The many traumas of children of conflict on the India–Pakistan border

This reporting was supported by the Dart Center for Trauma and Journalism’s Global Early Childhood Reporting Fellowship..Late one night in 2020, a mortar shell struck a house in Balkote village, in the Indian union territory of Jammu and Kashmir. A seven-year-old girl living in the house suffered her first anxiety attack that night. When I met her family this year, the girl’s father, Mehraj Ahmad, told me that as they prepared to move to a nearby bunker, the child began howling and pleading for her life. “Since that night, she often wakes up in the middle of the night, shouting the same desperate plea – ‘Please save me, I don’t want to die.’”.Balkote, in the Uri sector of Baramulla district, lies less than two kilometres from the Line of Control, or LoC – the military frontier between India and Pakistan. In 2016, militants attacked a military base in Uri, killing 17 Indian soldiers. This led to a retaliatory attack on Pakistan’s territory by Indian forces, and an escalation of hostilities between the two countries. .Nearly three years had passed but the mortar strike on her house was still fresh in the girl’s mind when I met her in September. She suffered frequent panic attacks. “She won’t even play outside or in the lane during broad daylight,” Ahmad said. “She needs someone from the family to be constantly by her side. She can’t even interact with the other children in the neighbourhood.”.Ahmad’s daughter was dressed in a brown kameez and shalwar, her head wrapped in a matching scarf, and moved quietly as she served us tea and snacks. “She is an exceptionally sensitive child,” Ahmad said. As we prepared to leave, the girl pointed to a wall and said, “You see that wall with the deep hole? It’s not just damaged; a shell hit it.”.Farooq Ahmad, a Balkote resident, said that nearly every one of the 30 or so households in his vicinity had one or two children with behavioural problems. In his layman’s estimation, some 15 or 17 families had at least one child with severe symptoms of anxiety or depression due to a persistent fear of violence. .Himal’s in-depth, long-form reportage shows you Southasia like you’ve never seen it before. Become a Patron today to support our work!.Three decades have passed since 1989, when the armed insurgency began in Kashmir. It has since claimed tens of thousands of lives, including those of women and children. According to a report by the Jammu and Kashmir Coalition of Civil Society (JKCCS), a Srinagar-based rights group , at least 318 children were killed between 2003 and 2017. The report highlights that, on average, 26 children lost their lives each year during this period – victims of action by government forces, alleged militants, unidentified gunmen, unexploded shells, or crossborder shelling along the LoC..Children across Kashmir have grown up under a cloud of fear. Their primary lesson has become one of vigilance – learning to protect themselves if violence erupts nearby – which forces them into a perpetual state of alertness. Instead of engaging in the exploration and learning typical of childhood, they witness traumatic events: curfews, gunfights, stone-pelting, the loss of relatives, and constant reports of shelling and crossfire. These harrowing experiences leave emotional scars that often manifest themselves as symptoms of psychological distress during their formative years..Research shows that post-traumatic stress disorder (PTSD) is prevalent among children in the region, and that cases have only increased in the last two decades. The decades-long conflict between India and Pakistan has not only fuelled insurgency and political instability but has also forced children into conditions of chronic stress and anxiety – and often also physical distress such as malnutrition – compounding their hardships. Growing up in such an environment often leads to long-term developmental and psychological challenges that continue to affect them as they mature..“Trauma can hinder language and developmental progress, as their minds become preoccupied with survival rather than growth,” Zaid Ahmad Wani, a child psychiatrist at the Institute of Mental Health and Neurosciences in Srinagar, said. “Socially, these children may struggle with trust, empathy, and forming healthy relationships, often showing signs of aggression or withdrawal. This early trauma can lead to mental health issues such as anxiety, depression and PTSD, which may become lifelong challenges. In essence, violence robs children of their innocence and resilience, hindering their ability to thrive and reach their full potential.”.IN ANOTHER NARROW LANE in Balkote, on the September afternoon that I visited the village, Rafiya Akhter’s children played outside their two-room house. Rafiya, a mother of four daughters, was dressed in a phiran, the traditional Kashmiri knee-length robe, and a grey scarf that she fiddled with anxiously. “Do you see this hole in the window screen?” she asked. “It was caused by a bullet during one of the crossborder escalations last year.” Rafiya’s husband is a Jammu and Kashmir police officer and is frequently stationed away from home, adding to the family’s feeling of insecurity. .Rafiya’s third daughter was four years old. She had draped a pink scarf around her head and was singing while she played just outside the window. Like so many other children in the area, she first heard the sound of bullets in her infancy. Rafiya recalled one instance from August 2020 – a time during which crossborder ceasefire violations between India and Pakistan were at their highest. Rafiya remembered how it was pitch dark and the sounds of heavy shelling reverberated through the village. She also remembered how her daughter, who was only months old at the time, cried and sighed heavily and clung to her mother’s clothes. “It was a heart-wrenching sight – a tiny infant, seeking comfort in her mother’s presence as the world outside descended into turmoil,” Rafiya said. .Wani said that early exposure to violence profoundly disrupts a child’s social and cognitive development, imprinting trauma that shapes their formative years. Instability and fear experienced in childhood can impair the development of neural pathways, affecting essential cognitive skills such as learning, memory and problem-solving. “These young children may become overly clingy, revert to behaviours like thumb-sucking or bedwetting, and experience disrupted sleep, often haunted by nightmares,” he added. .The majority of mental health studies focussed on the Kashmir Valley were conducted over the last 15 years. They consistently report a high prevalence of traumatogenic experiences and associated symptoms of mental distress. In 2013, the researcher Javaid Iqbal Khan measured mental health outcomes in 390 urban households in four administrative regions of Srinagar. A third of his respondents reported physical violence against at least one member of the household in 2010–11 and almost two-thirds said they had experienced verbal violence. Khan showed that 46 percent of his sample reported anxiety and 32 percent reported depression during the same time period. .In 2015, a major population-based study by Médecins Sans Frontières, Kashmir University and the Institute of Mental Health and Neurosciences covering all ten districts of Indian-administered Kashmir found a strong correlation between exposure to multiple traumatogenic events and symptoms of major depressive disorder, generalised anxiety disorder and PTSD. “Only 0.3 percent of Kashmiri adults have not experienced a traumatic event during their lifetime,” the study said. “On average, an adult living in the Kashmir Valley has witnessed or experienced 7.7 traumatic events during their lifetime.” One stark finding was that 49 percent of those reporting traumatogenic events said they witnessed the violent death of someone they knew.Paksi.The findings among children are even more pronounced. A 2006 study of 100 children with PTSD at a psychiatric hospital in Srinagar detailed their physical complaints – headaches, stomachaches, breathlessness, palpitations, loss of appetite and insomnia – as well as episodes of loss of consciousness, irritability, decreased academic performance, speech disorders and more. The majority of children diagnosed with PTSD were between 11 and 15 years old, and their distress may have been detected in schools because of their deteriorating performance and behavioural changes. The study assessed that the children had all experienced at least one traumatic event, and 49 percent of them had witnessed the killing of a close relative. Others had witnessed the arrest or torture of someone they knew, or knew someone caught in a crossfire, or were physically assaulted themselves..Other studies show a high prevalence of paediatric PTSD in Kashmir. In general, children with PTSD have elevated levels of cortisol, dopamine and norepinephrine – all of which are detrimental to physical or mental health. They also show abnormalities in brain electrical activity and have poor attention spans, and are unable to perform abstract reasoning or executive functions well. .Najmun Riyaz, a psychiatrist who lives in New Jersey in the United States but is from Kashmir, runs a telepsychiatry facility called Zehen for people in the region. She said that violence stemming from political unrest or war often leads to collective trauma – a shared experience of profound emotional and psychological distress that impacts entire communities. In an email, she explained that this trauma reshapes social dynamics and relationships, often persisting through a long conflict or even after it has ended. .For children, their coping mechanisms in response to such collective trauma are deeply influenced by the nature of their environment, Riyaz said. With strong community support, some children may show resilience – but prolonged exposure to violence can also foster feelings of hopelessness and insecurity. Culture also impacts how children cope with trauma. For example, in cultures that emphasise stoicism – standing strong even in the face of conflict or adversity – children learn to suppress their feelings, which can then lead to internal struggles..Gauri Divan, a developmental paediatrician and the director of the child development group at Sangath, an Indian mental healthcare non-profit, said that young children often do not have the language to express the impact of “negative environments” in words. “They respond to conflict and violence in different ways,” she said. “For example, a child may begin bedwetting, they may become excessively clingy to their caregivers, lose their appetite, or demonstrate disruptive behaviours.”.SHAHEENA AKHTER LIVED a few doors down from Rafiya in Balkote. Shaheena had three daughters, aged ten, nine and seven, and a five-year-old son. She welcomed me, offered me water, and then excused herself. “Please speak with my daughters, I need to finish up on the farm,” she said. The three girls sat around their brother, who was having lunch – a simple meal of white rice, kidney beans and curd. While initially shy and reluctant to engage, the oldest told me about the family. “Our father was eager for a son, as was customary in our village,” she said. “We were all overjoyed when our brother was born. However, that joy quickly turned to sorrow when, just days after his birth, the border tensions escalated.” .The house was hit by a shell, jolting the structure and damaging the roof. The baby boy seemed to be numb for many days after the incident. The family had to flee to Uri, the nearest town, where they had relatives. Shaheena’s daughter described how her brother was not able to eat or sleep. The family sought help from faith healers, but to no avail. As the boy grew up, he developed a profound attachment to animals. He bonded with the family’s goat, cow and two calves. “Initially, his fear was all-consuming,” the girl said. “But over time, his concern shifted to his beloved animals. Whenever we had to seek shelter, whether nearby or in a bunker, he would resist leaving, constantly worrying about who would care for the goat, cow and calves.”.After one such episode, when the family had to shelter away from home and returned only a week later, the boy refused to attend school. He became somewhat of a recluse, his sole focus being his animals. “He doesn’t want to play or go to school,” his sister explained. “He follows the animals wherever they go. Even today, we had to search for him to make sure he had his lunch.” The boy ate his meal silently, not once taking his eyes off his plate..Wasim Kakroo, a clinical psychologist and a child and adolescent therapist at the Centre for Mental Health services at Srinagar, explained that “the risk factors for post-traumatic stress disorder among children include, but are not limited to, lower levels of education, reduced cognitive abilities, lack of social support, lower socioeconomic status, a family history of psychiatric disorders, exposure to multiple traumatic events, and the presence of neurotic or extroverted personality traits.”.Kakroo said the earlier “adverse childhood experiences” occur, the more profound their impact on children. These can often shape their mental health well into their formative years. “Young children lack the cognitive maturity to navigate difficult situations, and such trauma directly affects the emotional centres of the brain,” Kakroo explained..In 1989, governments around the world committed to the United Nations Convention on the Rights of the Child – an international agreement to protect children. On this basis, they made laws, policies and investments for children to get healthcare and nutrition, and created safeguards to protect them from violence and exploitation. India signed on to the convention in 1992, but the Indian government falls short of its resulting commitments..India currently has approximately 9000 psychiatrists, with about 700 new graduates entering the field each year. This results in a ratio of only 0.75 psychiatrists per 100,000 people, well below the recommended three per 100,000. In Jammu and Kashmir, the shortage is even more acute. According to India’s census in 2011 – the last time the exercise was conducted – Jammu and Kashmir, with a population of around 12.5 million, has only 41 psychiatrists, most of whom are based in teaching hospitals in the cities of Jammu and Srinagar. .Under the National Mental Health Programme, the District Mental Health Programme was initiated in several districts of Kashmir. Currently, there are 140 inpatient beds spread across 10 districts, with outpatient services provided by only 16 psychiatrists, 12 psychologists and a single social worker. Districts including Srinagar, Budgam, Pulwama, Anantnag and Baramulla have only five or six psychiatrists each. .Although doctor consultations are free, accessing hospitals is particularly challenging for residents in areas like Balkote, situated right on the LoC. For even basic healthcare, people must travel nearly 50 kilometres to reach the nearest town. This, combined with a lack of awareness on mental health, leads families to seek out less scientific solutions. Many families believe that children who display symptoms of mental illness are “possessed”, and so seek out spiritual healers for them..When Ahmad’s seven-year-old daughter was struggling with anxiety attacks, his wife consulted a faith healer. Despite his reservations, Ahmad, a retired army officer, agreed to this step under family pressure, but only on the condition that they would also seek professional medical advice. “I had to travel to the main town of Uri and then to the nearest district, Baramulla, to see a doctor,” he explained. “With the medication, her health improved to some extent. While her mother believes the faith healer worked miracles, I am aware of the true source of her improvement.” .Riyaz said that faith and spirituality could provide solace and resilience, helping individuals find meaning and hope in the face of adversity. Drawing parallels from different cultural contexts, she explained how creative and spiritual outlets can play a role in processing trauma. “In America, hip-hop serves as a medium for many African Americans to voice their trauma, which often facilitates healing. Similarly, in the Shia community, marsia – poetic lamentations – become a way to process collective grief and pain. In Kashmir, practices like wearing a tawiiz, or anklets inscribed with Quranic verses, can offer a sense of hope and act as a symbolic form of healing.” But she cautioned that it was essential to ensure children are neither manipulated nor mistreated in the name of faith-based practices..“In many Asian cultures, mental health awareness is limited, leading families to consult faith healers, who may sometimes exploit these situations,” Kakroo said. “Social workers can play a vital role in such communities by identifying cases in need of support, and connecting families to appropriate mental health resources.” He called this form of community outreach “psychological first aid”, where families and community leaders could be trained to give children early support. .“In communities like Kashmir, where faith healers have a mass following, psycho-education for faith healers is also valuable, helping them understand when cases require professional mental health care rather than spiritual intervention,” Kakroo added. “Collaboration between faith healers and mental health professionals could improve outcomes for children in communities with limited awareness, fostering a recovery partnership.”.“While resilience can develop in children as a response to stressors like conflict-linked violence, it is essential for communities and governments to implement mechanisms that safeguard children during these formative years,” Anant Bhan, a health researcher who has looked at how early exposure to violence impacts child development, said. He added that “special interventions that focus on mental health and psychosocial support, like the Psychosocial Care for Children in Conflict Areas, must be adapted to and evaluated within the local context to effectively address these urgent needs.”.Until such safeguards are put in place, children in Balkote and other hotspots of conflict in the region remain at risk. “We would have left this place long ago, but we have nowhere else to go,” Rafiya, the mother of four, said. “This small house and a patch of land are all we have.”