During
the last 3-4 weeks, an estimated 317 people have received pellet gun injuries
in the Kashmir unrest, with half of them being shot in their eyes. The two sixteen bedded ophthalmology wards in
the SMHS Hospital Srinagar had to cope with around ten times the patients they
have capacity for. The use of pellet
shotguns was first introduced in Kashmir in 2010. During the 2010 unrest and subsequent years,
hundreds of people received pellet injuries with eyes being a common target.
The
eye being a very delicate balloon shaped organ, the pellet not only perforates
but ricochets inside the eyeball causing severe damage to the cornea, lens,
vitreous, and retina, destroying the whole eye from within. Although classified as a nonlethal weapon by
the police, the medical fraternity, especially the ophthalmologists, have
unequivocally agreed that the pellet guns are very lethal blinding most people
for life. Even after multiple surgeries, the prognosis remains grim, with
majority becoming totally blind.
The
local ophthalmologists are able to perform emergency surgeries trying to
salvage the eyeball with whatever facilities they have, but the hospitals are
not equipped to deal with the type of injury the pellets cause to the inner
structures of the eye. Concerns have
been raised that treatment of pellet eye injury is not available locally, with
the state being complacent; the victims are not referred to the appropriate
centres outside for unknown reasons. The
valley even lacks an eye bank. Most of
the pellet victims come from a poor background and cannot afford to travel
outside of the state for specialised treatment. Hence if some have chances to
regain eyesight with appropriate treatment, they become blind because of the negligence
of authorities. There is a sense that any whistleblowing would not be tolerated
by the authorities for political reasons.
There
is hardly any research when it comes to the treatment of eye pellet injuries
and long term prognosis in the local context.
A study published in 2012, reported 198 patients with pellet gun
injuries attending Sheri-Kashmir Institute of Medical Sciences (SKIMS-MC)
between the months of June and September 2010. Another study published in 2012,
included 60 patients seen at the ophthalmology department SMHS Hospital for
various eye injuries between June and September 2010. The study concluded that
the prognosis for pellet gun eye injuries was bad. A study published in 2014, which looked
retrospectively at the pellet gun eye cases from 2010 cohort, suggests that
visual prognosis remains bad despite adequate treatment at the time of actual
injury. Half of the cases were blind with visual acuity of less than 3/60.
Western
literature suggests that people who lose their eyesight late in life are worse
off emotionally that those who are blind from birth. Even people losing their eyesight
due to medical reasons are highly likely to develop depression and other
psychological problems. This is thought
due to the fear of unknown, fluctuating ability to see and rather being on an
emotional roller coaster. Losing vision
is akin to a grief reaction where the loss is mourned by the person. More than
30% of people who develop blindness due to medical reasons develop depressive
symptoms.
In
comparison to medical conditions, people who lose their eyesight due to a traumatic
injury inflicted on them, like the pellet guns, are highly likely to develop
severe psychological problems. This is due to the trauma they experience and
their final memory of seeing the world shattered by a pellet. The visual loss
also happens within seconds of the injury, giving the individual little time to
get used to the change in comparison to the loss of vision due to medical
reasons. Suddenly young people find themselves blind, maimed and in pain facing
a very bleak future. The uncertainty around recovery, multiple surgeries,
inadequate treatment and subsequent poor prognosis further worsens the
emotional health.
Such
victims of the brutal blinding violence are likely to develop post traumatic
stress disorder, depression and other anxiety disorders. The sudden loss of functional life, almost
negligible prospectus of future and inadequate support systems, in the long run,
makes their situation more miserable. The victims get some attention in the
immediate aftermath from doctors, their families and society. But in the long run, they are forgotten and
left to grieve on their own. They often become hostages in their own heads. Sadly this is followed by stigma from their
families and friends.
Apart
from a lack of proper treatment in the acute aftermath, there are no support
systems to help them to adjust to the change.
They not only need physical rehabilitation but also psychological
rehabilitation and training so that they are able to adjust to the catastrophic
change which has overpowered them without any warning. Unfortunately, no such facilities exist in
Kashmir valley. The local doctors, psychiatrists and civil society need to
support the victims even after the acute phase is over, or else they may curse
themselves wishing it is better to lose life than light. Counselling and
rehabilitation services need to be established in all hospitals to help such
victims cope with the loss of vision, life skills training and treatment of
psychological problems.
The
hospitals would need to be funded properly and appropriate infrastructure
developed to deal with such injuries in future. For now, the state has a
responsibility to fund their treatment in appropriate centres across India or
even abroad if needed. Finally, the use
of such lethal weapons needs to be stopped immediately as no amount of justification
makes them nonlethal.
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