Broken hearts of war
MU team helps start healing Afghanistan's refugee children.
By WAYNE ANDERSON Special to the Tribune
Published Sunday, June 15, 2003

The Akora-Khattak refugee camp in west-central Pakistan is a teeming slum of 110,000 people. Many of its residents fled Afghanistan either under Taliban rule or after the U.S. invasion. Many of them, particularly the children, carry the psychological scars that come from witnessing violence and violent upheaval.

There is a mental health clinic in Akora-Khattak, the only such clinic in any of the hundreds of refugee camps in Pakistan. It was established under the direction of Arshad Husain, a Columbia psychiatrist and director of the MU International Center for Psychosocial Trauma. Every day, more than 30 women, men and children come to the clinic in the camp. Some live close by, but others travel great distances by bus and by foot. Sometimes they must wait for hours, and some must wait until the next day. They all come seeking something to numb the pain that they feel.
A team from the MU center, led by Husain, recently returned from Pakistan. Anne Farina, a social worker from St. Louis University who traveled with the team, spent three months interviewing children in a school at Akora-Khattak to make a mental health needs assessment. The research, similar to that previously done by the MU center in Bosnia and Kosovo, is also being done in Palestine.

Farina studied 141 children between 7 and 15, most of them between 10 and 12. All have been displaced from their homes in Afghanistan, and 37 saw fighting. Part of the study seeks to discover the difference in post-trauma reactions based on actually seeing violence such as bombing, torture and dead bodies as compared to simply being displaced from their homes. Of the 37 who saw fighting, 34 met the criteria for post-traumatic stress disorder, 16 of them at the severe level. The needs assessment also studied accompanying psychological problems such as depression, conduct disorders and substance abuse. The MU team also has a continuing interest in what factors contribute to resiliency or the ability of children to recover from trauma.

Living conditions
The Akora-Khattak refugee camp has existed for many years, but there was a big influx of refugees after the Taliban took over in Afghanistan. In the early days of the camp, many people lived in tents that often became killer ovens in heat that could reach 120 degrees. Open sewers run between buildings, and water is supplied by wells.
The tents have slowly been replaced by adobe homes made with mud. Each house is 13 feet by 16 feet by 11 feet and has a window, door and six ventilation holes near the ceiling. Members of the occupying families are supervised by a master mud mason who helps them mix mud and build their own homes. The doors, windows and other supplies cost $180 and are provided by a non-governmental organization called Shelter Now.
Farina, living in Peshawar, had a 11⁄2 hour drive each way to Akora-Khattak with 20 staff members crammed into a 15-passenger van. Staff members were not allowed to live in the camp because of the danger of robbers who sometimes shoot people.
Farina described the stark conditions in Peshawar, where pollution is heavy and living conditions are poor. “Some nights I go ‘mosquito hunting’ in my room before I go to bed,” she said. “Some nights I find them, but most nights they wake me up at 4 a.m., with big bumps on my face and arms. The other creatures known to lurk in the shadows are lizards. Big fat lizards with big scary eyes. Fortunately, they are actually more scared of me and quickly run and hide when they see me.