Mental health in Afghanistan

Summary of published letter

Following the events of September 11th all international aid workers of both local and INGO's were evacuated from Afghanistan. As a result, the task of bringing food aid into Afghanistan fell to Afghan aid workers. During the course of this work Afghan workers faced many dangers and attacks, resulting in enormous emotional stress. In a recent letter to the Lancet there were reports of Afghan workers talking about trauma and the difficulty of doing their work due to flashbacks, intrusive thoughts, nondirected anger, depression and fear of the future. Many of the men had been beaten, imprisoned or tortured and found it difficult to keep anger and other emotions out of their family life. Female staff had also been harassed and beaten. Debriefing, as a process of helping aid or disaster relief workers cope with the emotional stress of their work, is standard procedure in the western world. However, an informal survey of NGOs working with refugees in Pakistan and in Afghanistan showed that only a few agencies were addressing staff mental health needs.

The author of the letter works for an NGO called 'Cooperation for Humanitarian assistance' (CHA) which has initiated a mental health programme for its staff working in Afghanistan. The programme initially started with a workshop in March 2001. Follow up was provided by an American Counsellor who assisted staff and trained a mental health team. The counselling method taught, called 'focusing' is closely linked to Sufi tradition and can be easily linked to Islamic models. It was chosen because it allows deep work on psychological issues to be done without breaching ethical dilemmas of trust and disclosure. Since the programme was initiated staff in CHA have reported that levels of tension and anger at work have decreased. 'Focusing' has also helped staff cope and feel hopeful for the future despite the worry and uncertainty of their situation. The programme has proved particularly relevant given the Afghan experiences in the aftermath of September 11th.

The author of the letter stresses that aid agencies must address the mental health needs of their staff in situations like Afghanistan where mental health problems may develop.

Omidian.P (2001) Aid Workers in Afghanistan: Health Consequences. The Lancet, vol 358, November 3rd, pp 1545.