You are on page 1of 2

Dire need for child and adolescent psychiatrists in Afghanistan

GUL G. MANALAI 21 May 2011


About the author
Ms. Gul Manalai, M.D., is an Afghan pediatrician currently residing in the United States. She can be
reached at gmanalai@yahoo.com

The number of psychiatrists currently working in the country can be counted on one hand, and
psychology and psychotherapy are so underdeveloped as to be virtually non-existent. The situation
for the mental health problems of children and adolescents is even worse.
Afghanistan, a country victimized by civil war for decades, is in dire need of re-building and
rehabilitation. Decades of war and conflict in the country have ruined all aspects of the nation's
infrastructure, including healthcare facilities. Afghanistan is among the poorest countries in the
region in terms of human suffering, lack of basic necessities, access to basic health care and
sanitation.

The people of Afghanistan are constantly struggling to live under conditions of insecurity, inadequate
health care, lack of education and other public services, as well as gender inequalities. While
malnutrition, preventable infectious diseases and maternity complications destroy many thousands
of lives, ongoing war inside the country, unexploded mines and continuous violence put another
burden on the exhausted shoulders of the nation.

In such conditions, mental health and especially children's and adolescents' mental health has
received little if any attention in the country. According to WHO estimates, about 20-30% of the
population is suffering from mental disorders; moreover, about 30-40% of Afghans are facing
psychological problems which interfere with their daily routines and could lead to serious disorders in
the future. However, due to people’s cultural beliefs, having a mental disorder is a big stigma, and
neither patients nor their families tend to seek medical help for such afflictions. It is widely accepted
in Afghan communities that mental disorders are not medical problems; rather, they stem from the
penetration of bad creatures (Jennies) into the bodies of individuals.

As a result, people with mental disorders are subject to a wide range of human right violations. They
are outcast from society and do not receive the care they need. In many parts of Afghanistan,
mentally ill patients are put in chains and are brought to particular shrines with no proper clothing
and sanitation. It is also believed that keeping these patients hungry will improve their condition and
they are exposed to prolonged starvation as well. Beating the patients is another ‘treatment’ in such
places in order to indirectly ‘banish the bad spirits (Jennies) from the patient’s body'.
There are few mental health facilities in the entire country and these facilities are facing problems
with human resources, medication and required equipment. The number of psychiatrists currently
working in the country can be counted on one hand, and psychology and psychotherapy are so
underdeveloped as to be virtually non-existent.

The situation for children and adolescent’s mental health problems is even worse. As one out of five
children in Afghanistan does not see his/her fifth birthday due to malnutrition, respiratory disorders,
diarrhoea and related complications, infectious diseases including tuberculosis, and many other
preventable diseases, mental illnesses and the needs of mental health patients are completely
neglected. Children are exposed to numerous physical and psychological human rights violations.
They are deployed in manual work and involved in strenuous physical activities; they are also the only
breadwinners in most families. Verbal and physical abuse is very common. Many girls are mothers
and caretakers for the entire family by the time they turn 15; thus, they are subject to conflict-prone
large family systems. Many children have witnessed violent scenes of loss of lives and mutilations (i.e.
military conflicts, tribal/religious animosities, landmines, etc.). All these factors collectively put the
children in danger of developing mental disorders. A large number of children suffer from
Posttraumatic Stress Disorder (PTSD), with no help in sight.

In spite of such distressful living conditions for the children, child psychiatry has received virtually no
attention in Afghanistan. In cases when mental illnesses are being diagnosed by pediatricians, there
are no mental health facilities available to refer children to; most commonly, inadequate and
sometimes inappropriate treatment is embarked on by pediatricians without any proper
psychological evaluation being carried out.

For any individual, physical, social and mental health are vital for their overall well-being. Mental
health is as crucial for healthy living as physical health and is required for a purposeful, productive
life. Developing mental health infrastructure and nurturing psychiatrists and psychologists are
essential and should receive proper attention. Child psychiatry should be developed in Afghanistan as
children are building blocks of strong and powerful nations.

You might also like