On the edge

How ceasefire violations fuel a mental-health crisis along the Indo-Pak borders

Khushal Ahmed Mesi, a 40-year-old mason and farmer, lives with his wife and five children in Chrunda, a village near the Line of Control in Uri tehsil. He has seen shells and gunfire hit his house, and has lost count of the number of friends and neighbours who have died in cross-border firing. “Even in my sleep, I get nightmares of shells and gunfire hitting my house.”
30 November, 2019

On a winter morning in 2001, Irshad Ahmed Chalkoo, an 18-year-old at the time, took a walk around his village, Silikote, in the Uri tehsil of Kashmir’s Baramulla district. The village is located along the Line of Control, the de facto border that divides Kashmir between India and Pakistan. Chalkoo had started taking these walks a few weeks earlier, after he appeared for a fitness test to work in the Indian Army. When he was heading back home, with the Haji Peer river flowing to his right, the Indian and Pakistan armies started trading gunfire across the LoC.

At first, Chalkoo thought it was a routine cross-border fire, and kept walking home. A few steps later, a mortar shell from across the border hit his right leg, breaking it into two pieces. He was rushed to a hospital, around fifteen kilometers away in the town of Uri, where the doctors amputated his leg. “The call letter from the army came 15 days after the incident,” Chalkoo told me.

I met him nearly eighteen years later, in April 2019. The psychological trauma of the incident changed him, he said. Chalkoo exhibits symptoms of depression and anxiety. He quickly gets irritated, finds it difficult to focus when someone is talking and spends most of his time idle in his room. Above all, he lives with the fear that he will one day die in the cross-border shelling. “Now, I am like a living corpse,” Chalkoo said.

India and Pakistan have fought at least three wars over Jammu and Kashmir since 1947—a disputed territory between the countries. The International Border, often called the Radcliffe Line—in Jammu, Samba and Kathua districts in the Jammu division—and the LoC separate the territories of India and Pakistan. In November 2003, the two countries decided to observe ceasefire along both the borders. But the agreement did not stand for long—violations started to spike in 2008, when the peace process between the two countries got derailed. In the last decade, the situation has worsened. The lives of those living along these borders are marred with violence. Both the countries have regularly indulged in a blame game when it comes to violating ceasefire, often trading allegations of “unprovoked fire.”

In April and May, during my three-week long trip to the villages and towns along these borders, the human cost of these violations was evident. Dozens of residents told me that cross-border firing, mortar and artillery shelling have become a part and parcel of their life. This has severely affected their mental health, giving way to depression, anxiety and even Post Traumatic Stress Disorder. Arshad Hussain, a professor of psychiatry at the Government Medical College, Srinagar, described the situation in border areas as “a brewing volcano of mental-health distress.”

In 2015, Médecins Sans Frontieres—also known as Doctors Without Borders— an international medical non-governmental organisation conducted a mental-health survey in almost four hundred villages across the ten districts in Kashmir Valley. The survey found that a substantial percentage of the adult population showed symptoms of significant mental distress, probable anxiety and PTSD—respectively, 45 percent, 26 percent and 19 percent. The districts Baramulla and Badgam had the highest prevalence rates of symptoms for the three issues. According to the survey, symptoms of depression, anxiety and post-traumatic stress were prevalent more in women than men.

“Border residents are living in intense fear, with many of them having near-death experiences leading to post-traumatic stress disorder,” Hussain, who was a part of the MSF team that conducted the 2015 survey, said. “We also see many of them suffering from severe depression, generalised anxiety disorder, phobias and panic, leading to severe socio-occupational impairment,” he said. But even “what we have seen in tertiary-care hospitals is tip of the iceberg,” Hussain added, referring to hospitals that offer a high level of specialised care.

The MSF report highlighted that 93 percent of adults suffered from “conflict-related trauma.” Nadeem Akbar Abassi, a 34-year-old contractor, lives with his parents and three brothers in Uroosa, a village near Kaman Aman Setu—a bridge which connects India and Pakistan—in the Uri tehsil. Around twenty years ago, Abassi lost his eight-year-old niece to cross-border shelling. He and his cousins spent hours collecting the scattered pieces of the child’s body. The incident haunts him even now. “I get headaches and can’t sleep peacefully. Sometimes, I run in panic to save my other niece, fearing that a shell might hit our house, even if there is no incoming fire in reality,” Abassi told me. “I don’t want to live and die like this. It is excruciating to die a slow death.”

Khushal Ahmed Mesi, a 40-year-old mason and farmer, lives with his wife and five children in Chrunda, a village near the LoC in Uri tehsil. In 2001, a mortar shell from across the border hit his cousin Nazeer Mesi, who used to work as a porter for the Indian Army, shattering his legs into two pieces. Nazeer died on the spot. Khushal had to pick up his body parts the next day and bury them.

Khushal narrated another story of a friend being killed because of cross-border shelling—his friend’s body was found with the intestines bulging out of the abdomen. “Even in my sleep, I get nightmares of shells and gunfire hitting my house. The fear of another ceasefire violation always looms large in my head, stressing me out all the time,” Khushal told me. “I just smoke packets of cigarettes to get rid of it, but they don’t work anymore.”

On a morning in October 2014, Tilak Raj, man in his early sixties, was standing outside his house in Arnia, a town around four-hundred kilometers away from Uri, situated along the International Border in the Jammu Division. A mortar shell from across the border hit his house and destroyed the structure completely. Its splinters pierced everything in their way. Raj blacked out. After a few days, Raj woke up in pain at a local hospital to find that the doctors had to amputate his right leg. The splinters from the shelling were stuck in his body. For the next two years, he consulted various doctors to subside the pain caused by the splinters, but to no avail.

Last year, Raj and his family took loans from their relatives to construct a brick and concrete house. “Now, bullets can’t pass directly through the walls,” Raj said. He fears that cross-border firing might force him to abandon his new house as well.

Raj has changed since the incident in 2014 and exhibits signs of depression. He mostly stays silent for most of the day, confined to his bed, and dislikes social gatherings. Raj eats less, often gets irritated and is even violent with his family at times. Chanchal Devi, Raj’s 38-year-old daughter-in-law, said, “He never behaved this way earlier.” Raj pitched into the conversation. “When I see my town turning into a war zone, which for most of my life was peaceful, how can anyone expect my mind to stay at peace,” he said. On being asked if they have ever consulted a psychiatrist, Devi replied in the negative.

Jammu and Kashmir has only two psychiatric hospitals that cater to more than twelve million people spread across 22 districts. Moreover, according to a Greater Kashmir report, in 2012, the state’s human rights commission inspected the Government Psychiatric Diseases Hospital Srinagar. During the inspection, they found that the hospital’s negligence was resulting in the “suffering of the patients and endangering their lives.”

According to Manu Arora, a consultant psychiatrist at Government Medical College, Jammu, “most border residents don’t have access to mental-healthcare infrastructure.” Many residents I met did not even know that there are such facilities available in the erstwhile state. For those who knew, the facilities were too far away and due to a scarcity of resources, they lived without any treatment. As a result, Arora added, many of them turn to faith healers, “thus, exacerbating the symptoms.”

Since the Indian government read down Article 370 of the Indian Constitution and abrogated Jammu and Kashmir’s special status on 5 August, the situation on the borders has escalated. Various reports of ceasefire violations have emerged. Between August and October 2019, Pakistan violated ceasefire 950 times along the LoC and 79 times along the International Border, Shripad Naik, a minister of state in the Indian government’s defence ministry told the parliament in November this year. “Appropriate retaliation to the ceasefire violations, as required, has been carried out by Indian Army,” Naik added.

During my visit to the villages along the borders, mental healthcare was among the last concerns of those living in border areas. Nazeera Begum, a 70-year-old woman who owns cattle and a few acres of land in Abdal, a small settlement near the Chrunda village in Uri tehsil. She spends most of her day gazing at the army posts on the other side of the border. Begum told me that her conversations with other women in the village were mostly confined to the loss of families, cattle and the prospect of war. “My peace inside has been taken away,” she said. “The only thing that rules my mind is fear, sadness and a wish for death.”