancet, but at the same time showing complete disregard for human beings and health concerns with total and complete lack of empathy. It would be hard to argue if this is in context of the totalitarian state policies which is taking root in India, racism, communalism or just mob mentality. After all I have trained, worked, debated, and argued with same clinicians for years now and we have always been humans and friends at the end. Did I question myself? Yes, I did. I went back into history, terrified how doctors in Nazi Germany assisted the state in most inhumane experiments and interventions using the same arguments of national interest as my current colleagues from India or Indian origin seem to put forth.   Looking at the letters they wrote to the Lancet journal, one does not have to be an academic or a professional to see that apart from jargon of interfering into the internal matters of a country, there is almost no scientific argument which could put the Lancet’s editorial concerns on the wrong side. 

If this was not enough, a news article published in the daily newspaper The Hindu published on the 22^nd August 2019, wherein the current President of the Indian Psychiatric Society (IPS) was planning to protest against the Lancet editorial at the International Conference of World Psychiatric Association in Lisbon. Not only that, he also claimed that IPS has thirty members from Kashmir and the Lancet should have contacted them first, arguing there are hardly any mental health issues and if there are they are due to the inference of a neighbouring country, a favourite of the current political disposition to dismiss any idea about welfare of Kashmiris.  He also questions why the Lancet didn’t publish something when as per him; there was a publication about mental health issues published in 2006. The official letter issued by the President of IPS looks like a dossier from ministry of external affairs talking about Pakistan, terrorism and Osama Bin Laden. In no way does it come across as a letter drafted by a professional body representing highly educated psychiatrists of a country. There is no evidence based argument, no references to any scientific research whatsoever which could have proved the Lancet wrong. The letter talks about coming generations of Indians especially doctors and students carrying an unpleasant memory. What about millions caged at gun point and children staying home trying to avoid the barbed wires?

As a Kashmiri psychiatrist who happens to be a member of IPS as well, I would like to know did IPS at any point try to contact their registered members in Kashmir or did they just splash their names on the letter used to criticise the Lancet. How does a national organisation representing almost all psychiatrists in the country makes videos, issues political statements and politicise about Pakistan, but at no point thinks of questioning the politicians about policies which are putting the physical and mental wellbeing of millions of people at risk. One does not have to be a scientist to understand that putting an entire population in siege, arresting their children, cutting off their all communication links will scar them psychologically forever, more so when the exposure to trauma is more than 70%. One out of ten people have lost a loved one directly to the current conflict and one out of three has lost someone in their extended families.  There are hundreds of publications in peer reviewed journals from local Kashmiri psychiatrists, orthopaedics, surgeons, sociologists, and other specialities talking about the mental and physical morbidity as a direct result of on-going war like situation in Kashmir. This will only get worse and no matter what professional jingoism will say, the reality of mental scarring is real.

Lastly, the members of any organisation have every right to question the decisions made by their representatives, may it be a country or a professional body.  Would the politically minded office bearers of IMA and IPS clarify if they had consulted their members before making sweepings statements, made fun of the scientific premise they claim to follow, shown utter contempt of their terms of reference and more importantly denigrated the pain and suffering of millions of people than becoming their voice. I am sure if there was a responsible body in the country, all these doctors would lose their licences to practice due to probity issues and not adhering to the code of conduct which no doctor should forget. Will the members of IPS ask their president to resign remains to be seen? When the siege is over, I am sure the Kashmiri psychiatrists will have a story to tell and many more scientific papers to write on the very trauma inflicted on them and their loved ones.

‘Dear Indian Psychiatry Society.... Psychiatry has come a long way from just using chains... !’ , wrote a friend to me who happens to be an Indian psychiatrist as well.