Terrorism and its Impact on the Society
WHO defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (1). Terrorism has been rampant in Pakistan since 1989 following the Soviet occupation of Afghanistan. Let us discuss how this has affected health in our country.
Over the years, Pakistan has been on the frontline of the ‘War on Terror’. From 2002-2008, more than 141 suicide bombers and more than 100 remote controls and car bombs have struck Pakistan (2).A study in D.I. Khan reported an alarming figure with 32.96% of all homicidal deaths in their hospital and 11.75% of all injuries being due to bomb blasts (2). Typical bomb blast injuries reported in Combined Military Hospital, Rawalpindi included penetrating splinter injuries, open bone fractures, damage to the viscera, thoracic injuries and neurotrauma(3). Moving on, Zahid et al. reported that the most common complications faced by victims were neurodeficit disorders, wound infections, CSF leakage, epilepsy and post traumatic hydrocephalus (4).
Armed Forces Institute of Regenerative Medicine (AFIRM), situated in the heart of Rawalpindi, provides an opportunity for the rehabilitation of victims who are subjected to these dreadful catastrophes. Established in 2008, it aims to help the soldiers injured in blasts overcome severe limb, head, face and burn injuries that can take years to treat and usually result in lifelong impairment. According to their Annual Report 2012, the institute is researching and excelling in the fields of limb and digital salvage, craniofacial reconstruction, scarless wound healing, burn repair and treatment of compartment syndrome (5). Thus, it is a ray of hope for all those soldiers who not only lost a part of their flesh, but also a part of their souls in the line of fire.
Through centers like AFIRM, we have managed to cure bodily damage that was previously considered untreatable. However, there is another disease, even graver, that we have ignored: psychological trauma, which goes hand in hand with the physical disabilities suffered during a blast. This is more commonly known as Post Traumatic Stress Disorder (PTSD) which has been shown to be present in all the survivors of a bomb blast (6). PTSD is defined as a mental disorder that develops in response to catastrophic life events and involves three symptoms clusters: re-experiencing the trauma, avoidance and numbing and hyper arousal (7).A study carried out in Islamabad reported that 37 out of 50 female Muslim students showed suicidal ideation and desire for death one year after exposure to a suicide bomb attack. Two subjects had even engaged themselves in some degree of planning towards committing suicide (8).
Military Hospital Rawalpindi developed a program to combat stress that aimed to educate soldiers about the stresses encountered in the war zone, immediate treatment by psychiatrists, establishment of rehabilitation centers and return of the victims to duty as soon as possible (9). A similar pattern should be established in the civilian set up as well on the same guidelines. Sadly, WHO estimates that there are only over 320 psychiatrists available to deal with the 176 million patients in Pakistan. Further aggravation comes from the fact that most of them are not properly trained to provide the psychiatric care required.
I conclude by saying that indirect trauma is poorly studied outside the western world despite its common occurrence. Thousands of people have died in the terrorist attacks plaguing our country and millions have been displaced. These issues are widely discussed on the local news channels over and over again without due consideration given to their impact on public health. Every suicide bombing has the greatest mental and psychological effect upon the victims who are fortunate enough to survive.
The mental trauma of such notorious mishaps can be severe enough to annihilate their emotional and mental states. We medical students are just trainees in the discipline of physical health, not psychiatrists, and hence there is not much in our power to do. Yet, we are in the position to spread awareness among the families of such fatalities, who are the only ones able to provide the required cognitive support and help their kin come out of the ghastly ordeal they are living through.
1. Official Records of the World Health Organization, No. 2. Official Records of the World Health Organization, No 2. 1946. p. 10.
2. Humayun M, Zamman F, Khan J, Parveen Z, Zaman M. Homicidal Death and Injuries by Bomb Blasts in Dera Ismail Khan. Gomal J Med Sci. 2009;7(1):7–10.
3. Yasin MMA, Nasreen G, Malik SA. Injury pattern of suicide bomb attacks in Pakistan. Eur J Trauma Emerg Surg. 38(2):119–27.
4. Khan Z, Ali M, Sharafat S, Usman M, Aman R, Khan KM, et al. Bomb Blast Head Injuries: A Two Years Experience of 154 Patients. Rawal Med J. 2012;37(4):417–20.
5. Pottol K. Annual Report 2013 Technical Progress Reports [Internet]. 2013 p. i–v. Available from: http://www.afirm.mil/index.cfm?pageid=links
6. Kiran M, Rana MH, Azhar M. POSTTRAUMATIC GROWTH AMONGST SURVIVORS OF A SUICIDE BOMBING ATTACK IN NORTHERN PAKISTAN. J Pakistan Psychiatr Soc. 2010;7(1):29–33.
7. Foa EB, Keane TM, Friedman MJ, Cohen JA. Effective Treatments for PTSD, Second Edition: Practice Guidelines from the International Society for Traumatic Stress Studies [Internet]. 2009. Available from: http://www.worldcat.org/title/effective-treatments-for-ptsd-practice-guidelines-from-the-international-society-for-traumatic-stress-studies/oclc/226358226
8. Faruqui R, Bashir A, Taj R, Khan A, Yousaf F, Waheed A, et al. Prevalence of suicidal ideation and desire for death in a group of female muslim students one year after exposure to suicide bomb attack in Pakistan. Eur Psychiatry. 2011;26(1):1663.
9. Ali S. Combat Stress and Need for Development of Trauma Psychiatric Services in Pakistan Armed Forces. Pakistan Armed Forces Med J. 2006;4.
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