The Hidden Cost of War on Mental Health

By Dr. Asad Hussain 

Dr. Asad Hussain, a Consultant Psychiatrist in PakistanEditor: Dr. Asad Hussain, MBBS (PAK), MRCPsych (UK), DPM (UK), CCT (UK), QESP (UK) is a Consultant Psychiatrist currently working at Quaid-e-Azam International Hospital, Islamabad.

A young child, Akbar walks to the supermarket, happy and looking forward to getting an ice cream from his pocket-money. Suddenly there is a loud explosion. The impact is so severe that the child is thrown back. He sits up, his ears ringing, shattered glass around him and wounds on his body. What he sees in front of him will leave a mark on his mind for the rest of his life. He sees many people shouting, screaming for help. Their wounds so severe that many will not survive. He then sees dismembered parts of others. The innocent mind of the child has been scarred forever.

He looks around stunned, not knowing what to do, feeling helpless and frightened. The picture of the world in his mind has been changed forever. He now sees the world as frightening and dangerous. He slowly, falling and tumbling makes his way home crying. He reaches home to find his mother rushing out to hug him but he is mute and confused.

Meanwhile from another road, a young man, Sadiq, rides his motor cycle, making his way to work. He takes this route everyday and works as a clerk, sole bread earner for a family comprising of three children and his wife. The explosion is far enough for him to survive but the impact strong enough to throw him off his bike and roll a number of times backwards. He has broken an arm and a few ribs. The state of confusion is such that he is not aware of this. There is dust everywhere and he can hear the screams of various men, women and children in a distance. Some of them screaming for the last time before their souls go to Heaven. Sadiq is from an area where he has witnessed such incidents as a boy. Reflexively he thinks of his family and struggles to get home to check on his family. Fortunately his family are safe but the images of the destruction and horror are fresh in his mind.

A bomb blast in Pakistan

Akbar and Sadiq will go through a process similar to grieving but there is a high chance their lives have been changed forever. The initial recovery can be helped greatly by support from others.

Children such as Akbar may go on to develop symptoms/ signs ranging from anger, irritability, aggression to anti social personalities etc. Children in various stages of their development can present with different symptoms.

Young adults such as Sadiq, especially who have witnessed trauma in the past are more likely to go to on to develop mental health problems. Symptoms/ Signs ranging from shock, denial, disbelief  to full-blown depression and anxiety disorders. They start isolating themselves and their ability to function deteriorates at every level.

Although the above accounts are fictional, similar incidents and I dare say much worse have gripped Pakistan for many years. Although there has been some improvement in the security situation, a lot of work still remains. We have a generation of people traumatized by such events. Some are more resilient than other, however the scars of such events will never leave their minds. Many will go on to develop more severe mental disorders.

If the symptoms/ signs are more prolonged than a few months or rapidly deteriorate, then a specialist should be Consulted. Women are affected more than men, as are children and the elderly. If such problems in childhood are not resolved they can have a long-lasting impact with children seeing the world as a dangerous place and entering adulthood with a sense of fear and helplessness. Adults who are already under stress or have suffered losses are more prone to being traumatized as are people with a history of trauma in the past.

WHO data collected through WHO-AIMS in 2008 quotes a health budget to GDP ratio of 3.9. Mental Health expenditure out of over all Health Expenditure is 0.4%. There is <1 hospital bed for every 100,000 population. The total number of human resources working in mental health facilities or private practice per 100,000 population is just 87.023. As per the WHO report of 2008, in the entire Pakistan there are 342 Psychiatrists and 25,782 other doctors not specialized in Psychiatry. In 2007, only 0.002 doctors graduated as Psychiatrists from academic and educational institutions.

 With a constant brain drain problem facing Pakistan, I fear the figures would be worse now than in 2008. It is imperative that appropriate steps are taken to address this hidden problem as this will become a widespread problem in years to come. Awareness is a key issue and is also necessary to mobilize public support. Many times due to lack of awareness, the above problems are not identified even by parents or family members of the affected person.


  1. May I add here that to cater for pressures on individuals and families due to financial, economic and health issues, we need more qualified psychiatrists and psychologist in Pakistan. Specially the poor and lower middle class individuals are being treated for their psychological issues through medicines which is creating multiple issues. To counter this situation, medical doctors shall encourage the patients with professional honesty to consult psychiatrists for issues that fall in their domain.

  2. Are these figures correct, “there are 342 Psychiatrists for every 100,000 population”?

    • Dr. Asad Hussain says:

      Dear Mr. Iftikhar,
      Thank you for your query. I obtained the figures from a WHO report. The report can be accessed via link below:

      • Dear Dr. Asad Hussain,
        I have read the above WHO report. I think there is some confusion in the interpretation of the figures.
        The total number of human resources working in mental health facilities or private
        practice per 100,000 population is just 87.023.
        How can 25782 medical doctors be for 100,000 population? It comes to almost 1 doctor per 4 persons. It can’t be.
        The following figures quoted in the Report are not per 100,000 people, these are in fact for the entire Pakistan:-
        342 psychiatrist, 25782 other medical doctors (not specialized in psychiatry), 13643 nurses, 478 psychologists, 3145 social workers, 22 occupational therapists, 102597 other health or mental health workers.

        • Dr. Asad Hussain says:

          Dear Editor,
          I believe you are right and the the should indeed say the entire population, instead of 100,000. I will request an amendment and apologize for the misunderstanding.

  3. Harkinder Singh says:

    Very responsible doctor indeed – a true professional and a humanist. Thank you.

  4. Shah Alam, Canada says:

    Dear Dr. Asad,
    Thank you for inviting the attention of the readers to this problem. Indeed and unfortunately for those who survive such trauma, the pain and suffering afflicts them and their families for the life-time.
    You are right saying that “Awareness is a key issue and is also necessary to mobilize public support” but how is this to be done. My humble view is that rather than wait for the government, we may have to undertake this on our own: and if some as conscientious and knowledgeable like you can provide the patronage, you’ll not be left wanting for funds to create a charitable organization that will provide the necessary psychological care and treatment to such deserving cases.
    Best wishes,
    Shah Alam

  5. Major (R) Anwar Faridi Las Vegas NV USA says:

    Excellent write up, I am very upset to see kids as old as 5 years talking about dead bodies, guns, bombs and killings. They are being deprived of childhood and their innocence taken away. I wish Pak Army had started Zarb e Azb earlier not after what happened at Army Public School Peshawar in Dec 2014.

  6. Thank you Dr. Asad Hussain. It is very difficult for our self-created so-called Islamist murderers to comprehend it. The only solution to this human tragedy is to exert the power of the state, and also de-emphasize the colloquial version of Islam. My God never told me to go around and hurt the innocent, destroy property and create a nuisance rather mayhem.

  7. Nice article. Keep it up Dr. Asad Hussain.

Leave a Reply here