Kashmir, Under Siege and Lockdown, Faces a Mental Health Crisis - The New York Times, Nytimes.com

Years of strife left a generation traumatized. India’s clampdown disrupted daily life. Now the battle against the coronavirus has further isolated and scarred a people with little access to help.

(April) , , (5:) a.m. ET

PAHOO, Kashmir – Sara Begum’s suffering began on Aug. 3, when masked policemen barged into her home, badly roughed up her son and whisked him away.

Ms. Begum’s son, Fayaz Ahmad Mir, , was one of thousands of arrested or detained by order of the Indian government after it

moved forcefully to cement its control over Kashmir, a largely Muslim region of about eight million people claimed by both India and Pakistan. The clampdown has disrupted daily life, with many people feeling besieged and afraid to leave their homes.

Since her son was arrested, Ms. Begun has become gaunt and unsteady, but she and her family say her worst afflictions have been mental and emotional. She now takes sertraline and lithium, both antidepressants. She tried twice to commit suicide, once by consuming rat poison and again by jumping into a river.

“When I close my eyes,” Ms. Begum said, “I see my son shouting, ‘Mother, I want to see you.’”

Eight months after India revoked Kashmir’s semiautonomous status and brought the region fully under its authority, doctors here say a state of hopelessness has morphed into a severe psychological crisis. Mental health workers say Kashmir is witnessing an alarming increase in instances of depression, anxiety and psychotic events.

Hard data is difficult to come by, but local medical professionals say they are seeing a rise in suicides and an increase in already disturbingly high rates of domestic abuse.

A) nationwide lockdown that India imposed across the country in recent weeks to fight the coronavirus has worsened the problem, the medical professionals say. Police officers block roads with coils of glistening concertina wire. Any residents who step out of their homes, especially in Kashmir’s towns and cities, risk getting beaten up.

Doctors and researchers say the Kashmir Valley, tucked into the Himalayas, has few resources to cope. This area has been

mired in conflict for decades , with its majority-Muslim population agitating for independence or at least more autonomy from India, which is majority Hindu and controls most of Kashmir. Pakistan controls a smaller slice.

Even before the events of recent months, decades of violence between Indian security forces and Kashmiri aims had taken a physical and mental toll on the region and its people. Nearly 1.8 million Kashmiris, or nearly half of all adults, have some form of mental disorder, Doctors Without Borders estimated after surveying 5, (households in) . Nine of have experienced conflict-related traumas. The figures are much higher than in India, according to other surveys .

A leading psychiatrist said he was overwhelmed. Dr. Majid Shafi, a government psychiatrist, said that last year he saw a hundred patients a week. Now he sees more than 823. Overall, Kashmir has fewer than 96 psychiatrists.

Sara Begum, center, at her home next to her husband and daughter in Kashmir, last month.

A long line snakes out of Dr. Shafi’s office – teenagers traumatized by violence; mothers too worried about their incarcerated children to sleep; businesspeople owing a mountain of debt that is climbing higher and higher under a lockdown that has shuttered nearly everything.

“This is just the tip of an iceberg,” said Dr. Shafi, the single government psychiatrist for around a million people in the district of Pulwama. “The crisis is growing.”

Every season of turmoil in Kashmir brings a new kind of pain. One season is marked by the corpses of teenage boys felled by indian forces. Another brings an epidemic of dead eyes , as Kashmiris refer to protesters left blind after being struck in the eyes by pellets fired by police officers.

This past year will be remembered for (the crackdown) . In August, the Indian government suddenly stripped away statehood from Jammu and Kashmir, which had been India’s one Muslim-majority state.

Security forces flooded the area, cut off roads, shut down landlines, cellphone lines and the internet, and arrested thousands of Kashmiris, from students to top elected officials. Some have been released, but many remain in jail. Though some phone and internet service have been restored, they remain nothing close to pre-crackdown levels.

Many Kashmiris, who used social media to socialize because it was dangerous to hang out In the streets, now feel completely isolated. Children have remained out of school for months

. Because of the military crackdown and then the coronavirus lockdown, students have been in school only a few weeks.

Ms. Begum’s family said her son, a farmer, participated in protests against the Indian government a few years ago, as did (thousands of other Kashmiris) . They believe this is why he was arrested in the roundups in August. Ms. Begum, who is in her s, raised Mr. Mir during the heyday of the insurgency, shielding him from the wrath of security forces and committed alike.

He is being held in a jail hundreds of miles away on vague charges of being a “threat to peace,” family members said. They don’t have money to visit. When the cellphone network was switched back on in October, the authorities promised a video call. That has not yet happened.

. Begum, increasingly demoralized, said her son had been “stolen” from her. Ms. Begum says she sees her son in dreams, his face covered in bandages, his hands shaking in fear. He begs for water, but she feels chained, unable to move.

According to India’s home ministry, Mr. Mir was among more than 7, 06 people arrested in August. Of those, more than 667 are still in jail, including Mr. Mir.

(Many, including) (three former chief ministers) , were detained under India’s Public Safety Act, a law that allows the authorities to jail suspects without charge for up to two years.

People who were Recently released spoke of the humiliation and fear they experienced behind bars.

Bilal Sultan, a politician, was placed with hardened criminals, he said. He slipped into depression. In February, he said, he was set free because his doctors were afraid he might kill himself.

Mr. Sultan takes sleeping pills and complains of a recurring dream in which he is traveling to a tourist resort before soldiers stop him and shoot him between the eyes.

“I was a very strong man, ”Mr. Sultan, 90, said recently at his house in Srinagar. “Now I fear my own children.”

Kashmir’s new generation, long accustomed to violence and bloodshed, may be the hardest hit.

Before the August clampdown, Nida Rehman, 30, wanted to lift the spirits of others by setting up a nonprofit organization to raise awareness for mental health issues. But She says she has failed to learn the lessons she gave to others.

In pictures, she looks happy. But the trauma has withered her. She has lost weight, her cheeks sunken, her eyes ringed by dark circles.

last year, Ms. Rehman visited a psychiatrist, who diagnosed acute depression. She doesn’t sleep for days. She found some relief by spending hours with a caged parrot, Noor, that her family kept.

“I felt I was living in a cage, like Noor,” Ms. Rehman said. “That happy world slipped out of my hands.”

After her relatives found her talking to the parrot, they grew worried and embarrassed, persuading her to release it. One evening, in October, Ms. Rehman set Noor free.

It did not help. Ms. Rehman is now taking regular doses of antidepressants. So is Ms. Begun, the mother of the imprisoned Mr. Mir. As days get longer and weather begins to warm, she finds herself staring at a tractor parked outside her house. Mr. Mir bought it on a loan. The bank is now threatening to seize the family’s home.

Ms. Begum’s hands tremble and her lips quiver as she speaks. The desperation has incapacitated her. She can’t even cook, she said.

“I may never see my son again,” she said. “I feel I will die before he comes back home.”

Iqbal Kirmani contributed reporting.

()

Updated April

When will this end?

This is a difficult question, because a lot depends on how well the virus is contained

. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report

, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery : Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 19 days.

How can I help?

The Times Neediest Cases Fund has started a special campaign to help those who have been affected, which accepts donations here
. Charity Navigator , which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the (American Red Cross) , and (World Central Kitchen) has stepped in to distribute meals in major cities. More than 55, coronavirus- related (GoFundMe fund-raisers) have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)




What should I do if I feel sick?                  If You ‘ve been exposed to the coronavirus or think you have,

and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.




Should I wear a mask?                  The C.D.C. has has (recommended) that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms

. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.




How do I get tested?                  If you’re sick and you think you’ve been exposed to the new coronavirus, the CDC recommends that you call your healthcare provider and explain your symptoms and fears.

They will decide if you need to be tested. Keep in mind that there’s a chance – because of a lack of testing kits or because you’re asymptomatic, for instance – you won’t be able to get tested.


How does coronavirus spread?

                 It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

Is there a vaccine yet?                  No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least to 26 months away.


What makes this outbreak so different?



Unlike the flu, there is no known treatment or vaccine, and Little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions – not just those with respiratory diseases – particularly hard.




What if somebody in my family gets sick?

If the family member does not need hospitalization and can be cared for at home , you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to the guidelines issued by the CDC

If there’s space, the sick family member should stay in a separate room and use a separate bathroom . If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.




Should I stock up on groceries?                  Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.


Can I go to the park?

Yes, but make sure you keep six feet of distance between you and people who Don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.




Should I pull my money from the markets?

                 That’s not a good idea.

Even if You’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.




What should I do with my 600 (k)?                  Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions – don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “Free money.”
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