Trauma of terror violence taking a hidden toll on shell-shocked nation

Liaqat Ali is a victim of one of Pakistan’s worst bombings, but his injuries are not visible to the naked eye.

The 47-year-old government employee and part-time lab assistant was walking home through the grounds of a hospital in the north-west city of Peshawar in the autumn of 2009 when he stumbled upon the carnage left by the blast. Scores of bodies were packed into vehicles. Bleeding survivors with missing limbs and severe burns were scattered everywhere.

He has suffered from severe depression and anxiety ever since and is dependent on antidepressants to make it through the day.

Mr Ali’s plight has become increasingly common in Pakistan’s north-west – the main Taleban sanctuary in the country – where psychiatrists estimate millions are suffering post-traumatic stress disorder and other psychological illnesses after years of militant attacks, army offensives and US drone strikes.

“I think what we see is only the tip of the iceberg,” said Firaz Khan, a psychiatrist at the mental health ward at the government-run Lady Reading Hospital in the city of Peshawar, where most of the 40 to 50 patients who come in each day are suffering from violence-related trauma. “Most victims remain at home and are not getting help.”

Peshawar is located close to the border of Pakistan’s tribal region, the militant epicentre, and has been a major target for the Taleban since they started their insurgency in earnest in 2007.

Mr Ali’s nightmare began on 28 October, 2009, when militants detonated a car bomb in a market crowded with women and children. More than 100 people were killed.

“Some of them had lost arms, others legs. Some of them had burned faces,” said Mr Ali, becoming visibly disturbed during an interview at a private psychiatric clinic in Peshawar where he was being treated. “So many dead bodies were stuffed in a vehicle, as if they were not humans but slaughtered animals.”

Within days, Mr Ali was having trouble sleeping, experiencing flashbacks and intense fear.

These kinds of experiences have tripled the number of patients seeking help from psychiatrist Mian Iftikhar Hussain since he opened his private clinic in Peshawar in 2004. He now sees over 60 patients each day and cannot handle anymore.

While there are no official figures, Mr Hussain and another psychiatrist with a clinic in Peshawar, Wajid Ali Akhunzada, estimate that up to 60 per cent of the more than 20 million people who live in Pakistan’s north-west could be suffering from violence-related psychological issues.

Only five to 10 per cent of patients treated have PTSD, but almost all of them suffer from some combination of depression, anxiety and lack of sleep caused by the violence around them.

Use of antidepressants and anti-anxiety medication in Peshawar has more than doubled in the past few years, said Riaz Hussain, president of a wholesale drug association in the city.

“Previously these medications were mainly used by Afghan refugees,” he said.

The number of psychiatrists and psychologists in Pakistan is far short of the level needed to handle the current crisis. There are about 600 in Pakistan for a population of 190 million.