Dying day by day

Taking stock of mental and social health in Kashmir.

Body counts and missing person reports reveal one side of the human toll from Kashmir's insurgency, but they are unable to tell us much about the mental state of the living. How does one assess the mental and social health of Kashmiris, and by what measure do we calculate the accumulated damage on the mind of 13 years of conflict? Data collected from Srinagar hospitals and social surveys conducted by scholars and students in the state of Jammu and Kashmir are beginning to provide a partial answer to this pressing question. What they reveal is a highly traumatised population beleaguered by the effects of daily violence and social dislocation. Even if all violence in the state were to stop tomorrow, the psychological and social damage would continue to be felt for years to come. But the fact is that this political conflict is not likely to be tidily resolved in the foreseeable future, and the battle between the up to 700,000 troops stationed in the state and the 3500-odd insurgents (the figure presented by New Delhi) is expected to continue. Meanwhile, a continuously rising tide of depression, troubled families, delayed marriages and suicides is swamping the state.

Missing persons, disturbed survivors

Official statistics say 13,184 people have gone missing in Kashmir since 1990, most of whom state officials say have joined militant outfits, a claim disputed by many families. Out of this total, 135 (about one percent) have been declared dead by the government. Most families that are missing members have, despite repeated efforts, failed to find satisfactory explanations for the disappearances. In 1994, a group of these relatives formed the Association of Parents of Disappeared Persons (APDP). They have since visited security officials, police stations, politicians, courts and prisons throughout India with photographs of sons, brothers, fathers and husbands, trying to settle the uncertainty surrounding the disappearances. As of June this year, the State Human Rights Commission had received 1726 complaints concerning disappearances, out of which 811 have been 'processed', leaving 915 pending.

"There is a method in these disappearances", says Parvez Imroz, an APDP member. "The law enforcement agencies arrest people during raids, routine patrolling, search operations. When the relatives approach the security officials, they usually receive assurances that their relatives will be released shortly. That never happens. After a few visits the relatives are told that the people they are looking for were not even arrested. The local police almost never file a first-information-report against the security forces". The disappearance of thousands of young men has had a measurable economic impact since it is usually the earning member of the family who goes missing, leaving behind 'half-widows', women who for all practical purposes have lost their husbands, and children, who are sooner rather than later deserted by in-laws. But more corrosive still is the psychological impact on broken families – constant agony and transgenerational trauma. Over time, these develop into mental disorders, says Amit Basu, a psychiatrist who is helping APDP set up trauma centres throughout J&K.

Records from the out-patient department of Srinagar's Hospital for Psychiatric Diseases show that in the 1980s about 100 people were reporting for treatment in a week; today, between 200 and 300 people arrive every day. Most self-admitting patients are women aged 16 to 25. Because of the social stigma associated with psychological disorders, doctors believe that no more than 10 percent of those in need of psychiatric care are actually approaching the hospital.

One outcome of this under-treated trauma is an increase in teenage girl suicides. One 19-year-old girl, Jameela, witnessed her aunt being hit by a stray bullet while working in the kitchen garden, and later also witnessed a shootout in her locality. With no history of psychiatric problems, she began suffering from post-traumatic stress disorders: recurrent, intrusive and distressing recollection of the events, marked irritability, outbursts of anger, difficulty in concentrating, sleeplessness, sadness, and disinterest in all social, domestic and college activities. Following a minor altercation with her sister, she consumed pesticide and ended her life.

Depression and suicidal tendencies also affect male and female grown-ups. On an average day, two to three cases of attempted suicide are admitted into Srinagar's two main hospitals, known simply as SMHS and SKIMS. A large number of people, mostly from the villages, do not even make it to the city hospitals – they die on the way or in local health centres. For a hospital that rarely had to address psychiatric problems till before the troubles, in 1998 SMHS registered 167 suicide deaths – 92 women and 75 men. In 1999, the total was 208 – 144 women and 64 men. Between April 2000 and March 2001, altogether 567 suicides – 377 women and 190 men – were registered by the hospital.

Researchers attribute this dramatic rise to the fear, tension and uncertainty prevailing in J&K. Suicides among newly married men are also on the rise because of impotency, which doctors attribute to mental trauma from shock. Poverty and unemployment, other outcomes of the violence, are also causes of depression and suicide. These desperate measures, however, are not taken by only the local civilians; Indian troops stationed in Kashmir over a period of several years have also been similarly affected. According to published data, over 400 armed forces personnel have committed suicide in Kashmir since the insurgency began in 1989. Significantly, their reasons for committing suicide are not very different from those of civilians – fear of death, mental stress, but also homesickness. Srinagar's psychiatric hospital also receives a large number of patients from the paramilitary services.

Families without fathers

In the last 13 years, the political unrest in Jammu and Kashmir is thought to have produced about 18,000 widows and 40,000 orphans in the state. This growing population of indigents has become one of the biggest challenges facing Kashmiri society, and yet it is an escalating tragedy that has not received due attention. Widows are not typically acceptable brides, as Kashmiri society places a taboo on remarriage unlike Muslim societies in many other parts of the world. About 80 percent of widows are aged 25 to 32 with children below the age of 10. Even when remarriage is possible, many women prefer to remain single out of apprehensions for their children's welfare. A University of Kashmir study showed that 91 percent of widows surveyed had not considered remarriage.

Aisha, from Budgam, became a widow at 22 when her militant husband was killed in 1990. She has resisted pressure from her in-laws and parents to remarry, and has declined an offer from a brother-in-law. "If I remarry, my children would be ill-treated", she says. "I would then have another responsibility and my children's lives would be ruined. The objective of my life is to give them better education so that they do not get a feeling that they are orphans. Being a widow is my fate and I do not want to seal the fate of my children".

The University of Kashmir study revealed that widows face three sets of problems. The first difficulties surface soon after the death of their partners, in the forms of emotional stress, denial of inheritance rights, sexual harassment and general social undesirability. The second wave of difficulties arises gradually, as loss of control over the children, and a growing sense of inferiority. Finally, the widows are burdened by the long-term and growing demands of house care and the assignment of menial responsibilities. Altogether, the women find their position thoroughly compromised.

The Kashmir clergy claim to play no role in the taboo on widow remarriage, as Islam clearly encourages Muslims to remarry, and men are specifically encouraged to marry widows. In fact, polygamy in Islam is intended to provide sustenance and social security to widows through remarriage. In Kashmir, however, Islam has been greatly influenced by Hinduism and Buddhism, which may go to explain why widow remarriage is uncommon here. Widows of insurgents or the 'half-widows' of surrendered insurgents are the least desirable of all, as they are directly associated with violence through their husbands.

There are a few young men, however, who are willing to challenge the mores of Kashmiri society and marry widows. Riyaz Ahmad Khan, barely 20 years old, married the widow of his maternal uncle, a released insurgent who was killed by unknown assailants. She is more than 10 years his senior, but he feels proud of having married a widow and he hopes to create art example for others to follow so that more widows are given a respectable place in society. He challenges separatist political leaders, who pay much lip service to the sufferings of the people of the Kashmir valley, to come forward and marry their children to the widows of the conflict.

Brides without grooms.

The society has so transformed over the last decade that even finding a life partner in Kashmir has become a struggle. The 'marriage market' has undergone fundamental changes that damage the prospects of both sexes, but women in particular. "The market, especially for girls, is down", explains marriage broker Ghulam Muhammad Bhat. "Now even school teachers are getting matches whereas they used to have a difficult time. Parents are willing to marry off their daughters to anybody who is an earning hand". In spite of this, Bhat has a long list of girls who have been waiting for matches for many years. Young men have become extremely selective about prospective partners in these economically trying times. They want working women to help support the family, and not just any working woman will do. This explains why Bhat's list does not shrink even though the girls on it are mostly highly educated; they work in private schools for meagre salaries while most men want to marry government schoolteachers who have a good and assured salary and also the time after school hours to take care of the children

In Kashmir, women traditionally married in their early 20s but now many remain unmarried simply because there are not enough men available. Professor Bashir Ahmad Dabla, head of the sociology department at the University of Kashmir, says the number of eligible boys has dropped considerably as a direct result of the disquiet in the state. Hundreds have been killed, debilitated, arrested or permanently displaced. A colleague of Dabla's, Shabir Ahmad, says the increasing emphasis on higher education has lessened the number of young marriages. In the case of professionals, choice is often restricted to those in a related field, which prolongs a search. "It is ironic that instead of being a relieving factor, education becomes a positive hindrance to marriage", he says. "There is an inverse relationship between education and timely marriages". The prolonged turmoil has also intensified class divisions in the Kashmir valley. Most parents do not have the money to marry off their daughters, and even earning men often balk at the prospect of marriage.

As marriages get increasingly delayed, and young people try to cope with the increased stress in their lives, the impact is being felt by the next generation. There has been a rise recently in congenital disorders, particularly Down's Syndrome, which has a known association with the age of the mother at childbirth. Further, there has also been an increase in recurrent abortions and gynaecological complications. 'Multi Dimensional Problems of Women in Kashmir', a study sponsored by the Indian Planning Commission, suggests that late marriages, which is an increasing reality in Kashmir, affect the general health of couples and their children.

Joblessness and underemployment continue to destabilise Kashmir, as each additional year of violence further undermines economic and social stability. Nearly 100,000 graduates in the state are unemployed. It does not portend well for the future that owing to the conflict many times that number have never seen the inside of a school room. Tourism, a former staple of the Kashmiri economy, has predictably collapsed with the rise of militancy in the state as a result of the ongoing conflict. Social indicators suggest that with continuing violence the human toll, imperfectly measured in delayed marriages, unfulfilled marriages, mental disorders and suicides, will only grow with the coming generation. For the sake of the living, there need to be fewer deaths.

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Himal Southasian