In November 2006, the humanitarian organisation, Médecins Sans Frontières (MSF)–Holland, released a damning report on the psychosocial and general health situation of the Indian population of Kashmir. The report is based on 510 interviews conducted over 11 weeks in mid-2005. The findings of the survey reveal a bleak picture of the mental health of the people in this conflict-afflicted region, and raise important questions about the government’s failure to adequately provide mental health services to the population. It also begs further discussion of the continuing situation of impunity in Kashmir for those who perpetrate acts of terror and violence against the people of the region. Until this cycle of violence is addressed, the situation of the people of Kashmir cannot be improved. 

MSF findings 

The MSF interviews adopted the approach of assessing the incidence of physical violence or threats of physical violence against interviewees, and then examining the impact that these incidents had on the physical and mental health of those interviewed. The survey group self-defined 1989 as the beginning of the conflict period. In the period from 1989-2005, people reported that they had frequently experienced a range of violence such as crackdowns – defined as the surrounding of houses and all the occupants being asked to remain in one room during the search – as also frisking by security forces, round-up raids in villages, and the destruction or threat of destruction of property. One in six interview respondents reported they had been illegally or legally detained, and more than three-quarters of those detained reported that they were tortured whilst being held. Nearly one in ten people reported having lost one or more members of their immediate family due to violence in the period from 1989-2005. 

The survey also revealed that people were forced to perform labour (33.7 percent),or to give shelter to combatants (18.4 percent). 

Of particular concern was the prevalence of sexual violence revealed by the survey. Although the issue is not openly discussed in Kashmir, more than one in ten people interviewed stated that they had been victims of sexual violence since the beginning of the conflict. A further one in seven had witnessed rape, and nearly two-thirds had heard of cases of rape. Even taking into account different definitions of sexual violence in the region, which may have led respondents to include incidents of inappropriate touching in responses in this category, the occurrence of sexual violence is still unusually high. 

Not surprisingly given the incidence of violence reported, approximately half of the sample interviewed in the MSF survey reported that they never, or only occasionally felt safe. The responses to the Self-Report Questionnaire – developed by the World Health Organization to measure psychological distress, particularly in developing countries – also revealed that one-third of the respondents suffered from psychological distress. This figure rises to more than 70 percent of people suffering psychological distress if the more widely accepted, lower cut-off score is utilised. Overall, the situation revealed by the MSF report is that there is an acute need for a wide range of psychiatric and psychosocial support in the region. 

Mental health services in Kashmir 

The context for the provision of mental health services in Kashmir is set by the Indian Ministry of Health’s policy on mental health care, the National Mental Health Programme (NMHP), which was formulated in 1982. Under this programme, the ministry introduced a policy that mental health care was to be provided at a community-based level in order to ensure accessibility for the most vulnerable sections of the population, as well as tackling cultural stigmas around mental illness. [see Mental Health: An Indian Perspective 1946-2003, Ministry of Health and Family Welfare (2004), available at http://mohfw.nic.in/healthprogmain.html] 

In 2002, the Supreme Court directed the central government to frame a policy supporting the establishment of at least one Central Government run mental health facility in each state, and take steps to set these up. The Court also ordered state governments to create a similar policy framework for the establishment of at least one State Government run hospital per State for the exclusive treatment of mental health patients. The orders clarified that both these categories of facility were to be separate hospitals, designated solely for the treatment of mental health conditions (Civil Writ Petition Nos 334/2001 and 562/2001, 12 April 2002). 

The available data suggests that the facilities that are available for the treatment of mental health conditions in Kashmir are grossly inadequate given the scale of the situation there. Pursuant to the orders of the Supreme Court in 2002, the Central government had created a number of teams to undertake inspection and reporting on the state of national mental health resources and services. These teams conducted surveys of government mental health facilities in state capitals across the country. With regard to Jammu and Kashmir, the committee reported that large parts of the state lack even the most basic of mental health facilities, and that the main facility in Srinagar was also deficient. [see Appendix C – ‘National Survey of Mental Health Resources (April-July 2002) – in ‘Mental Health: An Indian Perspective’ cited above, at p.421]. 

The MSF’s assessment of the situation in Kashmir similarly revealed that there are no community-based mental health initiatives in existence in the state, other than those established by them. 

Conclusion 

The situation in Kashmir has long been of concern from a human rights perspective for numerous reasons. However, the impact of the situation on the mental health of Kashmiris has not been a widely explored aspect of the issue. Living for a prolonged period with the level of stress that this situation engenders has meant that a large proportion of people here are in need of mental health care. The Central government, and the state government of Jammu and Kashmir have failed to uphold their responsibility to provide basic levels of mental health care in line with the NMHP. As a result, NGOs like MSF have had to step in and provide community-based mental health services.  

The crisis in psychiatric care in Kashmir must be addressed urgently. In this regard, MSF has urged the authorities to “implement their own policies. These include provision of psychosocial support in the villages, along with basic psychiatric support, including medication, at the health post. The psychiatric hospital in Srinagar, it points out, only provides basic care, “and the number of patients is growing”.

 Human Rights Features