PTSD: Parachinar Traumatic Stress Disorder

Terror-struck town needs trauma centre and psychiatrists

PTSD: Parachinar Traumatic Stress Disorder

The children of Parachinar have a new game: Let’s cut off the Taliban’s hands.

"After witnessing so many attacks the children have come up with games focusing on suicide attacks, planning on how they will slash the throats of terrorists or how they will cut off the limbs of Daesh and TTP men," says A. Kazmi, a local youth.

It is small wonder that the children of this city feel this way. On June 23, a double-tap bombing in Punjabi bazaar killed 72 people and injured 250 others. A dharna started on that night to press for demands to protect the city.

I travelled there to assess their health care needs. As a Tehsil Headquarter for Fata’s Kurram Agency, Parachinar houses its Agency Headquarter Hospital, a 162-bed tertiary care hospital for a population of almost 200,000. The AHQ, much like any other public sector hospital in Pakistan, is not fully equipped, struggles with a shortage of trained staff and doctors (Many qualified people simple leave town for a better life).

What sets this hospital apart from the rest of public sector tertiary care hospitals is an absence of a desperately needed trauma ward, ICU and NICU or ICU for babies. (The army has since said that it will help develop a trauma centre).

When I asked the medical superintendent, Dr Haji Sabir Hassan, about the level of care provided by his hospital, he was not sure if it was primary, secondary or tertiary care.

This much was clear, if anyone had tried to attack the dharna, for which there were real risks, the AHQ would not have been able to cope with such a high number of patients. Indeed, on the June 23 it was overwhelmed, as it has been for previous attacks. “There was blood all over the floor here,” Dr Sabir told us during a visit as we stood at the central staircase.

The AHQ has three surgeons, all of whom have become experts due to the sheer volume of cases. One of them, Dr Dildar says, “the biggest issue they faced attending to the blast victims was the hindrance created by their relatives as a mob of around 200 people flooded the operation theatre which caused a five-hour delay in starting treatment.’’ He added that Peshawar, which was the nearest city with proper healthcare infrastructure was six hours away. (It costs Rs30,000 on average to travel to get proper treatment outside Parachinar.) Critical patients were sent there but many of them died en route.

“We need to be completely upgraded,” Dr Dildar said. “It is long overdue. We need more surgeons, physicians and support staff to manage such mass emergencies.’’ Positions for nine specialists are vacant. No one is there to fill them.

A. J. Bangash, a professional photographer, recalls June 23. “After hearing the blast we rushed to the hospital but the 12-bed emergency room was not enough,” he said. “Patients lay in the corridors waiting for their turn.” There were only two stretchers so they used rehris or fruit carts to transport patients.

Mental breakdowns

Another purpose of the visit was to assess the psychological impact on Parachinar. We interviewed young people and the elderly. Everyone said they were suffering from PTSD or post-traumatic stress disorder. 'We have been exposed to this since 1996,' many said. That is an entire lifetime. The continued bloodletting has stressed many families to breaking point. Young men in their late 20s said in group discussions that they do not talk about anything but terrorism in Parachinar. They said that whenever they pick a cause, the politicians sabotage it. There is anger against the system.

Families live in constant trauma. Mothers are too scared to send their children to school. "Female education and health has suffered because we are restricted to our homes because of the security threat," explained F, a college student.

A complete absence of psycho-traumatic counselling has exacerbated the problem. People said there was only one psychologist in town but even he had gone mad. When we asked how they were coping with daily life, they said, “We don't.” Aggressive behaviour is on the rise and women struggle to engage with simple domestic work. S. Waqar, who lost her father to a target killing in Peshawar, said: "The widows affected by terrorism want free education and healthcare for their children." Indeed, theirs is the cruellest fate; their sources of livelihood are cut off and they are plunged into poverty. Social restrictions and a lack of jobs and training mean that they can’t just go out and support themselves either.

“When will this stop,” AJ Bangash’s eight-year-old son Shahzad had asked him. He starts to cry out of terror when his mother tells him to take a lunch tiffin to his father’s office in the bazaar. “I wept when I took photos of the blast victims myself.”

Free blood

The good news is that Parachinar’s community leaders long recognised they needed to help themselves. This led to the effort to set up blood banks. There are two now: Chinar and Haidery. Chinar was set up in 2011 and both work with donations. People give blood in Muharram. The clinic provides treatment. Everything is half rate. They provide vaccinations for dog bite as well. They have ambulances. They do the testing for free. People only have to pay for the bag itself unless it is an emergency. They even serve people from Afghanistan. Once 50 people from an Afghan family needed vaccinations as they drank milk from a cow infected by a dog bite. Haidery Blood Bank provides free blood after testing. They ask people to just pay for the bag, but not during an emergency.
Haidery Blood Bank is working on a five-story hospital with an estimated Rs30 million on a 15-marla plot given by the state. The project has the support of Agency Surgeon Moin Begum, who everyone is proud to declare as the first of her kind from Fata. “She used to do a C-section in 12 minutes,” quips Liaquat Hussain with a smile. “She’s grown old so it takes her 25 minutes now.”

Edhi of Parachinar

Yousaf Ali runs a small orphanage and mortuary near the graveyard in Parachinar. He is called Parachinar's Edhi because he has taken in so many children. "I have buried 46 babies," he says, pulling out an improvised table to give ghusl to the tiny ones. It consists of a plastic top affixed to a plastic table. Outside his office there is a small glass box with the sign for people to leave abandoned children there. "Sometimes we get up to three a month," he says. These babies are abandoned out of poverty and rape.

Dr Talha Rehman works on disaster response with Elaj Trust. He can be reached at @Talha__Rehman