Canadian Women for Women in is a volunteer not-for-profit organization founded in 1996 with over ten chapters across Canada. The goals are to advance education and educational opportunities for Afghan women and their families; and to increase the understanding of Canadians about human rights in Afghanistan. Women & Mental Health in Afghanistan

Afghanistan has been at war since 1978. health. All of the women interviewed by PHR Lagging Progress: Mental Health Policy Generations have now been born during the indicated that they had become unemployed Post-2001 conflict, and have never known peacetime. due to Taliban policies” … “women attributed Mental health is a notable area of weakness The impact of war on a population’s the anxiety and depression that affects the in health policy and practice post-Taliban. mental health is pervasive, long lasting, vast majority of them to their fear of limited Mental health services are almost non- inter-generational and often devastating to opportunities for their children, specifically existent and there is little domestic capacity families and communities. The experiences denial of education to girl children.” – to prevent or treat mental illness. The of witnessing violence, losing loved ones, Physicians for Human Rights, 1998 Afghan Ministry of Public Health lists sustaining war injuries, becoming a refugee mental health as a priority in health policy or internally displaced person, serving as Quick Stats: to 2015; however, it does not clearly state a fighter, or being separated from family Mental Health inAfghanistan the measures it will take to reach its hoped- members inevitably have mental health • During the Taliban period, 81% for outcomes. impacts. Anxiety disorders, post-traumatic of women in one study reported a stress disorder (PTSD), and depression decline in their mental condition The Afghan Government are particularly common among Afghans. • 42% of the study participants “met introduced a Health and Nutrition The country’s social fabric has been deeply the diagnostic criteria for PTSD” Sector (HNS) Strategy in 2008. strained by conflict, impacting many • 86% demonstrated “significant The strategy for mental health aspects of daily life, from domestic violence symptoms of anxiety” to employability and economic hardship. (Strategy 3.6) outlines the However, surviving adversity also leads to • 97% reported “major depression” following: HNS will work with the practices of resilience and endurance, and • 21% reported having suicidal social and other sectors to develop a thus Afghans are also survivors as much as thoughts “extremely often” or “quite flexible range of integrated mental they are victims. often” [Source: The Taliban’s War on health support and care services Women: A Health & Human Rights The mujahideen-led civil war years and Crisis, Physicians for Human Rights, at all levels of the . then the Taliban government of 1996- 1998] Particular attention will be given to 2001 ushered in a regressive era of revived • In 2002, the prevalence of symptoms post-traumatic counselling through conservative attitudes towards women and of depression in Afghanistan was 73% the training of more community their work outside the home. The Taliban • The prevalence of anxiety was 84% mental health care workers and banned women from working altogether, for women and 58% for men psychologists and their placement with only a few exceptions negotiated by • The prevalence of post-traumatic in accessible community health humanitarian organizations such as UN facilities. Habitat who employed women to make stress disorder was 48% for women and 32% for men [Source: Center for bread and pasta during a food shortage Disease Control and Prevention 2002 In Afghanistan, mental illness is often crisis in the late 1990s in Mazar-i-sharif. National Population-based Mental misunderstood and stigmatized, as it is “the general climate of cruelty, abuse, and Health Survey of Afghanistan.] in most societies, making it even more tyranny that characterizes Taliban rule has had • In 2010, the Afghan Government difficult for people living with mental a profound affect on women’s mental health” announced its estimate that at least illness to access treatment and support. … “The denial of education also contributes 66% of the population suffered from Self-medicating amidst an unregulated to Afghan women’s deteriorating mental psychological problems. pharmaceuticals industry has led to high

website: www.cw4wafghan.ca P.O.Box 86016, Calgary, AB T2T 6B7 • Tel: 1 403 244-5625 • email: [email protected] rates of addiction to anti-anxiety drugs such more than 800 inpatients suffering from education at medical universities in as benzodiazepines, as well as illegal drugs drug addiction, mainly heroin and opium Afghanistan” (IMC website). like opium and heroin. Afghanistan has the addiction (IMC, 2011). The hospital, long dubious distinction of being possibly the notorious for its dilapidated and unhygienic “Easy access to cheap drugs, and limited only country in the world where the suicide state, has only 60 beds; while experts say access to drug treatment, combined with rate is higher among women than among at least a 300-bed facility is needed. It was three decades of war-related trauma, have men. also criticized in a 2010 assessment by the resulted in problem drug-use among IMC for not providing follow-up treatment almost one million Afghans. … At twice “an estimated 2,300 women or girls were post-discharge and for the high relapse rates the global average this…is debilitating, not attempting suicide annually - mainly due to of addicts and mental health patients. only for those affected, but also for their mental illness, domestic violence and/or socio- families, communities, and the country as a economic hardship (2010). This is a several- In 2010, over 6,400 patients were admitted whole.” - United Nations Office on Drugs fold increase on three decades ago” - Faizullah to the hospital and 21,000 patient and Crime 2009 Survey, ‘Drug Use in Kakar, former Deputy Health Minister to consultations took place (of which nearly Afghanistan’ President Hamid Karzai (IRIN, 2010) half were treated for depression and 5,000 treated for psychosis), which remains the Today, a small group of non-governmental Introducing: The Six Elements only mental health hospital in the country, organizations provide mental health services of the Basic Package of Health despite announcements by the Minister of to Afghan women; however, the few Services Public Health back in 2006 that 30-bed services that do exist are largely confined to 1. Maternal & Newborn Health: mental health hospitals would be opened urban areas. For example, a CW4WAfghan Antenatal Care, Delivery Care, in every region of the country, in addition partner organization, medica Afghanistan, Postpartum Care, Family Planning to 20-bed hospitals in every province, and provides professional psychological and Newborn Care. 10-bed clinics in every district. As of early counseling services to women and girls 2. Child Health and Immunization: 2011, the Ministry of Public Health had no affected by war and violence, among Extended program on immunization plans in place to construct a new hospital other services that help women regain services, integrated management of in ; however, in 2010, the European their independence and quality of life. childhood illnesses. Commission moved ahead with plans to Another CW4WAfghan partner, PARSA 3. Public Nutrition: Prevention, design a program to support the existing (Physiotherapy and Rehabilitation Support assessment and treatment of hospital and to build the capacity of the for Afghanistan) has worked for many . 128 hospital personnel. The program will years to assist war victims, with a focus 4. Communicable Disease Treatment be implemented by the international NGO, on women. Currently, PARSA provides and Control: Control of TB, Malaria International Medical Corps. counseling services to a women’s mental and HIV/AIDS. health facility in Kabul and children with 5. Mental health: Mental Health …“tertiary care facilities like the 60-bed mental health issues. education and awareness, case mental health Hospital and 40-bed Jangalak detection and identification and treatment of mental illness. detox center, which are mandated to accept “In some areas of the country, people with 6. Disability: Disability awareness, patients from across Afghanistan, lack the mental illnesses are taken to shrines where prevention, education, assessment and resources, space, qualified personnel and they are chained for days in an attempt referrals. internal systems to provide appropriate, to cure their sickness.” - Zarghona Salehi, [Source: The Ministry of Public Health humane care for patients.” – International Pajhwok Afghan News (Nov. 23, 2010) (MOPH), Basic Package of Health Medical Corps in Afghanistan, February Services, 2005] 23, 2011 The first mental health program founded by an NGO was launched by the International The Ministry of Mental Health currently Medical Corps, when it operated several Existing Mental Health Services in operates a mental health training program clinics in the Shomali plans region of Afghanistan with funding from the European Union Afghanistan, offering counseling and other Afghanistan reportedly has only 42 and Caritas, with plans to expand it to services to local people there. In the western psychologists and psychiatrists in the four hospitals in the northern region of province of Herat, the International entire country. In the capital, the Ministry the country in 2011. In Afghanistan, Assistance Mission manages a mental health for Public Health manages the Kabul there is no dedicated university faculty to hospital, which was founded in response to Psychiatric Hospital, founded around 1985, train mental health personnel; however, the particularly high rate of suicide among which also includes inpatient services for International Medical Corps announced in women by self-immolation in the western men and women, and a drug treatment February 2011 its plans to work with the part of the country. The Dutch-based centre called the Jangalak Substance Ministries of Higher Education and Public NGO, Health Net International, offers a Misuse Centre. In 2009, this centre saw Health “to improve advanced psychiatric

website: www.cw4wafghan.ca P.O.Box 86016, Calgary, AB T2T 6B7 • Tel: 1 403 244-5625 • email: [email protected] mental health program that is integrated within the existing health framework to help reduce stigmatism of mental health issues. Health Net works alongside the Ministry of Public Health to ensure proper implementation of reforms. One of the organization’s programs “aims at local capacity building and is being implemented in cooperation with the Ministry of Health in Jalalabad, covering several districts of Nangahar. It provides training materials in Pashto for doctors, nurses/midwives and community volunteers and in clinics, where there are trained personnel; essential mental health drugs are supplied” (Jeanne Bryer, BAAG, 2004:22).

Moving Forward: Healthy Minds, Healthy Communities The prevalence of mental illness in Afghanistan demands a serious, concerted effort at coordinated assistance for all men, women and children suffering from PTSD, anxiety, depression and other conditions. Yet, mental health remains one of the most neglected aspects of health policy and practice in the country, and among the international donor community. Building peace, reducing poverty, and supporting Afghans to rebuild their lives after war cannot happen without both healthy minds and healthy bodies.

website: www.cw4wafghan.ca P.O.Box 86016, Calgary, AB T2T 6B7 • Tel: 1 403 244-5625 • email: [email protected]