Photo: Fakhar Kakahel/IRIN No child's play: Pakistan's tribally-administered territories have been affected by nearly a decade of conflict
More than 60,000 people have fled North Waziristan Agency to safer parts
of Pakistan and neighbouring Afghanistan as Pakistan’s military
launches an offensive in the region. Most of the people
fleeing are children, and mental health experts are concerned that they will not have access to proper trauma care.
The Pakistani authorities have yet to set up camps to shelter the
displaced, and what little mental health aid is available - usually at
makeshift clinics in formal IDP camps - is out of reach for the North
Waziristan children.
Psychiatrists treating residents of the Federally Administered Tribal
Areas (FATA) in the northwest are especially worried about the long-term
effects of conflict on the children there. In regions like North
Waziristan Agency and Khyber Agency, children have been living with
armed conflict for nearly a decade. They have witnessed military
operations, Taliban attacks and drone strikes, and the results of these.
Many children have grown up knowing only war, and the long-term effects
of what they are experiencing worries mental health professionals.
New games, new behaviour
As an aeroplane takes off from Bacha Khan International Airport in
Peshawar, capital of Khyber Pakhtunkhwa (KP) province, children living
in a nearby camp for internally displaced persons rush to their
shelters, shouting, “Jet! Jet!”
Habib Afridi, 37, told IRIN: “Our children are still trying to escape
from the memories at home.” After a military offensive was launched in
his native Khyber Agency, Afridi and fourteen family members moved to
Peshawar to live with relatives. “In Tirah [valley], in Khyber Agency,
it was very normal that when a jet appeared in the skies it meant to
bomb [the area], so for our children every flying machine making a loud
noise means bomber jets.”
More than 43 percent of the
population
in FATA are under the age of 14, according to official figures, which
means a large part of the population have grown up knowing war. Children
are often doubly affected by the conflict, says Sana Ijaz, who has
worked with children in FATA through the Bacha Khan Trust Education
Foundation, a local NGO.
Often they cannot turn to the adults in their household - usually their
mother - for comfort and counselling, as many adults have themselves
been traumatized by the war. “Mothers are facing extreme forms of
post-traumatic stress disorder,” Ijaz told IRIN. “It includes their
feeling of insecurity and loss in [the] conflict, [and] they are
fostering these problems in their kids.”
The lack of support makes it even more difficult for children to
understand the situations they see outside their homes. In Datta Khel, a
district west of Miran Shah, about 17km from the Afghan border and a
popular corridor for insurgents travelling to Afghanistan, US drones
have struck more than 50 times, killing hundreds of militants and
civilians. People call them “ghangay” - literally from the noise the
drone engines make, which is locally heard as "ghang-ghang" but has
evolved into ghangay. Now, anything that sounds similar sends the
children scrambling for cover.
In the afternoons, children make their way out of mud-walled homes to
gather on bare hills to play before the evening lesson at the local
madrassa. Here, cops-and-robbers is now soldiers-and-Taliban. Around 10
children divide into two groups, one acting as the military, the other
as the Taliban. Most want to be in the Taliban.
Four children with sticks, pretending to be soldiers, try to find the
Taliban, who fan out to hide. The Taliban always outnumber the soldiers.
They ambush the soldiers, and the children throw dust into the air to
imitate explosions, and then capture the soldiers.
An “amir” (leader) - an older child - delivers a victory speech. “O
Infidels, beware! Whoever works for you will face the same consequences.
These are traitors of Islam. They sold their honour for dollars. Death
to them!” The rest of children shout “God is Great!”. When a kite
appears in the sky the children rush to safety, shouting, “ghangay,
ghangay!!” The children pretending to be soldiers laugh and run with the
rest.
Many schools in FATA have been destroyed, so there is little to offer
the children any distraction from the conflict. The FATA Department of
Education says more than 1,183 schools - a third of the total in the
region - are closed because they have been damaged, or people fear being
caught in the crossfire between the military and the Taliban. In the
schools that are still open there is often a shortage of teachers - in
Bajaur Agency there is one teacher for every 74 students. Only 33
percent of children in the FATA attend school.
Inspired by videos produced by militants, children pretend to be suicide
bombers or fighters. Their discussions revolve around the Taliban's
latest activities, their attacks and killings. “Even my own children at
home were always bringing [home] stories of Al-Qaeda, [the] local
Taliban, drone strikes, and killings in Mir Ali, in North Waziristan,”
Nasir Dawar, a journalist, told IRIN. “I saw children running and taking
shelter under beds whenever drones started hovering in the sky.” The
behavioural changes in his children prompted Dawar to resettle his
family in Peshawar.
Children overlooked
Dr Mian Iftikhar Hussain's 40-bed private clinic on the outskirts of
Peshawar is a busy place as residents from FATA wait to be seen by the
overbooked psychiatrist. A family arrives from North Waziristan, the
husband hoping the doctor can treat several women in his family
suffering from severe post-traumatic stress disorder.
“My head is full of noise, I can't sleep,” one of the women tells
Hussain, who believes the patient probably witnessed a drone attack
close to her.
Muhammad Gul, 70, has come from Bajaur Agency. He hasn't been the same
since he witnessed an improvised explosive device (IED) blowing up. His
heartbeat is irregular, he shivers constantly, and jumps at any loud
noise.
Pakistan lacks the
mental health
resources it needs to treat all the people who need help. A 2009 study
by the World Health Organization found there were only 342 psychiatrists
and 478 psychologists for a population of 190 million. The shortage is
even more acute in the northwest, where the conflict is constant.
Facilities like Hussain’s have been unable to keep up with
demand.
In 2011, the Sarhad Hospital for Psychiatric Diseases, one of the
largest in the region, treated almost 90,000 patients from FATA, of whom
around 50,000 were suffering from disorders caused by the conflict.
“Unfortunately, children are overlooked,” Hussain told IRIN. “[Just the]
number of women facing psychological problems is almost four times
higher than it was prior to the conflict in FATA.” Less than one percent
of the beds in Pakistan are reserved for children and adolescents with
mental health problems.
“What I have seen is that there are much deeper and stronger impacts of
war on children… Thousands of children [have] lost their childhood,”
said Hussain, who has been treating psychiatric patients for nearly
three decades. “Stubbornness, tendencies towards violence, rejection of
education, [and] an inclination towards drugs and crime are very common
among these children of war.”
He points out that “The age from five to fourteen is very sensitive for
human development, and unfortunately, much of the population left in
conflict-stricken areas is comprised of this age group.”
There are only a handful of government hospitals offering psychiatric
treatment to FATA residents, so most patients turn to overcrowded
private clinics and commercial hospitals, almost all of which are
located in Peshawar, an expensive, four-hour drive from North
Waziristan. “The children's situation is even more pathetic, since
nobody notices their issues and children cannot explain it
[themselves],” said Hussain.
One of the few places children do receive treatment is at relief camps
like the Jalozai Camp just outside Peshawar, where more than 12,000
children live, but they are a fraction of those fleeing the war.
Millions of FATA residents have been displaced, but the authorities
believe less than 20 percent have spent time in relief camps.
“What little resources are available are spent on camps, and that…
[covers] only a fraction of the population,” Ali Askar, a professor at
the University of Peshawar who is researching the impact of conflict on
children, told IRIN.
“The situation is so chaotic that nobody cares about these children and
the future of this region,” he said. “If proper attention is not given
to these children, they will definitely go on to a life of crime, if
they don't become lethal assets for terror networks.”
No fun and games
After 11 September 2001, Al-Qaeda set up special camps in North
Waziristan to train children, a task that was overseen for years by the
group's top leadership. A special group of child fighters, called Jaish
ul Tifal, was set up. The original camps are closed now, and most of the
Arab instructors have fled Pakistan, but the tactic has inspired a host
of other groups in North Waziristan to start their own programmes to
recruit children.
During the offensive to retake the Swat valley from Taliban militants in
2009, the Pakistani military claimed to have stumbled on a
training camp
for child suicide bombers and recovered some 200 children prepared to
carry out suicide missions. The children told local authorities that
before the raid there were 1,200 other children in the camp, many either
bought at prices ranging from US$700 to $1,400, or taken forcibly from
their parents to be trained as suicide bombers.
Children as young as 12 have appeared in propaganda videos released by the Taliban, beheading prisoners.