Rajeshree Sisodia in Dulhanga, Indian Kashmir, looks at the invisible scars of the earthquake that will not heal When they pulled nine-month-old Insha Mir from the rubble of her home, her body was limp, lifeless, crushed under collapsing walls and masonry as the earthquake wreaked its fury throughout the region. All that is left of the red-haired baby are memories, captured in the family photographs her mother Saleema clings to for consolation. Every night, Saleema has recurring nightmares in which her daughter returns to her. As day breaks, the reality that Insha is gone pierces through Saleema's dreams and drags her back to reality. Saleema, her husband Arsimman, 35, and sons Imitiaz, 12, Ishtiaq, five, daughter Shazia, seven, lost their home in the 8 October earthquake which devastated Pakistani and Indian- administered Kashmir, killing more than 75,000 people and leaving three million homeless. For 35-year-old Saleema her grief and isolation have formed a barrier few can penetrate. Arsimman's mother Akbar Bi was also killed when their home, in the tiny village of Dulhanga four kilometres from the Line of Control and neighbouring Pakistani Kashmir, was destroyed. The village, in Indian Jammu and Kashmir's Uri district, was razed to the ground in the disaster. Not a single home remains, where once 250 people lived and worked cropping corn. Dulhanga's few remaining horses graze as clustres of Indian Army-supplied tents and corrugated tin homes precariously straddle the side of the mountain. A snarled tangle of bright green bricks is all that remains of the village's mosque. The only way to get to Dulhanga is to cross the river Jhelum's icy torrents on a hand-pulled trolley and clamber up steep mountain slopes. Aid has been slow to filter into Dulhanga, and even though families have been supplied with tents and corrugated sheeting to build shelters, villagers say they do not have enough food to survive Kashmir's merciless winter. The fast-approaching winter and the reality that the family must continue with daily life mean Saleema is mainly preoccupied with looking after her surviving children. But the psychological toll the earthquake has taken seeps through her pragmatic veneer and manifests itself in recurring nightmares and depression. "I lost my daughter, she was a beautiful girl. We have lost our home, everything. We have been through so much. There is so much hurt," she says. Psychological scarring and the earthquake's potential to spawn a new wave of victims through the onset of mental illness is a grim reality international aid organisation Medecins Sans Frontieres (MSF) hopes to avert with a new psycho-social care and counselling programme for hundreds of thousands of people in earthquake-affected communities. MSF and Action Aid are the only two NGOs working on psychological rehabilitation of earthquake victims in Indian Kashmir. There is no equivalent counselling programme being run in Pakistani-Kashmir. The people of Kashmir suffer from a number of serious illnesses including abdominal pain, extreme insomnia, amnesia, flashbacks, anxiety attacks, depressive symptoms and fatigue in adults and aggression and bed-wetting in children have affected the majority of people in Kashmir's earthquake-hit communities. Identifying and treating these symptoms before they develop into serious psychological disorders is vital if communities are to recover, according to MSF clinical psychologist Arooj Yaswi. "Mental health needs don't really surface straight away because people are preoccupied with relief [but] all Dulhanga's 250 people need psycho-social support, psycho- educating the community to give them coping skills like talking with others and doing community work... there are many people in Dulhanga who need counselling," she says. Meanwhile, at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Jammu and Kashmir's summer capital Srinagar, Tabusam Khan's screams resound through ward six of the burns unit. Seventy per cent of her tiny body is covered in burns, injuries she suffered when the gas cylinder she was using to cook with exploded during the earthquake. Two months later and for 17-year-old Tabusam and her family, the physical and mental scars are slow to heal. Her parents, 48- year-old father Abdullah Amin Khan and 40-year-old Naseema Begum have kept a bed-side vigil for the last month. The family lost their home and Abdullah's small grocery shop in the earthquake. "My clothes caught fire. I looked down and my skin was coming off, my clothes had come off... then I don't remember what happened," says Tabusam. Dark almond- shaped eyes dominate her scar-free face. She was airlifted by the Indian Army from her home in Tangdhar to SKIMS, a 620-bed hospital at the forefront of efforts to treat earthquake victims, a month ago to be operated on and receive skin grafting treatment. While doctors at the hospital are confident the lively teenager will recover, she will remain physically scarred for life. Her psychological rehabilitation, the nightmares and anxiety attacks she continues to suffer, are symptoms four MSF volunteers are helping her to deal with. The volunteers have been trained to identify high-risk trauma patients at SKIMS by medical experts who helped tsunami-affected communities. The volunteers refer earthquake victims to specialist counsellors. "The volunteers help me a lot, they make me laugh, I like them, they make me feel better," says Tabusam. Kashmiris are a people familiar with, but not immune to, tragedy. More than 15 years of armed insurgency between separatists and the Indian Army has ravaged the region, claiming the lives of more than 100,000 people and subjecting thousands more to psychological trauma. But the earthquake brought with it misery in an unprecedented scale, compounding the suffering of an already traumatised people. For doctors, the psychological impact of the earthquake in a conflict area has largely remained uncharted territory, though psychiatric experts say mental health problems have increased in the wake of the earthquake. "In a normal situation, 80 to 90 per cent of people cope but Kashmir is not a normal area, it's a conflict zone... in psychological terms it's a trauma on top of a trauma." says MSF Mental Health Officer Silke Fromm. "Disasters only get attention immediately but the mental health problems only present themselves later, so in that sense [the psychological aspect] is forgotten." Her views are echoed by leading psychiatric expert Mushtaq Ahmed Margoob, an associate professor at the Department of Psychiatry in Srinagar's Government Medical College. According to Margoob, the number of people seeking help at the Government Psychiatric Diseases Hospital in Srinagar (the state's only psychiatric hospital) in 1989 when the armed insurgency started was 1,700. Last year, the number was 62,000. Margoob explains that "mental illnesses are likely to increase many fold [as a result of the earthquake], there is no doubt about that. The extent depends on how quickly we intervene in terms of psycho-social help. This kind of help can give a positive mental health benefit at this particularly crucial stage."
