GANDERBAL, India – The sun has just come out on a grey wintery afternoon and the snow-clad peaks of Harmukh are shining in the distance, casting sharp reflections over the horizon.
When some rays fall on Rahila’s* face, sitting on the verandah of her home, she turns around and giggles. “It is too bright!”
Winter in Kashmir can get quite harsh: heavy snowfall and sub-zero temperature block the sunlight from reaching the surface. For many, winter brings back memories of snowmen, while for others it is to bear the presence of a grey backdrop, which has become a keynote to much hidden suffering.
A wintery night for Rahila, 14, is a reminder of an event that robbed her of her father. In 2017, two masked men came to their house on the pretext of meeting her father, a former counter-insurgent commander in the state-sponsored Ikhwan militia, notorious for grave and widespread human rights violations. The masked men took her father into a room and shot him dead.
“That night still feels to me as if it happened last night,” recalls Rahila. “I lost my father forever but we are stuck with that night.”
Distress and trauma of loss define the bare lives of young girls like Rahila who cling to their grim memories shaped by the ongoing armed conflict in Kashmir.
The region of Kashmir has been an active site of political turmoil for the past three decades since the outbreak of an armed insurgency against the Indian rule, which responded with a heavy hand and used the counterinsurgents to contain the threat. Hundreds of thousands died in the conflict, leaving the local population traumatised. Outbreak of the COVID-19 pandemic and an unprecedented lockdown further worsened the mental health situation.
The families of former counter-insurgents, especially women and young girls, had to bear disproportionate burdens of the household and remain confined to home, which rendered them vulnerable to further isolation, anxiety, grief, and a shattered livelihood. While the media spotlight on counter-insurgents has long faded, hundreds of families live in abject agony – both mental and financial. Stigmatised by society, they are expected to express feelings of blame, shame, and worthlessness, leading to their social exclusion.
United by grief, trauma
Children experiencing direct trauma are at an elevated risk of many psychiatric disorders, according to research published by the British Medical Journal. It notes that depression, post-traumatic stress disorder (PTSD), conduct problems, substance abuse, self-harm, and suicidal thoughts or attempts are some of the common mental health problems that children struggle with.
In Rahila’s case, her father’s death was for her (and her family) a traumatic event, the gory scenes of it etched in her mind like oil on canvas. Since the incident, she has been complaining of violent outbursts and sleep apnea, an abnormal breathing pattern. Her father was among 300 former counterinsurgents who have been killed in retaliatory attacks by militants.
“I don’t want my mother to suffer further because of me,” she says. “We have no expectation of help or support from anyone. I’m afraid people will make fun of us and our life if they come to know about our personal struggles.”
Conditions of prolonged conflict in Kashmir have put widows and orphans under severe psychological pressure. Among those who suffer silently are families of former counterinsurgents, roughly numbering 800, whose plight worsened during the pandemic in absence of any psycho-social and financial support.
Shazia*, 25, was away at her grandmother’s home to study in 2007 when armed men in masks ambushed the vehicle in which her parents were travelling. While her father, a former counterinsurgent, was killed, her mother survived the injuries.
“Narrating this is the biggest struggle of all,” she says. “The memory is as fresh as yesterday.”
Shazia left her studies halfway and stayed home. Since the incident, she feels numb whenever anyone talks about her father. She is yet to cope with the tragedy.
“I feel like I have lost control of my life,” says Shazia. “It is a feeling of helplessness. I don’t think anyone would ever understand this struggle.”
Both Rahila and Shazia have weathered many storms on an individual level. Yet, they are united by their experiences of trauma and grief.
Women with mental illnesses are at a particular disadvantage, a 1993 World Health Organization report observes. It says that both patients and their families experience social isolation and stigma that increases their vulnerability in society.
For many families in Kashmir, mental health concerns are best addressed via the route of spirituality. After her traumatic experience, Rahila took recourse to shrines and local faith healers, a practice that enjoys widespread sociocultural and religious acceptability in the Kashmiri society. Rahila’s mother wears amulets locally known as taweez, performs rituals like niyaaz or khatam-i shareef, and chants verses of the Quran as exercises in healing.
Institutional stigma
Apart from mental illness facing a persistent social taboo in Kashmir, services of mental health have been confined mostly within mental health institutions and decentralisation at community level is still limited in the region, experts say.
“The institutional stigma of not fully integrating mental health into general health services is the biggest barrier in providing community-based support,” says Mujtaba Hussain, a child rights lawyer at Child Guidance and Well-being Centre, Institute of Mental Health and Neurosciences (IMHANS), in Kashmir.
Minorities and stigmatised communities facing mental disorders such as depression and anxiety are often ignored in India while institutional programs and financing are not sufficient at the grassroots level.
Even the universalisation of mental health is a problem, according to mental health advocates, that could further lead to discrimination, bias, and continuation of taboos.
“There is an urgent need to accommodate local contexts, especially sociocultural factors, to engage with local communities,” Hussain says.
For professionals like Hussain, who work within institutions, there is a scarcity of resources in extending their services and humanising mental health in the society.
“The institutional framework of mental health services should be made accessible, reachable and acceptable to bridge the rural-urban divide for patients seeking medical help. To do that, the outlook needs to be changed first,” he says.
But without local counselling options geared towards the community, most of the women have tried to bury their painful memories as best they could over the years – only for the memories to come back to haunt them.
India’s ban on NGOs
A government ban on foreign donations has badly affected the developmental work in Kashmir where the number of orphaned children and widows is huge, says A. R. Hanjura, who runs a non-profit organisation, Islamic Relief and Research Trust.
“Our work at the grassroots level has been imperilled by the ban,” he says. “The restrictions have put vulnerable communities at greater risk especially during the pandemic,” he says.
Since assuming power in 2014, the ruling Bharatiya Janata Party (BJP) has been waging a war of sorts against non-governmental organisations and social activists, particularly those working among rural poor and the marginalised. The government has accused the NGOs of misusing foreign funds by carrying out “anti-national” activities and religious conversions. Under the Foreign Contribution (Regulation) Act, 2010, registrations of 6, 677 NGOs were cancelled between 2017 and 2021.
“We are helpless,” says Hanjura, who had signed a memorandum of understanding (MoU) with a few international aid organisations. “We are not able to expand our reach apart from local contributions and charity. Our various health programs and educational outreach campaigns have stopped due to the ban.”
Low budgetary allocation
In 1982, a National Mental Health Programme (NMHP) was launched by the Government of India to cater to mental illnesses in the country. In 1996, the District Mental Health Program (DMHP) was started to decentralise mental health services by integrating them in the general healthcare delivery system and to provide mental health service at community level.
In 2017, the Mental Healthcare Act was passed, replacing the Mental Health Act 1987. The new law aims to acknowledge and safeguard the agency and rights of the citizens with mental illnesses.
Yet India faced an unprecedented (mental) health crisis during the Coronavirus pandemic and subsequent lockdowns. The principal cause of such major lapses are reflected in the Union Budget 2023-24, which sends a grim signal of how the country would continue to struggle in need of adequate health facilities and an under-resourced public health system.
The numbers say it all. The total budget outlay for the health sector in India for 2022-23 stood at INR 86,200 crore, two per cent of the fiscal outlay. The budget estimate for mental health is 0.7 percent. The National Mental Health Programme has received an allocation of INR 40 crores, which means 30 paises spending on each Indian citizen for mental health.
‘Suffering alone’
In Kashmir, counselling services are either unavailable or are not preferred, according to a 2020 study published by the Indian Journal of Psychological Medicine. The research suggests an urgent need for training community health workers and general physicians in addressing mental health concerns of the local population, which has been caught in decades of political violence.
But for Rahila’s family, seeking counselling means exposing their ‘deep traumas,’ something that scares them.
“Everyone here needs mental health counselling, not just us,” says Hasan*, Rahila’s elder brother. “But where are such services available in places like ours?”
Rahila says it is not easy to come out of the shadows without an empathetic support system. “We have learned to live with this truth,” she says. “We will have to carry our suffering alone.”