11. Februar 2022

Kurzbeschreibungen zu den in dieser Anfragebeantwortung verwendeten Quellen sowie Ausschnitte mit Informationen aus diesen Quellen finden Sie im Anhang.

Im Rahmen eines Zoom-Interviews am 2. Februar 2022 teilte Dr. Aria Wais, afghanischer Experte für psychische Gesundheit und Gründer einer afghanischen NGO für psychosoziale Gesundheit, mit, dass seines Wissens, für Menschen mit psychischen Erkrankungen kein erhöhtes Risiko bestehe, aufgrund ihrer Krankheit von den Taliban verfolgt zu werden. Die Taliban würden sich nicht wirklich um das Thema der psychischen Gesundheit kümmern, weil sie „nicht wirklich daran glauben“ würden. Sie seien nicht ausdrücklich gegen diese Form der Gesundheitsversorgung, aber sie würden sie auch nicht unterstützen. Konkret hänge das Risiko einer Verfolgung aber immer vom Hintergrund der jeweiligen Person ab. Als Beispiel nannte Dr. Aria Wais Menschen, die einen LGBTIQ-Hintergrund haben und unter psychischen Problemen leiden. Diese hätten beispielsweise durchaus berechtigten Grund, sich vor Repressionen durch die Taliban zu fürchten. Auch der Umgang der Taliban mit Menschen, die drogen- oder alkoholabhängig sind, sei anders: Diese Menschen würden sehr hart behandelt, sie würden geschlagen und inhaftiert (Dr. Wais Aria, 2. Februar 2022).

Amnesty International (AI) veröffentlichte im Dezember 2021 einen Bericht zu den während der Eroberung Afghanistans durch die Taliban verübten Verbrechen und zivilen Opfern. Darin heißt es, dass die AI zur Verfügung stehenden Unterlagen darauf hindeuten würden, dass Menschen mit Behinderungen und insbesondere manche Menschen mit psychosozialen Erkrankungen bei Angriffen der Taliban 2021 einem erhöhten Risiko ausgesetzt gewesen seien. AI räumte allerdings ein, dass hierzu weitere Untersuchungen erforderlich seien. Als Beispiele damit in Zusammenhang stehender Vorfälle nannte AI die Hinrichtung zweier Männer mit schweren psychischen Erkrankungen beim Überfall auf das Dorf Mundarakht im Distrikt Malistan durch die Taliban (AI, Dezember 2021, S. 6). Einer der Männer habe an einer schweren Depression gelitten, sei alleine aus dem Dorf geflohen und von den Taliban durch einen Kopfschuss getötet worden. Der andere Dorfbewohner soll an einer nicht diagnostizierten psychischen Erkrankung, eventuell Schizophrenie, gelitten haben. Er sei nicht mit den anderen Dorfbewohner·innen geflohen und ebenso durch einen Kopfschuss getötet worden. Ein Augenzeuge habe angegeben, dass die Bewohner·innen die Taliban gefragt hätten, warum sie den Mann getötete hätten. Diese hätten geantwortet, dass in Konflikten alle sterben würden, egal ob sie bewaffnet seien oder nicht. AI wies zudem darauf hin, dass Menschen mit psychischen Erkrankungen in bewaffneten Konflikten von Menschenrechtsverletzungen besonders bedroht seien. Sie seien oftmals weniger willens oder weniger leicht in der Lage zu fliehen und würden häufig mit sozialer Stigmatisierung und Diskriminierung konfrontiert, was die Wahrscheinlichkeit erhöhe, zur Zielscheibe zu werden (AI, Dezember 2021, S. 16).

Weitere aktuelle Informationen speziell zum Umgang der Taliban mit psychisch Erkrankten konnten nicht gefunden werden. Die folgenden Informationen konzentrieren sich auf die generelle Lage sowie die medizinische Versorgung von psychisch Erkrankten in Afghanistan seit der Machtergreifung der Taliban im August 2021. Am Ende der Anfragebeantwortungen finden sich weiterführende Informationen zum Umgang der Taliban mit drogenabhängigen Personen.

Im Jänner 2022 wies UN OCHA darauf hin, dass mit dem Ende der unmittelbaren gewalttätigen Konflikte in Afghanistan im August 2021 der Mangel an Nahrung und Wasser Hauptgrund für den Bedarf humanitärer Hilfe sei. Diese Faktoren würden sich auf das physische und psychische Wohlergehen der Bevölkerung auswirken und Millionen von Menschen in eine Krise stürzen (UN OCHA, Jänner 2022, S. 36). Eine Vielzahl an Quellen aus Wissenschaft, Medien sowie dem NGO-Bereich verwiesen auf eine besonders hohe Prävalenz psychischer Erkrankungen innerhalb der afghanischen Bevölkerung (Kovess-Masfety et al., 22. Juni 2021; Saleem et al., November 2021; Latifi, 6. September 2021; Healthnet TPO, 6. Oktober 2021). Im von jahrzehntelangem Krieg, politischer Gewalt, Instabilität und Armut gezeichneten Afghanistan sei jeder Haushalt mit psychischen Problemen konfrontiert (Healthnet TPO, 6. Oktober 2021). Die Bevölkerung Afghanistans sei in erheblichem Maße traumatischen Ereignissen ausgesetzt gewesen (Kovess-Masfety et al., 22. Juni 2021; Healthnet TPO, 6. Oktober 2021), die von erlebter Gewalt, Verletzungen, Todesfällen in der Familie bis hin zu Vertreibung reichen würden (Healthnet TPO, 6. Oktober 2021). Laut einer im November 2021 veröffentlichten Studie würde mehr als die Hälfte der afghanischen Bevölkerung unter Depressionen, Angstzuständen und posttraumatischen Belastungsstörungen leiden (Saleem et al., November 2021).

Auch Dr. Wais Aria erklärte während des bereits erwähnten Zoom-Interviews, dass die psychische Gesundheitsversorgung bereits vor der Machtübernahme durch die Taliban im August 2021 eine der größten Herausforderungen in Afghanistan dargestellt habe. Der Bedarf an psycho-sozialer Unterstützung sei sehr hoch, derartige Dienste aber nur sehr begrenzt verfügbar gewesen. Die meisten der verfügbaren Dienste seien von humanitären Organisationen bereitgestellt und von internationalen Gebern finanziert worden. Die afghanische Regierung habe demgegenüber nur über sehr begrenzte Kapazitäten und Budgetmittel im Bereich der psychischen Gesundheitsversorgung verfügt. Personen mit chronischen psychischen Problemen seien in der Regel von den Behörden an von humanitären Organisationen betriebene Einrichtungen verwiesen worden. Durch die Machtübernahme der Taliban sei die Prävalenz psychischer Probleme noch weiter gestiegen. Die Menschen würden sich nicht sicher fühlen und darüber hinaus sehr unter der Wirtschaftskrise leiden. Familien seien teilweise zu negativen Bewältigungsstrategien gezwungen, um ihr Überleben sichern zu können. Dies würde wiederum die psychische Belastung der Bevölkerung enorm erhöhen. Gleichzeitig hätten die meisten großen Geberländer ihre Unterstützung eingestellt und viele Organisationen, die psychosoziale Hilfe geleistet hätten, seien nicht mehr in Afghanistan tätig. Diejenigen Dienste, die nach wie vor in Afghanistan tätig seien, könnten nur eingeschränkt agieren. Viele Menschen hätten Angst, derartige Dienste oder Kliniken aufzusuchen. Frauen sei es derzeit nicht einmal gestattet, Einrichtungen allein aufzusuchen. Außerdem fehle vielen das Geld, um die Arztkosten bezahlen zu können (Dr. Wais Aria, 2. Februar 2022).

Mit der neuerlichen Machtübernahme der Taliban im August 2021 habe sich die Situation in Bezug auf die psychische Gesundheit der afghanischen Bevölkerung noch weiter verschärft (BBC News, 20. September 2021; Business Insider, 3. Oktober 2021; Healthnet TPO, 6. Oktober 2021). Ein Forschungsartikel, der im November 2021 im renommierten Fachjournal Nature Medicine veröffentlicht wurde, konstatierte, dass der Zusammenbruch der Regierung Ghanis und der Vormarsch der Taliban zu einer Katastrophe im Bereich der öffentlichen Gesundheit geführt habe (Jain et al., 8. November 2021). Gegenüber der afghanischen Nachrichtenagentur Pajhwok Afghan News (PAN) habe Dr. Azizuddin Himmat, ein Spezialist für psychische Gesundheit und Vorsitzender der afghanischen Psychologenvereinigung, Ende September 2021 erklärt, dass die Zahl der Menschen mit psychischen Erkrankungen höher sei als vom afghanischen Gesundheitsministerium angegeben. Im Hinblick auf den Machtwechsel in Afghanistan und die in verschiedenen Lebensbereichen auftretenden Probleme habe Himmat darauf hingewiesen, dass diese Faktoren der Bevölkerung psychisch stark zusetzen würden und habe davor gewarnt, dass sich die Anzahl der Menschen, die eine Behandlung aufgrund psychischer Probleme benötigen verdoppeln werde, wenn diesen Faktoren nicht entgegengewirkt werde (PAN, 30. September 2021). Dr. Wais Aria habe gegenüber der US-Nachrichtenseite Business Insider darauf hingewiesen, dass eine Vielzahl gesellschaftlicher Probleme, darunter die kollabierende Wirtschaft, katastrophale soziale Veränderungen und die drohende Gewalt, die ohnehin unterfinanzierte Infrastruktur für psychische Gesundheit in Afghanistan belaste (Business Insider, 3. Oktober 2021). BBC News verwies in einem Artikel auf einen Arzt im Westen Herats, der angab, dass es seit der Machtübernahme der Taliban zu einem drastischen Anstieg an psychischen Erkrankungen gekommen sei. Der von BBC News zitierte Arzt habe zudem angegeben, dass man es mit extrem hilfsbedürftigen Menschen und gleichzeitig mit äußerst begrenzten Ressourcen zu tun habe (BBC News, 20. September 2021). Das afghanische Gesundheitssystem, das bereits mit COVID-19, akuter Ernährungsunsicherheit und schwerer Dürre zu kämpfen gehabt habe, stehe nun vor neuen Herausforderungen, zumal die Offensive der Taliban mehr als eine halbe Million Menschen vertrieben habe und viele Mitarbeiter·innen des Gesundheitswesens fliehen hätten müssen (Jain et al., 8. November 2021). Auch die aktuell so dringend benötigten Psycholog·innen würden das Land verlassen (Business Insider, 3. Oktober 2021).

Aufgrund der wirtschaftlichen Instabilität des Landes mangle es zudem an Medikamenten und medizinischem Material. Medizinisches Personal habe teils seit Monaten keine Gehälter mehr erhalten (Jain et al., 8. November 2021; Healthnet TPO, 6. Oktober 2021). Der Wegfall der Finanzierung durch internationale Geber habe das von der internationalen Gemeinschaft abhängige Gesundheitssystem zum Zusammenbruch gebracht (Healthnet TPO, 6. Oktober 2021). Im Jänner 2022 berichtete HRW, dass der Zusammenbruch des Gesundheitswesens für viele Afghan·innen den Verlust des Großteils der physischen und psychischen Gesundheitsversorgung bedeutet habe (HRW, 13. Jänner 2022). Auch die niederländische Organisation für Entwicklungszusammenarbeit Healthnet TPO erklärte im Oktober 2021, dass die aktuelle Lage den Zugang zu psychosozialen Diensten noch weiter erschwert habe. Wenn die medizinische Grundversorgung bedroht sei, bedeute dies oft, dass die psychiatrischen Dienste als erstes gestrichen würden (Healthnet TPO, 6. Oktober 2021).

Der Bedarf für psychosoziale Unterstützung sei aktuell sehr hoch, doch die Angebote stark begrenzt, so Dr. Wais Aria. Expert·innen zufolge sei die psychische Gesundheitsversorgung Afghanistans nicht in der Lage der Vielzahl an Erkrankten zu helfen. Der ehemalige afghanische Gesundheitsminister habe zudem erklärt, dass dem Land eine Selbstmordwelle drohe. Andere Quellen hätten beschrieben, dass verzweifelte Afghan·innen teilweise versuchen würden sich mit Antidepressiva und Beruhigungsmitteln selbst zu therapieren. Laut Dr. Wais Aria würden viele Therapeut·innen und Ärzt·innen das Land verlassen, weil sie sich nicht sicher fühlen würden. Aria selbst sei Ende August aus Afghanistan in die USA geflohen, weil er befürchtet habe, durch seine Zusammenarbeit mit NGOs als Psychiater ins Visier der Taliban zu geraten (Business Insider, 3. Oktober 2021). In Bezug auf die von ihm gegründete humanitäre Organisation TABISH, die in Kabul, Jalalabad, Masar-e Scharif und Kandahar psycho-soziale Unterstützung angeboten habe, habe Aria erklärt, dass er nicht glaube, dass TABISH unter den Taliban überleben werde (Verywellmind, 14. September 2021). Dr. Judy Kuriansky, die Vertreterin der International Association of Applied Psychology bei den Vereinten Nationen, habe angegeben, dass sie Psychiater·innen bei der Flucht aus Afghanistan unterstütze, da deren Leben in Gefahr sei (Business Insider, 3. Oktober 2021). Der britische Guardian berichtet im November 2021, dass Dr. Nader Alemi, einer der prominentesten Psychiater Afghanistans, im September 2021 entführt und im November 2021 tot aufgefunden worden sei. Alemi war eine bekannte Persönlichkeit in Masar-e Scharif, wo er ein Krankenhaus betrieben habe. Er habe als der einzige Paschtu-sprechende Psychiater in Nordafghanistan gegolten, zu seinen Patient·innen hätten auch Taliban-Kämpfer gezählt (The Guardian, 19. November 2021).

Zu den vorherrschenden Mängeln in der Versorgungslage psychisch Erkrankter komme hinzu, dass manche Betroffenen sich nicht trauen würden, derartige Unterstützung in Anspruch zu nehmen. Die Stigmatisierung psychischer Erkrankungen stelle nach wie vor ein großes Hindernis dar. Psychische Gesundheit gelte als Tabuthema, weshalb Menschen ihre psychischen Probleme oftmals verheimlichen würden (Healthnet TPO, 6. Oktober 2021). Psychische Erkrankungen würden oft mit Schwäche oder Behinderung gleichgesetzt (Verma, 7. Dezember 2021) oder als Strafe Gottes, Besessenheit oder eine Form schwarzer Magie interpretiert. In Afghanistan würden psychisch Kranke im Allgemeinen von ihren Familien betreut. Diejenigen, die keine Familie hätten, würden entweder auf der Straße oder, wenn sie Glück hätten, in einer der wenigen Notunterkünfte („Marastoon“) landen (Latifi, 6. September 2021).

Im Oktober 2021 und Jänner 2022 berichteten Medien über den Umgang der Taliban mit Drogensüchtigen, die auf den Straßen Kabuls leben würden (siehe AP News, 7. Oktober 2021; Gandhara, 7. Jänner 2022; France 24, 11. Jänner 2022). Im Oktober hätten laut AP News Mitglieder der Taliban Hunderte Heroin- und Methamphetamin-abhängige Obdachlose aufgegriffen, verprügelt und zwangsweise in Behandlungszentren gebracht. In den Zentren fehle es an alternativen Opioiden, die normalerweise bei Drogenentzugstherapien eingesetzt würden (AP News, 7. Oktober 2021).

Detailliertere Informationen zum Vorgehen der Taliban gegenüber drogenabhängigen Personen entnehmen Sie bitte folgenden Medienartikeln:

·      AP News – Associated Press News: Now in power, Taliban sets sights on Afghan drug underworld, 7. Oktober 2021
https://apnews.com/article/business-only-on-ap-taliban-kabul-afghanistan-312374ad26aa5741394b2308bfd99487

·      Gandhara: Gandhara Briefing: Taliban Religious Police, Afghan Borders, Drug Addiction, 7. Jänner 2022
https://gandhara.rferl.org/a/gandhara-briefing-taliban-religious-police-afghan-borders-drug-addiction-afghanistan-pakistan/31644011.html

·      France 24: Afghanistan: Taliban set their sights on drug addicts, 11. Jänner 2022
https://www.france24.com/en/tv-shows/focus/20220111-afghanistan-taliban-sets-its-sights-on-drug-addicts

Allgemeine Informationen zum afghanischen Gesundheitssystem seit der Machtübernahme der Taliban entnehmen Sie bitte folgender ACCORD-Anfragebeantwortung vom 6. Dezember 2021:

·      ACCORD – Austrian Centre for Country of Origin and Asylum Research and Documentation: Anfragebeantwortung zu Afghanistan: Humanitäre Lage [a-11758], 6. Dezember 2021
https://www.ecoi.net/en/file/local/2064929/a-11758.pdf 

Quellen: (Zugriff auf alle Quellen am 11. Februar 2022)

·      AI – Amnesty International: No escape; War crimes and civilian harm during the fall of Afghanistan to the Taliban, Dezember 2021
https://www.ecoi.net/en/file/local/2065273/ASA1150252021ENGLISH.pdf

·      AP News – Associated Press News: Now in power, Taliban sets sights on Afghan drug underworld, 7. Oktober 2021
https://apnews.com/article/business-only-on-ap-taliban-kabul-afghanistan-312374ad26aa5741394b2308bfd99487

·      BBC News: Giving birth under the Taliban, 20. September 2021
https://www.bbc.com/news/world-asia-58585323

·      Business Insider: Afghans are self-medicating with antidepressants bought on the black market as despair at life under Taliban rule grows, 3. Oktober 2021
https://www.businessinsider.com/afghans-self-medicating-counterfeit-antidepressants-mental-health-crisis-suicide-2021-10

·      Dr. Wais Aria: Zoom-Interview vom 2. Februar 2022

·      France 24: Afghanistan: Taliban set their sights on drug addicts, 11. Jänner 2022
https://www.france24.com/en/tv-shows/focus/20220111-afghanistan-taliban-sets-its-sights-on-drug-addicts

·      Gandhara: Gandhara Briefing: Taliban Religious Police, Afghan Borders, Drug Addiction, 7. Jänner 2022
https://gandhara.rferl.org/a/gandhara-briefing-taliban-religious-police-afghan-borders-drug-addiction-afghanistan-pakistan/31644011.html

·      Healthnet TPO: Supporting Mental Health in Afghanistan, 6. Oktober 2021
https://www.healthnettpo.org/en/news/supporting-mental-health-afghanistan

·      HRW – Human Rights Watch: Afghanistan: Taliban Takeover Worsens Rights Crisis, 13. Jänner 2022
https://www.hrw.org/news/2022/01/13/afghanistan-taliban-takeover-worsens-rights-crisis

·      Jain, Bhav/Bajaj, Simar S./Noorulhuda, Mariam/Crews, Robert D.: Global health responsibilities in a Taliban-led Afghanistan. In: Nature Medicine 27(11), 8. November 2021, 1852-1853
https://www.nature.com/articles/s41591-021-01547-8

·      Kovess-Masfety, V./Keyes, Katherine/Karam, Elie et al.: A national survey on depressive and anxiety disorders in Afghanistan: A highly traumatized population. In: BMC Psychiatry, Vol. 21, 22. Juni 2021
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03273-4#:~:text=Overall%20point%20prevalence%20of%20psychological,0.08%20to%204.94%25%20across%20region.

·      Latifi, Abdul Hameed: The growing mental health crisis in Afghanistan, 6. September 2021 (veröffentlicht von Inspire the Mind)
https://www.inspirethemind.org/blog/the-growing-mental-health-crisis-in-afghanistan

·      PAN – Pajhwok Afghan News: Mental illness a silent threat to Afghanistan, 30. September 2021
https://pajhwok.com/2021/09/30/mental-illness-a-silent-threat-to-afghanistan/

·      Saleem, Sheikh M./Shoib, Sheikh/Dazhamyar, Ahmad R./Chandradasa, Miyuru: Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population. In: Asian Journal of Psychiatry, Vol. 65, November 2021
https://www.sciencedirect.com/science/article/abs/pii/S1876201821003105

·      The Guardian: Abducted Afghan psychiatrist found dead weeks after disappearance, 19. November 2021
https://www.theguardian.com/global-development/2021/nov/19/abducted-afghan-psychiatrist-found-dead-weeks-after-disappearance

·      UN OCHA – UN Office for the Coordination of Humanitarian Affairs: Afghanistan Humanitarian Needs Overview 2022, Jänner 2022
https://www.ecoi.net/en/file/local/2066646/afghanistan-humanitarian-needs-overview-2022.pdf

·      Verma, Aarushi: The Fate of Mental Health in Afghanistan under the Taliban, 7. Dezember 2021 (veröffentlicht von Inspire the Mind)
https://www.inspirethemind.org/blog/the-fate-of-mental-health-in-afghanistan-under-the-taliban

·      Verywellmind: Afghanistan’s Mental Health Community at Risk of Collapse, 14. September 2021
https://www.verywellmind.com/one-doctor-s-escape-from-afghanistan-5200696

 

Anhang: Quellenbeschreibungen und Informationen aus ausgewählten Quellen

Amnesty International (AI) ist eine internationale regierungsunabhängige Menschenrechtsorganisation mit Hauptsitz in London.

·      AI – Amnesty International: No escape; War crimes and civilian harm during the fall of Afghanistan to the Taliban, Dezember 2021
https://www.ecoi.net/en/file/local/2065273/ASA1150252021ENGLISH.pdf

„Although further research is needed, Amnesty International’s documentation also suggests that people with disabilities, and in particular some people with psychosocial disabilities, have faced elevated risks, including during Taliban attacks this year. For example, in the case in the village of Mundarakht in Malistan district, the Taliban executed two men with severe mental health conditions, simply because they were left behind in a village when it was overtaken.” (AI, Dezember 2021, S. 6)

„Not everyone fled Mundarakht during the initial attack, however. Zia Marefat, aged 28, was known to live with severe depression, and rarely left his home. The day after the Taliban took control of the village, his mother returned to find him, desperate to bring her son to safety. Zia Marefat did eventually leave at the urging of others, but he walked alone to the ilok, and on the way he was captured by the Taliban. They shot him in the temple. Likewise, Karim Bakhsh Karimi, aged 45, who was believed to have an undiagnosed mental health condition, possibly schizophrenia, for which he was not receiving appropriate health care. Neighbours said that he acted erratically at times and did not flee with the rest of the villagers. He was also shot, execution-style, in the head. ‘We asked the Taliban why they did this, and they told us, when it is the time of conflict, everyone dies, it doesn’t matter if you have guns or not. It is the time of war,’ said an eyewitness, who also helped bury the bodies. One resident estimated that the nine dead represented one quarter of the total adult male population of the villages. People with mental health conditions are particularly at risk of human rights violations during armed conflict, as they may be less willing or able to flee and often face social stigma and discrimination that increases the likelihood of being targeted. IHL provides special protection to persons with disabilities, including persons with psychosocial disabilities, like Zia Marefat and Karim Bakhsh Karimi. Under the Convention on the Rights of Persons with Disabilities (CRPD), state parties, like Afghanistan, have an obligation to take ‘all necessary measures to ensure the protection and safety of persons with disabilities in situations of risk, including situations of armed conflict.’ Additional research is required to understand whether there has been a pattern of unlawful killings of people with psychosocial disabilities like Zia Marefat and Karim Bakhsh Karimi, as well as the wider impact of the conflict and Taliban takeover on people with disabilities, particularly given the reportedly high percentage of the Afghan population living with a disability.” (AI, Dezember 2021, S. 16)

Die Associated Press (AP) ist eine Nachrichten- und Presseagentur mit Hauptsitz in New York City.

·      AP News – Associated Press News: Now in power, Taliban sets sights on Afghan drug underworld, 7. Oktober 2021
https://apnews.com/article/business-only-on-ap-taliban-kabul-afghanistan-312374ad26aa5741394b2308bfd99487

„Now the uncontested rulers of Afghanistan, the Taliban has set its sights on stamping out the scourge of narcotics addiction, even if by force.

At nightfall, the battle-hardened fighters-turned-policemen scour the capital’s drug-ravaged underworld. Below Kabul’s bustling city bridges, amid piles of garbage and streams of filthy water, hundreds of homeless men addicted to heroin and methamphetamines are rounded up, beaten and forcibly taken to treatment centres.

The Associated Press gained rare access to one such raid last week.

The scene provided a window into the new order under Taliban governance: The men – many with mental illness, according to doctors – sat against stone walls with their hands tied. They were told to sober up or face beatings.

The heavy-handed methods are welcomed by some health workers, who have had no choice but to adapt to Taliban rule. ‘We are not in a democracy anymore, this is a dictatorship. And the use of force is the only way to treat these people,’ said Dr Fazalrabi Mayar, working in a treatment facility. He was referring specifically to Afghans addicted to heroin and meth.

Soon after the Taliban took power on August 15, the Taliban health ministry issued an order to these facilities, underscoring their intention to strictly control the problem of addiction, doctors said. […]

On a recent evening, Taliban fighters raided a drug den under a bridge in the Guzargah area of Kabul. With cables for whips and slung rifles, they ordered the group of men out of their fetid quarters. Some came staggering out, others were forced to the ground. The sudden clinking of lighters followed another order to hand over belongings; the men preferred to use up all the drugs they possessed before they were confiscated.

One man struck a match beneath a piece of foil, his sunken cheeks deepening as he sucked in the smoke. He stared blankly into the distance.

Another man was reluctant. ‘They are vitamins!’ he pleaded.

Taliban fighter Qari Fedayee was tying up the hands of another.

‘They are our countrymen, they are our family and there are good people inside of them,’ he said. ‘God willing, the people in the hospital will be good with them and cure them.’ […]

In the end, they were at least 150 men rounded up. They were taken to the district police station, where all their belongings – drugs, wallets, knives, rings, lighters, a juice box – were burned in a pile since they are forbidden to take them to the treatment centre. As the men crouched nearby, a Taliban officer watched the plumes of smoke, counting prayer beads.

By midnight, they were taken to the Avicenna Medical Hospital for Drug Treatment, on the edges of Kabul. Once a military base, Camp Phoenix, established by the US army in 2003, it was made into a drug treatment centre in 2016. Now it is Kabul’s largest, capable of accommodating 1,000 people.

The men are stripped and bathed. Their heads are shaved.

Here, a 45-day treatment programme begins, said Dr Wahedullah Koshan, the head psychiatrist. They will undergo withdrawal with only some medical care to alleviate discomfort and pain.

Koshan conceded the hospital lacks the alternative opioids, buprenorphine and methadone, typically used to treat heroin addiction. His staff have not been paid since July, but he said the health ministry promised salaries would be forthcoming.” (AP News, 7. Oktober 2021)

·      BBC News: Giving birth under the Taliban, 20. September 2021
https://www.bbc.com/news/world-asia-58585323

„‘We are dealing with communities with extreme needs and very insufficient resources to hand. We are facing a catastrophic health emergency,’ says Dr Lodi, who treats patients in poor and isolated villages in western Herat province. Since the Taliban takeover, his team has seen a dramatic increase in malnutrition, anaemia, mental health disorders and childbirth complications.” (BBC News, 20. September 2021)

Business Insider ist ein US-Unternehmen, das Nachrichtenseiten betreibt.

·      Business Insider: Afghans are self-medicating with antidepressants bought on the black market as despair at life under Taliban rule grows, 3. Oktober 2021
https://www.businessinsider.com/afghans-self-medicating-counterfeit-antidepressants-mental-health-crisis-suicide-2021-10

„Afghans are traumatized and depressed, and experts say the mental health system is ill-equipped to help them.

Sources described how desperate Afghans are self-medicating with antidepressants and anti-anxiety medication.

Afghanistan's former health minister told Insider that the country is also facing a looming suicide crisis. […]

Dr. Wais Aria, an Afghan psychiatrist who heads up mental health non-profit Tabish, said that a cascade of societal problems, including a collapsing economy, cataclysmic social changes, and the threat of violence, is straining Afghanistan's already under-resourced mental health infrastructure.

‘Demand is very high and the services are very limited,’ he said. ‘And because there's no real psychosocial support for people to deal with their stress or mental health problems, people are looking for antidepressant pills or sedatives.’ […]

Psychologists are needed more than ever, but they're fleeing the country

Aria, who worked as a psychiatrist in Kabul until last month, said that the political turmoil had decimated the paltry supply of medical professionals in Afghanistan. ‘We have a lot of therapists and doctors who left the country because they do not feel safe there,’ he said.

Aria himself fled Afghanistan on August 25 for the US because, he said, he feared that his psychiatric work with NGOs could make him a target for the Taliban.

His friend, Judy Kuriansky, a psychology professor at Columbia University Teachers College and a United Nations NGO representative, is helping other psychiatrists escape. ‘They are needed more than ever, sure, but they cannot operate,’ she told Insider. ‘Their lives are at risk.’

[…]

With the mental health system crumbling around them, few have been able to get access to professional help. But those who have, like Zahra, the support has provided little solace.” (Business Insider, 3. Oktober 2021)

Gandhara ist ein regionaler Dienst des vom US-Kongress finanzierten Rundfunkveranstalters Radio Free Europe/Radio Liberty (RFE/RL).

·      Gandhara: Gandhara Briefing: Taliban Religious Police, Afghan Borders, Drug Addiction, 7. Jänner 2022
https://gandhara.rferl.org/a/gandhara-briefing-taliban-religious-police-afghan-borders-drug-addiction-afghanistan-pakistan/31644011.html

„Drug rehabilitation, Taliban style

In this video report, we take you to one of Afghanistan’s largest prisons. The Taliban has turned the facility in the city of Kandahar into a makeshift center for what it claims to be the rehabilitation of drug addicts.

‘If you decide to get rid of addiction, you can be cured,’ said one man at the facility. He is among the dozens of addicts at the prison, which also houses more than 150 inmates. ‘If we can't treat them here, we send them to the hospitals,’ said the Taliban official in charge of the prison.” (Gandhara, 7. Jänner 2022)

Healthnet TPO ist eine niederländische Hilfsorganisation.

·      Healthnet TPO: Supporting Mental Health in Afghanistan, 6. Oktober 2021
https://www.healthnettpo.org/en/news/supporting-mental-health-afghanistan

„One in two people living in Afghanistan suffer from psychological distress. Devastated by decades of war, political violence, instability and poverty mental health problems affect every household. With the ongoing crisis in Afghanistan, many people have become displaced, losing their homes, possessions and loved ones. Uncertainty for the future and the loss of a way of life can lead to mental health illnesses. As the health system is being pushed to the brink of collapse due to the loss of funding from international donors, access to mental healthcare has been severely cut off.

‘The current political situation, displacement of people, unemployment and a threatening crisis in Afghanistan have all impacted the mental health and psychosocial wellbeing among Afghan people. Health services, including mental health services are all restricted due to a loss of funding by international donors’. – Dr. Zalmai Sinwari, mental health professional, Afghanistan. […]

Mental health services are scarce across the country - most people who live with a mental health problem are not able to access the care they need, or do not dare to seek it. It is estimated that only 3% of people visiting health centres are offered help for their mental health. This is very low compared to the recommended target of 10-15%.

This is significant because most Afghans have experienced violence, losing loved ones, being injured or becoming displaced. All these traumatic experiences are scarring and can deeply affect mental health. Post-traumatic stress disorder (PTSD) is frequent among Afghan people because of their high exposure to trauma with 86% of respondents either having personally experienced or witnessed at least one traumatic event in their lives. 47% have experienced psychological distress with women suffering more than men on average. Children also have a high level of mental health concerns, with 11.5% of children struggling with their daily thoughts and feelings. […]

Afghanistan faces many challenges for the treatment of mental health problems. There is still the need for additional mental health professionals (psychiatrists, psychiatric nurses, psychosocial counsellor, and social worker and other trained health staff) to improve access to services for those suffering with their mental health. Inadequate financing of mental health and psychosocial interventions; increasing alcohol and drug abuse among the young; limited monitoring of services; and poor community mental health awareness all impact the ability to access treatment.

Stigma remains another huge barrier for people to reach out to mental health support. Mental health is considered a taboo topic, and people often hide their mental health problems and avoid seeking help from their families or from a professional. Recognising and seeking support is also influenced by someone’s personal beliefs, cultural and structural barriers, gender discrimination, poverty and ongoing conflict within the country.

The current situation in Afghanistan has further deteriorated access to mental health services. The loss of funding from international donors has pushed the health system - reliant on the international community - to collapse. Hospitals and health centres are not only running short on medicines and medical supplies, but health professionals have not been paid for months causing many to leave their medical work behind so they can provide for their families. The delivery of even basic healthcare is threatened – meaning mental health services are often the first to be pushed aside.” (Healthnet TPO, 6. Oktober 2021)

Human Rights Watch (HRW) ist eine internationale NGO mit Sitz in New York City, die sich für den weltweiten Schutz der Menschenrechte einsetzt.

·      HRW – Human Rights Watch: Afghanistan: Taliban Takeover Worsens Rights Crisis, 13. Jänner 2022
https://www.hrw.org/news/2022/01/13/afghanistan-taliban-takeover-worsens-rights-crisis

„The chaotic evacuation of thousands of Afghans left behind many who remained at risk of Taliban retaliation. Taliban forces summarily executed many former members of the Afghan government’s security forces. A freeze on Afghanistan’s currency reserves and the loss of foreign aid accelerated an economic collapse, leaving millions of Afghans at risk of famine. The collapse of the country’s health services meant that many Afghans faced a loss of most physical and mental health care.” (HRW, 13. Jänner 2022)

·      Jain, Bhav/Bajaj, Simar S./Noorulhuda, Mariam/Crews, Robert D.: Global health responsibilities in a Taliban-led Afghanistan. In: Nature Medicine 27(11), 8. November 2021, 1852-1853
https://www.nature.com/articles/s41591-021-01547-8

„The Taliban seizure of power in Afghanistan has intensified an already dire humanitarian crisis. Although media attention has been focused on the evacuation from Kabul’s international airport, the collapse of the Ashraf Ghani government and the Taliban advance have brought about a public health catastrophe.

Already confronting COVID-19, acute food insecurity and severe drought, Afghan public health infrastructure faces novel challenges, especially given that the Taliban campaign displaced more than half a million people. Many healthcare workers have been forced to flee; others have not received salaries for months. Economic instability has jeopardized access to medicines, and most important, the Taliban movement has laid claim to the state and its healthcare services.” (Jain et al., 8. November 2021)

·      Kovess-Masfety, V./Keyes, Katherine/Karam, Elie/Sabawoon, Ajmal/Sarwari, Bashir, A..: A national survey on depressive and anxiety disorders in Afghanistan: A highly traumatized population. In: BMC Psychiatry, Vol. 21, 22. Juni 2021
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03273-4#:~:text=Overall%20point%20prevalence%20of%20psychological,0.08%20to%204.94%25%20across%20region.

„The population of Afghanistan was highly exposed to traumatic events: 64.67% had personally experienced at least one traumatic event with or without witnessing somebody else’s trauma; among them 7.68% had experienced a trauma without witnessing traumas happening to others; 78.48% had witnessed one such event, with or without personal a trauma experience, among them 21.39% have only witnessed traumatic events without personal trauma; 57,36% have both experienced and witnessed trauma. Ultimately 86.16% of the population had either personally experienced or witnessed at least one traumatic event in his or her life.” (Kovess-Masfety et al., 22. Juni 2021)

Abdul Hameed Latifi ist ein afghanischstämmiger Psychiater, der in London tätig ist.

·      Latifi, Abdul Hameed: The growing mental health crisis in Afghanistan, 6. September 2021 (veröffentlicht von Inspire the Mind)
https://www.inspirethemind.org/blog/the-growing-mental-health-crisis-in-afghanistan

„While accurate data on mental health issues is not available in Afghanistan, according to the International Psychosocial Organisation (IPSO), as of 2019, about 70% of Afghans suffer from various forms of mental health problems. The mental health toll signifies a hidden consequence of war that is often overshadowed by bombed-out buildings and loss of life.

During the last 20 years Afghan governmental and medical centres have made some medical achievements, but they are still not capable of providing patients with specialized services; consequently, many Afghans who need specialized treatment travel to other countries such as India, Pakistan, Turkey and Iran.

The Kabul hospital is the only mental health hospital for all of Afghanistan and is supposed to serve the needs of all psychiatric patients in the country. This facility is organizationally integrated with the mental health outpatient facilities. None of the beds in the mental health hospital are reserved for children or adolescents, and 18% of users are female. The patients admitted to mental health hospitals belong primarily to the following two diagnostic groups: psychoactive substance use (58%) and schizophrenia (24%). There are no long-stay patients (more than a year) in the mental health hospital. This data was collected from Kabul Psychiatric Hospital.

In Afghanistan, mentally ill patients are generally looked after by their families. Some people still consider mental illness a punishment from God, possession by a djinn (devil) or black magic. They take the patients to shrines and mullahs (Imams) for treatment. Those patients who do not have family either end up on the streets or if lucky in a Marastoon (asylum house).

During my visits to Afghanistan, I found that depression, anxiety and PTSD are alien terms there; people, and especially women, are more likely to present to a doctor complaining of somatic symptoms, which on further inquiry, it happens to be an undiagnosed mental health condition. Psychosomatic illness features commonly in general medical outpatient clinics and access to a psychiatrist is practically non-existent. I have found that treatments are generally medical and there are only a handful of psychologists who have received their training outside Afghanistan. I have found that Afghanistan is unequipped, unqualified and unprepared to deal with its mental health crisis. The country’s only mental health hospital in Kabul is in bad condition due to war damage and lack of maintenance. All other provincial hospitals only offer counselling services and no real mental health care; the counselling centres are staffed by partially retrained nurses.

The European Union has supported the rehabilitation of the mental health hospital in Kabul and has paid for the construction of new building within it; the capacity of the hospital remains at 60 beds, however. Counselling is available in small clinics thinly distributed around the country. Even in Kabul they are few.

Some international NGOs offered training and help to the Afghan mental health service. Greek NGO Klimaka, for example, provided some equipment, translated a training manual into local languages, renovated facilities and provided 8-week training courses. HealthNet is the largest NGO involved in mental health care in Afghanistan, but their impact has so far been limited; their main contribution was the supply of some medicines. According to a WHO report, ‘psychosocial interventions centres were established in 2005 by some international NGOs in the capital but they have not been implemented in rural areas’.

The long-stay homeless patients reside in Marastoons (asylum houses) which are available only in four major cities of Afghanistan, including Kabul, Jalalabad, Heart and Kandahar Provinces. These Marastoons have limited capacity, the biggest of all is Kabul Marastoon with 78 female patients. There is no Marastoon for male patients in Kabul. Most of the residents are there for more than 5 years without any psychiatric care.

I last went to Afghanistan in July 2019, during this visit I spent three days in the Red Crescent Society’s Marastoon in Kabul. They call this place a Qala (fortress): the gate is always locked for their protection. As soon as the door was opened for us, we were surrounded by a dozen patients greeting us in Pashto and Dari and touching us. I noticed that all patients’ heads were shaved, it was later explained to me this was for hygienic reasons (headlice).

I was given a tour of the Marastoon. I noticed that between 12 and 16 patients were sleeping in one bedroom in bunk beds. The situation was heartbreaking and I could not control my emotion and broke into tears. I cut the tour short and asked the staff member to show me the clinic room they have prepared for me as I wanted to make the most of my time and see as many patients as possible.

I managed to assess 32 out of 78 patients in three days. I let a psychologist, a nurse and a family medicine doctor sit with me during the assessments to learn how we assess mentally ill patients in the UK. There was a physical health clinic attached to this Marastoon but none of the patients had been seen by a psychiatrist before me, and some patients had been there for more than five years. Some patients in the shelter showed symptoms of mental health problems since their early life, the majority of them were there because they have developed psychological problems during the war.

I also found that some people should not have been there, but because there are no social services and due to the lack of adequate outpatient mental health services, they remain.” (Latifi, 6. September 2021)

Pajhwok Afghan News (PAN) ist eine unabhängige Nachrichtenagentur mit Hauptsitz in Kabul.

·      PAN – Pajhwok Afghan News: Mental illness a silent threat to Afghanistan, 30. September 2021
https://pajhwok.com/2021/09/30/mental-illness-a-silent-threat-to-afghanistan/

„A mental health expert, concerned about the increase in psychological problems among people, warns the number of such patients will double if factors behind it are not prevented. […]

In an exclusive interview with Pajhwok Afghan News, Dr. Azizuddin Himmat, a mental health specialist and head of the Afghan psychologists’ union, said: ‘We have to say that the number of people with mental illness is higher than what was provided by the MoPH because there is conflict, insecurity and economic problems in the past 40 years.’

Referring to the change of government and problems arising in various areas, he said: ‘Since the day the country’s political system changed, insecurity had decreased.’

‘Unfortunately, people are not mental calm. There are factors have cause people psychological pain and a surge in their problems.’ […]

Dr. Himmat said job loss and delays in receiving salaries were among the reasons for negative effects on people’s mental state and led to psychological problems.

He added several people, including an ANA soldier, recently committed suicide in the capital and provinces due to economic problems

‘Surely, these people were already suffering from psychological problems. With an increase in economic problems, their mental ailments intensified. As a result, they committed suicide.’” (PAN, 30. September 2021)

·      Saleem, Sheikh M./Shoib, Sheikh/Dazhamyar, Ahmad R./Chandradasa, Miyuru: Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population. In: Asian Journal of Psychiatry, Vol. 65, November 2021
https://www.sciencedirect.com/science/article/abs/pii/S1876201821003105

„More than half of the Afghan population suffers from depression, anxiety, and post-traumatic stress disorder, including many survivors of conflict-related violence, yet only about 10 percent receive effective psychosocial therapy from the government. As a result of decades of bloodshed, many Afghans have sustained serious psychological traumas. […] The global mental health crises caused by the lengthy political struggle, as well as the COVID-19 pandemic, have collided in Afghanistan, worsening a complex humanitarian disaster and adding to the country's mounting mental health burden. Mental health is an issue that, at least in Afghanistan's current socio-political setting, requires immediate attention. While effective mental health investment is vital, funds must be spent judiciously to ensure access to adequate assessment.” (Saleem et al., November 2021)

The Guardian ist eine britische Tageszeitung.

·      The Guardian: Abducted Afghan psychiatrist found dead weeks after disappearance, 19. November 2021
https://www.theguardian.com/global-development/2021/nov/19/abducted-afghan-psychiatrist-found-dead-weeks-after-disappearance

„One of Afghanistan’s most prominent psychiatrists, who was abducted by armed men in September, has been found dead, his family has confirmed.

Dr Nader Alemi’s daughter, Manizheh Abreen, said that her father had been tortured before he died. […]

He had received threatening calls and messages in the months before his abduction.

The kidnappers originally demanded a ransom of $800,000 (£600,000). […]

Alemi was a prominent figure in Mazar-i-Sharif, where he opened his hospital. He was believed to be the only Pashto-speaking psychiatrist in northern Afghanistan, and his patients had included Taliban fighters.” (The Guardian, 19. November 2021)

Das Amt der Vereinten Nationen für die Koordinierung humanitärer Angelegenheiten (OCHA) ist verantwortlich für die Mobilisierung und Koordinierung von Akteur·innen im humanitären Bereich.

·      UN OCHA – UN Office for the Coordination of Humanitarian Affairs: Afghanistan Humanitarian Needs Overview 2022, Jänner 2022
https://www.ecoi.net/en/file/local/2066646/afghanistan-humanitarian-needs-overview-2022.pdf

„Post-August, as direct conflict declined, the main drivers of humanitarian needs affecting physical and mental well-being are the lack of adequate food and water, driving millions into crisis.” (UN OCHA, Jänner 2022, S. 36)

Inspire the Mind ist eine Online-Website, die sich wissenschaftlich mit Themen rund um psychische Gesundheit auseinandersetzt sowie Blogeinträge zu Erfahrungen mit diesen Themen veröffentlicht.

·      Verma, Aarushi: The Fate of Mental Health in Afghanistan under the Taliban, 7. Dezember 2021 (veröffentlicht von Inspire the Mind)
https://www.inspirethemind.org/blog/the-fate-of-mental-health-in-afghanistan-under-the-taliban

„The stigma associated with mental disorders is grim enough for people to believe that mental illness is synonymous with weakness and disability, leading to some being utterly oblivious to their illness and going about their daily lives. Consequently, victims of mental health ailments, especially Afghan men, prefer to conceal their maladaptive behaviour and psychological distress.” (Verma, 7. Dezember 2021)

Verywellmind ist eine Online-Nachrichtenseite, die sich auf das Thema der psychischen Gesundheit fokussiert.

·      Verywellmind: Afghanistan’s Mental Health Community at Risk of Collapse, 14. September 2021
https://www.verywellmind.com/one-doctor-s-escape-from-afghanistan-5200696

„As the Taliban takes over Afghanistan, the mental health of Afghan people and mental health professionals who treat them are at risk. […]

Since 2009, Wais Aria, a medical doctor trained in Afghanistan, has dedicated his life to helping Afghan children and adults deal with war trauma through his non-profit organization TABISH.

‘I [saw] there was high demand of mental health support for children and women [because there wasn’t anyone focusing on them at the] time, as well as at the moment. I thought being a doctor can help a person, but being a society doctor can help the population of a country,’ Aria says.

Through Tabish, national and international certified psychotherapists and counselors provide psycho-social and emotional support to Afghan people throughout Kabul, including in refugee camps and at Tabish clinics, which are located in Kabul, Jalalabad, Mazar, and Kandahar.

In some cases, counselors are on standby to visit areas where people have experienced violence or tragedies.

The organization has also helped pregnant women and orphans in marginalized communities and provided education and music programs to women and children. […]

As Aria copes with the situation and helps his family process the trauma of escaping Afghanistan and leaving family behind, finding a way to keep Tabish afloat also weighs heavily on his mind.

He says people in Afghanistan are traumatized and need his organization’s services more than ever, however, at the moment, his staff is in hiding and afraid to carry on with their work. He says he doesn’t think Tabish will survive under the Taliban.

‘[Still], we are thinking about our office—how to remove all our computers and close that because we can’t work. Most of our staff are women, there is no job for them, as well they are at risk of investigation,’ says Aria.

He worries about the mental health of his staff, too.

‘Our team who spent all their lives to help others, now they [are] suffering from isolation and depression, at risk, no job, so [I worry about] safety for them,’ he says. […]

As the representative of several NGOs (non-governmental organizations), including the International Association of Applied Psychology and World Council for Psychotherapy, and as part of the Psychology Coalition at the United Nations, Kuriansky is advocating at the United Nations and appealing to the State Department to extract mental health professionals trapped in Afghanistan.

‘Mental health professionals in Afghanistan are currently under extreme threat, given the Taliban’s [abhorrence] of their use of Western techniques,’ she says. ‘[They] are in danger worse than ever and we need to see how we can get them out of the country. It’s going to be a big task.’” (Verywellmind, 14. September 2021)