Psychosocial trauma caused due to conflict or terrorism has deep seated impact on human psychology. It has been widely ignored as compared to material losses that are easily quantifiable. The impact of Post-Traumatic Stress Disorder (PTSD) particularly, on the youth hailing from terror-affected areas in the tribal belt and Swat of Pakistan is significant. Terrorism is a part of a well-designed strategy of psychological warfare. It makes the youth mentally weak, disorganized, intolerant, and frustrated. Policy-makers need to realize such detrimental PTSD effects since a depressive youth population would be unproductive as well as a drag on sustainable peace and growth of the country. Countering the psychological effect of PTSD is imperative to ensure success.
Former Federally Administered Tribal Areas (FATA) and Swat youth have been suffering from severe-to-moderate symptoms of psychosocial trauma in the form of PTSD during the conflict and post-conflict phases. A varied array of PTSD symptoms are observed in individual’s behaviour experiencing anxiety, distrust, depression, hopelessness, nervousness, lack of concentration in thinking-and-learning process. If the PTSD is not healed timely, it may cause prolonged mental disorder, reducing the most-productive young human lot into a liability for the state. The severity of PTSD may last for a considerable time or may retrigger itself after an interval. It creates physical-mental complexities during the crucial phase of natural process involving development of the body organs. The stress-related hormones may cause cardiac problems at the prime age, when the youth are already undergoing physical and behavioural changes.
Destruction of schools in ex-FATA, students’ killings at Army Public School Peshawar, Bacha Khan University, and International Islamic University are few of the gruesome examples of violence in educational institutes, which have aroused fear, distress, and anxiety among the students, especially the females. Such frightening incidents drift the youth away from their real goals; causing inflexible and unstable attitudes, and unbalanced emotional behaviours.
Terror acts cause painful separation of the youth from their families or loved ones. Their horrifying impact weakens the emotional bonds that are essential for the youth to elevate their sense of security, self-esteem and self-reliance during their psychological growth. Harmful impact of the traumatic events may also be gauged by the fact that the affected youth become reluctant to participate in routine life activities, and avoid discharging their socio-civic responsibilities. The outcome is reflected in their feelings of social isolation, toxic stress, and inclination to drug addiction, crimes and psychological instability.
Psychosocial trauma may act asapushing factor, persuading the susceptible youth to adopt extremist views. Feelings of social disparities, dissatisfaction, sense of marginalization, and deprivation among the vulnerable youth, can easily be exploited by the militant elements, by treating their psychosocial disorders in the guise of so-called religious therapies. In this scheme of things, instability is factored out by insecurity, generating frustration among the tribal youth.
The successive governments have taken few short-term measures based on public-private partnerships — Mental Health and Psychosocial Support (MHPSS) initiative for Internally Displaced Persons (IDPs) in Bannu with the logistical support of the Army Field Hospital — to address psychosocial issues of tribal youth mainly during the migration phase. However, permanent framework or long-term plan is missing in the rehabilitation phase to heal the prolonged PTSD for psychological recuperation. Mental health-care response is “not sufficient” to meet the current challenges especially at the district level in ex-FATA and Swat. Local communities tend to seek private consultations for mental disorders in other big cities.
Before the 18 Amendment of the Constitution, the federal Ministry of Youth Affairs formulated the National Youth Policy in 2008. It was followed by the National Youth Development Framework 2020, prepared by the Pakistan Tehreek-e-Insaf (PTI) government. However, the violence related PTSD factor has been ignored. No intervention strategies have been suggested in these frameworks to mitigate the psychosocial harms of trauma by meaningfully engaging the ex-FATA and Swat youth in the post-conflict period. Contrarily, the entire focus centers around socio-economic and political empowerment of the youth. The policy suggests to bridge the gap between educational and labour market realities by developing technical skills.
The National Health Vision Pakistan 2016-2025 defines the mental ailment in the context of marginalization, deprivation and alienation, along with, other biological mental diseases. The psychosocial trauma (emotional and behavioural disorder), emanating from prolonged conflict/terror acts, is altogether missing in the Health Vision. This shows lack of integrated health policy within the existing structure of mental disorder treatment. This clearly indicates imbalance between psychosocial trauma response and mental health-care strategy in the entire Health Vision.
Department of Tourism, Sports, Culture, Archaeology, Museums and Youth Affairs of KPK has prepared a very comprehensive “Khyber Pakhtunkhwa Youth Policy in 2016” prior to FATA’s merger into Khyber Pakhtunkhwa. The policy indicates the psychological trauma and attitude issues faced by the IDPs during the migration phase. Besides, under the third chapter (Strategizing Youth Empowerment in KPK) of the Youth Policy, there appears just a reference to the report titled Post-Crisis Needs Assessment (PCNA 2010) for ensuring the delivery of basic services. However, in the recommendation section of the same chapter, the Youth Policy only suggests building the culture of peace, positive self-image, and national identity for the youth. Measures for the PTSD management have not been incorporated in that portion. Thus, no intervention plan has been conceived in the entire policy to address psychosocial trauma in the post-conflict or rehabilitation phase.
In order to mitigate the effects of PTSD, the PCNA-2010 report suggests psychosocial support-efforts, community-based mental-care programme, psychosocial care of crisis-survivors, and rehabilitation care for the disabled. However, after twelve years of the publishing of PCNA report, the ground realities show various lapses and discrepancies at the implementation level, coupled with demand-supply gap, as evident by the facts that only one newly-raised trauma centre exists in Kurram district for the whole tribal region and only one Burn, Trauma and Plastic Unit at Zakir Khan Shaheed Hospital covers the entire Swat.
The federal government plans to establish 68 Comprehensive Health Units (CHU) under Prime Minister’s Quick Impact Programme (QIP) for rendering medical facilities to all seven tribal districts of ex-FATA with the provision of specialists’ medical and surgical doctors, gynecologists, ambulance service and laboratories experts. However, the delivery of psychosocial support treatment by the professional team (psychiatrists and psychologists) has not been catered for in the CHU programme to address the psychosocial trauma. Departments of Zakat, Ushr, Social Welfare, Special Education & Women Empowerment Department of KPK have not taken any measures towards establishing special schools or centers in ex-FATA for the tribal youth, who underwent psychological disability during conflict period, especially for the youth of North Waziristan.
There should be an integrated health response system in the future health policy, wherein the psychosocial trauma response needs to be equally addressed, along with, the existing structure of mental health treatment for biological diseases. In this regard, the Ministry of National Health Services, Regulations and Coordination should introduce changes in the existing pattern of mental treatment in the National Health Vision by incorporating a comprehensive “Psychosocial Action Plan for Vulnerable Youth (PAPVY).” This suggested Plan should be based on bio-psychosocial model for healing mental disorders, while undertaking thorough assessment of terrorism-induced strain on individual’s behaviour.
The provincial government of Khyber Pakhtunkhwa of (KPK) should update the Pakhtunkhwa Youth Policy (2016) while formulating “Youth Engagement Strategy for Psychosocial Resilience (YESPR).” The YESPR should be based on programmes including: capacity-building of youth on normal responses to trauma; supportive counseling programmes (six-month long) for youth and families; community-based support group for behavioural therapy; psycho-education for anger and stress management through Narrative Exposure Therapy (NET); and psychosocial support for bereavement.
Under the Prime Minister’s Quick Impact Programme, National Health Services, Regulations and Coordination in collaboration with the Department of Health of KPK should introduce psychosocial and mental disorder treatment programme as a part of the Comprehensive Health Units. This calls for the establishment of psycho-traumatic counselling centers in all districts of ex-FATA and Swat, having a team of specialist professionals like psychologists, psychiatrists, psychiatric nursing staff, psychosocial workers, and therapists.
Note: This article appeared in Eurasia, dated 07 October 2022.
Disclaimer: The views expressed in the article are of the author and do not necessarily represent Institute’s policy.